Tuesday 20 October 2015

MOH: Baseless allegation of political motive in disclosure of Hepatitis C cluster

I refer to Ms Rachel Chang's commentary in The Sunday Times ("More questions than answers in hepatitis C timeline?"; Oct 18).

Ms Chang suggests that public officers and medical professionals, in both the Singapore General Hospital (SGH) and the Ministry of Health (MOH), may have delayed the disclosure of information to the minister and the public for political reasons.

She offers no evidence for this serious allegation. Neither did she put the allegation to the ministry and give it a chance to respond. Instead, she quotes a scene from an American TV political comedy to lend colour to her story.

The allegation is completely baseless. Medical professionals and public officers in MOH and SGH sought to perform their duties professionally and objectively. They acted in the interest of patient safety and to minimise risks to patients. Political calculations played no role in their consideration of the proper course of action. To suggest otherwise impugns the professional integrity of these public servants, who are unable to reply to defend themselves.

The Minister for Health was first informed about the matter on Sept 18. He directed that it be made public, and that a full public explanation be given. Ms Chang makes much of the minister being "officially" informed on Sept 18, implying that he knew unofficially before that. For good measure, she compares this to the situation in the American comedy. This, too, is totally baseless.

The timelines for key events, in SGH and MOH, have been made public. The independent review committee is still looking into the cause(s) of the infection, and the flow of information in SGH and MOH.

As the Minister for Health has said, if there are gaps, we will close them, if there are weak areas, we will correct them, and if there are shortcomings, we will improve.

It is irresponsible of Ms Chang to impute improper motives to the medical professionals and public officers concerned without any evidence.

Straits Times journalism cannot consist of repeating gossip while claiming to air opinions. Singaporeans expect higher standards of journalism from our newspapers, especially a paper of record.

Lim Bee Khim (Ms)
Press Secretary to the Minister for Health
ST Forum, 20 Oct 2015

• The Straits Times Editor replies: It was not the intention of our column to impugn the integrity of public servants. We also did not mean to imply that the Minister for Health was "unofficially" informed beforehand about this matter. We are sorry that our column gave these wrong impressions.

More questions than answers in hepatitis C timeline?
Review committee should examine the flow of information from SGH through the Health Ministry to the political leadership
By Rachel Chang, Assistant Political Editor, The Sunday Times, 18 Oct 2015

In the darkly hilarious political comedy Veep, there is a wonderful moment in the latest season when senior aides of the President of the United States approach her gingerly in the Oval Office.

Through bumbling machination, she and her team had just made it to the highest office in the land.

Now, the staff have found that someone from their political operation had hacked into confidential government medical records - and used these to lobby voters.

This, they knew, was a criminal breach of privacy. Having told Madam President that they need to speak to her urgently, they hem and haw.

"Ma'am, if we tell you, you'll know, and if you know, you'll be implicated," says one of them.

"Well, then, why don't you tell me and I'll decide whether or not I know it?" was her response.

The moment brilliantly encapsulated a tenet of politics: What happened, and what is known to have happened, are two distinct categories.

When the Ministry of Health released a timeline earlier this month detailing how it reacted to a cluster of hepatitis C infections, I could not help but think of this Veep moment.

After all, the timeline had been released in response to questions over the seeming delay in making the information public, which some believed was politically motivated.

The Singapore General Hospital (SGH) had diagnosed the infected patients between April and June, but notified the Ministry of Health only in late August.

The news was then made public at a press conference on Oct 6.

Given that the window between late August and Oct 6 contained a general election, opposition parties and some ordinary Singaporeans naturally assumed that the bad news was held back so as not to affect the ruling People's Action Party's electoral fortunes.

Two dates in MOH's timeline jump out:

The first is that on Sept 3, MOH's director of medical services Benjamin Ong met SGH staff, and was told that tests confirmed the 22 infections were linked.

This can be seen as the moment the Government became concretely involved in the situation.

The second notable date is Sept 18, when MOH says Health Minister Gan Kim Yong was officially informed.

The intention of highlighting the latter date in particular is to make clear that Mr Gan, the politician in charge, was officially informed only after the Sept 11 polls.

Given the severity of the situation - the infection could be linked to five deaths - and the extensive action authorised by senior MOH staff in early September - which included asking another government agency to confirm SGH's test results and appoint external parties to a review panel - the lack of information flow to Mr Gan between Sept 3 and Sept 18 could strike some as an echo of Veep.

For the thinking Singaporean, three reactions are possible here:

The first is to take the ministry's timeline at face value. We are talking about a period of a mere 16 days between Dr Ong entering the fray and Mr Gan being notified. This is perhaps just the standard pace of the workings of large bureaucracies.

The same timeline in any other month except the politically significant one of September 2015 would likely have raised no eyebrows.

The second is to persevere, as most opposition parties and opposition-leaning observers have done, in the belief that there was a political delay.

Those in this group must parse the question of the PAP Government's motivation.

Say the information had been made public smack in the middle of the campaign, in early September.

Would the news of 22 people being infected with a deadly virus in Singapore's largest hospital have had a negative impact on the PAP Government's vote?

The fault was SGH's, the situation had already been contained, and there were no Sars-like implications that would shut down large swathes of society.

If anything, a crisis is good for the PAP's vote, as its electoral history has shown. Singaporeans tend to rally around strong leadership when in doubt.

The only danger is that the news would have distracted from the PAP's campaign message, and given fodder to opposition parties in the hustings. No doubt there are political consultants and spin masters who would counsel politicians not to take the chance.

In my view, it was unlikely that the news, if it had been made known in late August or early September, would have had any impact at all on the PAP's landslide win of 69.9 per cent at the Sept 11 polls.

But as it was not, we will never know for sure.

The third reaction is to consider if there were pressures, external or self-imposed, that had made the civil and public servants (SGH is a public hospital) in question leave their political leaders out of the loop until the polls were over.

That is, was there a complicated mix of protectiveness and scenario-planning at play, of the sort displayed by the senior aides in that Veep scene?

The public service has become noticeably more politically savvy since the 2011 General Election. Then, misjudgment of the extent of discontentment on the ground contributed to the PAP's electoral setbacks.

In response, the public sector's communication machinery has levelled up and expanded in every facet.

Some of these are immediately apparent, like the resources put to communicating new policies to affected segments of the population, and boosting the front-line staff operations that deal with Singaporeans daily. Government agencies also now routinely take out advertisements promoting policies, whether on billboards or on YouTube.

Other aspects are less visible, like a big increase in government polling efforts to determine public sentiment, or the growing sophistication in political messaging, whether in press releases, policy timings or ministerial speeches.

That this sophistication would extend to the way civil servants conduct themselves during an election year is natural.

The question is if this conflicted with the proper flow of information to the public, and if so, to what degree.

An Independent Review Committee will probe lapses on the part of SGH that led to its slow response.

I hope the committee, if not Parliament, will also probe whether the flow of information from SGH through MOH to the political leadership was proper, and if not, why not.

If nothing else, this would help keep the gap between what happened, and what is known to have happened, as narrow as possible.

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