Legislative Council

LC Paper No. CB(2) 2712/98-99

Ref : CB2/BC/18/98

Bills Committee on Chinese Medicine Bill
Minutes of meeting held on Tuesday, 13 April 1999 at 8:30 am
in Conference Room A of the Legislative Council Building

Members Present:

Prof Hon NG Ching-fai (Chairman)
Hon David CHU Yu-lin
Hon HO Sai-chu, JP
Hon Michael HO Mun-ka
Hon LEE Kai-ming, JP
Hon Mrs Selina CHOW LIANG Shuk-yee, JP
Hon Ronald ARCULLI, JP
Hon CHAN Yuen-han
Dr Hon LEONG Che-hung, JP
Dr Hon Philip WONG Yu-hong
Hon YEUNG Yiu-chung
Hon Ambrose LAU Hon-chuen, JP

Members Absent :

Hon Cyd HO Sau-lan
Hon LUI Ming-wah, JP
Dr Hon TANG Siu-tong, JP
Hon CHOY So-yuk
Hon SZETO Wah
Hon LAW Chi-kwong, JP

Public Officers Attending :

Mr Gregory LEUNG Wing-lup, JP

Deputy Secretary for Health and Welfare 1

Miss Eliza YAU

Principal Assistant Secretary for Health and Welfare (Medical) 1

Miss Miranda NG

Senior Assistant Law Draftsman, Department of Justice

Dr LEUNG Ting-hung

Assistant Director of Health (Traditional Chinese Medicine)

Attendance by Invitation :

The Association of Licentiates of Medical Council of Hong Kong

Dr LI Sum-wo
Dr Alexander NG

The Medical Council of Hong Kong

Prof. Felice Lieh Mak (Chairman)
Dr LEE Kin-hung
Dr David FANG
Dr LO Wing-lok

Hong Kong Medical Association

Dr SO Kai-ming
Ms Yvonne LEUNG

Practising Chinese Medicine Practitioners

Mr TSUI Man-long
Mr YAU Chin-pong
Ms YICK Kit-ching
Mr FONG Seng

Qigong Practitioner

Mr YIP Lai-lam

International General Chinese Herbalists and Medicine Professionals Association Ltd

Mr NG Cheuk-lam
Mr CHEUNG Hong-ming

One Country Two Systems Research Institute

Mr SHIU Sin-por
Ms Queenie LEE

Timeless Software Limited

Dr Lloyd YAM

International Association (HK) for Chinese Manipulative Medicine

Mr LAM Shu-fan

Past Students' Association of Traditional Chinese Medicine Practitioners, School of Professional and Continuing Education, University of Hong Kong

Mr NG Kwok-chi
Mr MOK Ying-fan
Ms WONG Fan-oi
Ms LAM Shuet-ching
Ms LAI Shuet -ching

The Hong Kong Medicine Dealers' Guild

Mr FONG Chun-chun
Mr WONG kai-cheong

Clerk in Attendance :

Ms Doris CHAN

Chief Assistant Secretary (2) 4

Staff in Attendance :

Mr LEE Yu-sung

Senior Assistant Legal Adviser

Ms Joanne MAK

Senior Assistant Secretary (2) 4

---

I. Meeting with deputations

The Chairman welcomed the deputations to the meetings.

The Association of Licentiates of Medical Council of Hong Kong
(LC Paper No. CB(2) 1608/98-99 (03) )

2. At the Chairman's invitation, Dr LI Sum-wo of the Association of Licentiates of Medical Council of Hong Kong made the following points -

1. A standardized assessment system was required for evaluation of the standards of all Chinese medicine practitioners (CMPs) in order to establish their professional status;

2. The membership of the future Chinese Medicine Council (CMC) should include CMPs and those from outside Hong Kong to ensure transparency and fairness of its examinations and assessments;

3. Some of the existing medical practitioners had received formal university training in Chinese medicine in the Mainland. In the treatment of patients, they prescribed proprietary Chinese medicines for the patients and some of them used acupuncture as well. In view of their experiences and training, Dr LI suggested that these medical practitioners should be allowed to continue practising Chinese medicine after the registration system for CMPs was in place;

4. The Practitioners Board should include members from the Association of Licentiates of Medical Council of Hong Kong; and

5. To avoid over-supply of Chinese medicine graduates, the relevant degree course should be provided by one tertiary institution only at the initial stage after commencement of the regulatory system.

Medical Council of Hong Kong (HKMC)
(LC Paper No. CB(2) 1662/98-99 (01) )

3. Speaking on behalf of HKMC, Dr LEE Kin-hung made the following points -

1. The medical sector was supportive of setting up a registration system for CMPs;

2. The scope of "practising Chinese medicine" was not clearly defined in the Bill. A clear distinction should be made in the law between the practice of western medicine and that of Chinese medicine;

3. An exemption clause should be added in section 108(3) of the Bill specifying that "subsection (2) shall not apply to any treatment by way of modern scientific method by a medical practitioner registered under the Medical Registration Ordinance" (MRO).

4. The Bill did not specify whether or not CMPs would be allowed to use titles like .

5. Only registered medical practitioners should be allowed to practise western medicine and only CMPs could practise Chinese medicine as HKMC believed that only graduates who had completed the relevant medical studies were competent to practise the particular kind of medicine.

Hong Kong Medical Association
(LC Paper No. CB(2) 1675/98-99 (03) )

4. Dr SO Kai-ming spoke on behalf of the Hong Kong Medical Association and pointed out that the definition of "practising Chinese medicine" given in the Bill was not clear which might create much confusion to the public and hamper the long-term development of Chinese medicine in Hong Kong.

5. Mrs Selina CHOW was concerned about the definition of "modern scientific method" and questioned whether acupuncture was an example of it. In response to Mrs Selina CHOW's enquiry of the need for inclusion of the exemption clause as proposed by HKMC, Dr David FANG of HKMC said that it was because there were grey areas which could not be easily defined as within the scopes of Chinese medicine or western medicines. For example, many western medicines were actually developed from herbs and the prescription of such medicines might be mistaken as practising Chinese medicine. Moreover, the proposed exemption clause would just be similar to clause 31 of MRO by which exemption was granted to CMPs when they practised on the basis of traditional Chinese medicine. Mr Michael HO agreed that such grey areas were in existence, such as the fact that some existing medical practitioners were using acupuncture in their treatment of patients. He suggested resolving the problem by providing an exemption clause to the Bill or making consequential amendments to the related ordinances.

6. In view of the general concerns about the scope of "practising Chinese medicine", Dr LEONG Che-hung enquired whether the Administration would define it more clearly under the relevant subsidiary legislation. He questioned whether it would be more specific to re-name the Bill as the "Traditional Chinese Medicine" Bill. Professor Felice LIEH MAK of HKMC supported Dr LEONG's suggestion. However, Mr Michael HO disagreed that the Bill should be so re-named since the Bill was meant to regulate modern CMPs and to provide for the future development of Chinese medicine.

7. Dr SO Kai-ming of the Hong Kong Medical Association drew members' attention to the meaning of "practising Chinese medicine" given under clause 2 in the Bill which stated that "practising Chinese medicine means such act or activities" (like diagnosis, treatment, prescription and so on) carried out "on the basis of traditional Chinese medicine". He pointed out that the scope described seemed to be contradictory with the expectations of Mr Michael HO. In addition, Dr SO was concerned about whether disputes would arise as to the distinction between the practice of Chinese medicine and that of western medicine. For example, the method commonly used in the consultation process by CMPs was also used by some medical practitioners.

8. Dr LO Wing-lok of HKMC took the view that there must be such grey areas as said. He considered that Chinese medicine and western medicine were complimentary and suggested that the training in Chinese medicine should provide opportunities for students to learn about western medicine so that they would know when they should refer patients to see a medical practitioner. Likewise, he supported that the training in western medicine should include some courses on Chinese medicine.

9. Dr LEONG Che-hung commented that it was necessary for the Bills Committee to look at the following three groups of people -

1. existing medical practitioners using both Chinese medicine methods and western medicine methods;

2. some CMPs using methods in western medicine; and

3. existing medical practitioners using methods in Chinese medicine in the treatment of patients.

10. In response to members' enquiries, Dr LI Kin-hung said that HKMC had no objection to the use of titiles like
by CMPs so long as the Bill provided for the use of these titles by them. Dr LI took the view that acupuncture should not be used by a health care professional if the traditional training and theories of his/her discipline had no mentioning of such method.

11. Dr Philip WONG Yu-hong considered that for the benefit of the long-term development of Chinese medicine and western medicine, no one could say for sure what activities/methods that Chinese medicine and western medicine should or should not include. For example, he considered that it was not impossible for CMPs to perform operations in the future.

Mr TSUI Man-long, Mr YAU Chin-pong and Ms YICK Kit-ching (Practising CMPs)
(Enclosure (5) to LC Paper No. CB(2) 1418/98-99)

12. Mr TSUI Man-long made the following points -

1. Most of the existing CMPs had not received formal university training in Chinese medicine. The proposed requirement of having 15 years' continuous practising experience for registration could not really guarantee the standards of the CMPs. Details as to how to assess the years of practice in the cases of part-time CMPs should be specified;

2. For the interest of public health and the long-term development of Chinese medicine, all CMPs should be required to sit for examinations in order to be registered. Reference could be made to the relevant examinations held in the Mainland in setting the examinations;

3. It should be shown on a CMP's practising certificate as to whether or not the CMP concerned had completed formal training in Chinese medicine or had learnt it by private studies;

4. A gradual approach should be adopted for the implementation of the registration system. The self-regulatory system for Chinese medicine should be implemented by phases only after the first batch of Chinese medicine graduates coming out as they had received formal university training.

5. It was ridiculous that those who pocessed 15 years' experiences could register direct whereas those who had less than 15 years' experiences but had completed formal training in Chinese medicine in the Mainland had to sit for the registration assessment.

Mr FONG Seng (a practising CMP)
(Enclosure (1) to LC Paper No. CB(2) 1543/98-99 and CB(2) 1675/98-99 (02)

13. Mr FONG Seng considered that it was unacceptable to register a CMP just based on his years of practising experience as such critierion had no guarantee on the CMP's professional standard. He requested that all applicants for registration must sit for examinations. He held the view that part-time CMPs should be allowed to sit for examinations for registration.

Mr YIP Lai-lam (a qigong practitioner)
(LC Paper No. CB(2) 1608/98-99 (04) )

14. Mr YIP Lai-lam suggested that the regulatory system should cover "qigong" and advocated that the Administration should promote "qigong" to the public and the development of "qigong" in Hong Kong.

International General Chinese Herbalists and Medicine Professionals Association Ltd
(LC Paper No. CB(2) 1655/98-99 (02) )

15. Mr NG Cheuk-lam of International General Chinese Herbalists and Medicine Professionals Association expressed support for the Bill and its proposals. He further made the following points -

1. the Administration should seek to promote the development of Chinese medicine by taking the following meausres -
   1. incorporating Chinese medicine into the health care system and CMPs should be allowed to refer patients to see medical or other health care practitioners as appropriate;

   2. establishing Chinese medicine research institutions and Chinese medicine hospitals;

   3. providing Chinese medicine courses in tertiary education and subsidising education on Chinese medicine.

2. The Administration should explain what was meant by "acceptable academic qualification" under clause 94(b)(ii). In assessing the qualifications of applicants for registration, their training received in Chinese medicine in private educational institutions should be recognized.

3. The definition of "practising Chinese medicine" given in the Bill was not clear. CMPs should be allowed to use modern medical equipment such as stethoscopes and thermometres. The Administration should put in place a mechanism for distinguishing the genuineness of Chinese medicines.

16. Mrs Selina CHOW said that she agreed to some extent that it might not be reliable to assess a CMP's professional standard and register him merely based on the years of practice of him. However, she noted that a large number of CMPs had not received formal training in Chinese medicine and they had accumulated experience only through apprenticeship. As these CMPs would not be accustomed to taking examinations, there would be practical problems to require them to sit for an examination in order to be registered. Mr TSUI Chin-pong advised that for those CMPs who were too old to take examinations, they should at least attend a clinical test. He considered that this was essential to safeguard the public interest.

One Country Two Systems Research Institute
(LC Paper No. CB(2) 1635/98-99 (02) )

17. With reference to his submission, Mr SHIU Sin-por introduced the proposals made by the One Country Two Systems Research Institute, including -

1. The Bill should provide for reputable CMPs outside Hong Kong to come to practise Chinese medicine in Hong Kong in order to enhance the status of HK as a Chinese medicine centre; and

2. in assessing the years of practising experience of a CMP for registration, his/her experience of practising Chinese medicine outside Hong Kong should be recognized.

Timeless Software Limited
(LC Paper No. CB(2) 1655/98-99 (03) )

18. Dr Lyold YAM of Timeless Software Limited suggested that the Administration should find ways to promote Chinese medicines in the world market. He took the view that the scope of the Bill should include measures to enhance the safety standards of Chinese medicines and cultivate the confidence of overseas customers in Chinese medicines. In particular, priority should be given to developing more scientific ways in testing the saftey of Chinese medicine products. He considered the content of this Bill was very limited which mainly dealt with registration matters of CMPs.

International Association (HK) for Chinese Manipulative Medicine
(LC Paper No. CB(2) 1655/98-99 (04), (05) and (06) )

19. Mr LAM Shu-fan of International Association (HK) for Chinese Manipulative Medicine briefed members on the nature of Chinese Manipulative Medicine as set out in his submissions.

20. In response to the suggestions made by the One Country Two Systems Research Institute, Dr LEONG Che-hung pointed out that the limited registration mechanism as provided for under clause 83 of the Bill had already served the purpose of enabling CMPs outside Hong Kong to perform research and teaching work in Hong Kong. Moreover, he was concerned as to whether the proposals would give rise to abuses and they might result in that many CMPs outside Hong Kong would claim to be very experienced and reputable CMPs. This would be unfair to the local CMPs who had to pass examinations in order to practise.

21. In response, Mr SHIU Sin-por pointed out that the limited registration system was inadequate as it only provided for CMPs outside Hong Kong to come over to perform teaching / research work but not to practise in here. He stressed that in order to promote Hong Kong as a Chinese medicine centre, it was essential to have reputable CMPs to practise in here. Since most of them were quite old, it would not be practical to require them to sit for examinations. He further pointed out that there should not be any worry of abuses as he believed that the Pracititioners Board would scrutinize every application very strictly. Moreover, these CMPs could be required to provide evidence (such as their records of practising experiences) to the Practitioners Board for assessment.

Past Students' Association of Traditional Chinese Medicine Practitioners, School of Professional and Continuing Education University of Hong Kong
(LC Paper No. CB(2) 1655/98-99 (07))

22. Mr MOK Ying-fan said that the Association was in support of the Bill. However, he requested that the CMC after its establishment should publicise details as to how to assess and verify the years of practice and conduct more consultation with the sector to enhance the Council's transparency.

23. Mrs Selina CHOW invited Mr MOK Ying-fan to give views on how to strike a balance in ensuring the standards of the CMPs in order to safeguard public interest without affecting the livelihood of the existing CMPs. In reply, Mr MOK Ying-fan said that the Practitioners Board should adopt very stringent criteria for assessment of the years of practising experiences of a CMP. He suggested that certificates of commercial registration should not be relied upon as proofs . Instead, the patient records kept by the CMP, certificates of training in Chinese medicine received or any proofs showing that the CMP had learnt personally from a reputable CMP should be considered. Mrs Selian CHOW said that these suggestions were very useful and requested Mr MOK to give more suggestions to the Bills Committee in the future.

24. Miss CHAN Yuen-han sought Mr MOK Ying-fan's comments on the proposals made by the One Country Two Systems Research Institute. In response, Mr MOK considered that while he had no strong views on the proposal of counting the years of practising experience outside Hong Kong, he had reservations on the proposal of allowing reputable CMPs outside Hong Kong to practise in here as this would be unfair to the CMPs here.

The Hong Kong Medicine Dealers' Guild
(LC Paper No. CB(2) 1671/98-99 (02) )

25. Mr WONG Kai-cheong of the Hong Kong Medicine Dealers' Guild said that the sector was concerned about the following proposals of the Bill -

1. the meaning of "public interest" in clause 125 leading to "de-registration of proprietary Chinese medicines";

2. the requirements to improve the facilities and cleanliness of the concerned factories to be introduced to manufacturers of proprietary Chinese medicine; and

3. intellectual property protection in respect of Chinese proprietary medicine formulas.

26. Mr WONG Kai-cheong said that despite the fact that the Hong Kong Medicine Dealers' Guild and Hong Kong Chinese Patent Medicine Manufacturers' Association represented most of the traders/manufacturers of proprietary Chinese medicines, the two organizations were not invited to send representatives to sit on the Preparatory Committee on Chinese Medicine. So far they had only met and discussed with Dr LEUNG Ting-hung of the Department of Health. Mr WONG considered that there was no channel for them to express their views to the Administration. Mrs Selina CHOW considered that the trade of proprietary Chinese medicines was very important to the economy of Hong Kong and the Bill should not impact on the development of the trade. She requested the Administration to further contact the sector to seek their views.

Adm

27. The Chairman requested Mr WONG to provide a further submission to elaborate their views for members' deliberation. Dr LEONG Che-hung and Mr Michael HO suggested the Administration to provide the following information respectively -	Adm

1. details of the consultation conducted by the Administration with Chinese medicines traders; and

2. the possible impact on the manufacturers/traders of proprietary Chinese medicines brought about by the legislative proposals of the Bill.

(Post-meeting note : the Administration had subsequently provided a paper on "Consultation with Chinese medicines traders" which was issued to members under LC Paper No. CB(2) 1778/98-99 (05) on 23 April 1999.)

28. The meeting ended at 11:45 am.

Legislative Council Secretariat
23 August 1999