Prescription for doctors

Updated: 2014-09-02 07:18

By Andrea Deng(HK Edition)

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Prescription for doctors

Medical authorities are ready to clamp down on 'bad doctors' after a fresh spate of medical misadventures stirred renewed public alarm. The Hospital Authority's top management has responded to an outcry raised by the Medical Council of Hong Kong, writes Andrea Deng.

Changes are in the offing. A stricter, tighter supervision of medical staff, leading to more stringent disciplinary action in the public interest, would be in effect soon, China Daily has learned.

"We must renovate our current public complaint system to sift through the facts and make sure that doctors guilty of negligence and other medical misconduct cannot settle a case with a payoff," Joseph Lau Wan-yee, chairman of the Medical Council, told China Daily.

Lau described the current system for dealing with medical errors as a mediation process: the hospital apologizes for the error, patients consider the case closed. Patients who remain dissatisfied after the talks are offered compensation. Lau complained that serious incidents, including those involving medical malpractice, gross negligence and sometimes even unethical conduct, have been effectively covered up in such a manner. The errant physician is allowed to carry on in practice, even though circumstances may demand further investigation and disciplinary action.

Former president of the Public Doctors' Association, Kenneth Fu Kam-fung, who resigned from a public hospital in June, resonated with Lau's view. "The current incident reporting system is fine but there are huge variances in the seriousness of cases. Yet most of the time the Hospital Authority (HA) does nothing of substance after the cases are made known to the public," said Fu.

Rising medical mishap

In the past six months or so, the public has heard of medical incidents which to the layman appear unacceptable. A 50-year-old patient with asthma and heart problems was improperly administered a double dose of his prescribed medication by a member of the radiology department at Queen Elizabeth Hospital. The patient died six days later. In February a 75-year-old patient under treatment for heart failure was transferred from Yan Chai Hospital to Princess Margaret Hospital after suffering a heart attack. Medical staff neglected to turn on the equipment needed to keep his blood circulating during the ambulance ride. A few hours later, the patient was dead. Cardiovascular specialists say failure to use the equipment may be a case of negligence by medical staff.

Incidents like these, although widely reported in the media, were not listed in the HA's seasonal Risk Alert, a record of incidents intended to shed light on risks to patients, to try to prevent their recurrence. The periodical noted, however, that between the fourth quarter of 2013 and the first quarter this year 12 out of 27 "sentinel events" involved "remained instruments or other materials (left inside the patient) after surgery".

Prescription for doctors

"Some of these reported incidents might be a result of a faulty system inside the HA. If that is the case, HA is bound to solve the problem. But of all those foreign body cases, you're telling me that none of those involve human error? And in none of those cases should anyone be accountable? (Medical staff) can't even count from one to ten?" Lau demanded. He was referring to a simple practice that has been in place for decades. It required nurses to count used medical instruments before surgery concluded, to ensure that no instrument was left inside a patient's body.

Despite the frequency of errors, Lau said, only four medical mishaps were referred by the HA to the Medical Council for further action between 2006 and 2011. He was skeptical that only four cases in five years were deemed serious enough for referral to the Medical Council.

Statutory authority

Lau noted that the HA is a service provider and that it should not assume the responsibilities of the Medical Council, the statutory body which oversees medical licensing and discipline.

He said that he was not advocating that the HA's current public complaint system be abolished. The HA should carry out the first stage of examination of incidents and pass on the findings to the Council to assess and decide whether sanctions were warranted, he contended.

"I have already talked to Professor John Leung (who took over the chairmanship of the HA last October). He agreed there were problems with the current public complaint system, and promised to arrange a meeting for me with senior management. Leung acknowledged the Medical Council - not the HA - as the statutory body. I also had a brief, unofficial chat with Dr Leung Pak-yin (chief executive of HA). He also promised to arrange an official meeting," said Lau.

He says if the HA does not deem a case appropriate for referral to the Medical Council, then the HA must provide an explanation as to why the case does not involve the public interest.

"Doctors make mistakes because they have poor knowledge or poor skills that are not up to the latest medical standards. We cannot accept doctors prescribing medicine or using treatment methods previously dismissed as faulty or inadequate. If such a doctor is referred to us, we might suspend him and require him to continue medical education until he achieves a satisfactory standard. He may continue to practice, but only under supervision over a certain period of time," said Lau.

The Medical Council, he said, would adopt an evaluation system similar to the one in the UK to investigate medical incidents - in which misadventures are evaluated by a peer group of the doctor under enquiry.

Lau cited a case the Council investigated, in which a doctor failed to identify a cancerous tumor in a patient's lung. The Council asked a dozen other doctors to assess the patient's x-rays.

Everyone correctly identified the tumor. The Council ruled that the doctor under enquiry had failed to meet the standard necessary for a practicing physician.

"I understand that some doctors are nervous (about tighter regulation). Everyone makes mistakes, including medical professionals. But if we tolerate some mistakes made by doctors, our medical standard will be seriously depreciated," said Lau.

Contact the writer at andrea@chinadailyhk.com

Prescription for doctors

Prescription for doctors

(HK Edition 09/02/2014 page9)