Replies to LegCo questions
LCQ21: Monitoring of surgeries carried out in public hospitals and part-time doctors by Hospital Authority
Following is a question by the Dr Hon Elizabeth Quat and a written reply by the
Secretary for Food and Health, Professor Sophia Chan, in the Legislative Council
today (November 29):
Question:
It has been reported that last month, a private medical practitioner who was
also a part-time Associate Professor in the Li Ka Shing Faculty of Medicine of
the University of Hong Kong left the operating theatre in the midst of
supervising a liver transplant which was underway in Queen Mary Hospital (QMH),
and went to a private hospital to perform a surgery for another patient. The
chief surgeon paused the surgery to wait for the return of the supervising
doctor, resulting in a three-hour delay in the completion of the liver
transplant surgery. QMH has initiated an investigation into the incident. Some
members of the public have expressed concern about the monitoring by the
Hospital Authority (HA) of the surgeries carried out in public hospitals and
their part-time doctors. In this connection, will the Government inform this
Council if it knows:
(1) whether a part-time doctor of a public hospital is required to inform the
management of the hospital concerned and obtain its consent before leaving the
hospital during a surgery to perform surgeries in another hospital;
(2) whether there were surgeries performed in public hospitals in the past three
years which were not completed or were delayed in completion because the
doctor-in-charge performed more than one surgery at the same time; the measures
to be taken by HA to address such problem;
(3) whether HA has drawn up any manpower backup plan and notification mechanism
in respect of a public hospital doctor leaving the operating theatre in the
midst of a surgery for whatever reasons; if so, of the details;
(4) the division of responsibilities between the supervising doctor and the
chief surgeon in a surgery performed in a public hospital; whether the chief
surgeon has the authority to complete a surgery in the absence of the
supervising doctor; if not, the measures put in place by HA to prevent the
recurrence of incidents in which the doctor-in-charge leaves the operating
theatre in the midst of a surgery;
(5) the current number of private medical practitioners working as part-time
doctors for HA, and whether any full-time doctors of HA work as part-time
doctors in the private healthcare system; if so, of their number;
(6) how HA's part-time doctors compare with their full-time counterparts at
present in terms of number and remuneration package;
(7) the reasons why HA employs private medical practitioners to work as
part-time doctors; whether HA has put in place a comprehensive system or
guidelines to monitor the performance of those doctors in order to maintain the
quality of public healthcare services; and
(8) the number of medical incidents in the past decade caused by the negligence
of those part-time doctors, and set out in a table the details and investigation
outcome of each incident; the measures to be taken by HA to reduce the
occurrence of such kind of medical incidents?
Reply:
President,
My reply to the various parts of the question raised by the Dr Hon Elizabeth
Quat is as follows:
(1) to (4) The Hospital Authority (HA) provides treatment for patients in the
form of clinical management teams. In general, "major" and "ultra major"
operations are performed by surgical teams. If a surgeon of the team needs to
leave the operating theatre in the midst of an operation to handle emergency
clinical work, the remaining surgeons will continue to perform the operation in
hand. Arrangement will be made for an appropriate surgeon to substitute if
necessary. The surgeon who needs to leave the operating theatre will give a
detailed account of the clinical situation of the patient to the surgeon(s)
taking over to ensure that the operation could be completed smoothly.
(5) As at September 30, 2017, there were 366 part-time doctors working in the
HA, providing support equivalent to about 132 full-time doctors. According to
the human resources policy of the HA, an employee should obtain prior approval
before he/she can undertake part-time outside work. Under normal circumstances,
full-time employees are not allowed to engage in paid part-time outside work
which is related to their profession.
(6) As at September 30, 2017, there were 5 853 full-time doctors working in the
HA. The remuneration of an HA contract part-time doctor is calculated on the
basis of the number of hours worked with reference to remuneration of a contract
full-time doctor, taking into account the nature of clinical work involved.
(7) The HA employs part-time doctors having regard to, mainly, the demand for
manpower in various specialties, the expertise and experience required for
service development as well as training needs. The HA has established code of
practice and assessment mechanism to monitor the performance of part-time
doctors.
(8) The HA has implemented the Sentinel Event and Serious Untoward Events Policy
since 2007. The policy is not intended to blame individual staff member or
hospital, but to encourage staff members to report promptly any sentinel events
and serious untoward events in an open manner, with a view to conducting early
investigation and learning lessons from the events to prevent similar medical
incidents from happening in the future.
In case of medical incidents, including those outside the scope of specified
sentinel and serious untoward events to be reported, the hospitals concerned can
report the incidents to the HA Head Office via the Advanced Incident Reporting
System. The hospital clusters concerned and the HA Head Office will take
appropriate actions, such as conducting investigation and reviews, having regard
to the nature of the incidents. Where necessary, they can adopt the same
follow-up procedures as those for handling sentinel and serious untoward events
and the HA can appoint an expert panel to conduct detailed analysis, with a view
to identifying the possible causes of the incidents, and exploring and
formulating improvement measures.
In most cases, patients in hospitals of the HA receive professional services
provided by a medical team instead of an individual type of doctors (such as
full-time or part-time doctors). Hence, the HA does not maintain the statistics
of medical incidents caused by the negligence of individual types of doctors.
Ends/Wednesday, November 29, 2017
Issued at HKT 14:54
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