Young doctors fear errors most

NST: KUALA LUMPUR: Making mistakes is many young doctors’ worst nightmare.
A survey has found that it was one of the biggest worries haunting newly qualified medical students who feared that their errors would cause harm to their patients.
Their fears are not without justification.
Health Ministry records showed that the number of cases with potential medico-legal implications at its hospitals has increased over the years.
In 2003, there were 72 cases. It rose to 79 in 2004, and 83 last year.
The amount of compensation paid was between RM220,000 in 2000 and RM330,000 last year.
In view of this worrying trend, the Malaysian Medical Association has decided to provide new government doctors with a professional medical indemnity scheme.
The scheme is offered by the Medical Protection Society (MPS), Britain, at an annual fee of RM200.
Under the scheme, doctors will be able to seek professional advice and help when they encounter ethical dilemmas, medical mishaps or problems such as complaints, inquests, medical council enquiries, claims or even media enquiries.
Health Minister Datuk Seri Dr Chua Soi Lek, who launched the MPS scheme at MMA House, described it as a timely move.
“This scheme will provide doctors with assistance and advice to protect them and their patients.”
He said medicine was not an exact science and when mistakes happened, it was important for doctors to respond with compassion, care and openness and for patients to have access to redress.
Dr Chua said a doctor who was familiar with medico-legal issues would be less fearful when dealing with mishaps.
On another issue, Dr Chua said Malaysian students pursuing medical studies in Britain could now apply for a three-year working visa upon the completion of their courses.

Faster help on the way with 800 ambulances

NST: KUALA LUMPUR: Help is on the way. Some 800 ambulances will be bought under the Ninth Malaysia Plan to help tackle a shortage which is delaying the response time.
Health Minister Datuk Seri Dr Chua Soi Lek also said that the Economic Planning Unit was studying the proposal to lease the vehicles or outsource the ambulance service.
He was commenting on a New Straits Times report that the shortage of ambulances was nearing critical levels and that the state of medical emergency response was not up to international standards.
The NST found out that there is not even a clear picture on how many ambulances there are in the country.
In the Klang Valley, the 14 all-day ambulances cater to 6.5 million people and the response is usually more than 15 minutes.
Dr Chua conceded that the ambulance service posed a big problem to his ministry.
He noted that there were 1,000 ambulances in the country but believed many were out of service after years of abuse.
“The ambulance service has been a headache for the government; normally, a new vehicle will break down after only four years due to poor handling.
“Because of this, the ministry feels it is better to rent the ambulances or pay to use the private ones available,” he said after launching the “Special Discounted Indemnity Insurance Scheme for Young Medical Doctors” here yesterday.
Dr Chua said the ministry had submitted a proposal to this effect.
“We are awaiting the outcome of the study. We will then do an indepth study on the ambulance service.”
The ministry plans to have an Ambulance Call Centre and enough ambulances to reach patients within 10 minutes of a call.
But Dr Chua cautioned that a large number of ambulances need not necessarily guarantee quality service.
“It’s akin to being at a restaurant. The presence of many waiters does not mean your food will arrive fast.”
At the function, Dr Chua presented a RM10,000 cheque from the Malaysian Medical Association to the family of the late Dr Norbaizura Yahya.
Dr Norbaizura, who was attached to the Seremban Hospital for two months, was escorting a patient to Selayang Hospital in an ambulance when it skidded and landed in a ditch after one of its tyres burst along the North-South Highway near Bangi.
After 16 days in a coma, Dr Norbaizura died in the Serdang Hospital’s Intensive Care Unit on Sept 19.

Hoping for a big blast, he almost loses face

NST: ALOR STAR: The country’s first firecracker explosion victim this year was more daring than victims in previous years.
Instead of playing with the usual firecrackers — banned by the government anyway — he made a meriam tanah.
The idea is to create a loud explosion by digging a hole in the ground and placing a small amount of carbide inside before covering it with a plank.
The next move is to light a match and it goes “boom”.
Sidek Ahmad, 13, is lying in pain at the Alor Star Hospital bed here after he burned his face and hand during the making of his underground explosive.
“I will never do it again,” he said, on the verge of tears.
The incident happened while Sidek was playing meriam tanah with his 10-year-old brother Wahab behind his home in Kampung Lebai Saman in Naka, Kuala Nerang.
The two boys had kept it a secret from their parents and went to the site after breaking their fast about 8pm on Monday.
After successfully setting off the first explosion, Sidek was checking the hole when a burst of flame spewed out and burned the flesh on his face and left arm.
His brother, who was behind him at the time, was not injured.
The boys ran home, with Sidek screaming in pain. They confessed their actions to their parents who then rushed them to hospital.
A family member said the boy might have to spend two weeks in hospital.
The police, however, are not taking the case lightly.
Padang Terap district police chief Deputy Superintendent Hamzan Darus said that while firecrackers were illegal, meriam tanah was deemed more dangerous.
“This type of explosion-making is classified under Section 4 of the Explosives Act 1957,” he said.
The police believe that such explosive could be used for illegal purposes. The Act stipulates that the offence carries a maximum five years’ jail sentence or a fine of RM10,000, or both.

We lack trained personnel, says Chua

Star: KUALA LUMPUR: The Health Ministry has proposed outsourcing ambulance services to the private sector to overcome issues like the lack of trained personnel and maintenance of vehicles.
Health Minister Datuk Seri Dr Chua Soi Lek said the Economic Planning Unit was studying the ministry’s proposal, which was submitted in June.
“Our problems are basically lack of trained personnel accompanying the ambulance, the attitude of drivers and poor maintenance of the ambulances. So it is better to rent the ambulances or outsource the service to the private sector based on the number of ambulances they can offer.
“We will only accept their offer if the rates are appropriate and do not burden the Government. In many countries, ambulance services are outsourced and operated separately from the hospital setting,” he said.
Dr Chua said presently there were 1,000 ambulances in the country, with an additional 800 to be purchased under the Ninth Malaysia Plan.
He said this after launching the special discounted indemnity insurance scheme introduced by the Malaysian Medical Association (MMA) in collaboration with the Medical Protection Society (MPS).
The professional indemnity insurance for young non-specialist government doctors is to create awareness of clinical risk management as well as encourage the officers to practise with medical indemnity cover.
MMA president Datuk Dr Teoh Siang Chin said the annual premium of RM200 was inclusive of MMA membership, and for locum work outside the Health Ministry’s premises, there would be an additional subscription.
Meanwhile, the Health Ministry is finding ways to help Malaysian medical students whose specialist training has been disrupted by the new British policy.
Dr Chua said the ministry would consider allowing them to continue their Masters programme locally.
He said British High Commissioner to Malaysia William Boyd McCleary had said that Malaysian medical students could work in Britain for three years, which would enable them to be recognised by the British Medical Council.
After the three years, students who planned to do their specialist training would have to apply for a work visa, but priority would be given to British and European Union citizens.

Dead doc’s family not eligible for compensation

Star: KUALA LUMPUR: The family of young Dr Norbaizura Yahaya, who died two weeks after being involved in an ambulance accident, is not eligible for compensation because she was not confirmed in her post.
To ease the burden on her family, the Malaysian Medical Association gave a RM10,000 donation to her clerk father, Yahaya Shahuddin, 50, yesterday.
MMA president Datuk Dr Teoh Siang Chin said her death raised the issue of young doctors being exposed to occupational risks but not eligible for compensation until they are confirmed in their job.
“Confirmation can take up to two years after reporting for duty and during this period the doctor has to carry out all normal duties in hospital as well as accompany patients on emergency transfer.
“Hundreds of such emergency trips take place each day in all the states under varying road and traffic conditions. Even more dramatic are the mercy helicopter flights,” said Dr Teoh.
On Sept 4, Dr Norbaizura was accompanying a patient in an ambulance from the Seremban Hospital to the Selayang Hospital when the vehicle burst a tyre at the expressway near Bangi and landed in a ditch.
Dr Norbaizura, 24, from Sabak Bernam, went into a coma and died last week. She graduated two months earlier.
Her husband Kapt Muhd Pasli Sarman said: “I was told the Health Ministry is investigating the accident but I have not been given any details.”
The army engineer, attached to the Iskandar Army camp in Johor, said they had been married for two years.

Health Ministry Proposes To Privatise Ambulance Service

KUALA LUMPUR, Sept 26 (Bernama) — The attitude of drivers and lack of trained personnel have driven the Health Ministry to privatise the ambulance service in government hospitals.
Minister Datuk Dr Chua Soi Lek said his ministry had sent a proposal to the Economic Planning Unit in the Prime Minister’s Department in June and was awaiting approval.
He said the ambulance service was a headache to his ministry as a new vehicle would often break down after only four years in service due to poor handling and maintenance.
“Because of this, the ministry feels it is better to rent the ambulances or pay for the services of privately-run ones,” he said when asked on public complaints about the poor ambulance service in government hospitals.
Government hospital ambulances are said to be late in arriving at places of emergency and are inefficient.
There are 1,000 ambulances in government hospitals nationwide, with 800 new ones to be bought under the Ninth Malaysia Plan.
Dr Chua, however, said a large fleet of ambulances would not necessarily guarantee quality service.
“It’s like being in a restaurant. The presence of many waiters and waitresses does not mean your food will arrive fast,” he added.
Earlier, Dr Chua launched the “Special Discounted Indemnity Insurance Scheme for Young Medical Doctors” where he also presented a cheque for RM10,000 from the Malaysian Medical Association to the family of the late Dr Norbaizura Yahya.
Dr Norbaizura, 24, who was attached to Tuanku Ja’afar Hospital in Seremban, died two weeks ago after being in coma for 16 days following an accident involving an ambulance in Bangi.

M’sian Medical Grads Can Do Housemanship In UK

KUALA LUMPUR, Sept 26 (Bernama) — Malaysian medical students who complete their basic medical degree in the United Kingdom are allowed to do a three-year housemanship there.
The housemanship would qualify them to obtain the British Medical Council recognition, Health Minister Datuk Seri Dr Chua Soi Lek said Tuesday.
He said this was conveyed to him in writing by British High Commissioner to Malaysia David McCleary in reply to a query on the matter by his ministry.
“If the newly-graduated doctors want to work in the UK for more than three years, only then they need to apply for a work permit,” he told reporters after launching the special discounted indemnity insurance scheme for young medical doctors.
The British government announced in April that foreign doctors wishing to work in the country’s hospitals need to apply for a work permit, a move seen to provide employment opportunities for doctors from the United Kingdom and European Union member states.
However, the latest move by the British government is said to have affected Malaysian doctors intending to pursue medical studies at Master’s level or specialise in that country.
Of the 11,500 Malaysians studying in the UK, 1,000 are medical students.
“Malaysian doctors working in the UK with a valid work permit are allowed to continue serving there until their permit expires,” Dr Chua said.
He said doctors who could not complete their Master’s degree or specialised medical programmes in the UK would be permitted to continue their studies at local universities.
“They can come back and we’ll consider accordingly, to enable them to pursue a Master’s programme at the local universities,” he added.

‘991′ service leaves a lot to be desired

NST: KUALA LUMPUR: Gurdip Kaur from the Independent Living and Training Centre in Rawang gets frustrated and angry talking about the “991″ ambulance service. She had a bad experience six months ago.
When her fellow resident at the centre, Ramzam Begum collapsed on the sofa, Gurdip, paralysed from the waist down, called “991″.
“There is no promise we will send an ambulance. All our ambulances are out,” the operator told her.
Fifteen minutes passed. No ambulance arrived.
“Froth was starting to form in Ramzam’s mouth. That is a danger sign, and I was getting anxious,” said Gurdip, a former nurse.
She called again and was told the same thing.
She joined other residents — five wheelchair-bound and one who had only one leg — in trying to revive Ramzam, who had a history of fits and is paralysed on one side of her body.
“We kept rubbing her palms and calling out her name,” Gurdip said.
About 45 minutes later, a St John Ambulans Malaysia vehicle arrived to take her to the Selayang Hospital.
“I think the most unfortunate people in the world are the disabled because we are helpless. Disabled people should be given priority in medical emergency cases,” she said.
Edward Lee of Seksyen 5, Petaling Jaya, would rather avoid what Gurdip went through and just call a private hospital, even if it means paying for the ambulance service.
A few months back, Lee called for an ambulance from the Assunta Hospital in Petaling Jaya, for his sister Lily, who was in a semi-coma state.
The ambulance arrived within 15 minutes and the hospital charged him RM50.
“With the ‘991’ service, I am not sure which hospital my sister would be sent to.
“I would rather go to a hospital where my sister’s records are kept. In a medical emergency, you don’t want to take any chances,” he said.

Striving for fast response to emergencies

NST: KUALA LUMPUR: The emergency response times of Malaysian ambulances are still slow.
The average times — from the call to the time the ambulance reaches the victim — should be between 10 and 15 minutes.
“Anything more than 15 minutes is unacceptable,” said Director-General of Health Tan Sri Dr Ismail Merican.
He added that even this was slow compared with Western countries which had a benchmark of seven to eight minutes.
But not all agencies in Kuala Lumpur dash to their victims within 15 minutes.
The Civil Defence Department’s (JPA3) response time is less than 30 minutes from its headquarters on Jalan Ampang.
The Malaysian Red Crescent (MRCS) response time is about 20 minutes from its headquarters on Jalan Ampang, while the University Malaya Medical Centre’s is between 10 and 45 minutes from Jalan University, Petaling Jaya.
St John Ambulans Malaysia (SJAM) says its response time is about 15 minutes within a five kilometre radius.
SJAM, MRCS, UMMC and JPA3 blame the traffic and lack of co-operation from motorists for the delay in arriving at emergency scenes.
SJAM’s regional commander for the Federal Territory Dr Lee Hoo Teong said many motorists do not move out of the way despite the sirens when it rained.
The Civil Defence Department in Kuala Lumpur plans to introduce a motorcycle squad next year to buy time until the ambulance arrives.
The MRCS was the first to start a motorcycle squad service for medical emergency in 1997. The SJAM started a similar squad last year.
Some agencies admitted that the delay in arriving at the emergency site was also due to poor communication and weakness in the emergency hotline (999 and 991) service.
Dr Lee said there was a lack of communication among agencies and this leads to either no ambulance arriving, or too many attending to one emergency case.
The problems in the emergency hotline service could be one reason why Johor 991 calls sometimes end up in Malacca, said Johor JPA3 director Che Osman Hussin.
“I believe we should have one central number just for Johor so that the agencies can handle the emergency cases efficiently,” he said.
The thousands of ringgit needed for ambulance maintenance and rising petrol costs make it difficult for non-profit organisations, such as the SJAM and MRCS, to respond to medical emergencies.
Dr Lee said SJAM spent RM2,000 a month on petrol and about RM400 to RM500 on vehicle maintenance.
“It is difficult for us to sustain as we receive, at most, about RM1,000 in funds monthly,” he said.
MRCS secretary-general Datuk Abu Hassan Salleh appealed to the public for funds to buy more ambulances to cope with the increasing number of cases.
Penang general hospital physician handling the medical emergency department, Dr Teo Aik Howe said, however, that the strategic location of the agencies responding to the emergency calls was more important than the number of ambulances they had.
“When an emergency call comes in, the first thing we have to know is who is nearest to the victim,” he said.
The Penang Hospital has four ambulances, while the JPA3 also has four and the SJAM has just one.
The JPA3 handles about 30 cases daily in George Town and Butterworth on the mainland.
The Penang Hospital handles about 19 cases daily in areas within a 20km radius from Jalan Residensi in George Town.
It used to handle cases in Bayan Lepas on the south of Penang but recently brought in the SJAM to handle those cases under the Emas Project, a community-driven initiative.
Residents in Cameron Highlands can call their Hospital Desa in Tanah Rata directly instead of calling ‘991’, said Ellangovan Nadarajah, who sits on the hospital’s advisory board.
He said the hospital had three ambulances that not only responded to emergency cases but also ferried critically ill patients to the Ipoh General Hospital when the need arose.

Emergency services not up to the mark

NST: Your loved one has just collapsed. You dash to the phone and call 991. You wait, wait and wait. Your concern turns to fear, then to frustration and anger. There is still no sign of the ambulance…

KUALA LUMPUR: There are not enough ambulances in the country — a shortage that is nearing critical levels, the New Straits Times has found.
But sources reveal that the shortage of ambulances is just the first layer of the problem.
They cannot match international standards, taking longer than most developed countries to reach more than 5,000 accidents in the nation every day.
When they do reach the patient, they usually have no medically-trained person on board to treat the injured or critically-ill in what doctors call the “golden hour”.
There is not even an Ambulance Act, a law common in many countries to set the benchmark for emergency services.
The state of medical emergency response here is prompting the government to move urgently to fix the problem.
Malaysia’s top health official, Director-General of Health Tan Sri Dr Ismail Merican, agreed there was an ambulance shortage.
“We should have more, and the number depends on the location. Urban areas usually require more. Fourteen ambulances in KL is not enough.”
He also noted that the services take too long to respond.
“Anything more than 15 minutes is unacceptable,” he said.
There is not even a clear picture of how many ambulances there are in the country, and the authorities who have the figures are tight-lipped about them.
In the Klang Valley, the 14 all-day ambulances cater to 6.5 million people — not including ambulances in private hospitals, which charge a lot more.
The 14 services have to dash about handling an average of 85 emergency calls daily, while in Penang, just five vehicles respond to about 50 calls a day.
Kepong MP Dr Tan Seng Giaw said it was clear that the number of ambulances was inadequate for KL while Segambut MP Datuk Dr Tan Kee Kwong suggested that the number of ambulances should be about 80 for KL.
In greater London, there is one ambulance for every 27,000 people.
This is about four times more than the number catering to the KL population, according to figures from St John’s Ambulans Malaysia regional commander for the Federal Territory Dr Lee Hoo Teong.
Kepong’s Dr Tan said: “Not only should we have more ambulances, they should be manned by well-trained personnel and be well-equipped.”
Dr Ismail admitted that not all ambulances operated by the agencies were in good condition or well-equipped and that not all staff were well-trained to treat victims, adding that the ministry was looking into these problems.
Another thing the ministry is trying to fix is the lack of coordination, which leads to public confusion.
Only 11 ambulances in Klang Valley respond to the familiar “991″ telephone number.
They include two from SJAM, four from University Malaya Medical Centre and five from Malaysian Red Crescent Society.
The remaining three ambulances are from the Civil Defence department, which answers 991 calls.
Saying this was an important issue, Dr Ismail revealed that the ministry was now working on co-ordinating the ambulance services in the country.
Among the efforts are an Ambulance Call Centre and a motorcycle ambulance squad to race to areas where ambulances would take longer to arrive.
“Our aim is to provide service within 10 minutes of getting a call for an ambulance.”
In developed countries, ambulances aim to arrive within seven to eight minutes of any crisis.
In Malaysia, even the ambulance agencies themselves admit they cannot match that. Estimates range from 10 to 45 minutes.