The Financial Times has today reported that Beckton Dickinson (“BD“) – a New Jersey based medical technology company – is set to acquire Bard (a healthcare equipment manufacturer) for USD 24 billion in cash and shares.

One of the reasons cited by BD’s chief executive in connection with the acquisition is that it would:-

“…accelerate our ability to offer more comprehensive, clinically relevant solutions to customers and patients around the globe. . . [and] generate outstanding value both near- and long-term for shareholders.”

[emphasis added]

The activity in the industry is not surprising, given the scope for the development, implementation and use of medical technology in the treatment of patients.

A related question which arises, however, is the legality of, and extent to which, surgeons or doctors based overseas would be in a position to provide medical care and advice – and even conduct procedures on – patients based in Singapore, a practice known as telemedicine.

Singapore strictly licences and regulates the practice of medicine in Singapore – and with good reason. However, to what extent does such tight regulation curtail the development of telemedicine and legitimate options available to patients?

It’s not difficult to envisage a scenario where a Singapore-based patient seeks a specific type of procedure, which can be conducted remotely by a specialist in a foreign country through the use of remote surgical robotics.

The Medical Registration Act (the “MRA”)

Under Singapore law, the MRA is the sole piece of legislation which governs the licencing and practice of medicine in Singapore. Whilst there is local literature dealing with the practice of telemedicine as between clinics and hospitals within Singapore, there is nothing which addresses the cross-border practice of telemedicine.

To the contrary, Section 13 of the MRA prohibits any person practicing as a medical practitioner unless that person is registered under the MRA and has a valid practicing certificate. In a situation envisaged in the example above, the foreign surgeon in question would be neither registered nor appropriately certified.

Whilst there are exceptions which allow for a foreign doctor to obtain emergency registration, or registration for educational purposes, these exceptions are cumbersome and generally exercised on a case by case basis.

This is the reason why patients would more often than not have to fly to the specific country where the medical practitioner is located to have the procedure done in that country. This creates obvious problems, since sometimes flight is not possible.

What creates even more instability is that the practice of medicine in Singapore – which a remote, surgical procedure would constitute – without a valid licence or registration will constitute a criminal offence generally justifying a custodial sentence.

Moreover, in guidance issued by the Singapore Medical Council, the SMC advised that foreign-qualified doctors should refrain from providing medical services or carrying out any procedures without a valid licence.

Analysing the law and the SMC’s pronouncements, one can understand why Singapore is not a friendly jurisdiction for international telemedicine to flourish.

Legislating Telemedicine & Concluding Observations

As medical technology continues to advance, Singapore must keep pace and allow – in some way, shape or form – the practice of international telemedicine. True, it is necessary to regulate the process, but the present regime does not allow for any such practice whatsoever.

As a health services hub, and one of the countries possessing some of the most advanced surgical equipment and robotics, Singapore should consider when and how to best incorporate the practice of international telemedicine.

From a present reading of the MRA, this would only seem capable with legislative amendment. To keep apace, and to harness overseas expertise from top specialists around the globe, Singapore should develop a framework to licence the conduct of remote procedures by foreign doctors.

This may after all, be in the patient’s best interests.

24 April 2017

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