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Hep C Saga: Difference between review committee and committee of inquiry

SGH

On Sunday, the Workers' Party (WP) called for the current review committe appointed to look into the hepatitis C saga at the Singapore General Hospital (SGH) to be reconstituted as a Committee of Inquiry (COI) under the Inquiries Act.

In response to this, the Ministry of Health (MOH) said the findings and recommendations of the current review committee will be made public. A police report has also been filed and the police are conducting investigations.

The ministry also said,

"The WP statement is careful not to make any suggestion that SGH or MOH officers acted with improper motives. Yet it has asked for a COI ahead of the Committee’s report and the conclusion of Police investigations. If the WP believes that there are questions that the Committee cannot answer, or that any officer acted with improper motives, it should state so directly. The Government will convene a COI provided the WP is prepared to lead evidence before the COI, to substantiate whatever allegations it might have."

The WP seemed to have pre-empt what MOH would say and had earlier declared in its statement, "Calls on the government to explain the delays in detail should not be met by calls to provide evidence of any inappropriate motivation."

Did the WP overreact by calling for a COI to look into the matter?

To allow us to determine this, let us first take a look at what are the Terms of Reference (ToR) of the review committee set out by the MOH and how this compares to a COI under the Inquiries Act.

The ToR for the review committee are:

a)  To provide an independent, objective and critical review of SGH’s report, and seek to ascertain if all possible measures had been taken to:

  1. Identify the possible points of infection control breach;
  2. Remedy any weak points in the overall workflow particularly with regard to infection control;

b)  To reasonably investigate any activity within its terms of reference, which will include but is not limited to the following:

  1. Review the work and findings of the two Committees convened by SGH to investigate this Cluster (i.e. the Medical Review Committee and Quality Assurance Review Committee)
  2. Interview any staff member to clarify issues; and
  3. Perform site inspections at SGH.

Review committee bounded by the scope of SGH's reports.

The first point to note in the ToR is that the review committee is to present their findings based on a review of the SGH's report.

By limiting the committee's point of reference to just the hospital's report is narrowing what the review committee can investigate with regards to the whole incident.

The review committee is tasked to review the work and findings of the two committees convened by SGH and to interview staff to clarify issues. But this means the review committee will not be able to conduct its own investigations beyond what SGH has presented as its findings.

In the example of the recent COI for the Little India riot in 2013, under its terms of reference as set out by the Ministry of Home Affairs, the COI was tasked to establish the factors and circumstances that led to the riot in Little India on 8 December 2013 and how the riot unfolded and how the security forces managed the incident.

There was no limitation of what the committee could choose to investigate or the individuals it could summon or interview to shed more light on the incident.

Its remit was not limited, for example, to any reports of the police to dictate the scope of investigations.

Testimonies are not sworn under oath

Anyone who is interviewed by the current MOH review committee is not bound by law to share all details pertaining to the case and to have their testimony sworn under oath.

Although one would not expect any witnesses to lie, it is nonetheless important to ensure that all accounts heard and documented are the truth and nothing but the truth, witnesses have to be held accountable to their testimonies.

Witnesses too are themselves protected by the law under the Inquiries Act, which says:

"No evidence taken under this Act shall be admissible in any civil or criminal proceedings whatsoever against the person who gave the evidence, except when the person is charged with giving or fabricating false evidence."

Awkward position for current review committee members

As mentioned by the WP in its statement, the review committee is composed of currently serving clinicians in public healthcare institutions.

The committee members are placed in an awkward position for being tasked to review MOH’s workflow and critique the actions of senior civil servants who oversee and administer government policy that affects the members’ work as clinicians on a day-to-day basis.

Compared to the COI in the Little India riot, the committee was formed by retired professionals from the relevant ministries or individuals who were unlikely to be affected by the findings of the inquiry.

Would the findings by the review committee be truly free from influence, direct or otherwise? Such a possibility cannot be ruled out with the current appointment of committee members.

Truncated findings by review committee

Although MOH said again and again that the review committee’s findings and recommendations will be made public, but to how much of the total findings?

Through the COI, unknown facts of circumstances leading up to the incident were revealed, giving a clear picture of what happened that very day.

Further information of how the timekeeper lied in court about not using vulgarities on the migrant workers, with three witnesses at the hearing saying that she was notorious for it and how the coach driver had never turned on his coach's monitor screen for the video camera which would have informed him of the deceased's presence were revealed. However, these were not mentioned in the findings and only those who were at the hearing got to know of it. (see here for COI's report)

Given such instances of filtered findings in Singapore, how can a member of the public hope to be given unfiltered, raw findings in the final report from the current review committee?

Given the above mentions, why is MOH so insistent that WP provides evidence for any officers acting with improper motives before the ministry convenes a COI when clearly the issue brought out by the political party is about the issue of transparency and methodology of the investigations?

Is this case of Hepititis C infection not serious enough for MOH to warrant a much serious approach in finding the root cause of the outbreak or the task of restoring public faith in the public health care not a serious concern to MOH? Or does MOH have other things that it finds being to be a higher priority than the two?