The Infectious Diseases (Amendment) Bill - Second Reading

25 Apr 2003

By Mr Lim Hng Kiang

Mr Speaker, Sir, I beg to move that the Bill be now read a second time.

Background

We are faced today with an unprecedented public health crisis. This crisis has been caused by the outbreak of Severe Acute Respiratory Syndrome or SARS. Several senior doctors told me that they have not experienced anything like this in the last 40-50 years. The SARS outbreak can destroy the capability of our national healthcare system if it is not contained. It can have wide and severe repercussions on many sectors of our economy.

The SARS outbreak can be very pernicious because SARS is likely to be more infectious when the patient is more ill. And the patient is likely to be most ill when he is in the hospital. Once a group of healthcare workers is infected by SARS in the hospital, it can spread quickly within the hospital. In Hanoi and Beijing, they had to take the very drastic step of closing down the affected hospital, keeping everybody within the hospital, in order to stop the transmission into the community.

Even when SARS is contained, it will take a heavy toll on the healthcare system. SARS will place a disproportionate demand on ICU facilities and isolation rooms.

The Government is doing its utmost to control the SARS outbreak in Singapore. However, we need the co-operation of all Singaporeans in this battle. Until we have reliable and effective diagnostic tests, our doctors have to depend on two main criteria to assess whether a person has SARS. First, the clinical symptoms, like fever, cough, muscle aches and chills, which can be very non-specific. Second, the contact or travel history. With global travel and the complex web of interactions in a modern bustling city, establishing contact history is not an easy task unless the patient is truthful and forthcoming.

If a patient admitted to a hospital does not tell the truth about his contact or travel history, he may not be categorized as a suspect case and may not be isolated quickly. As a result, the infection can spread throughout the hospital. If a person with a fever sees a general practitioner and lies about his contact or travel history, he would not be referred to Tan Tock Seng Hospital and he goes on to infect others in the community.

The Infectious Disease Act provides for the control and prevention of infectious diseases in Singapore. Today, I propose new amendments to the Act, to give additional and necessary powers to the Ministry of Health to control the outbreak of SARS in Singapore. The main specific provisions cover five key areas: home quarantine orders, the quarantine of premises, the prevention of persons from acting irresponsibly which cause the infectious disease to spread, compliance with disease control measures and the handling of bodies of deceased persons who are suspected to have SARS.

Home Quarantine

It is important that all persons with SARS are identified early and isolated for treatment in Tan Tock Seng Hospital. This will minimise transmission of the disease to other persons. We also impose home quarantine orders on contacts of patients with SARS. Although asymptomatic contacts of SARS patients are well, the imposition of home quarantine allows us to pick up cases of SARS much earlier and prevents them from infecting others in the community. Home quarantine is therefore a key measure to prevent community transmission of SARS in Singapore. If people placed under home quarantine disregard their quarantine, they risk infecting others in the community. Clearly, this endangers the public health and we must not allow this to happen.

To begin with, the amended Act will make the legal process of issuing home quarantine orders clearer. Currently, home quarantine orders are issued under Section 15(1) of the Infectious Diseases Act which allows any person who is or who is suspected to be a case, carrier or contact of an infectious disease to be detained and isolated in a hospital or any suitable place. Section 15(2) of the current Act that deals with the issue of home quarantine can only be applied to persons who are suffering from an infectious disease. Furthermore, we cannot compound a fine if a person breaks home quarantine.

Clause 5 of the Bill will amend the Act to allow a person who is, or who is suspected to be a case, carrier or contact of an infectious disease or has recently recovered from an infectious disease or has been treated for an infectious disease to be quarantined in his home. He will also have to follow the conditions which are applied to him with respect to his quarantine. One of these conditions will be to wear an electronic wrist tag if he breaks his quarantine.

To tighten the control on persons who are put on home quarantine, the amendment will make it an offence for persons to break home quarantine or to refuse to comply with any condition applied to the quarantine. The offence will then be compounded by my Ministry. Persons who break their quarantine may also be arrested by the police or authorised Health Officers and be detained in a hospital or other appropriate place and be required to undergo necessary medical examinations and treatment. Repeat offenders can also be referred to the courts and the courts will take his previous offences under the Act into account in sentencing.

Isolation area

Clause 7 of the Bill will give my Ministry new powers to quarantine any premises for the purposes of controlling or preventing the spread of an infectious disease. This will be accompanied by necessary powers to make specific orders in relation to the restriction of persons or goods within the quarantined premises as well as powers to authorise the destruction, disposal or treatment of goods, structures, water supply, drainage, sewerage system or any other matter known or suspected to be a source of infection. This section is included in the Act as a contingency to cater for a scenario like that of the Amoy Gardens in Hong Kong.

Civic responsibility

Mr Speaker Sir, to prevent persons from behaving irresponsibly and endangering the health of others, the Bill proposes a new section to be added to the Infectious Diseases Act to prohibit certain acts which are liable to expose others to the risk of infection. Under this new provision, a person who knows or suspects that he is suffering an infectious disease must not expose others to the risk of the infection by his presence in a public place. The only exception to this is when he is seeking medical treatment. However, if the Director of Medical Services has designated a specific place for the medical treatment of the infectious disease concerned, then the person must seek treatment in the place specified. This provision only applies to infectious diseases which are specified in a new Fifth Schedule. SARS will be the first infectious disease listed in the Fifth Schedule.

The Prime Minister had in an open letter to Singaporeans on 22 April, quoted two examples of such irresponsible behaviour. The first case was the family of eight who is related to the 72-year man who works at the Pasir Panjang Wholesale Centre. Despite being instructed by the doctor to remain where they were while waiting for the ambulance to arrive, they removed their masks and wandered off to a nearby food centre and a Chinese medical hall. The other case was the man who visited a General Practitioner clinic, a polyclinic and two sinsehs before going to Changi General Hospital. He should not have gone to so many places to seek treatment.

In our battle against SARS, we need a higher level of social discipline and social responsibility. Singaporeans must have the confidence that fellow Singaporeans will not commit irresponsible acts that expose others to the risk of infection. Clause 8 sets out the provisions to ensure that this is so.

Refusal to cooperate and providing false information

My Ministry's officers have encountered several instances when persons refuse to cooperate for example, by refusing to answer telephone calls or telling our officers not to bother them. Some persons even provide misleading or false information. Clause 16 amends section 64 of the Act to make it an offence to refuse to cooperate with disease control measures and to provide false or misleading information. Under the amended Act, the first offence carries a fine of up to $10,000 and/ or a prison term of up to 6 months and for subsequent offences, the fine is up to $20,000 and/ or a prison term of up to 12 months.

Wakes and disposal of corpses of person with infectious disease

To protect the public health, Section 14 of the Infectious Diseases Act empowers the Director of Medical Services to impose conditions for the collection, removal and disposal of the body of any deceased person who has died from an infectious disease. Currently, we have patients who die in hospital before a diagnosis of SARS can be made. There are also some who may have died from another medical condition e.g. a heart attack or cancer, but doctors cannot totally exclude a concurrent SARS infection. This is because we now recognise that SARS can present in very atypical ways in some patients with other chronic conditions and that SARS infection can also be superimposed on other forms of bacterial infection. The diagnostic methods for coronavirus which are currently available are not sensitive enough to exclude a diagnosis of SARS.

Thus in some cases, there is not enough clinical evidence for a diagnosis of SARS to be made but yet the doctors cannot completely rule it out. Let's consider as an example, an elderly patient with multiple medical problems and a bronchopneumonia due to a bacterial infection, confirmed on laboratory testing. The patient also has a history of contact with a SARS patient. When such a patient dies, the cause of death will not be attributed to SARS, since bacterial bronchopneumonia is a common and well-recognised cause of death in such patients. However, in line with our very cautious approach to SARS, as a precautionary measure to minimise the risk to those who are handling the body, MOH will treat such cases as potentially infectious and the death to be treated in the same way as a SARS death.

The Infectious Diseases Act currently has no provision to empower the Director of Medical Services to issue directives for the disposal of bodies of those who are only suspected to have an infectious diseases. Clause 5 will amend section 14 of the Act to allow directives to be issued by my Ministry on how the body of the deceased is to be disposed of even when the diagnosis of SARS is only suspected. In addition, the Ministry can also issue directives to disallow funeral wakes if necessary. Failure to comply with the Directive will be an offence.

Related to this, Clause 4 will also amend the Act to allow the Ministry to require a post-mortem on persons who were suspected of being a carrier or contact of an infectious disease if this is deemed necessary to investigate an outbreak of an infectious disease or help to prevent its spread.

Increase in Penalties

The provisions under the Infectious Diseases Act have been enacted after careful consideration in order to protect the public health. Offences under the Act are serious and can potentially endanger the lives of many persons. We want to impress upon all Singaporeans of the seriousness with which we take the protection of public health. The Bill amends the Act to raise the general penalty for those who commit an offence under the Act from $5,000 to $10,000 and/or imprisonment for a term not exceeding 6 months for the first offence upon conviction and in the case of a second conviction, the penalty has been raised to $20,000 and/or imprisonment for a term not exceeding 12 months. My Ministry will compound any offence by home quarantine breakers and the offender will required to pay a sum not exceeding $5,000.

Other provisions

Medical examination

The Ministry of Health may need to require not just persons who are suffering from an infectious disease or who are contacts with such infected persons to undergo a medical examination to prevent the spread of an infectious disease. Clause 3 will amend section 8 of the Act to enable my Ministry to also require persons who are suspected to be contacts of persons with an infectious disease or carriers to undergo medical examination if necessary. This will enable us to implement more stringent measures if necessary to prevent the spread of infectious disease.

Issue of directives to health care institutions and medical clinics

The current Act only allows the Ministry of Health to issue directives for the investigation of infectious diseases and for the treatment of infected persons. This has limited the Ministry from issuing directives to health care institutions and clinics under the Act. Clause 4 of the Bill will amend the act to allow such directives to be also issued to prevent the spread of an infectious disease.

Information from patients and medical practitioners

For the purpose of investigating outbreaks or suspected outbreaks of infectious diseases, or in preventing the spread of such disease, Clause 4 read with Clause 16 will also amend the Act to allow the Director of Medical Services to require medical practitioners to obtain necessary information from his patient and transmit this information to the Ministry of Health. It will be an offence for the patient to refuse to provide the information required or to provide false and misleading information. This will help the Ministry of Health to obtain essential and accurate information when required so that control measures can be taken quickly to contain the spread of any infectious disease.

Disclosure of information

Clause 11 of the Bill will also amend the Act to allow the Director of Medical Services to disclose information obtained under the Act to any person if this is necessary to prevent the spread of certain infectious diseases as specified in a new Sixth Schedule. SARS is the first disease to be included in this Sixth Schedule. I would like to reassure members of this House that the amended Act will only allow such information to be transmitted to enable the implementation of measures which are necessary to prevent the spread of infectious diseases. These measures must also be permitted by the Director of Medical Services.

Conclusion

Mr Speaker, Sir, Severe Acute Respiratory Syndrome is a clear and present danger to the health of all Singaporeans. We must be able to act swiftly and decisively to prevent and contain its spread. In the future, there may also be outbreaks of other infectious diseases both known and new which may again threaten the health of Singaporeans. The amendments to the Infectious Diseases will enable the Ministry of Health to do the best we can to protect the health of all Singaporeans.

Mr Speaker, Sir, I beg to move.