When hospitals are a fire hazard

Many old hospitals have fire risks, including the 138-year-old Hospital Sultanah Aminah, which experienced a deadly fire as seen in this 2016 filepic.

Healthcare professionals put their heart and soul into ensuring that the care to patients is delivered as safely as possible, being fully aware of the ethos “Primum non cere”, which is Latin for “First do no harm”.

Many are also probably aware of British paediatric nephrologist Prof Dr Sir Cyril Chantler’s statement in 1998 that “Medicine used to be simple, ineffective and relatively safe.

“It is now complex, effective and potentially dangerous.”

Yet healthcare professionals have sometimes been let down by decision-makers when patients experience danger due to structural and organisational deficiencies in healthcare facilities.

The Hospital Sultanah Aminah (HSA) fires in Johor Baru illustrate how all the efforts of healthcare professionals may end up for naught in such situations.

Dangerous deficits

HSA, which was founded in 1882, has had more than one fire in its history.

The most deadly one was in its intensive care unit (ICU) in October 2016, where six patients died, with many others injured.

The latest fire in June (2020) was in the female ward. Fortunately, there were no casualties that time.

Subsequently, it was announced that fire audits would be carried out in all Health Ministry hospitals, starting with the older ones.

Previously, in March 2017, Parliament was informed that fire audits in 46 hospitals aged over 50 years, had found that the risks identified were “ageing fire prevention systems, dilapidated electrical wiring and installation systems, the installation of medical gas systems, which were not according to required standards, and other discoveries, which needed engineering systems to be upgraded”.

This was similar to a 2015 review of fire safety in four public hospitals, published in the Advances in Environmental Biology journal.

The Universiti Sains Malaysia researchers who conducted the review, concluded that the problems encountered in fire safety management were documentation, combustible material, lack of installation of fire measures or outdated fire safety technology, locked doors due to security reasons, lack of training of hospital staff, and blocking of fire safety systems.

The investigation panel into the 2016 HSA fire presented its report to the Health secretary-general in June 2018.

The panel chairman also called for the report to be made public then.

The then Health Minister announced last November (2019) that the Cabinet had decided that the report would be made public by the following month.

Subsequently, the minister confirmed that the report was declassified on Feb 24 (2020) and that some remedial measures recommended in the report had been undertaken before he left office.

Whither public interest?

A health web portal then published stories about the report on March 9,11 and 12 (2020).

Subsequently, the portal’s editor was summoned by the police on June 26 (2020) for questioning about the stories.

Medical professional societies, civil society and politicians on both sides of the political divide have previously called for the fire investigation report to be made public.

However, the decibel level on the action that led to the summons has been less.

A pertinent question is, who made the police report?

The inevitable and natural next question, rightly or wrongly, is whether there was something in the fire investigation report that was meant to be kept from public knowledge and scrutiny.

Another pertinent question concerns the prima facie non-compliance with the Cabinet decision to make the fire investigation report public.

In the private sector, anyone who does not implement their employer’s and/or board of directors’ decision(s) will face an investigation, followed by disciplinary action if found guilty.

Will this be the same for those who did not prima facie implement the Cabinet’s decision to make the report publicly available?

The 2016 HSA fire investigation report is of public interest as it will contain lessons for all healthcare administrators, decision-makers and professionals, which would enable them to improve fire safety in both public and private hospitals and clinics to prevent further similar occurrences and tragedies.

The Health Ministry states that it is committed to building a safety culture in healthcare delivery.

Did the action that led to a police summons facilitate the promotion of a safety culture?

Will healthcare practitioners in Health Ministry facilities be encouraged to raise safety issues by the said action?

The ministry has stated that “Safety is everyone’s business”, and rightly so.

This is as every one of the millions who access healthcare in public and private healthcare facilities hopes to be cured, or at least, get better, but certainly not to be harmed due to structural and organisational deficiencies in the facilities.

As the late US president Theodore Roosevelt said: “Knowing what’s right doesn’t mean much unless you do what’s right.”

Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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