Islands Hospital: Public-private partnership causing legal issues

The choice of a public-private partnership (PPP) for the management and operation of the Islands District Medical Complex, also known as the Islands Hospital, is creating unexpected legal issues in the establishment of its managerial structure.

Such a conclusion comes from the press briefing held yesterday at the Legislative Assembly (AL) after a meeting from the third standing committee on the analysis in detail of the bill that will establish the legal grounds for the operation of the medical facility.

To the media, the chairman of the third standing committee of AL, Vong Hin Fai explained that in this first meeting of this committee to analyze the bill the members were warned by the Juridical Advisory of the AL that there were some issues worth noting, among them, questions related to the integration of the PPP with existing laws.

As further explained, doubts arise from the fact that the “Islands Medical Center” is considered a public institution but will be under private management and operation, a fact that generates ambiguity, for example, over the responsibility for the medical institution concerning regulations on medical error, acquisition of good and services and inspection and supervision, among others.

In reality, Vong explained that the questions and doubts extend even to the name of the institution, with the chairman of the committee admitting that lawmakers do not know if there was any agreement established between the government and the Peking Union Medical College Hospital for the use of this institution’s name.

Another of the issues found by the AL legal advisors is related to the entity itself, as it is presented as a managerial structure but, according to the legal experts and based on the Articles of the bill, it should be a juridical structure instead.

Who decides?

As explained in further detail, there is some ambiguity in several aspects of the bill from the very start with the AL legal advisory calling the attention of the lawmakers to the roles and relationship between the managing institution (Peking Union Medical College Hospital) and an organization created by the Chief Executive (CE) Ho Iat Seng, and named Macau Hospital Strategic Development Committee, which in the Article 6 of bill states to be the “top decision-making entity.”

“We want to hear from the government on this. We want clarification on the relationship between the two parties and if there will be shared management or if there will be different parts or sections [according to theme] to be attributed separately to each entity,” Vong said.

Similar doubts occur in the application of the legal organization for medical error as well as on the acquisition of goods and services, with the lawmakers wanting a clarification as to whether the Islands Hospital will abide by the rules established for public entities or if there will be a “more flexible regime like in the private sector.”

Bill resembles the statutory regime of UM

While addressing the issues found in the first round of the analysis of the 15 articles that comprise the bill, Vong said that this bill presents a high degree of similarity to the one that established the statutory organization of the University of Macau (UM). Contrary, however, to that bill, which concerns a juridical institution, the one being addressed on the islands’ hospital is considered a managerial entity, a fact that no one seems to be able to understand.

Similar issues arise from the fact of being a public institution under the control of the Secretary for Social Affairs and Culture and, consequently, the Health Bureau, such as how these government bodies and entities can exercise their inspection and supervision power, since the bill does not explain any of this.

Lawmakers also questioned the composition of the Strategic Development Committee which is composed of eight members, but no reference is made in the bill regarding their qualifications or area of expertise, not even the requirement for any medical or health management knowledge or skills.

unaware of the content of side regulations

Article 14 of the bill notes that a series of complementary norms such as Administrative Regulations and Staff Regimes will be presented on the side of the bill, which will not pass through the scrutiny of the AL.

Lawmakers are concerned with these complementary regulations as they say they have no information on the content or purpose of them, besides the fact they will be done through a dispatch from Secretary Elsie Ao Ieong.

“We want to ask the government for more details on [the side regulations] as well as the date for the entry into force of the law itself. The bill is silent on this too,” the chairman noted while adding that while there are many questions and much work to do, there is also some sense of urgency in the process as it is expected that the Islands Hospital Complex will start operations at the end of this year.

Although there is now acknowledgment from the lawmakers that there is a lot to explain and very little information on the bill, this bill passed unanimously at the AL in its first reading on January 16.