Objection to changes in Poison Act


  • Letters
  • Thursday, 05 Dec 2019

THE Poison Act (Amendment) Bill (https://bit.ly/2qhAg9w), which was tabled by the Health Minister for first reading at the Dewan Rakyat on Nov 25, has drawn the ire of various national medical and dental organisations.

Prescriptions are part and parcel of the medical and dental practice which are controlled and regulated by the Medical and Dental Acts.

The Private Healthcare Facilities and Services Act (PHCFSA) namely Sections 35 and 36, and regulations 18 and 26-27 contain provisions for patients’ rights in their entirety and not just prescriptions.

The Poison Act regulates “the importation, possession, manufacture, compounding, storage, transport, sale and use of poisons”. Poisons are classified as groups A, B, C and D under the Poison Act, which states that group B poisons can only be supplied by a registered doctor, dentist or veterinarian or by a registered pharmacist in accordance with a prescription by a registered doctor, dentist or veterinarian.

The proposed Section 19 (2A) in the Bill provides for a statutory requirement for a doctor, dentist or veterinarian to issue a prescription upon the request of a patient or client. The penalty upon conviction will be a fine not exceeding RM50,000 or imprisonment not exceeding five years or both.

This proposed section usurps the Medical and Dental Acts.

All doctors and dentists have to comply with the Medical (MMC) and Dental Council (MDC) Code of Professional Conduct. Refusal to provide prescriptions to patients upon request may border on professional misconduct which exposes the practitioner to disciplinary action.

There is no provision in the Poison Act for encroachment on the professional autonomy of doctors and dentists provided in the Medical and Dental Acts.

No other country in the world is known to criminalise a refusal to provide a prescription upon request as in the proposed Section 19(4)(b).

The spectrum of infractions in practice is wide. Refusal to provide a prescription upon request is very different from refusal to attend to the doctor’s or dentist’s patient who collapses. The former would lead to a custodial sentence under the proposed Bill while the latter would lead to a disciplinary action or a law suit.

The argument that the proposed section protects patients’ rights is fundamentally flawed and warped. The phraseology of the section does not protect patients who request prescriptions without clinical indications, for example psychotropic drugs, sleeping pills, antibiotics or self-administered abortion pills.

This leads to interpretation abuse, threats, blackmail and even corruption. There can also be adverse consequences from abuse of repeat prescriptions and self-medication.

A patient has a right to consult any doctor or dentist. If there is refusal to provide a prescription upon request, the patient can consult another doctor or dentist or lodge a complaint with the MMC, MDC or Health Ministry.

The proposed Section 21 (2A), “Electronic Prescription”, provides that every prescription for group B Poisons shall be created and dated electronically, signed digitally, and sent to a pharmacist electronically. This section also usurps the Medical and Dental Acts.

Electronic prescribing requires organisational and regulatory frameworks that are currently not in place.

This section can also be abused by unregulated commercialised online health services, which have been reported to be prescribing and dispensing group B poisons without physical examinations.

The proposed Section 34B provides for the admissibility of improperly obtained evidence of agent provocateurs in criminal proceedings. There is already such a provision in the Dangerous Drugs Act (Section 40). Why are offences under the Poison Act treated the same as that of the Dangerous Drugs Act?

Furthermore, the proposed Sections 31A-F are contentious as enforcement officers are given powers that may supersede the provisions of confidentiality in the PHCFSA and Personal Data Protection Act, and without check and balance on their powers.

The regulatory impact assessment includes, among others, establishing the scope of the problem; stakeholders’ consultations; whether the problem has to be addressed by a legal approach;

and whether any proposed amendment is consonant with any other law(s).

It is patently clear that there is a complete lack of proportionality in addressing prescription practice. The proposed amendments are a ham-fisted approach to a problem, the scope of which is ill-defined. Are there no mechanisms currently in place? Should a possible unethical practice be treated with criminalisation?

Arguments that it will protect patients are not only fundamentally flawed but also warped. Such an ill-considered approach has no place in any developing country, let alone one that is aspiring to be a developed nation.

The Commonwealth Medical Association is urging the Health Ministry to withdraw the proposed amendments and “seek more sincere and productive consultation with stakeholders, particularly the Malaysian Medical Association and the Malaysian Medical Council” (https://bit.ly/34ZfTwM).

Withdrawal of the Bill and genuine engagement with the stakeholders are the only way forward.

DR MILTON LUM

Petaling Jaya


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