Opening Speech for Second Reading of Traditional Chinese Medicine Practitioners (Amendment) Bill by Dr Amy Khor, Senior Minister of State, Ministry of Health, 11 Feb 2019

     Mr Speaker, on behalf of the Minister for Health, I beg to move, “That the Bill be now read a Second time.” 

2.  The Traditional Chinese Medicine Practitioners Act, referred to as “the Act” in this speech, was enacted in 2000 to safeguard patients' interests and safety, raise professional standards and regulate the professional ethics and conduct of registered TCM practitioners (TCMPs). 

3.  Under the Act, the Traditional Chinese Medicine Practitioners Board (the Board) was established to register practitioners engaging in prescribed practices of TCM in Singapore, accredit TCM courses for the purpose of registration as well as the Singapore institutions of higher learning offering such courses, regulate the professional conduct and ethics of registered practitioners, and make recommendations on the continuing training and education of registered practitioners. 

4.   Since then, the Ministry of Health (MOH) and the Board have progressively put in place programmes and frameworks to raise the professional standards of TCMPs in Singapore.

5.  In 2013, MOH set up a $3 million TCM Research Grant to encourage collaborative research between researchers in public healthcare institutions, the TCM sector and institutions of higher learning, with the objective of better informing effective TCM practices. A total of $2.6 million has since been awarded to 11 proposals shortlisted from three grant calls. In view of the encouraging response, a further $5 million has been added to the Grant in 2017. 

6.   Last year, a $5 million TCM Development Grant was also established to support skills development and capability building of the sector. Individual TCMPs are eligible to apply for the Development Grant, capped at $200 per year, to defray the cost of attending TCM classes. Accredited TCM training providers may also seek funding support to conduct local TCM conferences and seminars. 

7.   As we strengthen professionalism within the TCM sector, MOH has reviewed the Act to ensure that the Act remains relevant and responsive towards the changing practice environment.

8.   The TCMP (Amendment) Bill before us today proposes amendments to the Act to better protect patients' interests and safety, improve the timeliness and fairness of the disciplinary framework for registered TCMPs, and help raise professional standards. 

9.   Speaker, allow me now to highlight the major provisions of the Bill. 

Implementing Compulsory Continuing Professional Education 

10.  Continuing professional learning is important to ensure that TCMPs keep themselves currentin their professional practice. Continuing professional education has already been implemented for other healthcare professions, such as doctors, nurses and pharmacists. MOH and the Board introduced voluntary Continuing Professional Education (CPE) in 2013 to enhance the standards and safety of TCM practice. Under the voluntary CPE programme, all registered TCMPs are encouraged to accumulate at least 25 CPE points per year. 

11.   Clause 5 of the Bill amends section 17 of the Act to provide that the Board may refuse to grant or renew a Practicing Certificate (PC) if the TCMP fails to comply with the prescribed CPE requirements. 

12.  The target is for all registered TCMPs to accumulate at least 50 CPE points within a two-year period in order to renew their PCs. The requirement as defined would allow some flexibility for individuals to plan their learning without unduly affecting their professional practice. 

13.  We developed this CPE points assessment framework after engaging with the TCM community extensively on CPE since 2013, taking note of their concerns on the availability and the range of CPE courses offered and reasonableness of the costs of these courses. We appreciate the constructive feedback and have taken them into consideration, such as expanding the accredited course offerings, to include new modes of learning to suit the different needs of TCMPs.

Changes to Strengthen Disciplinary Framework for TCMPs 

14.  Currently, all complaints against registered TCMPs are investigated by Investigation Committees appointed by the Board. While these cover a wide range of matters, the disciplinary framework does not adequately deal with allegations that a registered TCMP is unfit to practise due to his physical or mental condition. These cases do require a different approach since a health inquiry into the TCMP’s fitness to practice is required as opposed to an investigation into an incident or transaction. 

15.   The current framework also does not enable stoppage orders to be made in extreme situations where a TCMP must be made to immediately stop practising because of serious and imminent risk to the public if there is no stoppage, or if stoppage is required to avoid any actual incident that endangers the public.

16.   Clause 11 of the Bill introduces the new Part IVA of the Act, which sets out the revised disciplinary framework for TCMPs, which I will elaborate next in detail. 

17.   First, the new section 26A allows a registered TCMP to voluntarily curtail his practice if he believes that: (a) his fitness to practise is impaired by his physical or mental condition; or (b) the quality of the professional services he provides does not meet the standard which is reasonable to expect of a registered TCMP to carry out. The Board, with the agreement of the registered TCMP, may cancel the practitioner’s registration, suspend the registration for up to 3 years or impose appropriate conditions on the registration. A disciplinary inquiry does not need to be conducted in order for the Board to accede to the practitioner’s request. 

18.  However, this avenue will not be available in cases where there is evidence of professional misconduct or there is a pending disciplinary inquiry against the practitioner. 

19.  The process in the new section 26A is initiated by the TCMP, which encourages practitioners to come forward if they are of the view that they are unable to continue practising at the standard expected of a registered TCMP. This improves the timeliness of the process and allows the Board to resolve appropriate cases expeditiously. 

20.   Second, the new Part IVA sets out in the body of the amended Act a revised framework for inquiries into disciplinary matters concerning a registered TCMP. The processes have been streamlined to speed things up and to fit the introduction of a health inquiry. 

21.   A person may make a complaint against, or provide information about, any registered TCMP to the Board touching on any of the grounds set out in section 19(1). The complaint or information will be reviewed by the Board upon receipt, and for purposes of its review, the Board may require the complainant or TCMP concerned to answer any inquiry or provide any record that the Board considers relevant. The Board may dismiss any complaint or information that is frivolous, vexatious, misconceived or lacking in substance. However, if the case is not dismissed on any of those grounds, the Board must refer the complaint to an Inquiry Committee. 

22.  The Inquiry Committee will have 6 months to carry out its inquiry from the date of the referral of a complaint to the Committee, unless the Chairman of the Board grants an extension of time. 

23.  The Inquiry Committee must direct one or more investigators to investigate the facts and circumstances of the complaint. The investigator must give the TCMP concerned written notice of the complaint against him, and the TCMP can provide a written explanation to the investigator. The TCMP also will have the opportunity to appear before the Inquiry Committee, whether in person or represented by counsel, to be heard on the complaint.

24.  Upon completion of its inquiry, the Inquiry Committee will submit a report of its findings to the Board, together with its recommendations on the disciplinary action to be taken under section 19 of the Act against the TCMP. After considering the Inquiry Committee’s report, the Board may take such action under section 19 as it thinks fit, or dismiss the case. In appropriate cases, the Board may also refer the complaint back to the Inquiry Committee once more for the Inquiry Committee’s reconsideration or a further report on such matters as the Board may specify. 

Interim Orders 

25.  Third, the new section 26H enables the Board to make an interim order that requires a TCMP to immediately stop his practice for a period not exceeding 18 months. No prior inquiry or investigation is needed before making such an interim order. But the Board may do so only if there are reasonable grounds to believe that, either there is a serious and imminent risk to the public if there is no such stoppage, or if it is to avoid any actual incident that endangers the public. 

26.  If the Board is satisfied that it continues to be necessary to prevent the TCMP from practising, the Board may confirm the interim order, with or without modifications. Before the interim order is confirmed, the Board must refer the interim order to an Inquiry Committee. The TCMP may make representations or objections against the proposed confirmation to the Inquiry Committee. The Inquiry Committee will then consider the facts of the case before making a recommendation to the Board whether or not to confirm the interim order. 

Disciplinary penalties for errant TCMP 

27. The next group of amendments concerns the disciplinary penalties that may be imposed on a registered TCMP who has been found guilty following a disciplinary inquiry under the new Part IVA. 

Increased Penalties for Errant TCMPs 

28.  Currently, the Board may cancel the registration of an errant TCMP if he has been found guilty of professional misconduct or negligence, or any of the other grounds of misconduct under section 19 of the Act. Alternatively, the Board may caution or censure the TCMP, impose a financial penalty of up to $10,000, add, delete or replace conditions on his registration for a period not exceeding 3 years, or suspend his registration for up to 3 years. 

29.  To provide sufficient deterrence and punishment for misconduct so as to protect the safety and interests of the public, clause 7 of the Bill amends section 19 of the Act to increase the maximum financial penalty that can be imposed from $10,000 to $50,000, where the TCMP is found guilty on any ground in section 19(1)(e) to (k) of the Act. The increase will bring about better alignment with the other healthcare professional Acts and provide greater assurance and confidence to the public that errant TCMPs will be dealt with appropriately vis-à-vis other healthcare practitioners.

30.   Clause 7(d) introduces further disciplinary penalties that the Board may impose on the TCMP. These include the Board ordering the errant TCM practitioner to give an undertaking, on such terms as the Board thinks fit, to abstain from the conduct that was the subject of the disciplinary inquiry. The Board may also refer the matter for mediation between the TCM practitioner and the complainant. Examples of cases that may be suited for mediation include cases arising from poor service provided to patients and miscommunication. 

Immediate Cancellation 

31.  Taking Clause 7(h) and 9 of the Bill together, sections 19(5) and 21 provide that the Board’s decisions on disciplinary matters does not take effect until the 31st day after the date of the decision. This is to allow the TCMP sufficient time to consider whether to file an appeal to the High Court against the Board’s decision. Similar provisions are found in the Medical Registration Act and the Pharmacists Registration Act. Where there is an appeal to the High Court, the decision of the Board takes effect only when the High Court confirms the decision or dismisses the appeal, or the appeal is withdrawn. 

32.   However, this is subject to the new section 19(5A), under which the Board’s decision to cancel the registration of the TCMP takes immediate effect if the Board certifies that there are grounds to believe that either there is a serious and imminent risk to the public if the cancellation does not take immediate effect, or it is appropriate or requisite that the cancellation takes immediate effect to avoid any actual incident that endangers the public. 

Enhanced Investigative Powers 

33.   Clause 12 of the Bill repeals and re-enacts sections 28 to 30 of the Act to enhance the enforcement powers of investigators investigating into disciplinary matters concerning registered TCMPs, as well as offences under the Act such as unlawful practice of TCM by unregistered persons. 

34.  Currently, for the purpose of investigating into offences under the Act, authorised officers may enter and inspect any premises which are used or suspected to be used to carry out any prescribed practice of TCM, and inquire into the conditions under which the practice is carried out. However, the officers are unable to search the premises or seize evidence without a warrant, which hinders the timely and effective conduct of investigations.

35.   Under the new section 29, investigators appointed to investigate into offences under the Act or its subsidiary legislation may, without first obtaining a court warrant, enter and search a place which is used or suspected to be used to carry out any prescribed practice of TCM, or to keep any document, record or thing used in connection with carrying out of the TCM practice, and to seize evidence for the purpose of investigating an offence under the Act. However, if the investigator is investigating into a disciplinary complaint under the new Part IVA, these powers of entry, search and seizure can be exercised only if: (a) a court warrant has been obtained; (b) the occupier of the place consents; or (c) the investigator believes on reasonable grounds that there is an imminent or immediate danger of serious bodily injury or death to any individual who is receiving or is about to receive any treatment at the place. 

36.   The new section 30 makes it an offence for a person to: (a) provide any document or give information that is false or misleading in a material particular; (b) knowingly obstruct or prevent an investigator in the discharge of the investigator’s powers or duties; (c) intentionally alter, suppress or destroy any document or information which the person is required to provide); or (d) fail, without reasonable excuse, to provide any information the person is required to provide. 

37.   Finally, the new section 30A provides for the disposal and forfeiture of items seized by an investigator under the amended Act.

Other Amendments 

38.  Next, I will turn to the other amendments in the Bill, which are mostly of a housekeeping nature. 

Increase in Board Size 

39.   Taking in feedback from the TCM community, clause 3 of the Bill amends section 3(2) of the Act to increase the maximum size of the Board from 9 to 11 members, which allows for a broader representation of the TCM profession on the Board. 

List of Registered TCMPs with PCs 

40.   Clause 6 repeals and re-enacts section 18 so that the Registrar of the Board is not constrained to publishing a list containing information about all registered TCMPs with a valid practising certificate in the Gazette. Instead, the amendment will allow the list to be published on the Board’s website or by other means. 

To Clarify the Types of Costs and Expenses 

41.    Clause 8 amends section 20 to clarify the types of costs and expenses that the Board may require a TCMP who is the subject of disciplinary proceedings under Part IVA to pay. This includes the cost and expenses of any assessor or advocate and solicitor appointed by the Board for any proceedings before an Inquiry Committee, and reasonable expenses the Board may pay to witnesses.

Composition of Offences 

42.   Clause 14 inserts a new section 34A to provide that the Board may compound any offence under the Act that is prescribed as a compoundable offence. The maximum composition sum is the lower of one half of the amount of the maximum fine that is prescribed for the offence, and $2,000. This empowers the Board to compound such offences without having to rely on section 243 of the Criminal Procedure Code. 

Conclusion 

43.    Mr Speaker, Sir, please allow me to conclude in Mandarin. 

44.   中医师专业水平的提高是推动中医在新加坡发展与成熟重要的必备条件。因此, 卫生部重视也提倡中医执业者的继续教育。我们成功地在2013年开始实行志愿性中医继续教育计划, 并且取得不错的回响。当国会通过立法，强制性继续教育计划的实行更是提升专业水平的另一个里程碑。我们感谢中医团体及个别中医师对于继续教育计划所给予的反馈，也采纳了建议，如：增加学习平台，认可网上教学课程，以及增加讲师、自修的学分。中医师在参与继续教育的课程也可以享有中医发展补助金框架下每年给予两百元的课程费用补贴及技能创前程培训补助津贴，以便支持中医师继续学习。除了继续教育计划，卫生部也希望通过修改法令加强规管的程序与制度，使得纪律框架更加有效率，同时也更有效地保障病人与公众的安全。 

45.    With this, I seek the Members’ support for this Bill. 

Mr Speaker, I beg to move.