Dr John Chew (spmps President) Presentation

MALAYSIAN MEDICAL ASSOCIATION & SOCIETY OF PRIVATE MEDICAL PRACTITIONERS SARAWAK

st

21 December 2008 2.00 pm – 6.00 pm

MMA Life membership Promotion ends 31st Dec 2008 Society of Private Medical Practitioners Sarawak Acknowledgements Dr Mohd Kamil Dr Asmah Dr Manalan SN Lee Geok Nio Ms Chai Eastern Oxygen Borneo Cyntex 3A Dorothy Tan, Amanda Liew Committee Members

MMA(Sarawak) SPMPS Post Registration Inspection and Dispensing Workshop Programme 2.00 pm - Welcome by Organising Chairman, Dr Tan Lean Sim 2.10 pm - Introduction by SPMPS President, Dr John Chew - Short Address by Sarawak State Health Director, Dr Mohd Kamil Hassan 2.30 pm 3.00 pm 3.20 pm 3.30 pm

- Post Registration Inspection Check List By Dr Asmah Nazahiyah Bte Said Asst Director, (Medical), Private Medical Practice Control Unit - Meeting The Requirements of the Post-Registration Check-List By Dr S R Manalan, National Chairman, MMA PPS - Q&A - Refreshment

4.00 pm

- Cold Chain Maintenance By Ms Lee Geok Noi, Staff Nurse, Private Medical Practice Control

4.10 pm

- Dispensing Medicine By Ms Chai, Enforcement Officer, Pharmacy Department, SGH - Sharing by Dr Lim Meng Lang and Dr Kiu Chiong Chin - Rights, Responsibilities & Reasons To Be A Private Medical Practitioner by Dr Mohd Hirman Ritom, Commissioner Human Rights of Malaysia - Discussion & Conclusion Briefing by Encik Faizal, Eastern Oxygen

Unit 4.25 pm 4.45 pm 5.00 pm

MMA(Sarawak) SPMPS Post Registration Inspection and Dispensing Workshop 4.00 pm 4.10 pm 4.25 pm Chin 4.45 pm

- Cold Chain Maintenance By Ms Lee Geok Noi, Staff Nurse, Private Medical Practice Control Unit - Dispensing Medicine By Ms Chai, Enforcement Officer, Pharmacy Department, SGH - Sharing by Dr Lim Meng Lang and Dr Kiu Chiong - Rights, Responsibilities & Reasons To Be A Private Medical Practitioner by Dr Mohd Hirman Ritom, Commissioner Human Rights of

Malaysia 5.00 pm - Discussion & Conclusion

Workshop What we hope to achieve? 1.

2.

3.

4.

Support network for the single practitioner. Building Bridges between the Government Department and the Doctors Bulk purchase of equipment and drugs. Sharing Expertise and Resources

Government Departme MOH Regulators Private Doctors

PHFS Act 1998 and Regulations 2006 APPLICATION FEE RM500 APPROVAL FEE RM1000

HOUSES BANKS HOUSES HOUSES CARS BANKS BANKS JOBS CARSCARS JOBS POLITICIANS JOBS POLITICIANS

Western Digital to cease operations in Sarawak, 1,500 to be laid-off By JACK WONG Published: Saturday December 20, 2008 MYT 3:06:00 PM

ASIAN TSUNAMI 26th DEC 2004

"Great minds discuss ideas; Average minds discuss events; Small minds discuss people" Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

CHANGE WE CAN BELIEVE IN TWO WARS PLANET IN PERIL FINANCIAL DISASTER

PHFS Act and Regulations to improve the delivery of healthcare Dr Basmullah’s conviction RM 120,000 fine; three months jail in default Released March 2008 Dr Rahdakrishan’s RM15,000 fine 10/09/2008

MMA Workshop on PHFS Act and Regulations 20th April 2008 9.00 am Current Challenges for the Private Practitioners Sector

Dr S R Manalan, Chairman, PPSMMA 9.30 am Challenges in the Enforcement of the PHFSA Dr Mohd Khairi Bin Yakub, Director of Medical Practice Division, MOH 11.00 am Private Health Care in a Developed Malaysia 2020

Ybhg Tan Sri Datuk Dr Hj Mohd Ismail Merican, Director General of Health, MOH

Malaysian Medical Resources- youtube, facebook www.medicine.com.my www.fpmpam.org www.mma.org.my

Post Registration Inspection DR ONG HEIN TEIK Penang “Made to feel like a criminal" -NST, Sept 17 An official reply: NST Online » Letters (2008/09/24) HEALTH MINISTRY INSPECTION: Thanks for the feedback By : DR NOORAINI BABA, Director Medical Practice Division , Ministry of Health Malaysia.

HEALTH MINISTRY INSPECTION: Thanks for the feedback By : DR NOORAINI BABA, Director Medical Practice Division , Ministry of Health Malaysia n n

n

checks on physical structures, basic emergency equipment inspection of documents on the organizational set-up policies, procedures and registers of private clinics. These inspections are designed to educate and to promote compliance by private registered medical practitioners to ensure patients' safety and quality healthcare, and is not meant to be

DR NOORAINI BABA, Director Medical Practice Division , Ministry of Health Malaysia (2) 4. This practice is consistent with the requirements of the Poison (Psychotropic Substance) Regulations 1989 that psychotropic drugs must be supplied by a registered medical practitioner for medical treatment. 5. Under Paragraph 88(2)(e) of the Act, an inspector is also allowed to inspect and take extracts from any book, document or record relating to any private clinic which the inspector considers necessary to assist him or her in the checks. (Including fees charged) 6. His (Dr Ong’s) feedback will serve to

GUIDELINES ON EMERGENCY MEDICAL SERVICES FOR PRIVATE HOSPITALS AND CLINICS

Emergency Care in Clinics     

Rare events Maintenance of Skills Short expiratory of drugs Expensive equipments Chains of Survival

3.1 Level / Category 1 of the Service ( Single practice General Practitioner(GP), Primary care etc) 3.2 Level / Category 2 of the Service ( Group Family Medicine Practice/ GP with or without Family Medicine Specialist or equivalent) 3.3 Level / Category 3 of the service ( Ambulatory Care Centre, Nursing Homes, Old Folks Home etc) 3.4 Level / Category 4 of the service ( Private Hospitals with Basic, Single Discipline, Specialist Practice) 3.5 Level / Category 5 of the service ( Private Hospitals with multidisciplinary Specialist Practise

REQUIREMENT / GUIDELINES FOR THE LEVEL 1 SERVICE 1) Structure : Resuscitation and treatment room i) Patient trolley/ Bed with privacy ( curtain) ii) Adequate lighting iii) Adequate space approximately 28 x 10 ft / 853 x 305 cm per room The GP examination room with privacy is acceptable

2) Equipment and consumables Airway management 1) Oropharyngeal airway (various sizes) 2) Bag-Valve and Mask 3) ETT Tube Breathing and Ventilatory Support 1)Oxygen Supply or Oxygen Tank with oxygen regulator 2) High Flow Mask 3) Nebuliser mask 4) Suction Outlet or Portable Suction

2) Equipment and consumables Circulation and Haemorrhage Control

1) Automated External Defibrillator (AED) 2) Intravenous cannulae 3) Intravenous fluid for resuscitation 4) Haemorrhage control bandages Skeletal Immobilisation 1) Cervical collar 2) Universal Skeletal Immobilization Kit Eg: upper limb , lower limb, bandages

Emergency medications ( Medication for resuscitation procedure ) 1) Adrenaline 2) Atropine

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From: Mohd Anis Bin Haron (Dr) <[email protected] > <[email protected]> Date: Thu, Dec 18, 2008 at 5:04 PM Subject: PHFS Act 1998 and Regulations 2006 - Reply from Dr. Asmah. To: "Sr. Mary Cardosa" <[email protected] > <[email protected]> Cc: "Dr. Ahmad Razid Salleh" , "Dr. Afidah Ali" , drnooraini_b , , , > [email protected]>, "Dr. Asmah"

Dear Dr Mary, I am terribly sorry. Her reply was at the bottom of her email. The following is the extract from her reply in RED i.e.:

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"Assalamualaikum. Apart from what being mentioned in the Act, we did not ask for other things. We asked the PIC to get defibrillator for Haemodialysis Centres not clinic.  If I'm not mistaken, during the earlier part of the post registration inspection, we asked for everything in the checklist and the GP did well.They even keep ET and Laryngoscope (that was not listed in our checklist). After sometime we noticed a lot of  GPs did not comply with the basic emergency equipment, so we asked them to refer to FIFTH SCHEDULE of the Act because we did not supply them with the checklist(not much difference with our list). Some of the GP clinics do not have OXYGEN TANK, INDWELLING URINARY CATHETER, IV SUPPLIES and EMERGENCY DRUGS  too. They were saying that they were waiting for the news from MMA Sarawak to notify them on the latest list of the emergency equipments (MMA having discussion with KKM to exclude certain things including Oxygen). What we do now is we ask what they have and jot down .If not complete ask them to refer to Fifth Schedule . Various response from the GPs, some have everything listed in the FIFTH SCHEDULE and one GP even refused to keep any basic emergency equipment and said he only have to drive the patient to the hospital just in case patient collapses in his clinic (maybe not MMA member )I'm myself also not clear about the final decision. Due to the mixed response by the GPs, we refer to both checklist and FIFTH SCHEDULE until the final say. Anyway after last week 's meeting, we conclude that only ET is EXCLUDED and that is what I'm going to inform them during our briefing. Thank you." With regard to the 5th Schedule, there has been different opinions from various agencies including our National Advisor for Traumatology i.e Datuk Abu Hassan who insist that the lists should be retained. We have yet to make arrangement to discuss further this matter. Thanks.

Emergency care      

Checklist Fifth Schedule Both Checklist and Fifth Schedule MMA List MMC List ??? Final List

Checklist       

Emergency call system Oxygen Airways and manual breathing bag IV supplies Suction equipment In-dwelling urinary cathethers Drugs and other emergency medical equipment/supplies deemed necessary

Fifth Schedule

both adult and paediatrics         

Emergency call system Oxygen Ventilation assistance equipment, including airway and manual breathing bag Intravenous therapy Electrocardiogram Laryngoscope and endotracheal tubes, if possible; Suction equipment In dwelling urinary catheters Drugs and other emergency medical equipment and supplies, necessary for the level of services to stabilize the patient as specified by the person in charge.

Emergency Care 

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NHS: No Statutory Requirement Designated Emergency Centres Victoria, Australia: Drugs provided Mobile ICU Singapore: Ambu Bag Emergency drugs:Adrenaline, Atropine, Antihistamines, Hydrocortisone.

Emergency Care  

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I.V. Adrenaline 50-100mcg over 5 minutes I.M. Adrenaline 0.3-0.5mg repeated after 510 minutes I.V. Promethazine 0.2mg/kg I.V. Hydrocortisone 100-200mg. I.V. Dextrose 50% I.V. Diazepam 5-10mg.

Negligence       

Duty of Care – failing to attend ( Lowns v Woods 1996) Breach of the duty of care – ineffective treatment is not negligence. Objective standard Bolam principle Rogers v Whitaker 1992 Soo v Foo 2002 Good Samaritan clause

Medical Manslaughter on the Rise …. Changes in the way that doctors are held accountable for their mistakes, and the rise in charges of medical manslaughter. Dato Dr NKS Tharmaseelan MPS Consultant

RISK MANAGEMENT Fire extinguisher and hope never to have fire

BURNING ISSUES 1. Clinical Waste Disposal 2. Clinical Practice Guidelines 3. Documentations for Insurance 4. Pharmacy Enforcement 5. EPF, SOSCO, Labour laws , tax 6. FOMEMA, e- Kesihatan 7. ASEAN COMMON MARKET by 2013 8. Over supply of doctors. 9. Revisions to the MEDICAL ACT 1971 10. Impaired doctors 12. Health Financing, Medical Devices, TCM

Malaysian Medical Council 2008 22,000 doctors registered 2,300 Housemen registered per year (3,000 per year in 2010) 15,000 medical students in 21 Medical Schools 1,000 per year sent overseas by Government. 1,000 per year sent overseas by FAM scholarship 1:600 ratio achieved between 2013 and 2018

Registered Medical Practitioners 2007 Sarawak Public Private Total Malaysia Public 8868 Private

2001

205 276 481 5219 7209

276 357 828

Pharmacy Board of Malaysia 2001 Sarawak Public Private Total Malaysia =4420 Public Private Total

2007

20 126 146 Pharmacist 460 2108 2665

Corporate = 414

ASEAN COMMON MARKET 2013 Your employer

SINGAPORE Your competitor

PHILLIPINES

CHEW CHEE-MING, JOHN Full Registration No: 25208 1st January 2009 Medical Act 1971

We survived because we were stronger than we thought. We suffered because we were weaker than we should have been. Bill Young Former POW BLTC, Kuching Borneo Post 21st Dec 2008

THANK YOU

MMA Life membership Promotion ends 31st Dec 2008 Society of Private Medical Practitioners Sarawak Acknowledgements Dr Mohd Kamil Dr Asmah Dr Manalan SN Lee Geok Nio Ms Chai Eastern Oxygen Borneo Cyntex 3A Dorothy Tan, Amanda Liew Committee Members