Minister of Health should assert his authority and show that he is master in his own Ministry

Speech by Ketua Pembangkang, DAP Secretary-General and Member of Parliament for Bandar Melaka, Mr. Lim Kit Siang, at a DAP Public Rally at Bandar Hilir Padang, Malacca, on Sunday, 16th Sept. 1973 at 9.30 p.m.

Minister of Health, Tan Sri Lee Siok Yew, should assert his authority and show that he is master in his own Ministry and not a puppet of Malacca Hospital authorities

Since my first press conference on August 22 making public the unusual number of Malacca Hospital deaths and calling for a Public Commission of Inquiry into the negligence and maladministration of the Malacca Hospital which made such deaths possible, the Minister of Health, Tan Sri Lee Siok Yew, has established an investigation committee and promised that if there is any finding of negligence or carelessness on the part of anyone, disciplinary or other action would be taken.

From our investigations, it is clear that the Minister of health, Tan Sri Lee Siok Yew, had been misled by the Malacca Hospital authorities time and again into making public statements which are not borne out by facts.

It is a serious and sorry state of affairs that the Minister of Health, the head of his Ministry, should be consistently misled and misinformed by his own subordinates into making untrue public statements.

I will tonight give three instances to justify my statement.

Minister of Health misled by Malacca Hospital authorities:

(1) The condemning of the autoclave

What the Minister was led to say publicly: On August 24, the Health Minister was misled into stating that when one autoclave in the Malacca Hospital was condemned on July 21, immediate action was taken by the hospital authorities to use the second autoclave available in the hospital.

When the second autoclave started to break down on August 13, it was immediately stopped and arrangements were made for sterilized bottles and other medical materials to be supplied by the Seremban General Hospital.

The facts: The autoclave that was condemned on July 21 was to have been condemned in May, which means that the autoclave was used for two more months after it should have been condemned.

The Malacca Hospital did not have a second autoclave – as stated by the Minister of Health – to sterilize bottles and other medical materials. The so-called second autoclave that was used in replacement after July 21 was actually a disinfectant unit for disinfecting mattresses and such like materials. Thus for a month, a disinfectant unit meant for disinfecting mattresses was used to sterilized bottles and medical materials, loading to contamination of bottles, saline and blood.

This was why when contamination was discovered a month after use of the disinfectant unit as an autoclave, the hospital authorities destroyed 42-pint bottles of blood and over 2000 bottles of saline in mid-August.

(2) The number of deaths between July 21 to August 20

What the Minister was led to say: The Minister of Health said there were 12 deaths during the period in question, and he ordered an investigation into the deaths in a press statement dated August 24. On Sept. 4 at the end of his visit to the Malacca General Hospital, he told pressmen that the figure of 12 deaths was ‘not unusual’.

The facts: In actual fact, the 12 deaths were selected cases picked by the Malacca Hospital authorities for the Minister and the Investigation Committee, and does not constitute the total number of deaths during this period from July 21 to August 20.

We have discovered that for the first six months of this year, from January to June 1973, the average monthly mortality rate is 70 persons in the Malacca General Hospital.

But for the period from July 21 to August 20, a period of one month, the number of deaths shot up to 110 – exceeding the monthly mortality rate for the first six months of this year by 40 deceased.

This is a shockingly unusually high rate of deaths which by itself should have prompted the Malacca Hospital authorities to report to the Minister for an inquiry. But no, a Member of Parliament from the Opposition had to make public this unusually high number of deaths, and in spite of this, the Malacca Hospital authorities fed the Minister with untruths and distortions. This was why the Minister of Health publicly told the newsmen on Sept. 4 that the figure of 12 deaths is not ‘unusual’.

The extent to which the Minister of Health is kept in the dark about important things in his own Ministry is indeed shocking, and difficult to find a parallel in any other Ministry in the world.

(3) Decrease in inpatients and surgical cases after spate of unusual deaths

When I met the Minister of Health in his office in Kuala Lumpur on August 30, I told him that as a result of the spate of unusual deaths, the public of Malacca have lost confidence in the Malacca Hospital, leading to a great drop in the number inpatients and surgical cases.

When the Minister of Health visited the Malacca General Hospital on Sept. 4, he told the press after his inspection that it was untrue that there had been a decrease in the number of inpatients since the deaths. He made the shocking statement: “We have figures to show that the number of inpatients has increased rapidly since then.”

The Minister made this statement without seeing the inpatient figures and the number of surgical cases for the relevant periods, that is July, August, and the time before and after July 21 – August 20. He relied on the figures of inpatients for three days, Sept. 1, 2 and 3, and what he was told by the Malacca Hospital Authorities. The Minister was neither shown the inpatient figures for the months before, during and after the period in question, or the number of surgical cases for this period. I know because I was with the Minister during the tour.

A complete shake-up of Malacca hospital urgently needed

I am indeed shocked and amazed that the Minister of Health can be so misled and misguided by his subordinates in the Malacca Hospital on so many important matters.

I call on Tan Sri Lee Siok Yew to assert his authority and powers to show that he is master in his own Ministry, and not a puppet of the Malacca Hospital authorities who speaks and acts at the behest of his subordinates and who can be put by his staff in their pockets.

There must be an immediate complete shake-up of the Malacca Hospital administration. The hundreds of millions of dollars of taxpayers’ money spent on the public hospital service must not go to waste because of hospital maladministration, incompetence and inefficiency. Even more important, human lives must not be unnecessarily lost because of sheer hospital maladministration, incompetence and inefficiency.

Two days ago, when opening a conference of State health directors and heads of divisions in Kuantan, Tan Sri Lee ordered hospital authorities to take action against ‘the few who are blemishing the good name of the hospital service’ and assured them of his full support. The Minister of Health must first prove that he himself has this resolution and authority to exercise impartially disciplinary powers.

After nearly a month since my public expose of the unusually high number of deaths in the Malacca Hospital in July and August, no action has been taken by the Ministry of Health to reform the entire hospital administration apart from the establishment of a departmental inquiry.

Those who are responsible for the July and August deaths, those who are responsible for misleading the Minister about vital matters pertaining to these deaths and Malacca Hospital administration, causing the Minister to publicly make untrue statements and misleading the public in turn, are allowed to continue with their ways without Ministerial action.

This is why public confidence in the Malacca Hospital has not returned, for the people see no change in the administration, attitude towards patients or standard of patient care.

Call for Hospital Suspensions

The Minister of Health must order an immediate shake-up of the Malacca Hospital administration and service, and take all necessary action, including suspensions, against those who are responsible for the July and August deaths, and those for misleading him about important facts pertaining to the deaths and the Malacca Hospital causing the Minister to mislead the public.

Malacca wants efficient, dedicated and considerate hospital administrators, and not those who have lost all notions of their responsibility to the hospital and public, or take from three to seven months’ leave a year.

Investigation Committee – Five Conditions

It is because of the above background to the present affair that I have no full confidence in the Investigation Committee appointed by the Minister of Health to inquire into the hospital deaths.

On behalf of the Committee of Families of Deceased of the Malacca Hospital from July 21 to August 20, in my capacity as their Adviser I call on the Investigation Committee to fulfil the following five conditions:

1. Conduct its inquiry in public;

2. Include into the Committee of Investigations an Opposition Member, a foreign medical expert, and a representative of the decreased families.

3. Investigate into all the 110 case of deaths between July 21 to August 20 and not just the 12 cases selected by the Malacca Hospital authorities.

4. Hear testimony from relatives of deceased.

5. Sit at a stretch until completion of its inquiry and publication of its finding without adjournments or postponements because of the gravity of the subject matter. All committee members should set aside their other commitments and duties until this overriding public responsibility is discharged.

On behalf of the Committee of Families of Deceased of the Malacca Hospital from July 21 to August 20, I serve notice on the Ministry of Health that we reserve our position as to whether to accept or reject the findings of the investigation Committee unless the five conditions are satisfied and the public are convinced about its independence, impartiality and thoroughness.

Also, on behalf of the Committee of the Families of deceased of the Malacca Hospital from July 21 to August 20, I want the Investigation Committee to specifically investigate the following ten cases of death during this period.

1. Tan Kim Chat, 20, admitted on July 19 on first case of pregnancy, given drips on 26th July, gave premature birth on July 27 at 12.30 a.m. Baby was stillborn, but mother alive and well. Husband saw wife at 8 a.m. and was told she was all right. She had rigors at 11 a.m. and died at 2.30 p.m.

2. Vaithilingam s/o Kupusamy, 35, admitted on August 10 for a stone in bladder operation. Given drips and blood transfusion. After his operating on morning of August 10, complications developed, followed by second surgery. Died on August 11 at 7 p.m.

3. Zaiton binte Mohamad, 33, case of Caesarian operation. Given drips after operation on 12.8. midnight, and died on 13.8. The whole body turned blue. Survived by 11 children.

4. Choo Khing Bui, 27, admitted on 16.8 at 2 a.m. for sixth birth. Gave birth to a son on 17.8, given drips, died on 18.8. Death certificate gives as cause of death ‘Endotoxin shock’ or blood poisoning. Survived by six children.

5. Thesera Das, 40, admitted to General Hospital on 3.8.73 for fever, given blood transfusion on 9.8. to boost her for an operation. Had rigors and died the next day, before an operation.

6. Sapiah binte Hassan, 46, (F) admitted on 7.8. for growth in stomach. Operated on 14.8, patient coming out of operation in great pain, shouting and shivering. Given blood transfusion and drips. Died 17.8. After her death, family told she underwent cancer operation. Before operation, family not informed that patient had cancer and there was to be an operation for cancer.

7. How Joo Choon (F) admitted on 29.6 for simple repair of hernia. Operated on July 2, followed by complication. Given drips. On 2.8 when given drips, developed rigors, rise in temperature, drop in blood pressure. Similar reactions took place on 11.8, when she lapsed into coma and died on 19.8.

8. Jamuldin Anan, 1 year 2 months. Admitted on 9.8 at 4.30 p.m. for breathing difficulties. Given injections. Operated on 10.8 and died the same morning.

9. Low Keong, admitted on 26.7 for bleeding. Given blood transfusion. Operated on 29.7 and died the same day.

10. Lee Yong Wai, 2 years. Admitted on 14.8 for intestinal obstruction. Operated on 14th midnight. Well on 15.8. Given drips, complication developed, had second operation, lapsed into unconsciousness and died on 17.8. Parents told on 15.8 that the child had fully recovered by medical staff.

We are in touch with other cases, and shall make them public at a later stage. If the Ministry of Health and the Malacca hospital authorities have nothing to hide and genuinely want the entire truths to be out and investigated, then a suggest that the Malacca Hospital authorities send me the list of the 12 deaths which is being investigated by the Investigation Committee.

As I said in my first press conference on August 22, “we will not rest until the government has acted resolutely, firmly and fairly on this matter”, and I have no doubt that I have the full support not only of the people of Malacca but the whole country to demand that there should be no more attempt to hush up this very serious lapse in hospital administration and standard of patient care.