MALAYSIAN MEDICAL ASSOCIATION

&
SOCIETY OF PRIVATE MEDICAL
PRACTITIONERS SARAWAK

st
21 December 2008
2.00 pm – 6.00 pm
 MMA Life membership Promotion
ends 31st Dec 2008
Society of Private Medical Practitioners Sarawak
Acknowledgements
Dr Mohd Kamil
Dr Asmah
Dr Manalan
SN Lee Geok Nio
Ms Chai
Eastern Oxygen
Borneo Cyntex
3A
Dorothy Tan, Amanda Liew
Committee Members
 MMA(Sarawak) SPMPS
Post Registration Inspection and Dispensing
Workshop
Programme
2.00 pm - Welcome by Organising Chairman, Dr Tan Lean Sim
2.10 pm - Introduction by SPMPS President, Dr John Chew
- Short Address by Sarawak State Health Director,
Dr Mohd Kamil Hassan

2.30 pm - Post Registration Inspection Check List

By Dr Asmah Nazahiyah Bte Said
Asst Director, (Medical), Private Medical Practice Control Unit
3.00 pm - Meeting The Requirements of the Post-Registration Check-List
By Dr S R Manalan, National Chairman, MMA PPS
3.20 pm - Q&A
3.30 pm - Refreshment

4.00 pm - Cold Chain Maintenance

By Ms Lee Geok Noi, Staff Nurse, Private Medical Practice Control
Unit
4.10 pm - Dispensing Medicine
By Ms Chai, Enforcement Officer, Pharmacy Department, SGH
4.25 pm - Sharing by Dr Lim Meng Lang and Dr Kiu Chiong Chin
4.45 pm - Rights, Responsibilities & Reasons To Be
A Private Medical Practitioner
by Dr Mohd Hirman Ritom, Commissioner Human Rights of Malaysia
5.00 pm - Discussion & Conclusion
Briefing by Encik Faizal, Eastern Oxygen
 MMA(Sarawak) SPMPS
Post Registration Inspection and Dispensing
Workshop

4.00 pm - Cold Chain Maintenance

By Ms Lee Geok Noi, Staff Nurse,
Private Medical Practice Control Unit
4.10 pm - Dispensing Medicine
By Ms Chai, Enforcement Officer,
Pharmacy Department, SGH
4.25 pm - Sharing by Dr Lim Meng Lang and Dr Kiu Chiong
Chin
4.45 pm - Rights, Responsibilities & Reasons To Be
A Private Medical Practitioner
by Dr Mohd Hirman Ritom,
Commissioner Human Rights of
Malaysia
5.00 pm - Discussion & Conclusion
 Workshop
What we hope to achieve?
1. Support network for the single
practitioner.
2. Building Bridges between the
Government Department and the
Doctors
3. Bulk purchase of equipment and
drugs.
4. Sharing Expertise and Resources
 Government Departme
MOH Regulators
Private Doctors
 PHFS Act 1998
and Regulations
2006
APPLICATION FEE RM500
APPROVAL FEE RM1000
HOUSES
BANKS HOUSES
HOUSES
CARS BANKS BANKS
JOBS CARSCARS
POLITICIANS
JOBS
JOBS
POLITICIANS
Western Digital to cease
operations in Sarawak, 1,500 to
be laid-off
By JACK WONG

Published: Saturday December 20,

2008 MYT 3:06:00 PM
ASIAN TSUNAMI 26th
DEC 2004
"Great minds discuss ideas; Average
minds discuss events; Small minds
discuss people"
Eleanor Roosevelt - US diplomat &
reformer (1884 - 1962)
CHANGE WE CAN
BELIEVE IN
TWO WARS

PLANET IN PERIL

FINANCIAL DISASTER
 PHFS Act and Regulations
to improve the delivery of
healthcare
Dr Basmullah’s conviction RM 120,000
fine; three months jail in default
Released March 2008

Dr Rahdakrishan’s RM15,000 fine

10/09/2008
 MMA Workshop on PHFS
Act and Regulations
20th April 2008
9.00 am Current Challenges for the Private Practitioners
Sector
Dr S R Manalan, Chairman, PPSMMA
9.30 am Challenges in the Enforcement of the PHFSA
Dr Mohd Khairi Bin Yakub, Director of Medical Practice
Division, MOH
11.00 am Private Health Care in a Developed Malaysia 2020
Ybhg Tan Sri Datuk Dr Hj Mohd Ismail Merican,
Director General of Health, MOH
Malaysian Medical
Resources- youtube, facebook
www.medicine.com.my
www.fpmpam.org
www.mma.org.my
 Post Registration
Inspection
DR ONG HEIN TEIK Penang
“Made to feel like a criminal" --
NST, Sept 17
An official reply:
NST Online » Letters (2008/09/24)
HEALTH MINISTRY INSPECTION: Thanks for
the feedback
By : DR NOORAINI BABA, Director Medical
Practice Division , Ministry of Health
Malaysia.
HEALTH MINISTRY INSPECTION: Thanks for the
feedback
By : DR NOORAINI BABA, Director Medical
Practice Division , Ministry of Health Malaysia

n checks on physical structures, basic

emergency equipment
n inspection of documents on the
organizational set-up policies,
procedures and registers of private
clinics.
n These inspections are designed to
educate and to promote compliance by
private registered medical practitioners
to ensure patients' safety and quality
healthcare, and is not meant to be
 DR NOORAINI BABA, Director Medical
Practice Division , Ministry of Health
Malaysia (2)
4. This practice is consistent with the
requirements of the Poison (Psychotropic
Substance) Regulations 1989 that
psychotropic drugs must be supplied by a
registered medical practitioner for medical
treatment.
5. Under Paragraph 88(2)(e) of the Act, an
inspector is also allowed to inspect and
take extracts from any book, document or
record relating to any private clinic which
the inspector considers necessary to assist
him or her in the checks.
(Including fees charged)
6. His (Dr Ong’s) feedback will serve to
GUIDELINES ON
EMERGENCY MEDICAL SERVICES
FOR
PRIVATE HOSPITALS AND CLINICS
 Emergency Care in
Clinics
 Rare events
 Maintenance of Skills
 Short expiratory of drugs
 Expensive equipments
 Chains of Survival
3.1 Level / Category 1 of the Service
( Single practice General Practitioner(GP), Primary care etc)

3.2 Level / Category 2 of the Service

( Group Family Medicine Practice/ GP with or without
Family Medicine Specialist or equivalent)

3.3 Level / Category 3 of the service

( Ambulatory Care Centre, Nursing Homes, Old Folks Home
etc)

3.4 Level / Category 4 of the service

( Private Hospitals with Basic, Single Discipline, Specialist
Practice)

3.5 Level / Category 5 of the service

( Private Hospitals with multidisciplinary Specialist Practise
 REQUIREMENT / GUIDELINES
FOR THE LEVEL 1 SERVICE
1) Structure :

Resuscitation and treatment room

i) Patient trolley/ Bed with privacy
( curtain)
ii) Adequate lighting
iii) Adequate space approximately 28 x
10 ft / 853 x 305 cm per room

The GP examination room with

privacy is acceptable
 2) Equipment and
consumables
Airway management
1) Oropharyngeal airway (various
sizes)
2) Bag-Valve and Mask
3) ETT Tube
Breathing and Ventilatory
Support
1)Oxygen Supply or Oxygen Tank
with oxygen regulator
2) High Flow Mask
3) Nebuliser mask
4) Suction Outlet or Portable Suction
 2) Equipment and
consumables
Circulation and Haemorrhage Control
1) Automated External Defibrillator (AED)
2) Intravenous cannulae
3) Intravenous fluid for resuscitation
4) Haemorrhage control bandages
Skeletal Immobilisation
1) Cervical collar
2) Universal Skeletal Immobilization Kit
Eg: upper limb , lower limb, bandages
Emergency medications
( Medication for resuscitation procedure )
1) Adrenaline
2) Atropine
 From: Mohd Anis Bin Haron (Dr) <mohdanis@moh.gov.my
<mohdanis@moh.gov.my> >
Date: Thu, Dec 18, 2008 at 5:04 PM
Subject: PHFS Act 1998 and Regulations 2006 - Reply from Dr. Asmah.
To: "Sr. Mary Cardosa" <mary.cardosa@gmail.com
<mary.cardosa@gmail.com> >
Cc: "Dr. Ahmad Razid Salleh" <razid@moh.gov.my
<razid@moh.gov.my>,>, "Dr. Afidah Ali" <afidah@moh.gov.my
<afidah@moh.gov.my>,
>, drnooraini_b
<drnooraini_b@moh.gov.my>,
drnooraini_b@moh.gov.my>, "Dr. Asmah" <asmahn@moh.gov.my
<asmahn@moh.gov.my> >

Dear Dr Mary,
I am terribly sorry. Her reply was at the bottom of her email.
The following is the extract from her reply in RED i.e.:
"Assalamualaikum.
Apart from what being mentioned in the Act, we did not ask for other things. We asked
the PIC to get defibrillator for Haemodialysis Centres not clinic. 
 If I'm not mistaken, during the earlier part of the post registration inspection, we asked
for everything in the checklist and the GP did well.They even keep ET and Laryngoscope
(that was not listed in our checklist). After sometime we noticed a lot of  GPs did not
comply with the basic emergency equipment, so we asked them to refer to FIFTH
SCHEDULE of the Act because we did not supply them with the checklist(not much
difference with our list). Some of the GP clinics do not have OXYGEN TANK, INDWELLING
URINARY CATHETER, IV SUPPLIES and EMERGENCY DRUGS  too.
 They were saying that they were waiting for the news from MMA Sarawak to notify
them on the latest list of the emergency equipments (MMA having discussion with KKM
to exclude certain things including Oxygen). What we do now is we ask what they have
and jot down .If not complete ask them to refer to Fifth Schedule . Various response
from the GPs, some have everything listed in the FIFTH SCHEDULE and one GP even
refused to keep any basic emergency equipment and said he only have to drive the
patient to the hospital just in case patient collapses in his clinic (maybe not MMA
member )I'm myself also not clear about the final decision.
Due to the mixed response by the GPs, we refer to both checklist and FIFTH SCHEDULE
until the final say. Anyway after last week 's meeting, we conclude that only ET is
EXCLUDED and that is what I'm going to inform them during our briefing. Thank you."
With regard to the 5th Schedule, there has been different opinions from various agencies including
our National Advisor for Traumatology i.e Datuk Abu Hassan who insist that the lists should be
retained. We have yet to make arrangement to discuss further this matter.
Thanks.
 Emergency care

 Checklist
 Fifth Schedule
 Both Checklist and Fifth Schedule
 MMA List
 MMC List
 ??? Final List
 Checklist
 Emergency call system
 Oxygen
 Airways and manual breathing bag
 IV supplies
 Suction equipment
 In-dwelling urinary cathethers
 Drugs and other emergency medical
equipment/supplies deemed necessary
 Fifth Schedule
both adult and paediatrics
 Emergency call system
 Oxygen
 Ventilation assistance equipment, including
airway and manual breathing bag
 Intravenous therapy
 Electrocardiogram
 Laryngoscope and endotracheal tubes, if possible;
 Suction equipment
 In dwelling urinary catheters
 Drugs and other emergency medical equipment
and supplies, necessary for the level of services
to stabilize the patient as specified by the person
in charge.
 Emergency Care
 NHS: No Statutory Requirement
Designated Emergency Centres
 Victoria, Australia: Drugs provided
Mobile ICU
 Singapore: Ambu Bag
Emergency drugs:-
Adrenaline,
Atropine, Antihistamines,
Hydrocortisone.
 Emergency Care

 I.V. Adrenaline 50-100mcg over 5 minutes

 I.M. Adrenaline 0.3-0.5mg repeated after 5-
10 minutes
 I.V. Promethazine 0.2mg/kg
 I.V. Hydrocortisone 100-200mg.
 I.V. Dextrose 50%
 I.V. Diazepam 5-10mg.
 Negligence
 Duty of Care – failing to attend ( Lowns v
Woods 1996)
 Breach of the duty of care – ineffective
treatment is not negligence.
 Objective standard
 Bolam principle
 Rogers v Whitaker 1992
 Soo v Foo 2002
 Good Samaritan clause
 Medical Manslaughter on
the Rise
…. Changes in the way that doctors
are held accountable for their
mistakes, and the rise in charges of
medical manslaughter.

Dato Dr NKS Tharmaseelan

MPS Consultant
 RISK MANAGEMENT
Fire extinguisher and hope never
to have fire
 BURNING ISSUES
1. Clinical Waste Disposal
2. Clinical Practice Guidelines
3. Documentations for Insurance
4. Pharmacy Enforcement
5. EPF, SOSCO, Labour laws , tax
6. FOMEMA, e- Kesihatan
7. ASEAN COMMON MARKET by 2013
8. Over supply of doctors.
9. Revisions to the MEDICAL ACT 1971
10. Impaired doctors
12. Health Financing, Medical Devices, TCM
 Malaysian Medical Council
2008
22,000 doctors registered
2,300 Housemen registered per year
(3,000 per year in 2010)

15,000 medical students in 21 Medical

Schools
1,000 per year sent overseas by
Government.
1,000 per year sent overseas by FAM
scholarship

1:600 ratio achieved between 2013 and 2018

 Registered Medical
Practitioners
2001
2007
Sarawak
Public 205 276
Private 276 357
Total 481 828
Malaysia
Public 5219
8868
Private 7209
 Pharmacy Board of
Malaysia
2001 2007
Sarawak
Public 20
Private 126
Total 146
Malaysia Pharmacist
=4420
Public 460
Private 2108 Corporate = 414
Total 2665
ASEAN COMMON
MARKET 2013
Your employer

SINGAPORE
Your competitor

PHILLIPINES
 CHEW CHEE-MING, JOHN
Full Registration No: 25208

1st January 2009

Medical Act 1971
We survived because we were
stronger than we thought.

We suffered because we were

weaker than we should have been.
Bill Young
Former POW
BLTC, Kuching
Borneo Post 21st Dec 2008
THANK YOU
 MMA Life membership Promotion
ends 31st Dec 2008
Society of Private Medical Practitioners Sarawak
Acknowledgements
Dr Mohd Kamil
Dr Asmah
Dr Manalan
SN Lee Geok Nio
Ms Chai
Eastern Oxygen
Borneo Cyntex
3A
Dorothy Tan, Amanda Liew
Committee Members