Replies to LegCo questions
LCQ16: Medical incidents
Following is a question by the Hon Paul Tse and a written reply by the Secretary
for Food and Health, Dr Ko Wing-man, in the Legislative Council today (July 11):
Question:
It has been reported that a newborn baby boy had his finger almost cut to the
bone during the caesarean delivery process performed for his mother at Kwong Wah
Hospital; when the baby boy was less than a month old, his large intestine was
perforated during the examination by suprapubic tapping, which was suspected to
be the cause leading to his subsequent rectal constriction and intestinal
abscess, and an operation was arranged to be performed on him to remove part of
the obstructed rectum and an abdominal stoma was created for defecation. The
baby boy is barely four months old and he has been put under general anaesthesia
for three times and has repeatedly been injected antibiotics with his abdomen
incised for removal of necrotic intestine. While Kwong Wah Hospital pointed out
in its reply letter to the baby boy's mother on May 30 this year that there was
a "known uncommon risk" that babies might be cut during delivery and their large
intestine might be perforated when suprapubic tapping was performed, the
President of the Hong Kong Medical Association pointed out that doctors cutting
the baby's finger when performing caesarean section on the mother was uncommon
and it was also uncommon that baby's intestine was perforated during urine
sample collection. He also indicated that accidents could be avoided if an
ultrasound scan was performed to confirm the location before tapping for urine
sample collection, and hence, this was obviously a technical fault of the doctor
and parents could seek compensation. Apart from the aforesaid case, a magazine
also reported quite a number of other medical incidents involving newborn
babies. In this connection, will the Government inform this Council:
(a) whether it has followed up the aforesaid case; if so, of the progress;
(b) whether it knows the numbers of medical incidents involving newborn babies
in public hospitals under the Hospital Authority (HA) in each of the past five
years, as well as the numbers of relevant complaints received; how many cases
were proved to be caused by human errors and negligence upon investigation;
(c) given that the President of the Hong Kong Medical Association has pointed
out that the aforesaid incident is an "obvious(ly) technical fault", "the
blunder may be related to staff shortage in public hospitals" and that "with so
many patients, blunders are unavoidable in such busy schedules, and patients'
rights can be safeguarded only if the authorities tackle expeditiously these
problems", whether it knows if HA has investigated whether a number of medical
incidents involving newborn babies were caused by shortage of staff; if it has,
of the investigation result; if not, whether an investigation will be conducted
immediately; in addition, what policies and measures are in place to prevent the
recurrence of medical incidents involving newborn babies in public hospitals;
and
(d) given that a representative of a patients' rights group has pointed out that
doctors are investigated by their peers under the existing complaint handling
mechanism, which might not be fair, and most people seeking assistance would
give up pursuing because of the hassle involved, whether the Government has
reviewed the existing complaint mechanism to enhance the objectivity of the
mechanism?
Reply:
President,
With the increasing advancement of medical technology, treatment procedures have
become more sophisticated. The emergence of complications, the side-effects of
drugs, as well as the changes in patients' conditions may also increase the
risks involved in treatment procedures. In the event that a medical incident
occurs, it is necessary to conduct a detailed analysis to find out whether it is
caused by known risks, complications, clinical conditions of the patient or
human factors. Since not all treatment procedures can achieve 100% of their
intended medical outcome, healthcare professionals will explain to the patient
and his/her family members in detail the treatment procedures involved,
including the known risks and possible complications, etc. before the treatment
is carried out.
My reply to the various parts of the question is as follows:
(a) The sick baby involved in the case mentioned in the question has already
undergone surgical procedures and his recovery is progressing in a satisfactory
manner. The hospital concerned has also arranged follow-up consultation for the
baby to follow up on his conditions.
(b) and (c) The Hospital Authority (HA) has all along attached great importance
to the quality of its services and patient safety and has since 2004 introduced
an electronic Advanced Incidents Reporting System to enable frontline staff to
report incidents directly. Subsequently, HA has also implemented a Sentinel and
Serious Untoward Events Policy to standardise the process for reporting,
investigation and management of these medical incidents in public hospitals to
facilitate immediate and proper handling of the incidents so as to minimise any
possible harm caused to patients, their family members and the staff involved
and provide them with the necessary support.
The number of complaints received by HA regarding its medical services since
2007 is set out in Table 1, and the number of sentinel and serious untoward
events is set out in Table 2.
Although the number of medical incidents in public hospitals in Hong Kong
remains stable generally, HA has handled each and every of these cases in a
serious manner. Each sentinel event and serious untoward event will be
investigated by an expert panel appointed by HA, with a view to identifying the
likely causes of the incident and formulating improvement measures.
HA has over the years sought to ensure service standards and continued to
improve service quality through implementing measures such as hospital
accreditation, clinical audits, schemes to monitor and improve the effectiveness
of surgical services, mechanisms for introducing new medical technology and drug
handling, as well as internal mechanism to govern research ethics etc. In
addition, HA has established a clinical governance structure to safeguard the
service quality of clinical departments, and provide training, clinical guidance
and supervision to staff in various grades to ensure professional standards and
patient safety. HA has also engaged overseas experts to conduct a review on its
clinical governance system with reference to the highest international
standards. HA will study in details and follow up on the improvement
recommendations as appropriate upon completion of the review.
(d) HA has established a two-tier complaint system, with checks and balances, to
handle complaints. There is a Patient Relations Officer or Patient Relations
Manager in each of the hospitals under HA. Their role is to deal with complaints
from patients and their families and provide them with assistance, which
includes assisting them to take legal action where necessary. Therefore, all
initial complaints and views will be handled and responded to directly by the
hospitals or clinics concerned.
If the complainant wishes to put forward further views or is not satisfied with
the handling or outcome of his/her complaint, he/she can file an appeal with the
Public Complaints Committee (PCC) of HA. PCC is responsible for deliberating and
adjudicating all appeal cases independently and making service improvement
recommendations to hospitals. It is comprised of a total of 24 members with 20
of them having no affiliation with HA. As one of the special features of PCC, 17
of its 24 members are non-medical professionals coming from different sectors of
the community, including patients' representatives. By virtue of the independent
status of its members, we believe that PCC can handle all complaints fairly and
impartially.
Ends/Wednesday, July 11, 2012
Issued at HKT 13:50
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Annex