While in Malaysia we are talking about the entry qualifications to do medicine, a more interesting but rather sad incidences are happening in other parts of the world. I had talked about increasing litigation rate, declining income of doctors, doctors closing shops due to high maintenance cost and declining income etc etc, but in our neighbouring country as well as in UK, laws are being created to send doctors to jail!.

In Indonesia, there was a recent uproar by the O&G community when 3 gynaecologist were sent to jail for negligence. I do not know the real story behind this event except from what was reported over here and here.  Indonesian health system is still developing and due to their poor control of the medical education,poor accessibility of healthcare and a huge area to cover,the quality of products/healthcare is questionable. Singapore and Malaysia benefits a lot as the major contributor of medical tourism in Malaysia are Indonesians. I do see quite a number of them and they practically DO NOT trust their doctors! I don’t blame them as when I see the medications and the diagnosis made, it is worst than whatever I had seen over here. However, some of their top universities are better than ours. Nowadays I see more Indonesian academics presenting papers in international conferences than Malaysians, despite their poorer command of English. One day, they might overtake us, who knows?

IN the UK, the Prime Minister is drafting a law to send doctors/healthcare staffs who neglect patients, to prison! It’s interesting when a politician talks about neglecting people!!  The NHS itself need a lot of rectifications before you implement such a law. The GMC in UK is already an independent strict body in monitoring the practice of doctors.  In March 2012, I wrote THIS where the GMC had warned that doctors will face stern action for ignoring poor care. It basically says that if you are a doctor who notice a poor care is being provided to a patient by another doctor, it is your duty to report it. If not, you will also be penalised!

So, what’s happening in our Bolehland? The quality of products are deteriorating day by day as we speak. We are still fighting over entry requirement when it should have been decided long time ago. The education system has gone down the drain with countless number of people scoring straight As. The deteriorating quality of junior doctors are very obvious as I had mentioned and shown evidences many times before. Will the same situation and laws be implemented in Malaysia in the future? I was saying that Indonesians are coming to Malaysia as they do not trust their doctors. Will the same scenario happen to Malaysians very soon? I can already see it happening when many patients who came to see me, openly said that they do not trust the junior doctors in KKs and government hospitals (not to say that the private doctors can be trusted either!). And, these were patients who have been going to government clinics/hospitals for a long time. Thus, they can see the difference.

There was also an interesting news in Malaysia when MOH withdrew the admitting/inpatient license of a private hospital in Seremban. This is one of the oldest private hospital in Seremban which started as a maternity centre. Unfortunately, over the last few years, I heard that many of the resident consultants left due to internal problems. They were surviving on visiting consultants. Hope the MOH and MMC will take similar stern actions on under-performing, unethical, doctors and hospitals.

OB/GYN Strike Reaches Jakarta as Doctors Threaten National Walk Out

Indonesia’s gynecologists continued to rally on Tuesday behind a pair of doctors jailed over the death of a patient, calling for a nationwide shutdown and protests in the capital over the alleged “criminalization” of medical professionals.

“It’s not a strike. It’s a solidarity action that we will take to stop the criminalization of doctors,” Nurdadi Saleh, the chairman of Indonesia Obstetrics and Gynecology Association (POGI), said on Tuesday. ”We are not fighting for doctors to be immune from the law, but the cause of the death was not negligence. It was due to a gas embolism.”

The Supreme Court agrees, in part, with Nurdadi’s statement. The mother, Julia Fransiska Makatey, did die of heart complications resulting from a gas embolism, but the panel of judges placed the blame in the hands of Dewa Ayu Sasiary Prawani and her peers. Three OB/GYNs, Ayu, Hendy Siagian and Hendry Simanjuntak, were found guilty of negligence over Julia’s death at Rumah Sakit Umum Pusat Prof. Dr. R.D Kandou by the Supreme Court on Sept. 18, 2012.

The three doctors failed to receive the consent of Julia or her family before beginning a Cesarean section. Before the procedure, the doctors did not check the patient’s vital signs with an electrocardiogram (EKG), the court ruled. Julia died a short time later as a substantial amount of gas trapped in her vascular system reached her heart.

While it is normal for air to enter the circulatory system during surgery, it takes a sizable amount of gas — in excess of 100 ml — to stop the heart. Gas embolisms are a common risk for surgeries like Cesarean sections, but deaths resulting from embolisms following C-sections are rare in countries like Singapore where proper preventative measures have greatly reduced the risk.

Indonesia has made strides in recent years to reduce maternal mortality rates, but the nation still has one of the highest rates of death for pregnant mothers in Southeast Asia. According to data compiled by the World Bank, 220 mothers die for every 100,000 live births. Vietnam, the Philippines, Malaysia, Singapore and Myanmar all reported lower death rates.

Gas embolisms caused only 2 percent of those deaths region-wide, according to World Health Organization data tracking maternal deaths from 1997 to 2007. Hemorrhaging, or blood loss, resulted in 32 percent of maternal deaths in Southeast Asia during the same period.

Allegations of malpractice are common in Indonesia, but doctors’ so-called “conspiracy of silence,” has hindered efforts to prosecute negligent health care professionals. When Ayu, Hendry and Hendy were first brought up on malpractice charges, the three were declared innocent by a local court. The verdict was later overturned by the Supreme Court but by that point the doctors were already missing.

All were sentenced to 10 months in prison and were ordered to report to the jail to begin their sentences in early Nov. The Attorney General’s Office declared the doctors fugitives from justice after none of them reported to prison. Ayu was found working in Balikpapan on Nov 8 and detained. Her former colleague Hendry was detained a short time later.

Hendy is still at large.

The arrests sent shockwaves through the nation’s OB/GYN community. Gynecologists in North Sulawesi and Gorontalo walked out on a three-day strike last week over allegations of a witch hunt. The anger has now spread to the capital, where some 600 doctors plan to march on the Supreme Court on Wednesday. Gynecologists will wear a black armband and pins in solidarity with the three OB/GYNs, Nurdadi said.

“We have all been working nicely, but if we are still being stepped on how can we not shout with a protest,” he said.

The association is calling for the Supreme Court to revoke its decision and allow the doctors to walk free. The Indonesian Doctors Association (IDI) and POGI North Sulawesi have already filed for a judicial review. The case sets a dangerous precedent in Indonesia, IDI chairman Zaenal Abidin said.

“It could be bad jurisprudence as the doctors could be charged if the patients died or did not recover from illnesses,” Zaenal said. ”We will prove that the Supreme Court is wrong in implementing the law.”

The IDI itself admits that a gas embolism was found in Julia’s autopsy. But the POGI alleged that complications like gas embolisms are unpredictable and unpreventable. The patient was admitted to the emergency room and was only 26 years old, too young to necessitate a EKG reading before her surgery, Nurdadi said. She needed fast treatment to save the life of her child, which the OB/GYN staff successfully did, he said.

The doctors cannot be held liable for deaths that are out of their hands, Nurdadi said.

“How could something outside doctors’ capabilities be caused by negligence?,” he said.

The case received the backing of Indonesian Health Minister Nafsiah Mboi on Tuesday who said she supported the protest. The Ministry of Health will assemble a team to investigate the death, she said.

“The media and public must understand [the doctors’] feelings,” Nafsiah said. ”[What] if friends of yours were treated unfairly like this? Ayu was trying to help a pregnant woman and her unborn baby. She was in critical condition.

“The baby survived but the mother did not.”

Prime Minister David Cameron is promising tough action [REUTERS]

David Cameron said NHS workers who mistreated and abused patients would face “the full force of the law”, under the creation of the new criminal offence.The Prime Minister revealed one of the recommendations from a review of patient safety, set up following the Mid Staffs scandal.

Earlier this year, a public inquiry found poor care may have led to hundreds of needless patient deaths at Stafford Hospital.

A package of measures will be unveiled by Health Secretary Jeremy Hunt in Parliament on Tuesday.

Staff who mistreat and abuse patients will face punishment modelled on laws against the wilful neglect of adults under the Mental Capacity Act.

These include fines and prison sentences of up to five years.Mr Cameron said: “The NHS is full of brilliant doctors, nurses and other health workers who dedicate their lives to caring for our loved ones.

“But Mid-Staffordshire hospital showed that sometimes the standard of care is not good enough.

“That is why we have taken a number of different steps that will improve patient care and improve how we spot bad practice.

“Never again will we allow substandard care, cruelty or neglect to go unnoticed and unpunished.”

He added: “This is not about a hospital worker who makes a mistake, but specific cases where a patient has been neglected or ill-treated.

“This offence will make clear that neglect is unacceptable and those who do so will feel the full force of the law.”

Health chiefs urged the Government to make sure the new offence is accompanied by legally enforceable staffing levels on hospital wards, especially in the case of elderly care.

Dr Peter Carter, chief executive of the Royal College of Nursing, told BBC Radio 4’s Today programme: “This on its own will not be a remedy, it will not be a panacea to cure the perceived ills of the NHS.

“What you need to do is to ensure that you have legally enforceable staffing levels so that you don’t end up with the situation that we are finding increasingly with the care of the older people.”

The Government is acting on the recommendations of a report into the Mid Staffs scandal [EPA]

“Never again will we allow substandard care, cruelty or neglect to go unnoticed and unpunished”

David Cameron

NHS campaigners also want the new charges to include hospital managers who suppress or ignore whistleblowers.”This alone will not avoid another Mid Staffs,” said Julie Bailey, who set up the Cure the NHS group which campaigned for a public inquiry into Mid Staffs.

“When staff try and reach out and inform managers there is a problem on those wards, staff need to be listened to.

“And if they are not listened to by the managers, that’s when we need that criminal offence.

“It may be extreme, but it will save lives.”

But, the chair of the Royal College of GPs, Dr Maureen Baker, said proper, effective systems were more important than the introduction of new criminal charges.

“Doctors, nurses – we are human, human beings make mistakes. You can’t change the human condition, but you can help support the humans in having systems around them that help keep them safe, caring and compassionate,” she said.

“You can’t rely on the law to properly regulate how people do their jobs. We need to rely on the professionalism of doctors, nurses, managers.

“What we need to do is let the professionalism take more centrality so that people can flag up the way they need to work in a safe system to care for patients properly.”

Health Ministry shuts down Chinese Maternity Hospital

NOVEMBER 22, 2013

KUALA LUMPUR, Nov 22 — The Health Ministry has issued an order to the N.S. Chinese Maternity Hospital and Medical Centre (NSCMH) to suspend its in-patient services with immediate effect.

Health director-general Datuk Dr Noor Hisham Abdullah said this was because the hospital was found to have committed 10 violations of the Private Healthcare Facilities and Services Act 1998.

“These violations encompass matters involving both in-patient and out-patient services. One such example is that NSCMH lacks full-time resident doctors in certain core disciplines, thus raising concerns about patient safety,” he said in a statement, here.

The statement dated yesterday was faxed to Bernama, here, today.

Dr Noor Hisham said the hospital was now not allowed to admit new patients and the existing in-patients were to be transferred to other hospitals as patient safety and quality of healthcare were of paramount importance to the ministry.

He said the suspension order followed a thorough investigation into a complaint received by the ministry in August and was substantiated by findings obtained during a verification visit to the hospital on Sept 4.

“The ministry had twice issued show-cause letters on Sept 18 and Oct 21 respectively, asking for the hospital to provide detailed response regarding the remedial actions that had been taken and those that were being planned in order to overcome these 10 violations.”

He said a special meeting was convened on Oct 17 with the hospital’s representatives and NSCMH life members, seeking detailed explanation for the 10 violations noted during the verification visit and also to discuss possible solutions to the problems faced by the hospital.

“The hospital’s management was given 14 working days to respond to the second show-cause letter dated Oct 21 and that period lapsed on Nov 8.

“Hence, due to the failure of the hospital’s management to adequately address and overcome these 10 violations, the ministry was left with no other option but to issue a notice of immediate suspension of in-patient services at the hospital in order to ensure safe medical practices and to protect the interest of the patients,” he said. — Bernama

– See more at: http://www.themalaymailonline.com/malaysia/article/health-ministry-shuts-down-chinese-maternity-hospital#sthash.sjdkWGbM.dpuf