Sunday, September 17, 2006

The PHFS Act (1998) and Regulations (2006) – an update

The PHFS Act (1998) and Regulations (2006) – an update

IT has now been about four months since the Private Healthcare Facilities And Services (PHFS) Act 1998 And Regulations (2006) has come into force. The various open dialogues between the Health Ministry, the Federation of Private Medical Practitioners’ Association of Malaysia (FPMPAM) and other relevant stakeholders have culminated in a relatively easy registration process for private medical practitioners (see table).

For existing clinics (before May 1, 2006), registration can be made using Form A or online at http://medpcs.moh.gov.my. Duplicate copies of duly certified documents required include:

i) Annual Practising Certificate,

ii) Professional & or Specialist qualifications

iii) Assessment rate receipt

iv) A sketch plan that includes dimensions of physical structures

v) Contracts with any Managed Care Organisation if available

To facilitate the registration process, the various state private practitioners’ associations have been holding workshops with the co-operation of the relevant state health departments. The PMPASKL will be holding such a session on Sept 24 at the Sime Darby Convention Centre, Bukit Kiara, from 2-6pm. Doctors in the Klang Valley are encouraged to attend and at the same time hand in their registration forms to the State Health Officers who will be there to register them.

It is thus time to move on to facilitating compliance as seamlessly as possible with the specifications of the Regulations without causing undue interference to the delivery of patient care in the private sector. Implementation will have to be done gradually and without causing undue inconvenience and distress to the sick patient, the public and the doctor.

The Clinic Manual and Standard Operating Procedure (CMSOP)

One of the first important milestones in the process of compliance, which takes effect the moment a clinic is registered, is administrative compliance. The PHFS Act (1998) and Regulations (2006) requires that all private clinics shall have specific written policies and standard operating procedures to ensure that quality of care is maintained.

As part of our service to members in the private sector and to bridge the needs of the regulators, doctors and patients for better healthcare, the FPMPAM, in conjunction with the Health Ministry, has produced the Clinic Manual and Standard Operating Procedures (CMSOP), which was officially launched by the Health Minister on Sept 11 at the Marriot Hotel, PutraJaya.

The CMSOP will help private clinics streamline its administration almost immediately and to enable it to deliver better service to the patient while complying with the Act.

It is hoped that the CMSOP will set the bar for responsible and ethical clinic governance, and enable doctors to continue their good work in healing those in need while meeting the new provisions of PHFSA.

Among the many items in the CMSOP is a set format for Patient Grievance Mechanism and also a format for provision of Emergency Medical Care as required by law. The CMSOP can also be adapted for private dental clinics as well.

Four thousand copies will initially be distributed at cost to doctors via the individual state private practitioners associations that are members of the FPMPAM, with additional copies to be printed for distribution to all doctors.

Each book is priced at RM25, which covers the cost of its printing and production.

Safeguarding standards in private medical care

As the national medical body, the FPMPAM represents the interests of private medical practitioners in providing accessible, quality and compassionate patient care.

It is the stated objective of the FPMPAM to safeguard the foundations of ethical and responsible medicine while building on the sanctity of the patient-doctor relationship. Our motto, “Duty before Self”, is a testimony to this objective.

The FPMPAM is supportive of reforms to the nation’s healthcare system when they are aimed at improving the delivery and efficiency of healthcare services, upgrading facilities and treatment options available to patients, and enhancing the integrity of the medical profession.

As members of the medical profession and uncompromising advocates of our patients’ welfare, we acknowledge that there are inherent strengths and weaknesses in our current healthcare system, and that it has a large role to play in improving healthcare in Malaysia.

When the Private Healthcare Facilities Act and Regulations (PHFSA) was announced in May this year, the reaction of doctors all over the country ranged from anxiety to strong disapproval.

The profession is fortunate that the Ministry is sympathetic to the concerns of doctors and has the discretion to distinguish between healthcare policies that will likely succeed and policies that will likely do more harm than good.

Rather than a purist approach, the Health Ministry has welcomed input from parties affected by the new law, and has adopted a flexible and responsive approach in the implementation of the PHFSA.

While the FPMPAM has made significant strides in building consensus with the Ministry on the implementation of the Act, we are aware that there are outstanding issues that are of concern to doctors and patients in the country.

Important points to note for concerned parties are several proposals that are still under consideration by the Health Ministry, which aims to address the implications of emergency care, and the specific physical requirements for complying with the Act.

We look forward to a quick agreement with these proposals so as to provide a truly conducive social and clinical environment for doctors and their patients.

The Good Samaritan Clause

The PHCFS Act and its Regulations require that clinics provide emergency medical services to the occasional patient that is brought to the clinic. It is the position of the FPMPAM that patients in dire straits should not be turned away by the clinics.

However, it must be noted that this provision in its current form in the Regulations has too many grey areas which potentially will open the door to increased medico-legal litigation, an increase in medical indemnity insurance and eventually encourage defensive medicine. At the end of the day, it is the patient and the public that will have to carry this extra burden.

The FPMPAM has proposed a “Good Samaritan Clause”, which essentially states that, short of gross negligence or professional incompetence, doctors providing free and voluntary emergency care for such patients that are brought to the clinics should be protected from liability. This is only fair as the law is needed to protect those who need help, but also those who provide help.

General Provision (Regulations Part IX)

The Regulations also require many clinics to renovate extensively to comply with the general provisions of the Regulations.

Some of these provisions, like providing doors and passages to be 1.2m, is not possible in many clinics in view of the existing physical limitations of these buildings. Clinics that are located on the first floor of shop houses, including many dental clinics, will find this a major undertaking.

Furthermore, to renovate, many clinics will have to close for periods of time ranging from two to more than six weeks depending on the type of renovation that needs to be done. There will be considerable inconvenience to the patients and the public.

From the survey of clinics by the FPMPAM in Kuala Lumpur, Selangor, Perak, Perlis, Kedah and Penang, the estimated cost of renovation to the private sector will be in excess of RM250 million, not to mention a whole host of other intangible costs.

The FPMPAM is happy to note that the Health Minister, in his speech during the launching of the CSMOP, had mentioned that the Ministry will consider appeals on a case-by-case basis.

Conclusion

The medical profession is as old as age itself. Medicine, with its noble legacy of healing, is rich and momentous beyond comparison. The doctor’s duty is always first and foremost to his patients and the advancement of the patient’s health and welfare.

As a regulator, the Government can build safeguards, incentives and disincentives into our health care system, but the good and honest professional never needs to fear the regulator.

Note: Dr Chang Keng Wee is honorary secretary of the Federation Of Private Medical Practitioners’ Association Of Malaysia (FPMPAM).


Saturday, September 16, 2006

Spotlight: Kidneys always on his mind

15 Sep 2006 (NST)
ANNIE FREEDA CRUEZ

After 30 years of dedicated service at the Kuala Lumpur Hospital, consultant nephrologist Datuk Dr Zaki Morad Mohd Zaher is clocking out for the last time today, but don’t expect kidney diseases to be far from his mind, writes ANNIE FREEDA CRUEZ.

WHILE many people can’t wait to get out of a hospital, consultant nephrologist Datuk Dr Zaki Morad Mohd Zaher is reluctant to leave.

Not after 30 years of calling the Kuala Lumpur Hospital his second home.

When we caught up with him a few days before his retirement, Dr Zaki’s office was in a mess as he packed his medical tomes, and stacked medical CDs into boxes.

It is not that he dreads the prospect of clocking out for the last time today, but his sadness stems from the fact that he can no longer serve his patients with the same dedication he had shown all these years.

Celebrating his 56th birthday on Monday, Dr Zaki has come a long way from the day he reported for duty. Then, he was one of only two specialists in the nephrology department. The other was (Tan Sri) Dr Abu Bakar Suleiman, who later became the director-general of Health.

Recalling the challenges of those early days, Dr Zaki, who has the distinction of being KLH’s longest-serving doctor, said: "It was a depressing period as there were only two of us, six dialysis machines and a handful of beds.

"Hundreds of kidney patients were referred to us from all over the country every year, and many had to go home disappointed because there were no available beds and not enough dialysis machines."

The dialysis machines, he said, were dinosaurs which required patients to sit for eight hours, unlike today’s machines which only need four hours to do the job.

"By the time the patients finished their sessions, they could hardly walk."

What a contrast to his current surroundings where there is now an entire institute dedicated to urology and nephrology, with state-of-the-art facilities, the latest diagnostic machines and a kidney transplant team.

There are now five consultant nephrologists, six specialists, seven medical officers and a team of well-trained allied healthcare staff.

"All major hospitals in the country are now well equipped to handle kidney patients, with many providing dialysis treatment," he said, adding that this was also available in remote parts of the country, including Sabah and Sarawak.

Despite the hardship of his early days at the Kuala Lumpur Hospital, Dr Zaki was never tempted to join his peers in private practice.

"More kidney patients come to government hospitals for treatment compared with private hospitals. I felt I could serve them better if I stayed on here ."

Born on Sept 18, 1950, Dr Zaki’s aptitude for learning was evident from his school days in Langkawi, where he completed his education at a younger age due to double promotions.

He was offered many scholarships, including one for engineering overseas, but he opted to further his studies in Malaysia.

He obtained his MBBS from Universiti Malaya in 1975.

Dr Zaki started his career at KLH in 1976. He did a brief stint at the Kangar Hospital, in Perlis, before returning to KLH, where he served in the nephrology unit with Dr Abu Bakar before joining the department of medicine for two years.

He was handpicked by Dr Abu Bakar to be a nephrologist, and sent for a two-year training stint in Britain.

Upon his return, at the age of 33, he was promoted to consultant nephrologist.

Three years later, in 1987, he was appointed the head of the department of nephrology.

During his tenure, Dr Zaki introduced special areas in nephrology, and developed critical care nephrology, interventional nephrology, glomerular disease and chronic kidney disease prevention — and widened the scope of transplants and dialysis.

He also spearheaded the initiative to improve the quality in dialysis by introducing haemodialysis standards.

Dr Zaki, who headed the Clinical Research Centre in the Health Ministry from 1999, has produced a number of publications in collaboration with other researchers.

Asked about his vision, he said: "I want the government to take a proactive role in reducing kidney cases in the country by working together with primary care providers, as it’s very expensive to treat kidney patients. There is a need for a national programme."

While he may no longer be actively involved in the treatment of patients at KLH, Dr Zaki has no intention of taking things easy.

He intends to take up an offer to lecture at the International Medical University.

Dr Zaki is currently the president-elect of the Asian Pacific Society of Nephrology, a member of the Education and Curriculum Advisory Committee, International Society of Nephrology (ISN), and chairman of the sub-committee for the Southeast Asia Commission for the Global Advancement of Nephrology of the ISN.

He is also the vice-chairman of the National Kidney Foundation.

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Thursday, September 14, 2006

Anytime You Need a Friend


If you're lonely
And need a friend
And troubles seem like
They never end
Just remember to keep the faith
And love will be there to light the way

Anytime you need a friend
I will be here
You'll never be alone again
So don't you fear
Even if you're miles away
I'm by your side
So don't you ever be lonely
Love will make it alright

When the shadows are closing in
And your spirit diminishing
Just remember you're not alone
And love will be there
To guide you home

Anytime you need a friend
I will be here
You'll never be alone again
So don't you fear
Even if you're miles away
I'm by your side
So don't you ever be lonely
Love will make it alright

If you just believe in me
I will love you endlessly
Take my hand
Take me into your heart
I'll be there forever baby
I won't let go
I'll never let go

Anytime you need a friend
I will be here
You'll never be alone again
So don't you fear
Even if you're miles away
I'm by your side
So don't you ever be lonely
It's alright
It's alright

Mariah Carey