When did the Minister for Health need to know about the SGH incident?

I have just read the entire report of the Independent Review Committee. It’s… long. And full of medical acronyms. For most people, reading the summary by Bertha Henson would give a very good sense of what’s in the report. I read it because I wanted to find out whether the full report presented any convincing reasons why it was necessary to delay notifying the Minister and informing the public. There wasn’t. At least not any that I could see.

Para 3.47 of the report said:

“On 3 September 2015, the DMS was presented with findings from SGH and found that based on the information available then, he was not able to make a good assessment of the overall situation, in particular with regard to the severity and extent of the outbreak.”

DMS refers to the Director of Medical Services, i.e. the doctor in MOH with the most authority and oversees all professional functions in MOH. The people above him in MOH are the Permanent Secretary (PS) and the political office holders. The report then went on to state the list of additional information the DMS asked for “to better inform assessment and for further decision making”. He asked that the information be presented to him within two weeks.

Apparently, the DMS saw it fit to inform the PS of MOH on 3 September 2015. Para 3.48 of the report said:

“The DMS informed the Permanent Secretary of the matter on 3 September 2015, and she took reference from the DMS’s professional judgment that that there was insufficient information to allow for a fuller professional evaluation of the outbreak.”

And that was it. No other explanation why neither the DMS nor the PS deemed it necessary to inform the Minister. The report, in para 3.51 stated:

“The IRC noted that when DMS was briefed by SGH on 3 September, his key considerations were to make a professional evaluation of the severity and extent of the outbreak, to ascertain that adequate infection control measures had indeed been instituted, and to ensure that new transplant patients were not potentially exposed to HCV infection until the issues had been adequately addressed. He therefore asked for specific additional relevant investigations and actions to be taken in relation to each of these within two weeks, and when these were largely done, reported the matter to the Minister. The IRC is of the opinion that the additional investigations and actions required by the DMS are professionally valid and appropriate. Overall, while there were gaps in identification, management and reporting of the outbreak, there was no evidence to suggest that the escalation of the matter to DMS and the subsequent notification of the Minister had been deliberately delayed.”

I don’t think anyone would doubt that the additional investigations and actions were necessary. But the critical question is this: why was informing the Minister contingent on the completion of the additional relevant investigation? No explanation of that. At all. We just simply have to take the IRC’s word for it.

But the IRC did try to offer an explanation for the delay. No. It wasn’t any one individual deliberately causing the delay. It was incompetence on the part of the many people involved. Para 3.55 of the report stated:

“While SGH commenced investigations into the HCV cluster from mid-May, and implemented enhanced infection control measures from early June 2015 onwards which were instrumental in slowing the spread of infection, the IRC is of the view that the outbreak was not investigated and managed optimally. Within MOH, unlike community outbreaks, no one division has clear responsibility to deal with outbreaks of unusual HAIs. This hindered MOH’s ability to respond in a timely way to the unexpected event. In addition, the absence of an established framework for unusual and unfamiliar events resulted in delays in escalating the matter from SGH to SingHealth, from SGH to MOH, and within MOH.”

So it seemed that PAP, particularly the Minister of Health, benefited from the incompetence of the people in SGH, SingHealth and MOH. Imagine the shit storm this would have stirred up for the PAP during the GE if people in SGH, SingHealth and MOH did not screw up on the communications process?

This brings to mind a quote from the British sitcom, “Yes, Prime Minister”: “Apparently the fact that you needed to know was not known at the time that the now known need to know was known, and therefore those that needed to advise and inform the Home Secretary perhaps felt that the information that he needed as to whether to inform the highest authority of the known information was not yet known and therefore there was no authority for the authority to be informed because the need to know was not at this time known or needed.”

The moral of the story? If you want to screw up at your job, screw it up completely. Then at least your bosses can claim plausible deniability and you won’t be dragging everyone down with you.

The silver lining in this case is that all these shortcomings relate to Healthcare Associated Infections (HAI), not community outbreaks. In other words, it is possible that the system and framework to track and manage community outbreaks like SARS, MERS and Ebola are a whole lot more rigorous than the system and framework that led to the snafu in SGH. At least that is what we hope. But can we be sure? We don’t know.

Next question in this entire saga is… whose head, if any, will roll? How high up? SGH big boss? SingHealth CEO? DMS? PS? Minister? Fairly certain it won’t be the last three. I am also interested to see if any of the families of patients affected would sue SGH. Especially the families of patients who passed away as a result of being infected. It would be an interesting legal case.

This saga isn’t over yet. I think MOH has its job cut out for it. It has to do heck of a lot to regain the confidence of the public. Which is a pity, considering that, if not for this incident, they could end the year doing their little song and dance, celebrating their success in rolling out MediShield Life (which I think is a marvellous, albeit long overdue, policy). We will just have to wait and watch what MOH does from now.

[Featured image: Screenshot from CNA’s video of interview with Minister Gan]

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