LegCo Panel on Health Services

Closed Meeting

Action

Members agreed to discuss the following at the next meeting to be held on 9 December 1996:

(a) Communication between public hospitals on transfer of patients;

(b) Transfusion of wrong blood to a patient at Queen Elizabeth Hospital and procedure for checking blood for transfusion; and

(c) Control of Chinese proprietary medicines.

2. Members also agreed to schedule the following for discussion at the meeting on 13 January 1997:

(a) Manpower shortage of nurses;

(b) Manpower problem of Siu Lam Psychiatric Centre; and

(c) Review of the health care system pending completion of its report by December 1996.

(Post-meeting Note: the agenda for the meeting on 9 December 1996 was subsequently revised as follows -

(a) Monitoring of the quality of clinical services in public hospitals;

(b) Manpower problem of Siu Lam Psychiatric Centre; and

(c) Control of Chinese proprietary medicines

3. Members agreed to postpone discussion on the waste of blood at the blood bank of the Hong Kong Red Cross to a later stage when the independent committee had completed its investigation report on the matter.

4. Dr LEONG Che-hung briefed members on the questions he wanted to raise under agenda items II and III of this meeting. Members discussed and agreed on the approach to conducting the discussion on these two items.

Open Meeting

I. Confirmation of minutes of meetings held on 9 September and 3 October 1996 and matters arising

(LegCo Paper Nos. CB(2) 380/96-97 and 134/96-97)

5. The minutes of meetings held on 9 September and 3 October 1996 were confirmed.

Manpower problem of Siu Lam Psychiatric Centre (SLPC)

6. Mr Clement CHEUNG reported that following some discussions at the working level between the Health and Welfare Branch (HWB) and the Security Branch (SB), there were some technical difficulties in proceeding with the independent review of nursing manpower requirement at SLPC. Members agreed that representatives from SB would be invited to attend the next meeting to elaborate on such technical difficulties. The Administration would provide some relevant information on this subject to the Panel before the meeting.

Clerk

Adm

II. Private practice by University medical consultants and specialists

(LegCo Papers Nos. CB(2) 378/96-97(01) and 386/96-97)

7. Dr YEUNG Sum and Dr LAW Chi-kwong declared interest as employees of the University of Hong Kong (HKU).

8. Referring to the letter dated 6 November 1996 from HKU, the Chairman clarified that the questions raised on this item represented questions from the Panel as a whole and should not be regarded as questions raised personally by Dr LEONG Che-hung.

9. Mr FRENCH reiterated that it was a common practice in Universities world-wide that academic staff were permitted or even encouraged to undertake outside practice so far as it benefited their teaching and research. In the case of clinical medicine and dentistry, the community also benefited from the expert knowledge and specialist skills of the University which were not otherwise available to the community. He said it was also necessary for the University medical and dental staff to keep their clinical skill in practice which could be achieved by attending to public and private patients.

10. Mr FRENCH stressed that all the institutions funded by the University Grants Committee (UGC) had established procedures and guidelines governing their staff’s engagement in outside practice. In general, a staff member had to seek prior permission from his head of department and, in some cases, the head of the institution concerned. The criteria adopted in considering such applications were:

(a) that the outside practice did not affect the normal duties of the staff in the university nor constitute any conflict of interest; and

(b) the aggregate time spent on the outside practice should not exceed an average of about one working day per week for the clinical, medical and dental staff of the two universities.

11. Mr FRENCH invited members’ attention to the letter from Professor YOUNG of HKU which provided information on the following points concerning HKU and the Prince Philip Dental Hospital (PPDH) -

(a) the operation of the patients referral system;

(b) the private fee paying patients scheme of PPDH;

(c) the measures taken by the University to avoid direct competition with private practitioners;

(d) honoraria derived from private practice and received by the staff of the medical faculty represented only 2% of their total income whereas honoraria to the staff of the Dental Faculty represented a little more than 8.5% of their total income; and

(e) the student contact hours with full-time and part-time staff of the University’s Dental Faculty as requested by members at the previous meeting.

Mr FRENCH added that at Annex D of the paper submitted by UGC, the Chinese University of Hong Kong (CUHK) had also provided figures on income generated from private practice of its clinical staff which represented less than 4% of total remuneration of medical staff concerned.

12. Members noted the contents of the letter issued by Professor S H Y WEI and Mr M E PEAKE to clarify the statistics presented to the Panel at the meeting on 9 September 1996 on the time spent by the staff of the

Dental Faculty of HKU on outside practice. Mr FRENCH reported that a press release had also been issued by HKU to clarify the misinterpretations, for which he apologised on behalf of UGC and the institutions concerned.

13. Professor YOUNG supplemented that HKU had been monitoring the medical and dental staff’s engagement in outside practice also by way of a reporting system. Each teacher who had undertaken outside practice should report, following the end of the outside practice year (i.e. ending on March 31), details of the income earned and time spent on such work to the Vice-Chancellor and the University Council for monitoring use. Professor YOUNG also confirmed that the money received by a department from its staff undertaking outside work was all spent on teaching and research related activities.

14. Professor Joseph LEE informed the Panel that the situation in CUHK was similar to HKU with more or less the same restrictions and guidance laid down governing the clinical staff in undertaking outside practice. As CUHK had not submitted any paper, Professor LEE agreed to provide an information paper to the Panel after the meeting.

CUHK

15. Dr LEONG Che-hung clarified that the Panel was concerned about the system of checks and balances adopted by the university administration rather than exact earnings of individual clinical or dental staff concerned. As both HKU and CHUK were funded by taxpayers’ money, their administration systems should be accountable to the public and not open to abuse. Dr LEONG said that he honoured the academic autonomy of universities but it should not be the basis for exemption of universities from public scrutiny. In particular, the administration system of the universities was in no way a "total taboo" as what the UGC representative had said at the last meeting. In response, Mr FRENCH regretted that it was a misunderstanding on the UGC’s stance and he clarified that the role of UGC was essentially to monitor the development, funding, activities, and the rules and regulations of the two universities and the six other tertiary institutions. The point that UGC had intended to make was that the primary responsibility for matters like outside practice rested with the universities, which were themselves statutorily autonomous tertiary institutions directly answerable to the public as well. He assured that there were various channels for the public and the Government to monitor or obtain information on the activities of the universities. The checks and balances system had functioned well by way of the universities reporting to UGC and UGC reporting to the Government and LegCo. Professor YOUNG supplemented that the monitoring system of HKU was clearly spelt out in the Memorandum of Guidance of HKU (the Memorandum).

16. In response to Mr Howard YOUNG’ enquiry, Professor YOUNG explained that the medical staff of HKU undertaking private practice had charged patients in accordance with the amount stipulated by the Hospital Authority (HA). She informed that there was no medical staff in HKU receiving a net earning up to 60% of his clinical professorial average annual salary; and they had been complying with the regulation that they could spend at most one working day per week on private practice.

17. Professor YOUNG further explained that of the fee received from a private patient, 25% would go to HA or PPDH as appropriate. The remaining 75% would be distributed as follows -

(a) if the medical staff member was covered by the remuneration package offered by HA, 10% of the remaining 75% went to the University and the rest to the relevant department; and

(b) if the staff member was not covered by the HA package, which would be very rare, 10% of the remaining 75% went to the University. Of the remainder, 60% went to the department and 40% would be kept by the staff, which meant that the staff would retain no more than $30 out of a fee of $100 charged.

18. Professor Joseph LEE reported that the case of CUHK was similar and their medical staff also charged in accordance with the gazetted fees issued by HA. The percentages of the distribution of the fees collected were more or less the same as HKU’s.

19. Dr LEONG Che-hung queried whether it was necessary for the medical staff to keep abreast of the latest professional skill by undertaking outside work. He considered that the same purpose could be achieved by attending public patients. Dr LEONG further quoted the recent media reports disclosing that there were university medical staff offering regular sessions in private clinics and, in another case, being the director of a fee-charging medical centre. Dr LEONG considered that these were examples showing that the system of outside practice had been abused. He also questioned why the Universities needed extra funding from the fees charged on private patients since the Universities had been receiving substantial financial subsidies from UGC.

20. Mr FRENCH requested to be provided with the details of the cases quoted by Dr LEONG for investigation by UGC and the Universities, which would further decide on whether any disciplinary action was required if the staff members were found in breach of the regulations governing outside practice. Dr LEONG agreed to forward copies of the newspaper reports to Mr FRENCH for his further action. Dr YEUNG Sum requested UGC to furnish the Panel with the investigation report afterwards.

UGC

21. Mr FRENCH agreed that the Government had been increasing significantly subsidies to support the research and academic activities of the Universities over the past few years. This, however, did not mean that it was undesirable or unnecessary for the medical staff to engage in outside practice and to use some of the income generated to supplement their research funding, which were in fact very common and world-wide practices. Professor YOUNG supplemented that their private patients were referred by private practitioners because the patients were in need of the specialist skill which was only available in the University. She added that the practice not only allowed the patients a choice but also helped to save government funds indirectly. Professor YOUNG explained that departments were in need of extra money to subsidise, for example, the junior medical staff to attend overseas seminars or training; and to organise local medical seminars for all the medical practitioners in Hong Kong to participate. Professor Joseph LEE pointed out the amount of subsidies granted to the local universities were minimal as compared with some overseas universities. To keep abreast of the latest professional development, it was essential for the universities to invest on training programmes for themselves. As UGC provided no funding for these sorts of activities, the only source was the income generated from private practice. Mr FRENCH also opined that private practice was not totally unrelated to the medical staff’s advancement of his skill and knowledge. In some cases, it proved to be of value to the teaching and research of the staff as well. In fact, it had been the objective of the Government to encourage private industries to increase their support to the research activities in the universities which would be beneficial to the whole society as well. However, Dr LEONG objected that support from private sector was comparable in nature with private practice as the former would not reduce the time of the staff spent on his normal duties in the university. Mr FRENCH agreed that the primary responsibilities of the staff were teaching and research and that was why there were rules and regulations laid down to govern their engagement in private practice.

22. Referring to the cases of university medical staff running private clinics quoted by Dr LEONG Che-hung, Professor YOUNG said that staff of HKU were not involved as the Memorandum did not allow any direct practice and all the medical consultation had to be conducted at the clinics of the medical department in the University. She also stated that it was not allowed in HKU for any medical staff to owe shares or to run any medical service institutes outside campus. Professor Joseph LEE read out CUHK’s rules governing private practice by medical staff which were broadly in line with those promulgated by HKU. He said any outside practice of their medical staff, be it paid or unpaid, had to be reported to CUHK for record. At the moment he had no details on the cases reported by the media.

23. Responding to the Chairman’s question, Mr FRENCH explained that the role played by UGC was to ensure that the universities were applying their own rules properly, which were being examined from time to time by the University Council and the University Senate in collaboration with UGC.

24. In response to a question asked by Professor Joseph LEE, members clarified that the Panel did not intend or have any power to order the staff to refrain from undertaking any private practice.

25. The Chairman concluded that the Panel would further decide on whether it was necessary to review the existing rules and regulations of the universities after the investigation report to be compiled by UGC on the aforesaid media reports was received. The Chairman also requested UGC to include in the report an explanation on how they executed the role of monitoring the appropriateness of the universities’ rules and regulations.

UGC

III. Follow-up on role and governance of Prince Philip Dental Hospital

(LegCo Paper No. CB(2) 378/96-97 (02) )

26. Dr Iris BUDGE-REID introduced the paper submitted by the Administration by explaining the different sources of funding and general principle governing the level and use of the "block grant" for the Faculty of Dentistry and the "deficiency grant" for the PPDH. She stressed that the latter was intended to cover the cost of teaching-related care functions. She informed the Panel that the level and purposes of the deficiency grant were under review pending further information to be furnished by the University. She reported that, among other things, it had been suggested that the Secretary for Education and Manpower (SEM) should be more directly involved in the overseeing of PPDH. However, a decision on this was pending further clarification from PPDH on the nature of the problems which such a decision would be intended to address.

27. Dr LEONG Che-hung clarified that the adequacy of the deficiency grant or whether SEM should be involved in the management were not matters of concern to the Panel.

28. With reference to the figures provided by Professor YOUNG in her letter regarding the earnings and expenditure by the Faculty of Dentistry, Dr LAW Chi-kwong asked why it was zero under the direct expenses. In reply, Professor YOUNG explained that the direct expenses had already been covered by the 25% overhead charge paid to PPDH from the dental staff’s income earned from private practice (para. 17 above). As for the Faculty of Medicine, the direct expenses were absorbed by the earnings deducted for the University, which was the 10% of the remaining 75%.

29. With reference to the same table, Dr LAW further enquired why the number of private patients handled by the Department of Children’s Dentistry & Orthodontics (CDO) was surprisingly large. Professor WEI said that the number of 1,243 represented the total number for the year handled by altogether eight consultants. The number of cases was relatively high because CDO specialists were not available in the private sector. Professor WEI informed that the number of such cases for public patients was about ten times more. He explained that Annex A of the LegCo Paper No. CB(2)1748/95-96 actually indicated that the aggregate time spent on private patients by PPDH dental staff only ranged from 8% to 98% of the time allowed for outside work. In other words, no one was in breach of the University’s regulations.

30. In response to the enquiries of Dr LEONG Che-hung, Professor WEI explained the long waiting list of patients for CDO during the first quarter of 1996 was mainly due to the constantly high demand for orthodontic care and shortage of funding in that reporting year which had resulted in zero intake of postgraduate students of Orthodontics. Improvements had subsequently been made and the waiting list was much shortened now with a few dozens only remaining on the list. This year the intake of postgraduates in Orthodontics was the highest as compared with other disciplines and it would take three years for the postgraduates to complete their studies. Dr LEONG remarked that since there had been a shortage of postgraduates of Orthodontics, PPDH should not have accepted the 1,243 private patients in the first quarter of 1996 thereby further prolonging the waiting time of the public patients. Professor WEI clarified that the number of 1,243 included the combined cases of both Children’s Dentistry and Orthodontics, which were two separate subjects. He stressed that in any case they could not turn away any patients approaching them. In admitting private patients, PPDH had strictly adhered to the following principles -

(a) If there was no teaching value, the patient would have to be referred to private sector to avoid competition with the private practitioners. For example, in the first quarter of 1996, there were 869 patients referred by PPDH to the private sector after the first consultation. Only three of them were later referred back to PPDH. However, if the required specialist was not available in the private sector to handle the patient, PPDH would handle the case and the patient might be treated as public patient;

(b) All the private patients had to be referral cases from outside such as from the private sector, charitable organisations and government clinics; and

(c) With private fee paying patients, their cases could be used for teaching purposes if the patients agreed. In fact, of the total patient visits to PPDH, less than 5% were by private fee paying patients.

Professor WEI reported that every month the clinicians had to certify their number of private practice sessions. The department head then collated the information and certified it to the University and the Hospital that the clinicians had not exceeded spending one day (or two half-day sessions) per week on private practice. Professor WEI said the majority of the clinicians were in fact spending less than 10% of the time permitted for them to undertake private practice.

31. Professor YOUNG informed that a Faculty Outside Practice Committee had been recently set up in HKU to exercise further control on the system of outside practice. It comprised representatives from various departments of the Medical Faculty and was directly responsible to the University Council. In response to Dr LEONG’s comment that the Committee was not transparent enough with no outsider, Professor YOUNG said it was a peer monitoring mechanism.

32. There being no other business, the meeting ended at 10:45 am.

Legislative Council Secretariat
15 January 1996