Don't conflate accountability with naming and shaming

Senior health correspondent Salma Khalik argues for the identities of the 12 Singapore General Hospital (SGH) and four Ministry of Health (MOH) staff who were disciplined to be released ("Name those responsible for hep C infections at SGH"; last Saturday).

The commentary makes several pertinent arguments that support the case for revealing their identities. But there are also equally valid, if not stronger, considerations that buttress doing otherwise.

A key element to be considered is the principle of causality.

The comparison made between the hepatitis C outbreak at SGH and the case of an SAF serviceman who died after a training session involving smoke grenades is not quite appropriate.

In the SAF case, it involved a single and quick episode where two officers were clearly responsible for the training session that preceded the tragic death.

In contrast, the hepatitis C outbreak lasted several months and involved quite a few patients who were cared for by dozens, if not hundreds, of healthcare professionals.

Many other staff in supporting roles, such as housekeepers and porters, could also have contributed to the outbreak.

Establishing direct causality and, hence, an individual's direct responsibility for the mortality and morbidity that arose from the outbreak is, therefore, very difficult, if not impossible. Is it then fair to name the 12?

The commentary concludes that doctors and ministry officials must be held accountable, and that public confidence in the system will be "badly eroded" if it is perceived that they get "special protection".

Modern hospital care is team-based, involving many more professionals and staff than just doctors.

There is no evidence to suggest that the 12 SGH staff who were disciplined were all doctors and, hence, enjoying "special protection".

The SGH press release stated that the 12 were in leadership positions and included senior management.

Senior positions in hospitals are typically filled by people from different professional backgrounds. It would be reasonable to think that the 12 may include doctors, as well as nurses, allied health and "lay" managers. Why just single out doctors?

There is some, albeit unhealthy, satisfaction in seeing public servants being named and shamed.

But we must not confuse or conflate accountability with naming and shaming.

It is noteworthy that both SGH and MOH have stated clearly that only senior people were disciplined.

It would be more expedient to punish junior staff if the principle of accountability was not paramount.

Wong Chiang Yin (Dr)

A version of this article appeared in the print edition of The Straits Times on March 23, 2016, with the headline 'Don't conflate accountability with naming and shaming'. Print Edition | Subscribe