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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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