The Malaysian public recently witnessed yet again but not surprising squabble between the works minister and the health minister about the almost unending controversy of the still uncompleted new Alor Star General Hospital. On March 6, the deputy minister of health, Dr Abdul Latiff Ahmad, apparently accepted blame on behalf of the Health Ministry saying the delays were necessary so infrastructural changes could be made to accommodate the latest technological changes in medicine.

Not so, said the Health Minister Chua Soi Lek who was still insistent that the Works Ministry with its changing contractors were to blame for the mess. Later press reports reported Samy Velu sarcastically accepting blame for the delays, obviously peeved with the whole thing.

The existing 800-bed Alor Star Hospital was built in 1907. The previous hospital had all the major specialties but, in particular, was noted for its work in the subspecialty of urology. In view of Alor Star's half a million population and indeed Kedah and Perlis' three million population, more medical facilities were required for these states.

But true to the current penchant of the MOH in wanting to build unwieldy hospitals of dinosauric proportions - clearly outdated in today's medical world where information technology has ensured that hospitals would be more compact and modular - construction of a new hospital located at Jalan Langgar to be built at a cost of more than RM550 million began in October 2000 and was scheduled to be completed in 2003. So why the four-year delay?

Chua has reportedly commented that JKR is basically to blame as the building of hospitals is 'agak rumit' (can be difficult). It appears the minister is quite unaware that as far as engineering technology is concerned, the building industry in Malaysia has surpassed world standards and are indeed tendering for jobs around the world. Architects and engineers design and build what the customer wants. And what the customer wants is detailed out in specifications. And what were the specifications that the MOH gave that these builders of the Alor Star hospital had such difficulty delivering?

Is it because someone realised that there is more money to be made if new specialties like neurosurgery and cardiac surgery were added on to this new hospital project? So what if I, the 'Pengarah', sign off a few extra VOs (variation orders) and set the whole project back a few month each time?

I will, of course, win the lasting adulation of my clinical colleagues who will be doing multiple overseas trips to choose new equipment and attend numerous courses and conferences to learn about these new medical marvels all on taxpayers money and sometimes by courtesy of the supplier himself who will of course would have no qualms marking up the equipment cost to accommodate these trips.

So what's a few years delay and a couple of million ringgit extra? Shortage of staff and specialists? That wouldn't be my problem because by then I would have retired.

Puzzling indeed are media reports commenting that the new hospital would have state-of-the-art cardiac surgical facilities. Because of the rising incidence of heart disease and the very gratifying results of surgical treatment more of these cardiac units were planned for Ipoh, Kuantan, Kota Kinabalu, Malacca and Kuala Trengganu (though maybe not in this order). Priority of course will be based on population statistics, incidence of disease, logistics, etc.

But surprisingly the next cardiac unit is due to open is in Alor Star. This appears to be mind boggling as Alor Star is very close to the nation's northern regional centre based in Penang. Surely places like Kota Kinabalu, Ipoh or Malacca with a larger population base require these units more. On closer investigation, the decision to have it there may be a problem of Pak Lah's favourite theory of 'Little Napoleons' trying to sabotage the government's efforts to have more equitable healthcare.

Granted everyone wants his or her hometown developed but healthcare cannot usually be rationed this way. Taxpayer's funds must be invested carefully based on need rather then parochialism. If this situation was allowed to continue, by extreme analogy, RM10 million ringgit meant to cure bird flu in 1,000 patients could be blown to treat 10 patients for liver transplants.

We don't live in a perfect world with infinite resources and therefore we need to ration our healthcare dollar carefully.

For those in the know, Latiff, is of course, right. For individuals who advocate that the MOH hould still be health managers of our health resources in this day and age, the saga and problems of the new Sultanah Bahiyah Hospital in Alor Star, the Sultan Abdul Halim Hospital in Sungai Petani, the Sultan Ismail Hospital in Johor and the never-ending upgrading work in the Sultanah Aminah Hospital in Johor should be a revelation of what happens when there is little accountability when projects of first world infrastructure are managed by a third world mentality.

If anything else, it should remind the public how callous officials are when public funds are involved.