LCQ21: Monitoring of surgeries carried out in public hospitals and part-time doctors by Hospital Authority
Hong Kong (HKSAR) - 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):
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 toa 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?
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.
Published on: 2017-11-29
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