The Ministry of Health (MOH) and Singapore Medical Council (SMC) are inviting feedback on proposed amendments to the Medical Registration Act (Chapter 174) (MRA). The public consultation will take place from 28 September to 26 October 2018.
2. The MRA protects the health and safety of the public by providing for mechanisms to ensure that registered doctors are competent and fit to practise medicine, and uphold standards of practice and public confidence in the medical profession.
Objectives of Proposed Amendments
3. The proposed amendments to the MRA aim to improve the disciplinary proceedings under the Act for both the public and doctors as follows:
a. Improve the transparency and accountability of the appeals and disciplinary processes.
b. Bring better consistency and alignment of the disciplinary processes with those under the criminal proceedings and other professional boards.
c. Enhance efficiency and provide more certainty in terms of timelines.
Key Amendments
4. The key proposed amendments MRA are as follows.
Independent Appeals Committee to Consider Appeals Against Decisions of Complaints Committee
5. Under the MRA, the Complaints Committee (CC) is responsible for investigating into a complaint lodged against a doctor, and appeals against the decisions of CCs are to be made to the Minister for Health. To improve transparency and accountability, an amendment is proposed to provide for the appointment of an independent Appeals Committee to consider appeals against the decisions of the CC. The Appeals Committee will comprise a medical doctor, a legal professional and a lay person. It may by a majority vote, affirm the CC’s decision, direct the CC to conduct further investigations, or overturn the CC’s decision and refer the matter to a Disciplinary Tribunal (DT).
Excluding Council Members from Disciplinary Tribunal
6. Under the MRA, a DT is appointed to look into disciplinary matters. To ensure no conflict of interest, the SMC excludes Council members from taking up appointments as chairman or members of DTs. SMC has also been appointing a legal professional to every DT. These practices will be formalised under a proposed amendment.
Streamlining Appeals Against Disciplinary Tribunal’s Decision
7. The SMC and the respondent doctor can appeal to the High Court against the decision of a DT. The SMC appoints an Internal Review Committee to audit every DT’s decision, before deciding if it should make an appeal. The complainant can also apply to a Review Committee, appointed by the Minister, to review the decision of the DT. Under the current MRA, the Review Committee can potentially compel the SMC to appeal against a DT’s decision, contrary to SMC’s internal assessment and decision. An amendment is proposed to streamline the appeals process by removing the provision for complainants to potentially compel the SMC to appeal. This will align SMC’s disciplinary processes with those in criminal proceedings and avoid unnecessary delays and duplication of work.
8. Complainants can still appeal to the SMC, which will consider the request before making a final decision whether to appeal the DT’s decision. If a complainant disagrees with SMC’s decision not to appeal the DT’s decision, the complainant can institute judicial review proceedings against SMC’s decision. The complainant may also file a civil suit against the doctor regardless of SMC’s decision whether to appeal.
Staying the Operations of Disciplinary Tribunal’s Orders
9. Under the current MRA, the orders of a DT would only be stayed if the respondent doctor appeals to the High Court against the decisions of the DT. An amendment is proposed to allow the DT to stay the operations of its orders when either the doctor or the SMC appeals to the High Court against the decision of a DT. This will better protect the public by preventing situations where the doctor had already completed the initial term of suspension as ordered by the DT and had resumed practice before SMC’s appeal on the sentence is heard by the High Court. In addition, the DT would be allowed to decide for its order take effect immediately even when there is an appeal, if the DT is satisfied that it is necessary to do so in the interest of patient safety.
More Appropriate and Consistent Sentencing Guidelines
10. The SMC will appoint a Sentencing Guidelines Committee to develop sentencing guidelines to aid the DTs in deciding on appropriate sentencings and to bring about consistency and fairness in the sentences. An amendment is also proposed to remove the minimum suspension period of 3 months to provide DTs greater flexibility to ensure that the sentences commensurate with the circumstances of the cases.
Widening Pool of Potential Complaints Committee Chairpersons
11. An amendment is proposed to allow doctors who are not Council members but who are members of the Complaints Panel with the necessary experience and expertise to be appointed as CC Chairpersons. This will widen the pool of potential CC Chairpersons and bring about better efficiency and timeliness, without compromising the functions of the CC.
Dispensing Need for Health Committee Upon Agreement Between Complaints Committee and Doctor whose ability to practise has been affected by health issues.
12. To ensure public safety through the timely implementation of actions against a doctor who is unfit to practise, an amendment is proposed to allow the CC to dispense with the need for a Health Committee inquiry for any complaints related to the doctor’s physical or mental fitness to practise, if the CC and doctor agree on the measures to be taken. This will also avoid unnecessary cost and time for both the doctor and the SMC.
Public Consultation Exercise
13. Together, the proposed amendments will improve the transparency, consistency and timeliness of the disciplinary proceedings under the MRA for both the public and doctors.
14. MOH invites the public to contribute their views and feedback on the proposed amendments to the MRA. The public consultation paper with details of the proposed amendments can be found on REACH website and on the MOH website from 6pm on Friday 28 September 2018. Feedback on the consultation paper can be submitted to mra_public_consult@moh.gov.sg.
15. All feedback should reach MOH by 6pm, 26 October 2018. All responses received by the closing date will be carefully considered.
MINISTRY OF HEALTH
28 SEPTEMBER 2018