Keeping Locum or Part-time Healthcare Professionals Up-to-date with Clinical Practices

10 Dr Wan Rizal asked the Minister for Health in light of the recent report regarding the administering of undiluted COVID-19 vaccines, what are the safeguards in place to prevent similar situations from occurring in the future.

11 Ms Joan Pereira asked the Minister for Health what measures are taken to ensure that doctors, nurses and other healthcare professionals who work part-time, or as locum on a freelance basis, are kept up-to-date on the latest developments in healthcare and are adequately trained and familiarised with clinical practices.

The Senior Minister of State for Health (Dr Janil Puthucheary) (for the Minister for Health): Mr Speaker, may I please have your permission to answer Question Nos 10 and 11 on today's Order Paper?

Mr Speaker: Yes, please.

Dr Janil Puthucheary: Sir, my response will also cover matters raised in Parliamentary Questions filed by Mr Gerald Giam^1,2, scheduled for a subsequent Sitting, on 4 October 2022. I invite the Member to seek clarifications today and consider withdrawing his questions if it is adequately answered.

Sir, there are professional and statutory requirements for the provision of healthcare. All healthcare professionals are expected to be competent in providing safe and good quality care. Licensees of healthcare institutions also bear a responsibility to ensure that their staff, including part-timers or locums, are properly onboarded and adequately trained to perform the tasks that they are assigned, through establishing appropriate protocols and processes.

Professional Boards require that all registered healthcare professionals keep up-to-date on current standards of care and treatment, and participate in Continuing Professional Education (CPE) programmes or activities to renew their Practising Certificates. CPE consists of educational activities that serve to maintain or increase the knowledge, skills and professional performance of healthcare professionals.

All COVID-19 vaccination providers under the National Vaccination Programme (NVP) are licensed and regulated by the Ministry of Health (MOH). Specifically, for COVID-19 vaccination, we issued additional regulations to stipulate the prevailing eligibility criteria, the dilution and administration of the recommended dosage for each vaccine, the management of emergencies and incident reporting. Vaccination providers are expected to assess their staff competencies in COVID-19 vaccination administration.

In the event of any vaccine administration errors and medical emergencies following vaccination, the vaccination providers are required to report to MOH no later than three hours after the incident. The providers are also required to inform the patients immediately when a vaccination error has occurred, provide appropriate immediate care and then, monitor the patients' health with daily calls for the next seven days to ensure their well-being. In the event of an error, MOH will investigate. And if there are any systemic issues, we will work with the providers to review and improve their work processes.

MOH is currently investigating ProHealth Medical Group about the incident on 15 September 2022 and will take appropriate enforcement actions if there are any regulatory breaches. As of 26 September 2022, out of approximately 16 million doses of COVID-19 vaccines administered, there had been 11 persons affected by overdosing and 119 persons affected by underdosing of the vaccinations. Of these, seven were children, aged between five and 11, who did not have any adverse reactions. The adults had either no adverse reactions or recovered uneventfully.

Mr Speaker: Mr Gerald Giam.

Mr Gerald Giam Yean Song (Aljunied): Mr Speaker, these incidents occurred in the clinic in Bedok Reservoir-Punggol ward of Aljunied Group Representation Constituency (GRC), so I am naturally quite concerned about this. The incidents occurred on 15 September 2022, but MOH was only alerted on 19 September 2022, a four-day delay. I am concerned that a crucial window of time, where emergency actions need to be taken may be lost if there is a delay in reporting such incidents.

The Senior Minister of State said just now that they must report no more than three hours after an incident happens. So, clearly, there must be something that MOH will be investigating. Can I ask the Minister how soon must clinics notify the affected patients and extend emergency assistance to them and are there any penalties for non-reporting or late reporting?

Dr Janil Puthucheary: Sir, I thank Mr Gerald Giam for the questions. The patient should be notified as soon as the care provider knows that there is an error. That would be a reasonable expectation because the patient should then be directed for immediate care following on from the error. And that is going to require the informed consent of the patient. They need to know why they are perhaps under observation or required to attend an emergency department.

He asked about the penalties for late reporting to MOH. It would depend on the circumstances and reasons, and who it was that perhaps knew, but did not report. So, as the matter is still under investigation, it would be premature for me to comment.

Mr Speaker: Dr Wan Rizal.

Dr Wan Rizal (Jalan Besar): Thank you, Mr Speaker. And I thank the Senior Minister of State for the reply. My concern is more for the children, the elderly and the vulnerable groups. Given that this breach has happened, I would ask whether in this review process that is going on, will MOH be providing more stringent processes to ensure their safety and, of course, make sure that this does not happen again in the future?

Dr Janil Puthucheary: Sir, I thank Dr Wan Rizal for the question about the stringency of the processes. Sir, I would reiterate that these processes are part of the healthcare licensee expectations, the regulations that we have for the administration of a wide variety of drugs and vaccines. We will indeed be reviewing this licensee, this clinic, as well as the personnel that are involved.

The vast majority of the clinics and vaccine providers do a great job of ensuring that the patients are cared for safely, the vaccines are provided safely, with the correct dosage.

And so, I think we have to identify, first of all, whether this is an issue with an individual member or personnel, whether it is something about the processes at the site or whether it is something systemic about the overall vaccination process. All our data, so far, suggests that the last is not likely – the vast majority of our doses have been delivered quite safely. Nevertheless, MOH continues to review all of this.