Speech by Mr. Louis Ng Kok Kwang, MP for Nee Soon GRC at the Second Reading of the Traditional Chinese Medicine Practitioners (Amendment) Bill (Bill No. 2/2019)
Sir, I stand in support of this Bill.
In recent years, Traditional Chinese Medicine (TCM) has become more popular as a career of choice. From 2012 to 2017, the number of practitioners rose by 16%.
However, as the profession swells in ranks, it must keep up its standards. Despite their growth in numbers, degree holders still comprise only 21% of all registered practitioners, according to 2017 data. Some 5.7% of practitioners have no formal qualifications at all.
Practitioners must continue to learn, unlearn, and relearn to keep up with the times. This Bill mandates continuing professional education for practitioners. At the same time, it clarifies and elaborates the mechanisms used to keep practitioners in check.
I agree with these measures, and I thank the Ministry of Health for holding a public consultation and incorporating views from that consultation into this piece of legislation.
I have five points of clarification to raise.
Quantum of fines
My first point is about fines.
The Bill raises the maximum fine from $10,000 to $50,000. I agree in principle with the increase, as it strengthens deterrence and punishment in an area where human lives are concerned.
However, it is unclear to me why this penalty is less than that imposed on Western medical practitioners. Under the Medical Registration Act, medical practitioners face a maximum penalty of $100,000.
In effect, we are saying Western physicians get fined $100,000 for doing wrong, while TCM physicians get fined $50,000 for doing wrong.
In its response to the public consultation, the Ministry said that that Medical Registration Act more seriously penalises Western physicians for one reason only: that they pose “greater risk of potential harm to patients.”
Can the Minister explain how a Western physician might be more dangerous than a TCM practitioner?
Last September, the TCM Practitioners Board fined a physician the maximum $10,000 for recommending that a patient delay her cancer surgery. The physician conveyed a whole slew of dangerous advice to his patient. He told her the tumor would grow slowly. He told her that surgery would make the cancer cells proliferate more quickly. He told her that her tumor was not life-threatening.
In addition, he prescribed capsules of ginseng and herb that, at best, provided a false sense of comfort for his patient.
We were lucky that the patient’s daughter interceded and that the patient went ahead, promptly, with surgery. But not every patient is so lucky.
I am concerned about the message that this difference in fines sends. When patients sit in a physician’s office, the physician is the figure of authority. TCM physicians are in a prime position to influence the health decisions of patients. In this case, the physician took the patient down a dangerous, life-threatening course of action.
I urge the Ministry to further explain why a TCM practitioner should face a less severe penalty than Western medical practitioners.
Mandatory professional education for errant practitioners
My second point is about continuing professional education.
I am heartened that the Bill empowers the TCM Practitioners Board to reject the registration of practitioners who fail to comply with requirements of mandatory professional education。
My question is whether the Board can issue such requirements as part of a punishment imposed on errant practitioners.
In the case I previously mentioned, the Board issued only a fine and a suspension to the practitioner even though it found that he was “neither remorseful for his conduct nor fully aware of the danger that he posed to the patient.”
From that statement, it appears the practitioner did not agree or understand that what he did was wrong. What, then, is stopping him from making mistakes of a similar nature when he returns to practice? What course of action has been taken to ensure his knowledge base is updated to what the profession demands?
In many industries, it is common for errant professionals to undergo some program of training or education to rectify their gap in knowledge and understanding.
Can the Ministry clarify whether the TCM Practitioners Act equips the Board with powers to require offending practitioners to undergo specific courses of professional training?
Timelines under the complaint mechanism
My third point is about responding to complainants.
The new Section 26E details an array of timelines. Upon receiving a complaint, the Board has 2 weeks to start a review and 3 months to complete that review. If they refer the matter to an Inquiry Committee, the committee has six months.
All in all, it seems this process can take just under a year, extensions notwithstanding. It is a long time for a complainant to wait.
My questions are as follow: Does the Board have an obligation to respond to the complainant with the results of its review? If the review proceeds to the stage where an Inquiry Committee is convened to investigate, must the complainant be notified about the final findings? In either case, is there a requirement that the Board relays information in any prompt manner to the complainant?
It is laudable that we have an extensive framework for investigating complaints. Surely the point of these investigations is not only to be accountable but also to demonstrate accountability. It then seems important to me that the Board has a duty to reply to the complainant in a reasonably prompt fashion with a response that meaningfully addresses the complainant’s concerns.
Patient communication of investigation results
My fourth point is about sharing the results of investigations with former patients.
If TCM physicians have conducted themselves in a dangerous way, it is possible that they have done it before. For instance, a physician who has given incorrect advice about how to deal with cancer might well have said similar things to other cancer patients.
The TCM Practitioners Act does not appear to mandate that the Board release investigation results to former patients of the errant physician.
Historically, we have seen some cases of misconduct by TCM practitioners reported in the news media. However, it is perhaps not a stretch to say that many TCM patients may not follow the news media closely. Thus they may not be aware that the diagnosis or treatment they received was shoddy.
Could the Ministry share whether, and how, it communicates with former patients when physicians are found guilty of misconduct?
Mental and physical qualifications for practitioners and TCM Board members
My fifth point relates to mental and physical condition.
Section 6 of the Act bars a person from membership of the board if “he is incapacitated by a mental or physical disability.”
Section 19 contains a similar phrase. The section allows the Board to cancel the registration of a practitioner if he, quote, “is unable to carry out the prescribed practice of TCM for which he is registered safely or effectively by reason of a mental or physical disability.” In this Bill, the phrase “disability” is amended to “condition.”
I have two questions relating to this point.
One, why does one section use “disability” while the other use “condition”? Does the Ministry mean to make a meaningful distinction between the two usages?
Two, could the Ministry articulate what would constitute a mental or physical condition, or a mental or physical disability? More specifically, what would be a condition or disability that results in incapacity or inability to carry out safe and effective practice? Is a certifying doctor—Western or TCM—required to weigh in? Who is the final adjudicator on this matter of judgment?
Clarifications on this point, I believe, will provide guidance in future when there is any such dispute.
In conclusion, the Bill is a step in the right direction. It reflects meaningful input solicited through the Ministry’s public consultation, and it provides a robust framework with which to regulate a profession that helps manage the health of many Singaporeans.
Sir notwithstanding my clarifications, I stand in support of this Bill.