AL Plenary | Legislation on medical errors approved despite doubts over expert committee

The Legislative Assembly (AL) gathered last Friday for the final approval of the medical malpractice bill, which has been discussed over the last three years.
However, the plenary session was not without doubts.
Lawmakers questioned the composition and operation of the experts’ evaluation committee, which will analyze and finally decide on all cases related to hypothetical medical malpractice claims from users of healthcare services in both the public and private sectors.
Lawmaker Pereira Coutinho asked: “What kind of qualifications should be stipulated for these members? […] What is essential is a declaration of interests. We have to know if these people [committee members] are competent.” He also requested more details on how the government proposes to select the experts for the group.
“The first difficulty that the government will encounter is the constitution of the committee itself,” said Leonel Alves, explaining that seven effective members and three substitutes are required.
“I don’t know if we have these people in Macau. Regarding the medical staff, I have my doubts since I don’t know the sector well; regarding the jurists, I find it difficult since I can’t envision how they could have the necessary qualifications to perform such a task,” Alves said, remarking that the law permits the recruitment of committee members from outside the territory in the case of medical members, but this is not the case for juridical members.
But the legislator went even further, challenging the composition of the seven-member committee, that is expected to include five members from the medical sector and two from the judiciary one.
“Why is it necessary to have these specialized juridical members? In what sense can they conclude an investigation and technical expertise of the physicians? If I [have] my doubts about the need for one, why do we need two?”
The Secretary for Social Affairs and Culture, Alexis Tam, did not disclose many details on the inclusion of these members, claiming to have heard “a proposal from the standing committee which the government attended.”
“In Macau, there are many professionals from the health sector and we believe that it is possible to find them,” said Tam, even suggesting “recruiting retired physicians, even from abroad, that can still serve society.”
The Secretary also remarked that “the committee can also hire and even request experts from abroad to give a technical opinion, even if they aren’t included in the committee.”
Alves did not agree with Article 18 of the law, which states it is possible to appeal the committee decision. “But there isn’t a real mechanism for that, since the appeal is done for the same committee that analyzed the case in the first place,” he said.
In his opinion, this fact “weakens the protection of the rights of those that consider to have been harmed by the conclusions of the experts committee.”
Alves also said that the committee was created to expedite the processes, thus avoiding the need to go to court, but “does not replace that possibility.”
Au Kam San, another lawmaker, criticized some of the bill’s articles, claiming that the mechanism requires the payment of an expectedly large sum for the filing of a medical malpractice process, which “might constitute an obstruction for many people and more specifically for most of the vulnerable groups.” He called on the government to set a mechanism to exempt people in need from paying such a tax.
According to the bill, the sum in question  should be similar to the ones now paid in mainland China (approximately MOP5,500) or Taiwan (MOP8,900) which Tam admitted are the “reference amounts that are being considered.”
One of the relevant aspects of the bill now approves the introduction of mandatory insurance that grants compensation to patients in the case of proven medical malpractice. The insurance should be acquired by “six types of medical professionals,” said Health Bureau (SSM) director Lei Chin Ion. These include traditional Chinese medicine practitioners.
Tam says, “the introduction of the indemnity insurance protects both users and healthcare professionals.”
Legislator Chan Iek Lap, a physician, had participated in all the sessions and was most concerned with the insurance premium costs as well as the lack of information regarding the insurance.
“The physicians in Macau do not know how to acquire the insurance. I’m not as concerned about the hospitals [as I am] for the independent professionals; especially for the traditional Chinese medicine practitioners, this will be a problem,” he said, urging the government to “think of the reasonability of the premium and call for the support of the Monetary Authority of Macao [AMCM] to negotiate with the insurance companies.”
Executive director and AMCM representative Maria Luísa Man said: “We are working on that and probing the insurance sector regarding this matter. [After] the approval [of the bill] we need to review the administrative regulations to define the insurance contractual terms.”
The law was unanimously approved in general terms with the exception of Article 12 – Composition of the Committee – which had been voted upon separately, gathering two votes against and one abstention.

On the lawmakers’ agenda

Shortage of  drivers Mak Soi Kun has called the government’s attention to the fact that the shortage of heavy vehicle drivers has led to lower requirements and skills for these positions. The lawmaker cited a large number of recent accidents involving such vehicles, and said that the drivers have exhibited problems such as a “lack of experience and care when driving, [exhaustion], driving under the influence of alcohol, and driving with expired driving licenses.” According to him, this has caused “serious accidents with the loss of lives and assets by the drivers, passengers and pedestrians.” The legislator urged the government to fulfill their promises regarding the drivers’ professional training, but noted things “seem to be going the opposite way.”

Taipa Ferry Terminal Song Pek Kei and Lau Veng Seng said at the AL plenary that the Taipa Ferry Terminal at Pac On presents a “serious mismatching in size and function” to what was expected. According to data collected by Song, the Terminal will cost MOP3.8 billion, six times more than the initial budget projections. She added that “society thinks it will be a ‘white elephant’.” The lawmaker considers the project “over-sized,” claiming that the total area of 201,000 square meters is also four times bigger than predicted.  Song remarked that the terminal could receive 400,000 passengers per day, while both existing terminals currently host 69,000 passengers per day. “With the conclusion of the Hong Kong-Zhuhai-Macau bridge, a further reduction on these figures is expected,” she said.  Lau Veng Seng added that “the tourism capacity of the new terminal surpasses the actual needs by a large scale” and suggested that the routes to the mainland be expanded to capitalize on this.

Ride-hailing apps The government should follow China’s legalization of ride-hailing apps, Au Kam San said. He stated that the MSAR government should take inspiration from the mainland’s legalization of the taxi services in order to address issues with companies such as Uber. The legalization of this kind of service “could solve the shortcomings of the taxi industry,” the lawmaker said. Au’s suggestion comes in light of what he called the “lack of vision from the government on this matter” and his implication that following China’s resolutions on the matter might be an advancement.