The Ministry of Health (MOH) and Singapore Medical Council (SMC) are inviting feedback on the proposed amendments to the Medical Registration Act (Chapter 174) (MRA). The public consultation will be held 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. The MRA was last amended in 2010.
3. The proposed amendments to the MRA aim to improve the disciplinary proceedings under the MRA for both the public and doctors, as follows:
a. Improve the transparency and accountability in the appeals and disciplinary processes.b. Bring about 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.
4. The key proposed amendments to the MRA are as follows:
A. Amendments to Improve Transparency and Consistency
5. Amendment for appeals against the decision of a Complaints Committee (CC) to be considered by an independent Appeals Committee appointed by the Minister for Health. Under the MRA, the Complaints Committee (CC) is responsible for investigating into a complaint lodged against a doctor. The current appeals process requires appeals against the decisions of CCs to be made to the Minister for Health (Minister).
6. The proposed amendment will enhance transparency and accountability by providing for the appointment of an independent Appeals Committee (AC) to consider appeals in place of the Minister. The AC, which will comprise a medical doctor, a legal professional and a distinguished lay person drawn from a panel appointed by the Minister, will have similar powers that the Minister has under the current appeal process. It may by 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).
7. Amendment to formalise the current practice on the composition of DT. A DT is appointed to look into any disciplinary matters that a CC ordered a formal inquiry to be held or referred to it by the SMC. To ensure no conflict of interest, the SMC has been administratively excluding Council members from taking up appointments as chairman or members of DTs. SMC has also been appointing a legal professional to every DT. The proposed amendment will formalise these practices in the MRA.
8. Amendment to streamline the process for appeals against the decision of a DT. Under the MRA, 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 assessing if it should make an appeal against the decision. The complainant can also apply to a Review Committee, appointed by the Minister, to review the decision of the DT. The Review Committee can potentially compel the SMC to appeal against a DT’s decision, contrary to SMC’s internal assessment and decision.
9. The proposed amendment will 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 where the prosecutor reviews the Court’s decision and makes a final decision whether an appeal should be filed. It would also avoid unnecessary delays and duplication of work.
10. Even with the removal of the provision, the complainant can still appeal to the SMC, which will consider the request before making its final decision whether to appeal the DT’s decision. If a complainant disagrees with SMC’s decision not to appeal against a DT’s decision, the complainant can institute judicial review proceedings against SMC’s decision not to appeal. The complainant may also file a civil suit against the doctor regardless of SMC’s decision whether to appeal.
11. Amendment to allow DT to stay the operations of its orders if the SMC or the doctor appeals to the High Court against the decision of a DT. Under the current MRA, the orders of a DT would be stayed if the respondent doctor appeals to the High Court against the decisions of the DT. However, there is no similar provision when SMC appeals to the High Court, i.e. DT’s orders are not stayed if SMC appeals to the High Court against the decisions of the DT.
12. With the proposed amendment, the DT’s order will also be stayed when the SMC makes an appeal. This will prevent a situation whereby the respondent doctor had already completed his or her initial term of suspension ordered by the DT and had resumed practice before SMC’s appeal on the sentence is heard. The proposed amendment would also allow the DT to have the powers, in its original decision, to decide that its order take effect immediately even when there is an appeal, if the DT is satisfied that it is necessary for the protection of the public.
13. Amendment to remove the minimum suspension period of 3 months. In view of the feedback from the DTs on the difficulties in deciding appropriate sentences, the SMC will be appointing a Sentencing Guidelines Committee to develop sentencing guidelines. The sentencing guidelines will aid the DTs in deciding the appropriate sentencings and also ensure consistency and fairness in the sentences meted out.
14. Under the current MRA, a DT can suspend the registration of a doctor for a period of not less than 3 months, and not more than 3 years. In line with the establishment of the sentencing guidelines, the proposed amendment will remove the minimum suspension period of 3 months1 to allow the DTs greater flexibility to determine the appropriate sentences based on the circumstances of the cases.
15. Amendment to introduce a general exemption provision. Unlike in other professional Acts, there is currently no general exemption provisions in the MRA. The proposed amendment will align the MRA to other professional Acts by introducing a general exemption provision to allow the Minister, after consultation with SMC, to introduce exemptions for a class of persons from all or any of the provisions of the MRA, should there be a need.
B. Amendments to Enhance Efficiency
16. Amendment to allow doctor members of the Complaints Panel who are not Council members to be eligible for appointment as CC Chairpersons. The Chairman of the Complaints Panel appoints members of the Complaints Panel to a CC. Currently, the Chairperson of the CC has to be a member of the Medical Council, resulting in a limited pool of eligible doctors to serve as CC Chairpersons.
17. The proposed amendment allows doctors who are not Council members but are members of the Complaints Panel with the necessary experience and expertise to be appointed as CC Chairpersons. This amendment will widen the pool and bring about better efficiency and timeliness, without compromising the functions of the CC. The Chairman of the Complaints Panel, who must be a Council member, will appoint suitably experienced doctors on the Complaints Panel as CC Chairpersons.
18. Amendment to allow Complaints Committee (CC) to reach an agreement on appropriate measures with a doctor whose ability to practise has been affected by health issues. The proposed amendment will allow the CC to dispense with the need for a Health Committee (HC) 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 would ensure the timely implementation of actions against a doctor who is unfit to practise and ensure public safety. It will also avoid unnecessary cost and time for both the doctor and the SMC. The dispensation will not apply to disciplinary-related complaints which may involve allegations of malpractice, professional ethics and conduct issues. Such cases will still go through the due process of a DT inquiry.
19. Amendment to introduce a service provision for documents and notifications. Relevant parties are required, under the MRA, to adhere to timelines which commence from the date of service of relevant documents; or to take certain actions within a certain period of being notified of an event. In the absence of any explicit reference in the MRA on the mode of service allowed and as to when the documents are deemed to be effectively served, there could be room for varying interpretations on the receipt of documents or notifications and applicable timelines, and hence possible arguments against any breach of timelines.
20. The proposed service provision sets out the accepted modes of service and the situations in which the relevant party is deemed to have been served with any relevant document and/or notified of an event to make clear when the applicable timelines for compliance or action start to run. This amendment will prevent avoidable delay to the disciplinary processes due to non-action.
21. MOH and SMC welcome and value your feedback on the proposed amendments to the MRA. Please submit your feedback on the proposed amendments by 26 October 2018 in any of the following ways:
a. via Email to firstname.lastname@example.org
b. Mail to
Ministry of HealthMRA Public ConsultationCollege of Medicine Building16 College RoadSingapore 169854
22. Please provide your personal particulars so that we can contact you for further clarifications, if necessary. We will not release your personal particulars without your prior consent. The results of this public consultation will be published in an aggregate manner.
DOCUMENTS TO DOWNLOAD
23. For further reference, please download the draft Medical Registration (Amendment) Bill here.
1The Court of 3 Judges had indicated in a previous case that they would have imposed a shorter period of suspension if the option was available.