MMA welcomes ruling on Bolam test

Star: PETALING JAYA: The Malaysian Medical Association (MMA) welcomes the Federal Court ruling that the Bolam test can no longer be applied to decide on medical negligence cases.
MMA ethical committee chairman Dr Ravindran Jegasothy said the association welcomed the ruling and took it as a challenge for the medical profession.
“It will put people on guard. They will not do things sesuka hati (simply). The Bolam test is a long-held principle. Times have changed. The medical profession has moved away from being a doctor-centred model to one that is patient-centred,” he said yesterday.
He was commenting on the Federal Court ruling on a medical negligence suit by quadriplegic Foo Fio Na against Assunta Hospital and a surgeon.
The court also ruled that the judicial system stop using the Bolam test adopted from a 1957 negligence case in England, which freed doctors from responsibility so long as they had acted in accordance with an accepted medical practice to decide such cases.

Court punctures docs’ defence

Star: PUTRAJAYA: Doctors can no longer say that they had done their job just because they did it within the acceptable standards.
If something goes wrong, they can no longer use this reason as a defence in court when they are sued for negligence.
This was the decision of the Federal Court in a landmark decision that has raised the standards for medical professionals when carrying out their duty.
The nation’s highest court was deciding on a negligence suit by quadriplegic Foo Fio Na against As-sunta Hospital and a consultant or-thopaedic surgeon.
Doctors will now not only have to perform their jobs according to the normal acceptable standards but also to do so after seeking the best advice possible.
The three-man Bench Federal Court unanimously ruled that the Bolam test adopted from a 1957 negligence case in England could no longer be used as the yardstick to measure the degree of negligence.

(The Bolam principle, in substance, restrains the courts from scrutinising and evaluating the professional conduct of a doctor possessing a special skill and competence.
(The doctor is not negligent if he acts within a practice accepted as proper by a body of his own peers who possess similar skills and competence as the doctor in question.
(It matters not that there exists another body with a differing opinion that does not accept the action taken by the doctor.
(It is enough that he has acted in accordance with one of the bodies of opinion and the courts can never declare his action to be in any way negligent.
(This over protective and deferential approach conforms to the well-known phrase that “the doctor knows best”.)

Instead, the Bench decided that doctors here must now act within the standards of a competent professional as laid down in the 1992 Australian High Court case of Rogers vs Whitaker.
(The Whitaker case held that a doctor has a duty to warn a patient of any material risk involved in a proposed treatment.
(A risk is considered material if a reasonable person in similar circumstances will attach significance to the risk, or if the doctor is, or should be, cognizant that the particular patient will express concern about the risk.
(In that case, Maree Whitaker became essentially blind after an unsuccessful operation on her right eye caused sympathetic ophthalmia in her left eye.)

“There is a need for members of the medical profession to stand up to the wrongdoings, as is the case of professionals in other professions,” said Chief Judge of Malaya Justice Siti Norma Yaakob in her judgment.
“In so doing, people involved in medical negligence cases will be able to obtain better professional advice and the courts will be appraised with evidence that will assist them in their deliberations,” she added.
This judgment is even more significant as Siti Norma heard the appeal in 2002 together with former Chief Justice Dzaiddin Abdullah and current Chief Justice Ahmad Fairuz Sheikh Abdul Halim, who was then the Chief Judge of Malaya.

Now easier to win suits against specialists

NST: PUTRAJAYA: The Federal Court has made it easier for litigants to prove negligence against persons professing a specialised skill.
A landmark ruling yesterday raised the benchmark of service specialists owed to their clients.
The court made the ruling in allowing a medical negligence appeal by Foo Fio Na, who was paralysed following an operation performed by a consultant orthopaedic surgeon 24 years ago.
It said medical specialists were held to a higher standard of care when dealing with patients.
This means that specialists are no longer in the same league as ordinary medical doctors when they are slapped with medical negligence suits by their patients.
The decision is seen as departing from a 50-year English legal principle set out in the Bolam case where the standard of proof in medical negligence suits was that of a reasonable man, regardless of whether one was a medical specialist or general practitioner, and which was of a lower benchmark.
The apex court now appeared to favour the Australian case of Rogers vs Whitaker which imposed a higher standard of care on medical experts.

Foo, 47, whose cervical vertebrae were dislocated after a motor accident in Petaling Jaya on July 11, 1982, contended that as a result of the operation by consultant orthopaedic surgeon Dr Soo Fook Mun, her spinal cord was damaged, causing her to become paralysed.
She had also named Assunta Hospital in Petaling Jaya as defendants.
The then High Court judge Datuk Mokhtar Sidin, in his judgment on April 8, 1999, held that Dr Soo and Assunta Hospital were 100 per cent liable for Foo’s condition.
Mokhtar said that since Dr Soo was at the material time employed by Assunta Hospital, the hospital was vicariously liable for his negligence.
He had awarded more than RM500,000 to Foo in damages, interest and costs.
However, on April 15, 2001, the Court of Appeal reversed the High Court decision. The Federal Court reinstated the High Court’s award.

Chief judge of Malaya Tan Sri Siti Norma Yaakob, who wrote the judgment, said the facts of the case in the appeal differed vastly from the Bolam case.
“We are of the opinion that the Bolam test has no relevance to the duty and standard of care of a medical practitioner in providing advice to a patient on the inherent and material risks of the proposed treatment,” she said.
She said it was for the court to set the standard of care in negligence, based on evidence presented.
“The Bolam test fails to make this important distinction between the reasonable competent doctor and the ordinary skilled doctor,” she said.
Siti Norma said there was a need for members of the medical profession to stand up to the wrongdoings, if any, as in the case of professionals in other professions.
In so doing, she said people involved in medical negligence cases would be able to obtain better professional advice and that courts would be in a position to evaluate evidence to make their findings.
“On this basis, we are of the view that the Rogers vs Whitaker test would be more appropriate and viable test of the millennium than the Bolam test,” she said.
Siti Norma said the well-known phrase that “doctor knows best” should now be followed by the qualifying words “if he acts reasonably, logically and gets his facts right”.

This appeal was heard by then Chief Justice of the Federal Court Tun Mohamed Dzaiddin Abdullah, former Chief Judge of Malaya Tan Sri Ahmad Fairuz Sheikh Abdul Halim and Siti Norma in her capacity as Federal Court judge.
Siti Norma said this judgment was delivered pursuant to Section 78(1) of the Court of Judicature Act 1964 as Dzaiddin had retired.
Meanwhile, lawyer and lecturer Surdev Singh Gill said the ruling would have a far-reaching impact on individuals professing to be specialists.
“The expectation is now higher because clients want value for their money,” he said, adding that the decision had made it easier for aggrieved parties to prove negligence.
He said doctors could resort to defensive medicine because of the risk factor or impose a higher fee to pay for their insurance premiums.

Floods: Medical teams on standby in case of second wave

Star: PENANG: The Health Ministry has placed its medical teams from other states on standby in view of a possible second wave of floods in Johor, Pahang, Malacca and Negri Sembilan.
Health Ministry parliamentary secretary Datuk Lee Kah Choon said the medical teams comprising medical doctors and nurses were ready and would be despatched to help victims if floods hit again.
He said the ministry had ample medical supplies and medical personnel would be ferried to the flood hit areas by the police and armed forces.
Lee was commenting on concerns raised over the Meteorological Department’s forecast Wednesday of bad weather for Johor and south-eastern Pahang until Sunday, and continuous heavy rain for Malacca and Negri Sembilan for four more days which may result in further flooding.
Lee said the ministry had mobilised more than 1,000 medical personnel divided into 200 teams to help the 65,000 flood victims in Johor, Pahang, Malacca and Negri Sembilan.
He said the ministry’s medical personnel were monitoring the food preparations and cleanliness level at the evacuation centres daily to ensure the people received clean food and water supply.
“They will also distribute fliers to remind flood victims to clear stagnant water in their surroundings to prevent dengue outbreak,” he said.
Lee said about 50 cases of flu, cough and itchiness were reported at the flood-hit areas, so far.

Make medical tools, local firms urged

Star: PUTRAJAYA: The Health Ministry is encouraging more local manufacturers to produce medical equipment as the industry is expected to expand by 5% each year.
Deputy Health Minister Datuk Dr Abdul Latiff Ahmad said the RM1.2bil medical equipment industry constituted 8% of the health services industry and the demand was increasing.
He said more Malaysians and Asians were expected to face various health problems because of changing lifestyles, similar to the situation in Western countries.
“Local manufacturers should produce equipment that are suitable for Malaysians and Asians using local technology.”
He, however, added that the ministry would not give preference to any specific brand when buying equipment for hospitals but would use products that medical staff can handle easily.
Dr Abdul Latiff was speaking to reporters after launching a locally made haemodialysis machine called “Alice” produced by Chulia Facilities Management, Woodridge Life Sciences Sdn Bhd and Power Choice.
Fifty of the user-friendly machine have been sold locally and exported to India.
On kidney patients in the country, Dr Abdul Latiff said the number was increasing by 3% each year and most of them need at least 13 haemodialysis treatments a month.

Mercy sets up health camps at Johor flood sites

Star: MUAR: Mercy Malaysia has set up health camps in flooded areas to check for any outbreak of disease while the army is sending water to hospitals and homes.
A Mercy team, headed by Dr Abdul Malik Abdul Ghafur, is in Bukit Kepong, which has been cut off from the rest of the district.
Dr Abdul Malik said access was only possible by boat from Lenga or by helicopter.
The team set up camp there to check on the health of the villagers.
“After checking some 50 evacuees, we found that three children in a family had mouth ulcers and provided the necessary medication,” he said.
“The rest of the villagers seemed to be in good health but we urged them to only drink boiled water if there is no bottled water.”
Muar marine police commanding officer Asst Supt Lajis Tahir said all police boats stationed in flood areas were meant for rescuing residents, sending emergency supplies or ferrying victims to relief centres.
An army team under commanding officer Lt Col Ahmad Fareed Ariffin from Camp Batu Tiga in Kluang has been supplying clean water to the Sultanah Fatimah Specialist Hospital here.
The hospital, which has had no water supply since the district was flooded last week, made an emergency request to the army which rushed four water tankers there on Tuesday evening.
Lt Col Ahmad Fareed said the soldiers have since delivered nearly one million litres of clean water to the hospital.
He said 200 soldiers, four water tankers, 20 trucks and 16 boats were helping out in Bukit Kepong and Muar.
“Our duty is to save lives and we will do anything to serve the people in flooded areas. If the flood situation in Segamat improves, we will bring in our boats from Segamat to serve the people here,” he said in Pagoh yesterday.

Increase In Suspected Dengue Cases For Selangor, KL, And Penang

PUTRAJAYA, Dec 27 (Bernama) — Selangor, Kuala Lumpur and Penang have seen an increase in suspected dengue cases while the other states recorded a decline in the past week.
Deputy Director-General of Health (Public Health) Datuk Dr Ramlee Rahmat said Selangor recorded 441 cases over one week ending Dec 23 (329 cases previously), Kuala Lumpur with 276 cases (242), and Penang with 93 cases (88).
Perak, Johor, Kedah, Sabah, Pahang and Terengganu recorded between seven and 49 cases last week, a drop of between six and 30 percent compared with the previous week, he said in a statement.
He said that of the 1,167 suspected dengue cases last week, some 290 cases were positive. No death has been reported.
The cases were reported in Setapak, Subang Jaya, Shah Alam, Cheras, Petaling Jaya, Kajang, Kelang, Ampang Jaya, Gombak, Kuala Lumpur city centre, Jalan Klang Lama, Johor Baharu, Kepong, Hulu Selangor, Kuantan, Melaka Tengah, Damansara, Selayang and North-East and South-West Penang.
To check the problem, the Health Ministry has distributed mosquito larva killers, educate the public and conduct activities to eradicate Aedes mosquitoes.

Five specialist hospitals to ease KLGH load

Star: KUALA LUMPUR: Newly completed government hospitals will specialise in certain fields of medicine to help ease congestion at the Kuala Lumpur General Hospital (KLGH).
Health Minister Datuk Seri Dr Chua Soi Lek said the Government had this in mind when it built the new hospitals.
Five new hospitals were built in the past 10 years and each of them specialised in certain fields of medicine.
Dr Chua, who was speaking to reporters after a working visit to the newly completed Sungai Buloh Hospital, said the new hospitals were to meet the ever-growing needs of the Malaysian public.
“The public should know now that it is not necessary for them to go to the KLGH as they will be referred to the hospital that specialises in that particular ailment,” he added.
Apart from the Sungai Buloh Hospital, the other hospitals are in Ampang, Serdang, Putrajaya and Selayang.
Putrajaya Hospital will eventually specialise in endocrinology and cancer treatment.
Selayang will specialise in liver, eyes and hands surgery; Serdang in cardiology and respiratory diseases and Ampang in hematology.
Sungai Buloh Hospital would also specialise in infectious diseases, traumathology, neurosurgery, plastic surgery and spinal surgery in the near future.
Dr Chua said he was happy with his visit but noted that there were weaknesses such as shortage of trained personnel that he felt would be tackled in stages.
The RM880mil hospital that opened last October has 620 beds, 32 hospitals wards and 22 operation theatres.
Dr Chua also spoke on the issue of pork sellers threatening to strike for two weeks in protest of what they felt was double standards set by the ministry.
The Chinese daily, Nanyang Siang Pau, had reported that the pork sellers were protesting against why the ministry would fine them RM100,000 or 10 years’ jail if they were found selling pork with beta-agonist but would only quarantine the farms of pig breeders who used the banned substance.
They, however, said that they would seek a meeting with the minister before making a final decision on the proposed strike.
Dr Chua said he had six million Chinese to look after and that their interests were far greater than that of the pork sellers.
“I hope they understand that I am only doing my job,” he said.

Flood Victims Told To Be Hygienic To Prevent Outbreak Of Diseases

KUALA LUMPUR, Dec 26 (Bernama) — The Health Ministry, Tuesday advised flood victims who have returned home to maintain hygiene and remove water clogging in their houses and compound as they can be breeding grounds for Aedes mosquitoes.
Minister Datuk Dr Chua Soi Lek said if they did not do anything about it there could be an outbreak of dengue fever in the flood stricken areas in three weeks’ time.
So far the ministry has not received any report on the outbreak of contagious diseases such as dengue fever, typhoid and cholera in the flood hit states of Johor, Negeri Sembilan, Melaka and Pahang.
“There is no major problem encountered in the affected states as the hospitals are equipped with the medicines and sufficient personnel to deal with the situation,” he told reporters after visiting Sungai Buloh Hospital here Tuesday.
“What is important is that the people look after the cleanliness, hygienic and sanitation,” he said, adding that 400 health teams were deployed to provide medical care at relief centres in the four states.
On his visit, he said Sungai Buloh Hospital was one of the four hospitals built in the Klang Valley in the last 10 years to ease the burden at Kuala Lumpur Hospital. The other hospitals are Selayang Hospital, Ampang Hospital and Serdang Hospital.
He said each of the hospitals were given specialisation with Sungai Buloh Hospital catering for contagious diseases as well as neuro, plastic and bone surgeries.
Selayang Hospital caters for liver and eye ailments, and hand surgery, Serdang Hospital specialises in cardiology and respiratory problems, and Putrajaya Hospital focusing on endocrine and cancer.

Ministry seeks own drug test centre

Star: KUALA LUMPUR: The Health Ministry wants to have its own centre for drug tests.
“The ministry has to deal with a large number of end users of drug substance in food and medication.
“Having our own centre will enable us to carry out a bigger volume of tests in the shortest time possible,” said Health Minister Datuk Seri Dr Chua Soi Lek.
Currently, the ministry sends food and medication specimens to the Chemistry Department of the Science, Technology and Innovation Ministry for drug analysis.
More difficult specimens – that are either hard to test or seldom tested – are sent to the Universiti Sains Malaysia’s (USM) dope control centre in Penang, the only accredited doping control centre in the country.
The ministry has to usually wait for two weeks before test results are returned, Dr Chua said.
The long-waiting period is due to the high volume of drugs these centres have to test since other ministries also send samples there.
He said he had directed his officers to look into setting up a drug-testing laboratory similar to the centre at USM.
He said with its own centre the ministry could reduce the testing time to three or four days and enforcement work could be more focused and be expedited.
Asked if the role of the Chemistry Department could be expanded rather then have a new centre altogether, Dr Chua said the department was not under his ministry’s jurisdiction.
“We want our own laboratory since food safety is becoming a very important issue. When we want to import or export food, we have to certify its safety.”