MCs by 1Malaysia clinics – illegal?

By Dr Anony

I refer to the reply given by Dr Nooraini Baba (NST, March 30th, 2010) in which she claimed that Assistant Medical Officers (AMO) can issue Medical Certificates.

She had then explained that the MCs issued by AMOs are not illegal, but just that they are invalid for the purpose of workers absenting themselves from work without pay under Section 60F of the Employment Act. In her reply, Dr Nooraini had quoted from the MEDICAL ACT 1971 (Act 50).

I would like to point out that there is NO provision under any Act of Parliament for the Medical Assistants who man the 1Malaysia clinics, to be referred to as “Assistant Medical Officers.” Instead, the
Medical Assistants are governed under the MEDICAL ASSISTANTS (REGISTRATION) ACT 1977 (Act 180), and they are thus properly referred to as Medical Assistants, and NOT as “Assistant Medical Officers.”

I would like to ask Dr Nooraini, whether the fact that 1Malaysia clinics are manned by Medical Assistants, is in violation of MEDICAL ACT 1971, specifically Section 33. (1) (f), which reads:
    ’33(1) Any person not registered or exempted from registration under this Act who –
        (f)  uses the term “clinic” or “dispensary” or “hospital” or the equivalent or any of there terms in any other language in the signboard over his place of practice in purported practice of medicine or surgery as a person registered under this Act; shall be guilty of an offence against this Act.’

Also, the fact that these Medical Assistants are running the “1Malaysia clinics” without supervision of Fully Registered Medical Practitioners, would mean that they are also in violation of the MEDICAL (INSTRUMENTS) (EXEMPTION) REGULATIONS 1986, specifically Section 4(1) which reads:
    ‘4. Condition of exemptions.
    (1) In the case of a registered medical assistant who is employed in a Government hospital, Government health centre or other Government institution for the care, treatment or rehabilitation of patients the exemption shall only apply if he is using any of the instruments specified in the Schedule in the course of
carrying out his duties in the Government hospital, Government health centre or other Government institution for the care, treatment or rehabilitation of patients under the supervision of the officer.’
For those who are uninitiated, the MEDICAL ACT 1971 prohibits Non-registered Medical Practitioners from using certain medical instruments, which are normally used in the practice of medicine and surgery. The MEDICAL (INSTRUMENTS) (EXEMPTION) REGULATIONS 1986 was enacted specifically to exempt Medical Assistants from the prohibition under MEDICAL ACT 1971 of using those medical instruments.

However, it is clear that MEDICAL (INSTRUMENTS) (EXEMPTION REGULATIONS 1986, Section 4(1) allows their exemption ONLY when these Medical Assistants are practicing under the supervision of doctors.

Of course, one may then dispute the interpretation of the words “under supervision of.” This then leads us to the Poisons Act 1952 (Act 366), in which the prescription and supply of Poisons are strictly governed (many medications dispensed at clinics are scheduled poisons and require the words “Ubat Terkawal” to be imprinted on the packaging.) Section 19 of Poisons Act 1952 (Act 366) reads thus:
    ’19. (1) Any poison other than a Group A Poison may be sold, supplied or administered by the following persons for the following purposes –
    (a) a registered medical practitioner may sell, supply or administer such poison to his patient for the purposes of the medical treatment of such patient only;
    (4) Any medical practitioner, dentist or veterinary officer who sells or supplies any poison or medicine containing a poison not prepared by him or under his immediate personal supervision shall be guilty of an offence against this Act.’ It is also in the very same Poisons Act 1952 (Act 366), that the interpretation of “immediate personal supervision” is clearly defined, in Section 2(2):
    ‘ (2) In this Act where anything is required to be done under the immediate personal supervision of any person it shall be deemed to have been so done if such person was at the time it was done upon the premises where it was done and available for immediate consultation by the person doing such thing’

As far as had been publicized in the media, these “1Malaysia clinics” are manned only by Medical Assistants, who therefore are NOT practicing under the “supervision” of any fully registered medical practitioner, as defined by law. Thus, I can only conclude that these Medical Assistants are practicing in violation of several laws.

Now, if these Medical Assistants are functioning in a capacity which is illegal, aren’t the certificates, including the Medical Certificates, which they issue, also illegal?

Furthermore, by allowing these Medical Assistants to practice illegally, aren’t their superiors in the Ministry of Health, also guilty of abetment, as defined under the PENAL CODE (Act 574), specifically Sections 107, which reads:
    ‘107. A person abets the doing of a thing who—
    (a) instigates any person to do that thing;
    (b) engages with one or more other person or persons in any conspiracy for the doing of that thing, if an act or illegal omission takes place in pursuance of that conspiracy, and in order to the doing of that thing; or
    (c) intentionally aids, by any act or illegal omission, the doing of that thing.’

It would thus seem to me that the entire concept and practice of “1Malaysia clinics” are illegal, and in violation of more than one law, and therefore in the absence of any repeal or amendment to the violated laws, all Medical Certificates issued by the Medical Assistants manning the clinics are therefore also illegal.

  1. #1 by drngsc on Saturday, 10 April 2010 - 8:33 am

    Dr Anony,
    I cant agree with you more. For which reason, the Federation of Private Medical Practitioners objected. Some felt that we were objecting to ” protect our rice bowl”. That is not true. We felt that the urban poor should not be given sub-standard healthcare. They deserve better.
    However, Dr Anony, you must be aware that under the Medical Act 1971 ( which will soon be amended ), the Minister of Health have powers of discretion to allow wavers where the act need not apply.
    So basically, they can do whatever they wish. Only the public ( votes ) can control them. Why should be urban poor to given sub-standard healthcare?

  2. #2 by Winston on Saturday, 10 April 2010 - 8:41 am

    Well, well, well!!
    Doctors, we are short-changed on every side and every angle.
    Aren’t we!
    The time to dump those clowns in UMNO/BN are long, long, long overdue!!
    The time for everybody to put their greatest effort in this direction is NOW!
    And as doctors, I’m sure you have quite a lot of influence!

  3. #3 by johnnypok on Saturday, 10 April 2010 - 8:48 am

    Bodohland has the biggest number of human-parasites in the world.

    There are more parasites than hard-working people.

    Only 30% working and paying tax to fee the whole nation.

  4. #4 by waterfrontcoolie on Saturday, 10 April 2010 - 9:15 am

    All the pros and cons appearing here will not change the issue. As long as the Gomen do not hope anyone accountable for his/her action as a Gomen servant, nothing will change. All the meetings held are just to ensure the annual budgets get spent. The root cause of the situation is no accountability from top to bottom. As for the POWER of a Minister, it is always written at the end of every enactment that the minister can vary the laws or regulations when he deems it fit. It is built-in system to ensure the Minister has the final say, even when the MOH has no medical background. Why? you ask? to ensure that without his signature, nothing moves! Of course, signature isn’t cheap.even the AMOs are given their dues in the form of MCs. get it??

  5. #5 by boh-liao on Saturday, 10 April 2010 - 11:57 am

    If someone kicks d bucket or suffers long term damages bcos of misdiagnosis by d guys who play play lokun, can sue ah?

  6. #6 by k1980 on Saturday, 10 April 2010 - 11:58 am

    Stop and ponder—-consider a poor family which has only RM1 left and their child is down with a fever. That family has to go to the “1Malaysia clinic” nearest to them because they would be booted out of the private clinics charging at least RM50.00 for a small bottle of medicine and a half-dozen pills!

  7. #7 by Dipoh Bous on Saturday, 10 April 2010 - 2:05 pm

    Our ‘bomohs’ should have the last laugh…

    In the interior of S’wak, it’s bomoh first doctor/clinic last resort….

    Bomohs’ “pengeras” these days are rather expensive too….

    What say you 1Malaysia Bomoh?

  8. #8 by frustrated doctor on Saturday, 10 April 2010 - 4:22 pm

    Each 1Malaysia clinic cost 200K as govt allocated 20mil for 50 clinics. So unless govt owns building and clinic has ECG, USG and x-ray facilities, this was exhorbitant amount with lots of corruption. Malaysia Boleh!

  9. #9 by raven77 on Saturday, 10 April 2010 - 6:27 pm

    LKS. Please clarify. Does KKM internal circular overule the law of the land????? Is this a new tactic to overcome laws through the back door…Then what’s parliment for???? Just as well tutup kedai.

    If the Minister does not have the power of discretion if the law is read in the right context. And that context is clear. You cannot have one rule for one person yet another for someone else as this law carries a criminal charge. It is like saying A should hang for drug trafficking but B can escape because the Minister says so. That is utter rubbish.

    This Dr. Anony is absolutely right. MCs issued from 1Malaysia Clinic is illegal. Take it to court, and a decent judge will convict the HA.

    If the Ministry of Hell want to break the rules, then they should be fair to everyone. Let staff nurse and bomoh to also buka kedai and issue MC. Otherwise dont lah pandai pandai create laws that they themselves want to break.

  10. #10 by dranony on Sunday, 18 April 2010 - 11:52 pm

    drngsc, if you read all of the Acts mentioned above in their entirety, you will note that there is NOTHING that repudiates the assertions I’d put forth, ie:
    1. that MEDICAL ASSISTANTS, being non-doctors, CANNOT work UNSUPERVISED in a capacity of medical and surgical treatment, with the LIST of specified MEDICAL INSTRUMENTS.
    2. that non-doctors CANNOT work in a premise called a “CLINIC” if there is no doctor.

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