Replies to LegCo questions
LCQ1: Division of Cardiology of the Prince of Wales Hospital
Following is a question by the Hon James To and a reply by the Secretary
for Food and Health, Dr Ko Wing-man, in the Legislative Council today
(October 30):
Question:
The Head of the Division of Cardiology of the Prince of Wales Hospital
(PWH) was ordered on February 1 this year to immediately cease handling
all cardiac interventional procedures (suspension). Only after a lapse
of several months and a complaint on maladministration had been lodged
against its Chief Executive (CE of PWH) did PWH set up two clinical
audit committees (investigation panels) to investigate the incident. It
has been learnt that the incident has aroused wide public concerns, and
a joint statement has also been published in newspapers by some
patients, members of the public and healthcare personnel, urging the
authorities to dissolve the investigation panels and appoint afresh an
independent investigation committee to thoroughly investigate the
suspension. In this connection, will the Government inform this Council:
(a) whether it knows why PWH has, in the absence of sufficient evidence,
immediately suspended the doctor concerned from surgical duties prior to
the conduct of a formal investigation, whether such a move is an
established practice and of the existing mechanism governing the
suspension of doctors from surgical duties;
(b) of the number of cases of transcatheter aortic valve implantation
(TAVI) performed by the Division since February 1 this year, the number
of patients involved and, among them, the number of those who developed
complications; whether the Division has looked into the causes of such
complications and their impact on patients; whether the surgeries
resulting in complications were performed by doctors in accordance with
international standards and guidelines, and of the respective numbers of
qualified and non-qualified doctors jointly performing each of such
surgeries as well as the relevant details; and
(c) given that the two aforesaid investigation panels were set up by CE
of PWH after a complaint had been made against him and two-thirds of the
members of the two investigation panels were his subordinates, whether
the authorities have assessed if the investigations will not be
independent and will be in breach of procedural justice; of the number
of doctors in the investigation panels which are tasked with
investigating the relevant cases, and their actual experience in
performing TAVIs and left atrial appendage occlusions respectively;
whether the authorities have assessed if the investigation panels are
professionally competent to conduct investigations into the relevant
cases; given that the Independent Review Committee subsequently set up
by the Hospital Authority is mainly responsible for considering the
investigation reports submitted by the investigation panels and will not
conduct its own investigation, whether the authorities will appoint an
investigation committee that is genuinely independent in order to
thoroughly investigate the incident and to report its findings to the
public?
Reply:
President,
I understand the public's concerns over the incident of the suspension
of some clinical duties of the Head of the Division of Cardiology of the
Prince of Wales Hospital (PWH). I must point out that as the incident as
a whole involves patient safety and reputation of healthcare
professionals, it must and it will be handled fairly, objectively and
impartially.
My reply to the Member's question is as follows:
(a) According to the existing mechanism of the Hospital Authority (HA),
if the conduct of a staff member causes danger or brings negative impact
on patient safety or the operation of a hospital, he/she may be
suspended from all or some of his/her duties so as to protect patient
safety. Where necessary, appropriate investigation may be conducted or
an investigation committee may be set up to follow up the issue. In the
past five years (i.e. from 2008-09 to 2012-13), a total of four doctors
involved in complaint cases have been suspended from all or some of
his/her duties.
(b) PWH's cardiology team is qualified for performing coronary
interventional procedures independently. The team consists of
cardiologists with the relevant training and recognised qualifications
in Transcatheter Aortic-Valve Implantation (TAVI) and Left Atrial
Appendage Occlusion (LAAO), who can take independent charge of and lead
the team to perform the procedures concerned.
Since February 2013, PWH has performed seven TAVI operations and nine
LAAO operations for 16 patients. All operations were performed by
members of the team in accordance with the relevant guidelines under the
leadership of the team's experienced and qualified cardiologists.
All of the seven patients who received TAVI surgery had the devices
successfully implanted in their bodies. Three of them developed
complications, the risks of which are known. The clinical performance
indicators of the seven cases were fully in compliance with
international standards. The nine patients who received LAAO operations
did not develop any complications. All 16 patients have recovered and
have been discharged from the hospital after treatment. All of the above
cases will be included in the audit exercise in the long run.
(c) In January 2013, seven of the eight specialists (other than the
Head) of the Division of Cardiology of PWH made non-anonymous complaints
about the clinical procedures of some cases undertaken by the Head of
the Cardiology. All of the cases are related to complicated and
high-risk clinical cardiac interventional procedures, of which TAVI and
LAAO procedures involve particularly high risk and skills. Since the
safety of patients was involved, PWH considered the situation as
serious. Having examined carefully all relevant information and held
discussions with the Vice-Chancellor, Pro-Vice-Chancellor and the Dean
of Medicine of the Chinese University of Hong Kong, the Chief Executive
of PWH and the Chief of Service of the Department of Medicine, with
patient safety as the primary concern, made an administrative decision
to suspend the Head of the Division of Cardiology from part of his
clinical work, starting from February 1.
In end March 2013, PWH, upon consulting the relevant department in HA
Head Office, set up two expert panels in accordance with the established
mechanism to evaluate the treatment processes of the cases and review
the department's internal audit results. The terms of reference, mode of
operation and membership of the two expert panels were more or less
finalised in April 2013. HA Head Office has, upon receiving a complaint
against the Chief Executive of PWH, asked that Chief Executive not to
handle matters related to the investigation. Moreover, to ensure that
the investigation is conducted in a fair and independent manner, HA also
set up an independent review committee to receive and examine the
reports of the two expert panels. The committee will propose follow-up
actions based on the review findings of the expert panels. It will
deliberate on issues of clinical governance, including credentialing,
which has emerged as a concern in this incident. It will also review the
entire process in handling the case. Apart from the reports of the
expert panels, the committee also has power to directly access the
evidence relating to the complaints and the factors which have been
considered by the expert panels. HA has also engaged overseas experts to
give professional advice to the committee so as to support its work.
All members of the two expert panels and the committee as well as the
overseas experts have declared their interests as required in respect of
their participation in the investigation to ensure fairness and
impartiality. All declarations have been reported to the committee for
review and have been confirmed not to constitute any hindrance to the
work of the panels and committee. HA Head Office has also deployed the
Director (Quality and Safety) to provide the expert panels with policy
and procedural support. Upon completion, the reports of the expert
panels will be submitted directly to the committee without going through
the administration departments of PWH.
All in all, we are highly concerned about the incident. We have taken
comprehensive measures in strict adherence to procedural fairness to
investigate and review the incident in order to protect patient safety
and the reputation of healthcare professionals.
Ends/Wednesday, October 30, 2013
Issued at HKT 16:50
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