When the notorious Dr Amit Kumar alias Dr Santosh Raut was arrested by Nepalese police from a jungle resort camp in the southern town of Sauraha, about 60 km from the Indo-Nepal border town of Raxaul on Feb 7 for stealing more than 600 kidneys and selling them illegally, there was a clamour in India to clamp down on India’s illegal but lucrative organ trade. India’s Health Minister Anbumani Ramadoss, in a typical knee jerk reaction, stated that India’s Organ Transplantation Act would be amended to simplify the procedure and make the punishment for illegal transplants more stringent to curb unlawful practices.

However a week later, common sense prevailed when the Chief Justice of India KG Balakrishnan, when asked at a conference on kidney disease at the All India Institute of Medical Sciences (Aims) at Delhi about the need for stricter laws to check illegal transplantation of organs, said: ‘Sufficient laws are there, they just need to be implemented properly’.

In Malaysia, common sense is all but common when it comes to the civil service enacting new regulations as was the case with the genesis of the PHFSA (Private Health Care and Facilities Act) when it was first mooted in 1993. Consumer associations in Malaysia, for whom this law was created to appease, claimed that they often handled complaints from the public regarding poor services provided by private hospitals and clinics but were told that the health ministry's hands were tied. This was, of course, a lie.

The Medical Act 1971 is very clear especially in trying to apprehend bogus doctors. Doctors wanting to practice in Malaysia must have graduated from a recognised university, must have registered with the Malaysian Medical Council and must possess a valid Annual Practicing Certificate. Anyone not complying is a fraudulent or unlicensed doctor and is liable for a fine or jail term of two years or more. The Medical Act 1971 is in itself comprehensive. But what was absent, as in India, was enforcement.

Every time consumer associations indulge in their favourite pastime of doctor bashing, the Health Ministry (MOH) instead of enforcing existing laws, make themselves look relevant by trying to create new regulations. As such, the ‘Amalan Perubatan’ division at the MOH created the con about the bizarre requirement of a new law that will apply only to private doctors but not government ones. Among others, private practitioners will need to work in specified clinic conditions, pay a suspicious registration fee of RM1,500 and buy medical equipment they may never use.

The deceit developed a life of its own when mysteriously Dr A Krishnamoorthy, MMA’s (Malaysian Medical Association) president for the 1993-94 term was barred from discussing the Act with member doctors. The MOH and its minister cited the OSA (Official Secrets Act) though the PHFSA affects public interest and the very future of doctors themselves. Krishnamoorthy’s successor, Teoh Siang Chin, submitted a 37-page memorandum to the then minister Chua Soi Lek outlining four areas under the Act which were clearly vague and gave credence to reports that the Act was the hurried ‘cut and paste’ job of an amateur officer. Changes were promised but never ratified.

Despite all the disapprovals, still the administrative officers from the civil service in the ministry looked on while the medical authors of this half-baked law imposed their will by trying to sell the Act to parliament. The lie for a new law found an ally in an obstinate Chua Soi Lek and despite objections from almost the entire medical profession, it became law. The complete absence of the check and balance of an efficient civil service was completely mowed down by a couple of doctors and a director-general intent on having their way.

Parliamentary Opposition Leader Lim Kit Siang was more direct. He called for the Act to be scrapped immediately. His statement that ‘public interest in affordable quality healthcare even in the private sector is not served if the Act imposes bureaucratic controls and creates loopholes for graft and abuses of power’ not only fell on deaf ears but came true with devastating consequences.

Dr Basmullah Yusom, a USM graduate, registered with the Malaysian Medical Council with a valid Annual Practicing Certificate was fined an unjustifiable RM120,000 for not registering his clinic under the PHFSA and languishes in jail today as he could not afford to pay this fine.

If anything, this further demonstrates how the Malaysian civil service’s left hand knows not what the right hand does. It is also further evidence that the check and balance expected of senior civil service officers at the MOH is distressingly deficient if not completely absent.

This is a civil service that has gone awry where Little Napoleons overrule the General Orders, the rule of law and protocol. Administrative officers of the civil service have been reduced to spectators. We can only hope to see more bizarre regulations dished out of from this particular ministry.

This country appears to have exchanged democracy for the rule of Little Napoleons as the de facto method of governance in the civil service. And for this the ruling party may pay a heavy price at the current elections.