The tl;dr version of the Hep C saga

The Too Long; Didn’t Read version of the Hepatitis C saga that happened in SGH.  The full report by the Independent Review Committee can be viewed here.

Background

In October, SGH announced that 25 patients in its renal ward had contracted the Hep C virus, and subsequently lodged a police report. 7 have passed on due to the virus. The hospital has since screened hundreds of patients and staff through contact tracing, following the discovery of the cluster.

This led to the formation of the Independent Review Committee (IRC) appointed by the Ministry of Health (MOH) to look into the incident.

Police Investigations

Police investigations have ruled out foul play as a possible cause for the incident.

Independent Review Committee (IRC) Report

Cause of Outbreak

  1. The wards, 64A and 67, had mainly kidney transplant patients whose immune systems were compromised. The affected patients had medication administered to them through needles and had their blood taken, exposing them to hepatitis C through gaps in infection control and cleaning of equipment.
  2. Breaches in infection control may have been accentuated by the temporary move of the renal ward from 64A to 67, where the layout was different from what staff were familiar with.

Reporting of Incident

  1. There was a delay in reporting to its infection control unit for help in containment. The committee found a delay in escalation of the matter from SGH to its parent SingHealth and to the ministry because of the absence of an established framework for the unfamiliar and unusual event of the hepatitis C outbreak.
  2. HEP C is not easily detected as the incubation period for hepatitis C is 2 weeks to 6 months. Following initial infection, approximately 80% of people do not exhibit any symptoms.
  3. SGH was focused on putting in place infection control measures before escalating to MOH, as it was working within the existing workflow where the management of healthcare-associated infections is the responsibility of the hospital, and that SGH was taking responsibility before informing MOH.
  4. The committee said there was no evidence to suggest that the escalation of the matter to MOH and subsequent notification of Health Minister Gan Kim Yong on Sept 18 had been deliberately delayed.

Investigations and Management of Incident

  1. Incomplete investigations were done initially by SGH and only a complete investigation was only done after SGH met with MOH on Sept 3. MOH had to ask for additional investigation and action to be undertaken within the next two weeks after that meeting.
  2. The committee added that when faced with the uncommon and unfamiliar event of an HCV cluster, SGH showed a lack of clarity on roles and responsibilities for the management of such infection outbreaks.

Recommendations to Prevent Future Incidents

  1. The committee has called on SGH to review existing standard operating procedures (SOPs) and practices on infection control, to further reduce the risk of contamination of medical equipment and contact surfaces, as well as to ensure adequate environmental cleaning and disinfection.
  2. SGH should ensure staff adhere to standard precautions for infection control, and adopt best practices such as those laid out in guidelines from the US Centres for Disease Control and Prevention (CDC) – but adapted to the Singaporean context.
  3. SGH to strengthen the monitoring and supervision framework for staff to ensure compliance to SOPs.
  4. For the national notification and surveillance system for acute Hep C to be improved, taking references from best practices in other countries.
  5. To designate a team within MOH to carry out surveillance, identify and investigate potential outbreaks, and ensure adequate expertise
    nationally for investigations.
  6. Hospitals should continue to take responsibility and develop structures, frameworks and capabilities for Healthcare associated infections outbreaks. Where required, the hospital’s capabilities can be supplemented with additional resources from the national healthcare system.

Thoughts on the whole saga…

It is extremely unfortunate that this has happened and our hearts go out to the victims and their families. This incident could have been avoided with better preventive measures.

The review was fair and balanced. At the end of the day even the best practices are subject to the lowest common denominator. Human beings adhering to (or conversely, short-cutting), procedures. It seems like both a training and a discipline issue with regard to the staff. Management has also to take responsibility for this lack of discipline. Although there was no cover up per se, more might have been done to identify the issue earlier on in SGH. But having done and said that, it is often very difficult to see a trend that occurs over a period of time (as opposed to a sudden virulent outbreak).

Hopefully the hospital will learn from this and the report help bring closure to the families of the victims. Some compensation to the families would be a appropriate gesture on the part of SGH.

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Open letter from PE resident to AHPETC

A reader living in Punggol East submitted the following open letter to AHPETC to us for sharing:

Dear AHPETC,

I note with distress the latest Town Council Management Report for FY2014 which the Aljunied-Hougang-Punggol East Town Council (AHPETC) was banded “red” in the areas of service and conservancy charges arrears management and corporate governance.

The report has stated that most of the Town Council’s S&CC arrears reports since May 2013 are still outstanding. I find this highly disturbing, because submitting documents and reporting of stats should be the most basic and simple responsibility of the Town Council since they are managing public funds. AHPETC took over the running of Punggol East around that period as well, after the by-elections in early 2013.

I’m concerned, was AHPETC scrambling to take over the running of Punggol East or were they only focusing efforts on winning Punggol East so as to fill the financial hole in Aljunied Hougang Town Council(AHTC), hence leaving Town Council affairs in a mess? Punggol East was indeed wrong to have given you the chance to represent us.

Although I don’t really understand all the legal jargon over the estate management, and don’t profess to be the expert over it, but WP has never come forward to refute the claim that they have been using funds from Punggol East to cover up the financial hole in AHTC. The way in which the Town Council has conducted itself in this entire episode is simply unacceptable, and to profess to be accountable and transparent is simply an affront to the idea of accountability and transparency.

Since we cannot change the past, and what has been done has been done, I accept that and would like to move on too. But I hope to have some closure on this matter. Punggol East has been won back by the PAP in this recent elections, and I hope that the Town Council has a plan for handover for the merged Pasir Ris-Punggol Town Council to be formed. The fact that AHPETC has not submitted their accounts since May 2013 could mean that documents are not in order. In that case, I am not confident that AHPETC can handover to the new Town Council.

These are your Punggol East residents’, our, hard earned money. Overlooking all the overpayment to FMSS and the 2 page stunt pulled by Mr Low towards the end of elections, I hope that AHPETC can properly explain to residents what has been going on.

The new Town Council Chairman, Mr Pritam said,”Despite incremental enhancements made to the existing IT system over the last few years, there remain inherent limitations which continue to contribute to some management and reporting challenges associated with S&CC arrears management and corporate governance,” he said. “The new system is expected to be operational within 18 to 24 months from the award of tender.”

The new system is obviously unable to be operational before the handover of the Punggol East accounts to the new Town Council.

If the Town Council is unable to do a handover, it will be very difficult and almost impossible for the new Merged Town Council to be set up. Who is going to clean our estate in the meantime? Are we going to have to do it ourselves? Is AHPETC going to continue to maintain our estate until they are able to do the proper handover?

I am upset that this has happened, but it seems to only be dragging on. Residents need closure, and let a new Town Council take over. We are your residents, and Mr Pritam has said that he will answer to us. But so far, our questions have been left unanswered.

Yours Faithfully,

Your concerned Punggol East resident.

GPCs – Ownself check Ownself

Government Parliamentary Committees (GPCs) have been announced today, here’s a short graphic from the PAP’s facebook page, introducing the new Chairpersons of the various GPCs:

Government Parliamentary Committee (GPC) Chairpersons

Government Parliamentary Committee (GPC) Chairpersons

The one question on everyone’s mind: Simi GPC?

In short, GPCs were created to ‘ownself check ownself’.

GPCs consist of backbenchers (aka MPs) who are grouped into different ministries to provide an alternative voice to Parliament sittings. This was created in a time before the NMP scheme came out and there was close to no opposition representation in Parliament. The role of the GPCs was to be the “shadow opposition” in a Parliament with little opposition voices, and look critically at policies. Looking at the lineup, most of the Chairmen or Chairwomen seem to be newer and younger MPs, who can maybe provide a more fresh perspective on policies and how these can be improved, maybe even a step closer to becoming future office holders.

GPCs not only critique various policies, but also come up with structured recommendations on how to improve policies or even operations. Here’s an example of the recommendations by the Health GPC with regards to healthcare affordability. They reflected the ground sentiments of “it is better to die than to fall sick” (可以死不可以病) and provided suggestions to improve the healthcare system to have better safety nets for those who are unable to afford the growing cost of healthcare.

Actually hor, “ownself check ownself” not so easy hor, cannot say everything is nice and rosy, also cannot oppose for the sake of opposing. Still must write recommendations… hmm…

10 times PAP nailed it in GE2015

  1. Dr Ng Eng Hen – Nomination day

    Dr Ng started the election campaign with a strong message to those who jeer.

    Even if you jeer at us, we will continue to improve your lives!

    Even if you jeer at us, we will improve your lives!

  2. Chan Chun Sing – PAP’s first rally at Radin Mas

    Chun Sing, with a stark reminder: What is more important? Caring for residents or going to parliament and making grand speeches?

  3. Lim Swee Say – PAP’s rally at East Coast

    If anyone can explain the foreign workers policy in such layman terms, it’s ex- Secretary General of NTUC and current MOM Lim Swee Say. He also goes on to tell voters, it’s not because of 2011 that we have changed the policy direction, or because of the opposition presence in parliament. This decision was taken in 2010 during DPM Tharman’s budget speech, and is recorded in the hansard.

  4. DPM Tharman – PAP’s rally at Holland – Bukit Timah

    The best explanation on Singapore’s spending, ever. Tharman style.

  5. PM Lee Hsien Loong – PAP’s Lunchtime Rally at UOB Plaza

    PM reiterating the need for clean politics, calling to question the morals of the SDP and WP. “You may be running the Government, you may be running a ministry, you can be in a stat board, you can be in a town council … Whatever level you are, uphold high standards. Keep it clean. And don’t say ‘I didn’t go to jail, I’m okay!”

  6. Ong Ye Kung – PAP’s rally at Sembawang

    Ye Kung takes a swipe at the WP’s slogan. Technology is the one that is empowering people and our future, not the WP.

  7. Murali Pillai – PAP’s rally at Aljunied

    This is the true spirit of Pa Si Buay Zhao, 怕死不走. (Scared of death, but won’t flee)

  8. Dr Maliki Osman – PAP’s rally at East Coast

    Dr Maliki talking about how East Coast Cares. “We must show them that not only the government cares for them, but the community cares for them!”

  9. Grace Fu – PAP’s rally at Yuhua

    Grace takes a jab at the SDP’s proposals, telling voters what the SDP does not tell them in their proposals which move Singapore towards a more westernized country and the values it reflects.

  10. PM Lee Hsien Loong – PAP’s Lunchtime Rally at UOB Plaza

    Like father, like son. “This is not a game of cards, this is your life and mine! As long as I’m in charge, no one is knocking it down!” Even though Mr Lee Kuan Yew is gone, this spirit lives on in each and every one of us.

AIM-ing to give you the facts

The troubles in AHPETC have nothing to do with AIM. It is dishonest to link the two.

The PAP TCs consolidated ownership of the system under AIM as the start of the process to tender for a new system. By this time, the system was obsolete and worth very little.

“We entered into the transaction with Aim with the objective of benefitting the TCs. Over the last two years, the intended benefits have been realised. There is thus no basis to suggest that the AIM transaction did not serve the public interest, or was disadvantageous to residents in the TCs.” – Dr Teo Ho Pin 

AIM and its directors did not make any money from this consolidation and transfer of ownership.

The MND conducted an official inquiry and concluded that nothing wrong was done and this was discussed in Parliament.

When the WP took over AHPETC, it gave notice to AIM to terminate the contract for the system as it wanted to develop its own system. When it needed more time to do so, AIM granted extensions of time. AHPETC thanked AIM in writing for its assistance.

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With AHPETC’s accounts being flagged red and submitted late, the WP only raised the AIM issue 2 years later. But those had nothing to do with AIM.

The PAP Spirit – With you, for you, for Singapore

The PAP spirit shone through during nomination day, where PAP and opposition supporters gathered at the various nomination centres to support their candidates. There was more drama at some places than others, but how it was handled reflected the true spirit of the PAP candidates and supporters.

With You

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PAP supporter holds umbrella for Mr Chiam See Tong. Source: Yahoo Singapore

Heartwarming moment when a PAP supporter held an umbrella for Mr Chiam See Tong, Singapore People’s Party Secretary General. Mr Chiam will not be able to run this elections, but was nonetheless there to support his candidates running on behalf of his party. He is one of the most respected opposition MPs in Singapore, and fiercely against the PAP while he was an MP.

The bottomline is this: Kindness transcends party lines. 

The PAP will continue to stand with you, even when we don’t agree, even if we are from different parties, even when we are opponents.

For you

“Even if you jeer us, we will improve your lives … because we believe in Singapore!”: Ng Eng Hen 

The PAP will continue to work for you to improve lives in Singapore, There are going to be many naysayers, there are going to be many tough choices to be made, but these tough choices will be made in the interest of Singaporeans. Even when people jeer, especially if they jeer. This is what constructive politics is all about, keeping focus and not letting distractions distract you from the goal – serving Singaporeans.

For Singapore

PAP helps rivals to avoid disqualification. Source: Today

PAP helps rivals to avoid disqualification.
Source: Today

An error was spotted by one of the PAP activists in the RP nomination papers in West Coast GRC. He informed Mr Iswaran and he subsequently decided to let the reform party know about the error.

“We want to make sure that the voters of West Coast GRC have a choice. We want to have a fair fight and let the voters choose. I think the RP appreciated the fact that we highlighted this to them and they rectified it,” Mr Iswaran said.

A similar incident happened in Yuhua SMC. How graceful of Grace Fu to point it out to SDP. #NoPunIntended

Minister in PMO Grace Fu, who is the incumbent Member of Parliament for Yuhua SMC, said: “We noted it after it was pasted on the board. So, we highlighted to them and asked them to rectify it. It’s a technical issue and we didn’t want to make it a big issue. We thought the contest would be much better than to have them disqualified.”

These incidents really show that the PAP has the heart for Singapore and Singaporeans. They could have easily not helped and had a walkover and saved themselves 9 days of campaigning. Instead, they helped the opposition parties so that they could put up a good fight, all in the best interests of Singaporeans. This is the true spirit of sportsmanship!

Tan Jee Say style Coalition Government

Immediately after losing his bid to become president, Tan Jee Say set up his own Singaporeans First Party, and announced that he would focus on forming a coalition of opposition parties to contest the next general election in spite of the failed horse trading talks among the opposition parties.

He did an interview with foreign press, and in an article, they quoted him saying:

If the PAP failed to win a parliamentary majority in the next election, one possible scenario was a coalition of opposition parties forming a new government, he said. “The opposition today is more ready than the PAP in 1959 to form a government.” 

Really? Is the opposition of today more than ready to form a government?

Just take a look at their talks prior to the GE when they were deciding who should contest in which constituency. They could not agree with each other.

RP chief Kenneth Jeyaratnam left about half an hour into the meeting, after he said SingFirst insisted on contesting West Coast GRC. “We will try to resolve that with bilateral discussions,” he told reporters. “We contested there in 2011, we’ve been walking the ground.”“SingFirst hasn’t walked the ground there. They have approached a candidate to join them which shows they don’t have enough candidates,” he added.

NSP’s former secretary general Tan Lam Siong was seen outside NSP’s headquarters on Thursday evening. He said he was not present at the talks. “Unless there is a conclusion from tonight’s meeting that gives me a good enough reason to not contest (Potong Pasir SMC), there could be a three-cornered fight. As of now, I insist on contesting in Potong Pasir,” he told reporters.

It could be an issue of ego, no one willing to put their ego aside and come to a compromise.

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It is a surprise that of all opposition politicians, it is Tan Jee Say who comes out to say that the opposition is ready to work together to form a coalition government. He previously exited the Singapore Democratic Party (SDP) to run for presidential elections and when he lost, subsequently formed his own Singaporeans First Party.

Here is what Low Thia Kiang thinks of Tan Jee Say’s great idea.

That belief still stands today, said Mr Low. “I have made it very clear at the Punggol East by-election (in 2013) in my speech … that we have different objectives, different leadership,” he said.

This definitely calls to question his belief that the opposition can work together, and that the opposition has a common belief. Evidently, opposition parties do not see eye to eye. If they can’t even come to a compromise on simple things like where to contest, how are they going to take a common stance when it comes to national issues?

You can have 3 cornered fights over a constituency, but you should not have 3 cornered fights in parliament, within the “coalition government”.