Panel on Health Services (Minutes) 14 Sep 98

Legislative Council

LC Paper No. CB(2) 558/98-99
(These minutes have been seen
by the Administration)

Ref : CB2/PL/HS

LegCo Panel on Health Services

Minutes of meeting
held on Monday, 14 September 1998 at 8:30 am
in Conference Room A of the Legislative Council Building
Members Present:

Hon Michael HO Mun-ka (Chairman)
Dr Hon LEONG Che-hung, JP (Deputy Chairman)
Hon HO Sai-chu, JP
Hon Cyd HO Sau-lan
Hon CHAN Yuen-han
Hon Mrs Sophie LEUNG LAU Yau-fun, JP
Dr Hon YEUNG Sum
Hon YEUNG Yiu-chung
Hon LAW Chi-kwong, JP

Public Officers Attending :

For All Items
Mr Gregory LEUNG, JP: Deputy Secretary for Health and Welfare
Miss Winnie TSE: Assistant Secretary for Health and Welfare
For Agenda Item III
Mr Donald WONG: Acting Principal Assistant Secretary for Health and Welfare (1)
Dr MAK Sin-ping: Acting Deputy Director of Health
Dr LEUNG Ting-hung: Assistant Director of Health
For Agenda Item IV
Ms Jennifer CHAN: Principal Assistant Secretary for Health and Welfare (2)
Mr Derek GOULD: Principal Assistant Secretary for Health and Welfare (3)
Dr KO Wing-man: Deputy Director of Operations, Hospital Authority
Dr MAK Sin-ping: Acting Deputy Director of Health
Dr LEUNG Ting-hung: Assistant Director of Health

Clerk in Attendance :

Ms Doris CHAN: Chief Assistant Secretary (2) 4

Staff in Attendance :

Mr Y S LEE: Senior Assistant Legal Adviser
Ms Joanne MAK: Senior Assistant Secretary (2) 4

I.Confirmation of minutes of meeting held on 17 July 1998 and matters arising

(LC Paper No. CB(2)239/98-99)

1. The minutes of the last meeting held on 17 July 1998 were confirmed.

II.Date of next meeting and items for discussion

2. Members agreed to hold a meeting on 12 October 1998 at 8:30 am to receive a briefing to be conducted by the Secretary for Health and Welfare (SHW) on the Policy Address. Members also agreed to hold a special meeting on 9 October 1998 at 8:30 am to discuss the item "Food Safety and Environmental Hygiene".

(Post-meeting note: The meeting scheduled for 9 October 1998 was cancelled and combined with the meeting on 12 October 1998.)

III.Development of Traditional Chinese Medicine (CM)

(LC Paper No. CB(2) 235/98-99 (01) )

3. The Deputy Secretary for Health and Welfare (DS(HW)) informed members that the Administration was preparing the draft Chinese Medicine Bill (the Bill) and conducting consultations with the CM profession to collect their views, which would be taken into consideration in the drafting of the Bill. DS(HW) welcomed any suggestions put forward by members.

4. Dr LEONG Che-hung declared interest as a member of the Preparatory Committee on Chinese Medicine. Referring to paragraph 10 of the Administration's paper, Dr LEONG held the view that it was desirable for CM practitioners to embark on continuing education in CM in order to upkeep their professional standards. However, he disagreed that this should be made a mandatory requirement for renewal of practising certificates as CM practitioners might be prevented from taking part in such studies by various factors such as unavailability of suitable courses. In response, DS(HW) revealed that at the moment the Administration was inclined to adopt the said requirement as a mandatory condition of renewal of the practising certificates. However, some flexibility would be allowed in the arrangements. For example, applicants would not be required to complete their studies within a very tight schedule. To accommodate the anticipated large demands for courses on CM, DS(HW) said that the relevant institutions would be encouraged to organize as many such courses as possible. Participation in relevant seminars would be considered as a form of continuing education in CM as well. Nevertheless, DS(HW) emphasized that the Administration had not yet come to a conclusion as it was still in the course of consulting the CM profession.

5. The Chairman asked how the Administration would proceed if the above proposed condition of renewal was not acceptable to the Chinese Medicine Council, which would be authorized to oversee the entire regulatory system for CM and registration matters of the CM practitioners. DS(HW) replied that the Administration would conduct in-depth consultation with the CM profession before finalizing details of the Bill to ensure smooth implementation of the future CM ordinance. DS(HW) said that he had not heard any opposing views from the profession insofar as this proposed condition of renewal was concerned.

6. Dr YEUNG Sum enquired about the progress made in respect of the regulation of CM. In reply, DS(HW) said the Administration would draw up a list of commonly dispensed Chinese herbal medicines and a list of potent Chinese herbal medicines by 2000 and the latter could only be sold or dispensed on prescription. Replying to Dr YEUNG's further enquiry, DS(HW) said that priority would be given to establishing the registration system of CM practitioners, but the Administration would also seek to ensure the professional standards of dispensers of traditional CM by encouraging them to take part in training on CM.

7. Dr LEONG Che-hung suggested that the Administration should apply the existing registration system for western medicines to all proprietary Chinese medicines. In particular, testing should be conducted for all newly imported and locally manufactured proprietary Chinese medicines to see if they contained any ingredients of western medicines. He considered that the Administration should not wait to do so until the enactment of the relevant subsidiary legislation for the registration of proprietary Chinese medicines. In response, DS(HW) said that the Administration had been conducting sample testing of proprietary Chinese medicines on a regular basis to ensure they were safe for use. However, registration of them could not be done now as it was not provided for under the existing legislation which only covered the registration of western medicines. He also clarified that the Administration was not trying to extend the existing Pharmacy and Poisons Ordinance (Cap. 138) to cover the regulation of proprietary Chinese medicines but it was drafting a new legislation for the purpose. The Assistant Director of Health (AD(H)) supplemented that the Department of Health (DH) had been conducting sample testing of proprietary Chinese medicines sold in Hong Kong. Under Cap. 138, any product containing ingredients of western medicine was required to be registered. In the future, proprietary Chinese medicine without ingredients of western medicine would be required to be registered under the new CM ordinance. At Dr LEONG's enquiry, AD(H) clarified that DH was not conducting sample testing of all the proprietary Chinese medicines sold in Hong Kong at present but it would seek to increase the number of tests with a view to covering every product in future.

8. The Chairman enquired about details of the transitional arrangements for registration of practising CM practitioners in Hong Kong. In reply, DS(HW) said that the Administration was still seeking the views of the profession before finalizing the details. He informed members that the sector had already had an outline of the curriculum for the licensing examination. As to the registration assessment by the Chinese Medicine Practitioners Board, details had yet to be confirmed. DS(HW) assured members that the Administration would take into account the views of the profession before finalizing details of the transitional arrangements for registration of the CM practitioners practising in Hong Kong.

IV.Medical incidents

Remedial measures in public hospitals
Monitoring of private hospitals

(LC Papers Nos. CB(2) 235/98-99 (02) - (03) and LS 30/98-99)

Remedial measures in public hospitals

9. Dr YEUNG Sum referred to the list of factors accounting for medical incidents as provided by the Hospital Authority (HA) in its paper, and asked which of them was/were the major factor(s). In response, the Deputy Director (Operations) (DD(O)) of HA said that the list of factors set out in the paper sought to illustrate that the occurrence of medical incidents should not be attributable to the single factor of human errors. Rather, medical incidents were usually caused by a combination of various factors and it was hard to say which of the factors accounted more for the occurrence of medical incidents. Furthermore, it had been found that medical incidents had more to do with the systems of work which, if improved, could actually minimize the chance of human errors. In addition, HA would take steps to help staff to increase their confidence at work and reduce their pressure of work.

10. The Acting Deputy Director of Health (DD(H)(Atg)) agreed with DD(O) that medical incidents were caused by various factors including human errors, medical procedures and communication problems. She assured members that the Department of Health (DH) would review every single incident to seek improvement and minimize the chance of recurrence.

11. Mr YEUNG Yiu-chung suggested introducing an award-and-penalty system to encourage public hospitals staff to keep up with their good performance and to take disciplinary action against those committing serious errors. In response, DD(O) agreed that individual staff should be held responsible for any negligence or carelessness committed by them in the course of work. However, he considered that it was also important for HA to identify shortcomings in the systems of work and take effective remedial measures. To avoid different hospitals adopting varying standards in an assessment of how far an individual staff should be held responsible over a single incident, HA was considering to issue guidelines to hospitals advising on the common factors which should be taken into account in the assessment.

12. Mr YEUNG Yiu-chung further enquired whether a system of service quality assessment of each public hospital was in place. In response, DD(O) said that the public hospitals under the management of HA were required to report regularly to HA on the number of complaint cases received by the hospitals. HA assessed the service quality of each hospital based on their achievements in comparison with the benchmarks laid down and their ability in the prevention and handling of medical incidents.

13. Dr LEONG Che-hung declared interest as a member of the HA Board. He enquired whether pressure exerted on clinical staff by heavy workload was one of the factors contributing to medical incidents as this had not been mentioned in the HA's paper. In response, DD(O) said that pressure of work could be one of the factors causing human errors. However, he stressed that the occurrence of medical incidents should not be attributable only to human factors or inadequate resources or otherwise this would be only an irresponsible approach to this matter. While agreeing that human errors should not be the only factor contributing to medical incidents, Dr LEONG Che-hung considered that HA should at least recognize the fact that their staff were under very heavy pressure of work and reflect the problem to the Health and Welfare Bureau (HWB). He believed this would be important in boosting staff morale. In response, DD(O) said that notwithstanding limited resources, HA had made optimal use of the resources available to meet the healthcare needs of the community and strive for efficient and improved services. He noted that the Administration was conducting a healthcare financing system review and he expected that it would provide some solutions to the resources problems. Dr LEONG Che-hung clarified that he was not suggesting that the Government should allocate unlimited resources to the health care sector. He considered that to be fair to the health care staff, it was necessary to let the public know that the health care staff were under tremendous work pressure.

14. Mr LAW Chi-kwong enquired whether the Hospital Governing Committees (HGC) would follow up medical incidents which might involve taking disciplinary or legal actions. DD(O) said that HGCs comprised appointed members not working on a full-time basis. Therefore, whenever there was occurrence of serious medical incidents, HA Head Office would deal with the incidents first and the hospital concerned would report back to the HGC.

15. Mr YEUNG Yiu-chung noted that there had been quite a few medical incidents which had been uncovered by the mass media and not released to the public by HA. In response, DD(O) said that HA had ensured that the medical staff should explain clearly to the patients and their families about the patients' medical conditions. In case of any medical incidents where patient's condition was affected, HA would in the first instance explain fully to the patient concerned or his/her family and take full responsibility for what happened. However, as to whether or not HA should give a full account of the details to the public immediately after the occurrence of a medical incident, DD(O) said that it would depend on many factors, such as whether or not it was a suitable timing and whether or not the announcement was agreeable to the concerned parties. DD(O) assured that there were mechanisms which required all hospitals to furnish full reports to HA regarding medical incidents, complaint cases received and improvement measures subsequently taken.

16. Mr YEUNG Yiu-chung enquired whether HA had issued guidelines to HGCs on the procedures for releasing details of medical incidents. DD(O) replied that the final decision concerning release of the details rested with HA Head Office and it took full responsibility for the decision made. However, in the course of making the decisions, it was common for the HA Head Office to seek the views of members of the HGC and the senior management of the hospital concerned as well.

17. Mr LAW Chi-kwong enquired about details of the system of monitoring clinicians' performance in public hospitals. In response, DD(O) said that it was impossible for all clinicians to have exactly the same professional performance and standards given the fact that they varied in both seniority and experience. He stressed that HA had always ensured professional competence by recruiting clinical staff with appropriate professional and specialist qualifications, and by establishing a structured system of clinical supervision whereby the work of junior clinical staff was supervised and assessed by senior clinicians. DD(O) further briefed members on the clinical audit system established in clinical departments of all HA hospitals. In addition, the Central HA Clinical Audit Committee was in place to co-ordinate territory-wide clinical audit activities across various specialties, disciplines and hospitals.

18. Mr LAW Chi-kwong suggested that HA should consider releasing to the public details of the assessment conducted for each clinical department of all HA hospitals as a way of enhancing public surveillance of hospital services. In response, DD(O) said that HA had considered this option but added that there were always pros and cons of using competitive or punitive models to enhance performance. Mrs Sophie LEUNG agreed with DD(O)'s views that enhancing professional competence of clinical staff and clinical supervision was more important to the prevention of medical incidents. She further made the point that with the progress in medical technology, modern medical equipment had become increasingly sophisticated. She considered that medical staff should raise their alertness in the use of such equipment as any mishaps with the equipment could be at the cost of human life. She further suggested that the Panel should write to the University of Hong Kong and the Chinese University of Hong Kong to elaborate on this point and request them to provide training to their medical students to increase their alertness in this regard. However, the Chairman held the view that as the scope of the matter involved was quite large, the proposed course of action should be further deliberated first.

19. Dr YEUNG Sum commented that the standard of the health care services in Hong Kong was quite high. He held the view that the credibility of HA was the most important which, however, could be damaged by recurrence of medical incidents. He stressed that HA must maintain high accountability and give a full account to the public whenever medical incidents occurred.

20. In response to Miss Cyd HO's enquiry, DD(O) said that HA had ensured that only qualified dispensers performed dispensing duties in a dispensary. Some supporting staff who had not acquired the relevant professional training were only required to do simple manual work in a dispensary. Moreover, measures had been put in place to ensure sufficient supervision on the operation of these supporting staff.

21. Dr LEONG Che-hung enquired about the role played by the Administration in the prevention of medical incidents. DS(HW) replied that the Administration had been closely watching the factors contributing to the occurrence of each incident and explored the necessary improvement measures. It was also closely liaising and co-operating with HA to see what could be done to improve the delivery of public health services. The Chairman took the view that HWB was actually accountable to the public to monitor the performance of HA and it was necessary for the Bureau to strengthen its monitoring role. He said that the Panel would continue to pursue with the Bureau regarding any problems found with the performance of HA.

Monitoring of private hospitals

22. With reference to LC Paper No. LS 30/98-99, the Senior Assistant Legal Adviser (SALA) briefed members on the statutory framework relating to the supervision of private hospitals.

23. Dr LEONG Che-hung enquired about details of the monitoring measures taken by DH with regard to private hospitals. In response, DD(H)(Atg) informed the Panel that in the 1980s, the then Medical and Health Department had rejected the application of a private hospital for registration due to failure to comply with the staffing and accommodation requirements. She said that as a general rule, inspections of private hospitals were conducted prior to their first registration or annual renewal of licences. Further inspections would be conducted to follow up on any irregularities found with the medical institutions. Ad hoc visits were also conducted as and when necessary. In 1997, there were 12 private hospitals and 19 nursing homes. A total of 50 inspections (including four to five surprise checks) were conducted in the same year. About 10 cases had been recorded in 1996-97 involving conditions such as unsatisfactory hygienic conditions of catering and storage of dangerous goods. All the irregularities had been rectified by the hospitals. DD(H)(Atg) added that licensing conditions related in general to the appropriateness of accommodation and staffing with respect to the nature and scope of services provided by individual hospitals. Private hospitals were also required to self-regulate their day-to-day operation and management to ensure delivery of quality service.

24. In response to Dr LEONG Che-hung's follow-up enquiries, DD(H)(Atg) said that the warning letters issued to private hospitals were concerned mainly about storage of expired medicines and keeping of records of medicines. As regards staffing requirement in respect of licensing control, DD(H)(Atg) explained that the requirement varied from hospital to hospital depending on the nature and scope of services provided by individual hospitals. As to the guidelines on the standards set for private hospitals, DD(H)(Atg) said that "A Guide to Hospital Standards" (the Guide) had been issued to all private hospitals in 1992 which covered all the essential elements conducive to the delivery of quality care to patients.

25. Miss Cyd HO referred to section 3(1) of the Hospitals, Nursing and Maternity Homes Registration Ordinance (Cap. 165) and opined that the level of penalty stipulated therein was inadequate. By this provision, a person convicted of carrying on a hospital or a maternity home without being duly registered would be fined only $1,000. As the said provision was last amended in 1966, Miss HO called for a review of the law and the penalty level. She also enquired whether a review would be conducted on the current standards set for private hospitals as the standards were based on the recommendations made by the then Medical Development Advisory Committee (MDAC) in 1990. In response, DD(H)(Atg) said that private hospitals were regulated by some 30 other ordinances in addition to Cap. 165. Additional requirements were also imposed by relevant authorities such as with regard to fire safety and building requirements. Nevertheless, she agreed to review the relevant provision to see whether amendment was necessary. As to Miss Cyd HO's second question, DD(H)(Atg) said that the recommendations of MDAC had been reviewed at regular intervals to meet the needs of the public.

Adm

26. At Dr YEUNG Sum's enquiry, DD(H)(Atg) said she understood that the Hong Kong Sanatorium and Hospital was still studying the report submitted by the three-member investigation team appointed by the hospital to look into the kidney dialysis incident at that hospital and was preparing its own report. Pending the report to be submitted by the Hong Kong Sanatorium and Hospital within the week, DH targetted to complete its initial investigation report in three weeks' time.

27. Dr LEONG Che-hung declared interest as a member of the three-member investigation team and enquired whether DH would make public the relevant investigation report produced by the team and the report to be produced by DH. DD(H)(Atg) replied that as a death inquiry might be launched to investigate into the causes of the deaths in this incident, DH might not, subject to legal advice, publish the findings of the investigations until after the release of the coroner's report. DD(H)(Atg) further reported that after the incident, DH had been in close liaison with the private and public sectors to review the existing procedures and practices of kidney dialysis with a view to seeking improvement.

28. Dr LEONG Che-hung, who was the former chairman of MDAC, briefed members on the background leading to the issue of the Guide. He recalled that the then SHW had remarked that "current monitoring of standards in private hospitals was not satisfactory" and had supported that there should be more stringent guidelines for private hospitals to minimize hazards. He requested DH -	Adm

to provide a copy of the Guide issued in 1992;
to indicate the areas where revisions had been made against the previous version of the Guide; and
to show how far the Guide (1992) had been applied by DH in monitoring private hospitals.

29. The Chairman added that on his instruction, the Clerk had written to HWB on 11 September 1998 to request the provision of a copy of the Guide and information as to how far the Guide had been adopted. In response, The Principal Assistant Secretary (Health and Welfare) (3) (PAS(HW)(3)) said that the Guide would be made available to the Panel together with its Chinese translation which was being prepared. He added that the Guide as a whole had been adopted.

Adm

30. At the Chairman's enquiry, DD(H)(Atg) briefed members on the existing mechanism to monitor the standards of private hospitals. She reported that inspections had been conducted to examine areas like policies and procedures, treatment of clinical waste, storage of medicine, facilities, equipment and staffing, cleanliness of the environment and so on. Inspections were also conducted to follow up on areas requiring improvement. In terms of professional standards, private hospitals had their own clinical audit committees to monitor professional standards. They also participated in other accreditation programmes such as those organized by the various Colleges of the Hong Kong Academy of Medicine. DD(H)(Atg) further reported that in assessing the merits of individual hospitals for registration / annual renewal of licence, DH required each medical institution to furnish a report providing detailed information on its organizational structure, staffing, facilities, equipment, development plans and so on. DD(H)(Atg) would provide a sample copy of the report format for members' reference if necessary.

Adm

31. Dr LEONG Che-hung was dissatisfied that the Guide could not be provided to the Panel just because its Chinese translation was not available. He further considered that DH should explain in greater detail as to how far it had tightened its control in monitoring the standards of private hospitals. Mrs Sophie LEUNG took the view that DH should take a more proactive approach to liaise with the senior management of private hospitals to review their standards and seek improvement.

Adm

32. Due to running out of time, the Chairman directed that the monitoring of private hospitals be further discussed at another Panel meeting within the next two months.	Clerk

33. The meeting ended at 10:45 am.

Legislative Council Secretariat
31 October 1998