Sunday, May 14, 2006

The bottom line

Here is the letter by Dr Loh Chit Sing to the Star on the PHFS. Till now I have yet to see any letters in the Star from a doctor who supports this piece of legislation.


Can the Private Healthcare Facilities And Services Act 1998 And Regulations 2006 (PHFS Act and Regulations) oversee patient’s rights and affordable quality care in private hospitals?

AS we all know, many private medical centres are owned by large corporations, whose bottom line is a profitable annual return-on-investment to justify to their shareholders. Let’s face it, corporations like these are there for profit. When operated for profit, there can be a very fine line between profitable medical care, and ethical yet affordable medical care.

An important question thus unanswered so far is, who is there to oversee the day-to-day maintenance of the standard of ethical medical care and guarding patient’s rights in private hospitals?

The PHFS Act clearly requires that a private hospital “shall establish a Board of Management of whom two members shall be from the Medical Advisory Committee”, (MAC) whose members shall be “registered medical practitioners representing all medical practitioners practicing in the facility” and, whose function is to “advise the Board of Management(BOM) on all aspects relating to medical practice”.

As one can see, this article is to ensure that medical management of patients shall “vest in a registered medical practitioner” alone. It is thus clear that if the MAC is truly and independently elected, it is about the only body that can monitor the maintenance of rights of the patients and ethical and quality medical care on the ground. These guys are there every day and many a times, their views are not necessarily the same as that of the hospital owners.

The Regulations have been very efficient and thorough when dealing with basic administrative, infrastructural and equipment requirements of private hospitals. Unfortunately, the Regulations have left out the very important guidelines and procedures to ensure a true and independent election process for the MAC and the appointment to the BOM and also what to do when the advice of the MAC is not taken up by the BOM.

In some hospitals it can be envisaged that such “election/appointment” can be subject to patronage. Some hospitals even divided its consultants in class A, B or C and so on, each with different rights and privileges, as if they were like electrical contractors out to scrap for some menial rewiring work.

Any practitioner who is too outspoken on important issues like protecting patient’s rights, exorbitant hospital charges or unfair trade practices can be assured that he will not be called to serve.

At worst he can even expect to be prematurely terminated or duly expelled when his contract expires. To keep this whip ready and when needed, some hospitals offer their practitioners only year-to-year contracts. This is one of the best ways to ensure that all remains peaceful and quiet.

In legal terms, the role of the MAC is solely to “advise”. Sadly, the PHFS Act and Regulations does not in any way compel the BOM to accept and act on the advice of the MAC. What good is good advice when it falls on deaf ears?

Hence once again, we are back to square one. When good advice goes against the wishes of the shareholders, it will be conveniently ignored. Even worse, the bearers of this good advice can be duly sanctioned and disciplined, as has already occurred in some instances.

Sadly, the PHCFS Act and Regulations does not provide the doctors with a grievance mechanism to address their problems with private hospitals. If they are barely able to fend for themselves in the face of such overpowering pressures, how can they be expected to fend for patients’ rights?

Thus, we are now back again to the situation where ethical and affordable patient care shall remain subservient to a profit margin (the bigger the better), which was what we started off with before the Act came into place. When cost goes up and patients complain, the first to be blamed is invariably the doctor – the saga continues.

Boards of Directors of corporations make business policies and decisions which have to be executed by Boards of Management. Many, if not all, of these decisions and policies have ultimate impact on the cost of patient care. It is thus no wonder that the cost of private hospital care has increased and there is nothing that the MAC or the doctors that they represent can do about it even though they are legally supposed to advise on “all aspects relating to medical practice”, which in the strict term of the law should include cost of medical care.

However, enforcing this advice is legally not required, in which case, why bother to have it anyway? Perhaps we need another law or a new set of regulations soon?

Note: Dr Loh Chit Sing is past president of the Private Medical Practitioners Association, Selangor and Kuala Lumpur.

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