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Following is a question by the Hon Vincent Fang and a reply by the Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today (November 18):
Question:
Last month, a Judge of the Court of First Instance of the High Court handed down a judgment on a judicial review case, criticising the lamentable state of affairs of the Medical Council of Hong Kong (MCHK) in handling complaints; the protracted and cumbersome process and procedures for handling complaints; the handling of complaints by MCHK members on a voluntary and part-time basis; the inadequacy in administrative support and personnel to handle the volume of complaints; as well as the lack of appropriate guidelines (including guidelines on declaration of interests) and structure for handling complaints. Regarding the regulation of registered medical practitioners by MCHK, will the Government inform this Council:
(1) given that the secretariat service provided by the Department of Health to MCHK incurs a public expenditure of approximately $25 million each year, and yet MCHK's efficiency in handling complaints has repeatedly been criticised by various sectors, and the aforesaid judgment criticised that it was both excessive and unreasonable for the Preliminary Investigation Committee of MCHK to take two years to handle the complaint concerned, how the Government supervises and assesses the work performance of the MCHK Secretariat; whether the Government will make reference to the aforesaid judgment and conduct a comprehensive review of the staff establishment, the complaint-handling procedures and the work efficiency of the MCHK Secretariat to ensure the proper use of public money;
(2) as the aforesaid judgment has pointed out that MCHK has not formulated general guidelines on the topic of conflict of interests of its members and on the declaration of interests in relation to a complaint, and that MCHK should address this matter immediately, whether the authorities will make reference to the judgment and examine amending the Medical Registration Ordinance, including increasing the proportion of lay members of MCHK and improving the mechanism for declaration of interests by MCHK members, so as to forestall the public perception of "doctors harbouring each other" in the handling of complaints by MCHK; and
(3) given that in the five-year period from 2009 to 2013, MCHK received on average 470 complaints a year against registered medical practitioners, of which only about 60 cases involved medical practitioners employed by the Hospital Authority and, in other words, complaints involving private medical practitioners accounted for 87 per cent of the total number of complaints, whether the authorities will step up efforts in regulating private medical practitioners with a view to preserving public confidence in the medical profession?
Reply:
President,
The Government attaches great importance to the professional competence and ethics of healthcare professionals. A fair, impartial, open and effective mechanism for handling complaints involving healthcare professionals is necessary to ensure the quality of healthcare services and safety of patients, protect the interests of patients and foster mutual trust between patients and healthcare professionals.
On regulation of medical practitioners, the Medical Council of Hong Kong (MCHK) is an independent statutory body established under the Medical Registration Ordinance (Cap. 161) for handling matters relating to the regulation of medical practitioners in Hong Kong. It handles complaints against medical practitioners, conducts investigations and inquiries into allegations of professional misconduct and takes disciplinary actions.
The MCHK handles complaints against medical practitioners in accordance with the relevant regulations. Upon receipt of a complaint, the Preliminary Investigation Committee (PIC) of the MCHK will conduct preliminary investigation into the case. If the PIC determines that there is a prima-facie case, it will refer the case to the MCHK for a formal inquiry. If the MCHK finds that a medical practitioner is guilty of professional misconduct, it can impose punishment by issuing him/her disciplinary order or even revoke his/her professional registration.
My reply to the three parts of the question raised by the Hon Vincent Fang is as follows:
(1) The Government provides secretariat service through the Department of Health to support the MCHK in discharging its duties. Currently, the Medical Council Secretariat has a 16-strong establishment. Over the past year, the Food and Health Bureau has been discussing with the Medical Council Secretariat on the ways to improve the procedures and enhance efficiency in handling complaints, including reviewing the manpower and resource requirements of the Secretariat, with a view to ensuring proper use of public funding.
(2) Lay involvement, openness and transparency, as well as avoidance of conflict of interest are important elements of the composition as well as complaints handling and disciplinary inquiry mechanism of the MCHK.
Firstly, the current composition as well as complaints handling and disciplinary inquiry mechanism of the MCHK have a certain degree of lay involvement to ensure its objectivity and credibility. The MCHK comprises 24 registered medical practitioners and four lay members. In addition, the quorum of a PIC meeting includes at least one lay member. The quorum of a disciplinary inquiry meeting is five MCHK members, or no less than three MCHK members and two assessors, with at least one of whom must be a lay member.
Secondly, on the openness and transparency of the complaints handling and disciplinary inquiry mechanism, it should be noted that the inquiries of the MCHK are open to the public. The relevant judgments of the inquiry will be gazetted in accordance with the Medical Registration Ordinance for public access. The MCHK will also upload the relevant judgements onto its website.
Thirdly, to ensure fairness and impartiality of the complaints handling and disciplinary inquiry mechanism, sections 7(1) and 7(2) of the Medical Practitioners (Registration and Disciplinary Procedure) Regulation require PIC members to declare their interest upon receipt of a case. A member with conflict of interest must not participate in any deliberation or decision regarding the case.
The Government maintains communication with the MCHK and reviews its regulatory framework and operation from time to time in order to keep its operation abreast of the time and public expectation. The Government agrees that there is room to improve the mechanism for complaints investigation and disciplinary inquiry, including increasing lay involvement in the composition as well as complaints handling and disciplinary inquiry mechanism of the MCHK, further enhancing the transparency and efficiency of the mechanism and avoiding conflict of interest in a more effective manner, with a view to increasing the credibility of the mechanism, safeguarding public confidence and shortening the processing time for handling complaints and disciplinary inquiries.
(3) According to the Medical Council Secretariat, in the past five years (from 2010 to 2014), about two-thirds of the complaint cases handled by the PIC were considered as either frivolous or related to allegations which did not constitute professional misconduct, which were dismissed with no inquiries required. A considerable number of these complaints were to do with aspects like doctors' communication skills and attitude falling short of the expectation of the patients.
On the handling of complaints against doctors in public hospitals, the Hospital Authority (HA) has a two-tier complaint handling mechanism in place. The first tier is at the hospital level which is responsible for handling complaints lodged for the first time. If a complainant is not satisfied with the outcome of his/her complaint at the hospital level, he/she may appeal to the second tier, namely the Public Complaints Committee of HA. Moreover, we are conducting a review on the regulatory regime for private healthcare facilities (PHFs). Among other objectives, we hope to ensure, through premises-based regulation, that PHFs attach adequate importance to major issues including corporate governance, clinical quality and price transparency, as well as to establish a committee for handling relevant complaints, with a view to enhancing the public's confidence in the quality and reliability of private healthcare services.
In view of the ageing population and public expectation for quality healthcare services, the Government has set up a steering committee to conduct a strategic review on healthcare manpower planning and professional development in Hong Kong. On professional development, the steering committee has particularly looked at issues relating to the functions and composition of regulatory bodies, complaints handling and disciplinary inquiry mechanism, as well as training and development. The review is expected to complete in the first half of 2016. Upon the completion of the review, the Government will take forward the recommendations accordingly.
Ends/Wednesday, November 18, 2015
Issued at HKT 16:45
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