MAY 26 — Petaling Jaya requires a public general hospital. This has been widely acknowledged for a long time and is unlikely to be disputed. 

For decades, one of Selangor’s most densely populated and economically significant urban areas has relied on nearby public hospitals in Kuala Lumpur and Shah Alam, as well as on overburdened, small health clinics and the University Malaya Medical Centre (UMMC). UMMC is not legally classified as a government hospital and does not function like one.

However, building a new 800- to 1,000-bed general hospital in Petaling Jaya is not straightforward. 

It may have been so 30 years ago, but no longer. This is not a game of SimCity where a single click-and-drag immediately gets you land, a building, and a fully staffed hospital.

A modern general hospital of around 1,000 beds is not just a building. It is a small township. It needs land, access roads, utilities, parking, laboratories, operating theatres, intensive care units, imaging facilities, kitchens, mortuary services, clinical waste management, infection control systems, digital infrastructure, and a complex logistics and medical supply chain. 

Even setting up a district hospital in PJ similar to the one in Kajang, with around 500 beds, would be a major endeavour.

A general hospital needs thousands of nurses, doctors, pharmacists, allied health professionals, medical assistants, laboratory technicians, administrators, cleaners, engineers, drivers, and maintenance staff. 

Hospital Kuala Lumpur (HKL) has a workforce of around 12,000 healthcare and administrative personnel.  

Where would we find these healthcare workers in a system that is currently suffering from a haemorrhage of personnel, which is unable to retain, recruit sufficiently to replace, or even train to staff new facilities? Even fewer medical graduates are applying for training slots each year.

New places would be forced to cannibalise doctors, nurses, medical assistants, and administrators from existing surrounding hospitals and clinics, diminishing the latter’s capacity to provide healthcare services. 

The 304-bed RM 375.5 million Pasir Gudang Hospital, despite being declared operational in August last year, is struggling to operate with more than 60 per cent of approved positions remaining unfilled.

The capital expenditure to set up a new general hospital today would likely run into a few billion ringgit including the cost of construction, equipment, IT systems, commissioning, and future variation orders. 

The 288-bed Cyberjaya Hospital cost RM508.8 million (approximately RM1.76 million per bed). The proposed PJ hospital would likely cost around RM 2 million per bed at current levels.

Even if the money is approved tomorrow, PJ-ites and the surrounding communities should not expect such a hospital to be operational in three or four years. 

For a project of this scale in a mature urban area, at least 10 years is a more realistic expectation, which translates to at least two editions of the Malaysia Plan. 

The recently cancelled 76-bed Maran Hospital, at RM350 million, was approved under the 11th Malaysia Plan (2016-2020).

Hospital design, especially in tropical climates with hot, humid weather year-round, is also incredibly complex and should never be taken for granted. 

The wrong placement of key rooms and facilities, building orientation, and critical systems such as heating, ventilation, and air conditioning (HVAC) could be disastrous. 

Key issues include severe indoor moisture control problems leading to mould, mildew, and infection risks, and extreme cooling demands that cause sick building syndrome.

Even newly built facilities such as the Sultan Idris Shah Hospital’s Heart Centre and Hospital Al-Sultan Abdullah, have experienced repeated closures and costly repairs to operating theatres due to environmental control issues involving humidity and air conditioning. 

A simple design mistake could cause years of ongoing repairs and infection-control battles, draining millions of ringgit and continuing the closures of key services.

This is the tragedy.

Petaling Jaya should have had a public hospital decades ago. Previous federal governments failed to see the urgency and could not find the funds in their budgets. 

State governments passed the buck to the federal government. They allowed a major city to grow around private hospitals, commercial developments, highways, and high-density housing, but not around a proper public general hospital. 

What we are seeing today is not a sudden crisis. It is the result of years of deferred responsibility.

The current state and federal governments are now being asked to solve an old problem at today’s prices, under today’s constraints, and during one of the most uncertain global periods in recent memory.

As a result of the crisis in the Strait of Hormuz and the government’s dogged determination to maintain cheap RON95 prices at the pump, Malaysia’s fossil fuel subsidy bill is currently around RM7 billion per month.

That figure should shock every policymaker. RM7 billion in one month is enough to finance major health infrastructure, upgrade hospitals, expand cancer treatment, strengthen primary care, increase salaries, and build resilience into medical supply chains. 

It certainly would be enough to construct the general hospital that Petaling Jaya needs. Instead, Malaysia continues to burn enormous public resources keeping fossil fuel consumption artificially cheap.

The issue is not whether people need help with the cost of living. They do. The issue is whether broad fossil fuel subsidies are the most intelligent use of scarce public money when hospitals are overcrowded, health workers are exhausted, medicines are subject to supply shocks, and communities like Petaling Jaya still lack basic access to public hospitals.

We cannot keep saying there is no money to pay our healthcare workers better, to build clinics and hospitals, while spending billions each month subsidising petrol and diesel. That is not fiscal prudence. It is a policy failure.

However, the answer should not be to rush blindly into a mega-hospital project that will take a decade to complete. Petaling Jaya needs public hospital services now, not in 2036.

A more practical solution is available.

The federal government should seriously consider leasing one of the existing medium-sized private hospitals in Petaling Jaya and taking over its entire operations as a public hospital, either temporarily for 10 to 15 years or permanently through a negotiated acquisition or long-term concession.

This would not be a small outpatient outsourcing arrangement. It should be a full operational takeover. 

The Ministry of Health would lease the facility, contract existing staff, retain essential clinical teams, and convert services to public hospital rates. 

Emergency care, internal medicine, general surgery, obstetrics and gynaecology, paediatrics, orthopaedics, radiology, pharmacy, and specialist outpatient clinics could be phased in much faster than a healthcare facility built from scratch.

Petaling Jaya already has several private hospital facilities. The government should examine which facilities could be leased, converted, or integrated into the public system at the lowest cost and fastest speed.

This approach would not eliminate the need for a future purpose-built public general hospital. However, it would prevent another decade of waiting. 

It would immediately increase public hospital capacity in PJ, and reduce pressure on UMMC and neighbouring hospitals. 

It would give the government breathing room to plan a proper long-term facility without having to make desperate decisions.

There will be objections. Some will say private hospitals are too expensive to take over lock, stock and barrel. 

Others will say private facilities are not designed like public hospitals. Staffing will remain a problem. 

All true, but this proposal can be adapted faster than bare land can be turned into a functioning tertiary healthcare facility.  

Staffing a leased operational hospital may be easier and more cost-effective than building, equipping and staffing a brand-new hospital.

Petaling Jaya deserves a public hospital. But it also deserves honesty, realistic expectations and not populist rhetoric. 

A new 800- to 1,000-bed hospital will be expensive, complicated, manpower-intensive, and slow. The opportunity to build it cheaper and earlier was lost by previous governments.

The task now is not to repeat old mistakes in a more expensive form. The task is to deliver public tertiary healthcare services quickly, responsibly, and at scale. 

Leasing and converting an existing private hospital may not sound grand. However, it may be the fastest and most cost-effective way to give Petaling Jaya what it has been denied for far too long.

* Azrul Mohd Khalib is the Chief Executive of Galen Centre for Health and Social Policy.

** This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.