Be Prepared

While we are always warned to maintain high vigilance against Avian Influenza, the world was suddenly hit by a new H1N1 Influenza virus, the Swine Influenza.  Starting 18 March 2009, there were cases of influenza-like illness in the Federal District of Mexico.  The number of cases increased steadily from March to April.  On 23 April 2009, there were more than 854 reported cases, of which 59 died.  Amongst the Mexican cases, 18 were laboratory confirmed in Canada as Swine Influenza A/H1N1.  On 24 April 2009, the United States Government reported 5 confirmed human cases of Swine Influenza A/H1N1 in California and 2 in Texas.  The Swine Influenza A/H1N1 viruses spread quickly to a raft of countries within days.  On 29 April 2009, apart from Mexico and United States, seven more countries officially reported 148 cases of Swine Influenza A/H1N1.  They included Austria, Canada, Germany Israel, New Zealand, Spain and the United Kingdom.  On the same day, Dr Margaret CHAN, Director-General of the World Health Organization, decided to raise the level of influenza pandemic alert from phase 4 to phase 5.

In Hong Kong, the confirmed case involved a 25-year-old Mexican man who stayed in the Metropark Hotel in Wanchai after arriving from Mexico via Shanghai on 30 April 2009.  To safeguard the wellbeing of the community, Dr. LAM Ping Yan, Director of Health, issued an order [under Section 25 of the Prevention and Control of Disease Ordinance (Cap 599)], which required the staff and residents of the Metropark Hotel to be quarantined for a period of seven days.

Luckily, the pandemic seemed to be under control.  However, doctors and citizens alike should be prepared for the worst.  In this issue, our President and Immediate Past President both write on this influenza attack.

Also in newspapers, you might have read about the decisions of the Medical Council recently.  Most of you would focus on the doctor whose name was removed from the General Register for an indefinite period.  The order was also made to take effect immediately upon publication in the Gazette, which was referred to as an “unprecedented move” so as to prevent any delay in the removal.  The charge which caused this heavy sentence was that “between 1997 and 2007, he had inappropriate personal contact with Patient A.”  Medical disciplinary bodies always take very serious views on affairs, especially sexual relations, between doctors and their patients.  Patients are considered vulnerable because they are suffering from illnesses.  They go to their doctors to seek help.  They trust their doctors and are dependent on them. 

Abusing doctor-patient relation amounts to serious professional misconduct.  Psychiatric and paediatric patients are taken even more seriously.

However, another appeal case (CACV 403/2006) might have escaped from your attention.  The doctor was found professional misconduct because she “sanctioned, acquired in or failed to take adequate steps to prevent the appearance of her name, title, photographs and statements in an advertisement in (a newspaper) on (a date), in which she endorsed (products) offered by (a company) with which she had a financial relationship.”  She succeeded in the appeal and the decision was set aside.  Three issues were raised for the appeal:

1. It was wrong for the legal adviser to have been present during the deliberations of the Council and to have been involved in the drafting of the findings.
2. It was unfair to be prosecuted for breach of a norm (that doctors are prohibited from public endorsement or promotion of a commercial brand of … health related products) that had never been articulated.
3. The prohibition was not necessary or out of proportion.

All three judges agreed that the appeal succeeded because of the first issue.  Hon Le Pichon JA pointed out that he did not consider that the other issues had any merit and would have dismissed the appeal but for the first ground.  Hon Stone J in para 88 said, “In my judgment in the factual circumstances of this case this appellant has been fortunate to succeed on this appeal, which, save for the successful procedural point invoked in her favour by her eminent leading counsel, otherwise had little intrinsic merit.”  And he explained this in a very long sentence in para 81, “It must have been as plain as a pikestaff to this lady that the gravamen of the complaint was that she had impermissibly lent the medical credentials of a practising doctor to the health product marketed by her company in what, in my view, was an entirely unsubtle (if not brazen) press ‘Advertorial’, wherein the written and pictorial content of the article in question; nor is this a prescriptive norm of which she possibly could have been unaware, in light of her seniority within a profession which has always endeavoured to restrict approbation of commercial products by practitioners, and frequently has advertised this fact; the further suggestion that this appellant, the managing director of this company, had had no control over what was written in this ‘Advertorial’ in my view was risible.”

The main impact to the profession came from the first issue.  For many years, it had been a practice for the legal advisor to stay with Medical Council members and Assessors during their deliberations and to help drafting written judgments.  Hon Le Pichon JA pointed out in para 16 that “The authorities cited made clear, in no uncertain terms, that communication in any form by a non-member with a tribunal in the absence of the parties would give rise to a perception of unfairness, that justice would not be done inasmuch as the tribunal might have been influenced by what might have been communicated.”  Hon Cheung JA further explained this in para 63, “Article 10 of the Bill of Rights provides that in the determination of, among other things, a person’s rights and obligations in a suit of law, he is entitled to a fair and public hearing by a competent, independent and impartial tribunal established by law….  As part of the protection given by Article 10 one would expect a competent, independent and impartial tribunal to, first, deliberate the decision by its own members without the presence of a non-party and, second, to write its own reasoned decision.”

In summary, because of the presence of the legal advisor in the deliberation and his drafting of the judgment, the doctor succeeded in the appeal.  She was not guilty of professional misconduct because the trial was considered not a fair trial.  Then, how about all the other trials?  There were many cases which had been decided with the legal advisor present during deliberations and drafting judgments.  Will they also succeed if they do appeal based on the same reason?  Even the above mentioned doctor, who was removed from the General Register for an indefinite period, might appeal on the same ground.  Of course there will be limitation periods for appeals, and there remains an option of ordering a re-hearing for a series cases that succeed on procedural grounds.  This case is still a huge challenge to the Medical Council.  Please be prepared.

(Source: HKMA News May 2009) 

March, April, May

On 6 March 2009, the announcement of the contamination of a pharmaceutical product, Purinol (manufactured by Europharm Laboratories Company Ltd), marked a spate of drug-related blunders.  The next day, the HKMA advised members to stop using products from the said company until matters had been clarified by the Department of Health (DH).  A similar official advice from DH reached doctors on 10 March.  On 19 March 2009, unlicensed packaging of Amitriptyline tablets by Unipharm Trading Company was reported.  Two batches comprising 4,049 bottles of 25 mg tablets and one batch comprising 285 bottles of 10 mg tablets were recalled from public hospitals, public clinics, private hospitals, private doctors and pharmacies.  On 22 March 2009, two batches of Water for Injections were recalled from the Hospital Authority (HA).  According to initial investigation by the DH, the actual volume found in the two batches of products (ranged from 120 ml to 130 ml) did not match with the declaration of the label of each bottle (100 ml).  On 25 March 2009, during a current drug stock-taking exercise, the HA reported that the expiry dates shown on the labels of a same batch of Propranolol 10 mg tablets supplied by Unipharm Trading Company were different.  It was suspected that the cause of the discrepancy was related to an isolated computer malfunctioning when preparing the labels.  Then, reports concerning unregistered eye drops and other products came out.  More reports on unregistered and defective products are foreseeable.

On 24 March 2009, Mr. Donald TSANG Yam Kuen, the Chief Executive, said that the drug blunders would be taken seriously and investigations would be carried out for various incidents.  A high-level committee chaired by Ms. Sandra LEE Suk Yee, Permanent Secretary for Food and Health (Health), would conduct a comprehensive review of the whole system in a bid to regain public confidence.  It is true that these incidents adversely affect the confidence of citizens (and doctors) in pharmaceutical products and the statutory role of the DH in the control and monitoring of such products.  In this issue, our President and Vice President analyze the drug blunders in the President’s Message and the Forum respectively.

On 4 March 2009, our President and two of our Council Members were elected Chairmen of three Committees of the Medical Council of Hong Kong.  Dr. TSE Hung Hing was elected Chairman of the Ethics Committee.  Dr. CHEUNG Hon Ming was elected Chairman of the Licentiate Committee.  And Dr. CHIU Shing Ping, James, was elected Chairmen of the Health Committee.  Do you know the composition and function of these Committees of the Medical Council?  In the Interview Session of this issue, I invited the above three new Chairmen to introduce themselves and the Committees to our members.  Talking about elections of the Medical Council, one would immediately recall our Immediate Past President appearing in the media.  Dr. CHOI Kin lost in the election for Chairman of the Medical Council.  He again spoke out and provided some heated topics for discussion in the Interview.  

On 12 May 2008, the Great Sichuan Earthquake occurred in Sichuan province of China.  The earthquake had a magnitude of 8.0 Ms, lasting for around 3 minutes.  Official figures revealed that more than 90,000 people in total were dead or missing in the tremor.  It has been nearly one year’s time after the catastrophe.  Apart from the Hong Kong Medical Association Charitable Foundation’s hard work in emergency appeal, we do have great concerns about the recovery and redevelopment of the areas.  The 11^th Beijing/Hong Kong Medical Exchange will therefore be held in Chengdu, Sichuan instead of Beijing on 24 & 25 October 2009.  The main theme of the Meeting is “Rehabilitation after Disaster”, featuring aspects like orthopedic rehabilitation, rehabilitation of amputees, rehabilitation of spinal cord injuries, psychological rehabilitation etc.  A half-day visit will also be arranged for examining the ruins of earthquake and related medical institutions.  For details, please look out further announcement from the Secretariat.

On 24 May 2009, the Certificate Course on the Management of Drug Abuse Patients for Family Doctors will begin. It is funded by the Beat Drugs Fund Special Funding Scheme.  The objective of the Certificate Course is to increase family doctors’ interests, awareness and knowledge on the problems of drug abuse.  Most importantly, it aims at empowering family doctors to lead the management of young drug abusers in a team approach.  There will be an increasing need for trained personnel when the public become more aware of the youth drug abuse problem and the practice of drug testing is promoted in schools (many of the schools start adopting the drug testing practice).  As this Certificate Course will be a one-off programme, do not miss the chance.  Please kindly find attached circular for more details and enrollment.   

(Source: HKMA News April 2009)

Youth Drug Abuse

On February 27, 2009, five Form 2 school girls from Sheung Shui Government Secondary School fell ill in school after taking katamine during lunch time and were sent to hospital.  Two fifteen-year-old boys, who were suspected to provide the students with ketamine, were charged with trafficking in a dangerous drug.

As a Hong Kong citizen, I read in newspaper news related to youth drug abuse nearly every day.

As a member of the Action Committee Against Narcotics (ACAN), at every meeting I face statistics showing a continuously rising trend of young people abusing drugs including ketamine.

As a doctor joining the Project Mac (a pilot project of the ACAN to help young drug abusers by providing body check-ups and motivational interviews with doctors), I meet many teenagers who started their first abuse before the age of 12.  Many of them do not attend school, do not work, and are in debt because of regular drug abusing.

As a family doctor, I now and then encounter teenage patients with drug abuse problems in my daily practice. Some of them come for sick leave, the other come for symptomatic relief.  However, some of them do come to ask for help.  I was very sad to see a university student who developed psychosis after taking Ecstasy in several occasions in Karaoke because of peer pressure from classmates.

I believe that doctors can help young dug abusers.  We can do it as an individual doctor by increasing our alertness in screening and identification; and by sharpening our knowledge and technique in intervention.  The HKMA can take the leading role in organizing seminars and forming district networks.  In cooperation with the ACAN, we are organizing a Certificate Course on the Management of Drug Abuse Patients for Family Doctors.  There will be eight sessions of seminars and discussions, together with the formation of supporting networks between our Community Network and local NGOs.

The government also has set up the Task Force on Youth Drug Abuse to review current anti-drug measures, to spearhead cross-bureaux and inter-departmental efforts, and to enhance collaboration among NGOs, stakeholders and the community, with a view to identifying areas of focus and improvement.  I have invited the Chairman of the Task Force, Mr. WONG Yan Lung, SC, JP, Secretary for Justice, for an interview.  He shared with us the work of the Task Force and discussed how doctors and HKMA could fit in the battle against drug abuse.

Talking about legal matters, on March 2, 2009, the judgment handed down from the Court of Final Appeal with respect to the case of Frank Yu Yu Kai and Chan Chi Keung (FACV No. 11 of 2008) left some doctors, especially anesthetists, feeling uneasy.  The case concerned the claimant suing the defendant (an anesthetist) for clinical negligence because of radial nerve injury after radical prostatectomy.  The claimant failed in the High Court (HCPI 230/2004) but succeeded in the Court of Appeal (CACV 433/2006).  The anesthetist lodged an appeal to the Court of Final Appeal and the judges (by a ratio of 4:1) found that the burden of proof fell on the anesthetist (who was the defendant in the claim) to proof that he had discharge his duty of care to the patient and to explain why the radial nerve injury happened.  They found that the anesthetist failed to do so.  He was found negligent and therefore had to pay damage to the patient.

The gist of the case hinged on the maxim “res ipsa loquitur”, which is a Latin phrase meaning “the thing speaks for itself”.  In a clinical negligence case, the claimant has to prove that the defendant has breached his duty of care owed to the claimant, and causing damage to him which is not too remote.  The most difficult part is the proof of causation.  “Res ipsa loquitur” concerns causation and a classical description can be found in Scott v London and St Katherine Docks Co[1]: “where the thing is shown to be under the management of the defendant or his servants, and the accident is such as in the ordinary course of things does not happen if those who have the management use proper care, it affords reasonable evidence, in the absence of explanation by the defendants, that he accident arose from want of care.”  It is said that when this maxim is successfully invoked by the claimant, it can have the effect of shifting the burden of proof from the claimant and the defendant has to prove that he is not acting negligently in causing the damage.

But what was the problem here?  Quoting Mr. Justice Litton NPJ, the only dissenting judge, at para 133: “The event or ‘thing’ must be so clear-cut that a court can say with assurance: Unless the defendant can come forward with some credible explanation, it must be concluded that want of care produced that result.  As stated in Clerk & Lindsell on Torts [19^th ed.] para. 8-152, common experience suggests that in the absence of negligence, bales of sugar do not usually fall from hoists, barrels do not fall from warehouse windows, cranes do not collapse, trains do not collide and stones are not found in buns.  In the medical context because of the complexity of the human body and the fact that medical science is perpetually evolving and changing, things are seldom so clear-cut.”

However, the majority view, as given by Mr. Justice Ribeiro PJ, was that: “.…(Res ipsa loquitur) is an approach whereby, in cases where the plaintiff is unable to say exactly how his injury was caused but, consonant with his duty of care, one may expect that defendant to know, one asks whether the evidence has raised a prima facie case against the defendant and if it has, whether the defendant has, at the end of the day, dispelled that prima facie case by providing a plausible explanation for the plaintiff’s injury which consistent with the absence of negligence of his part.” (para 43)  He considered that this approach was also applicable in medical negligence case because the well recognized purpose of the rule was “to enable justice to be done when the facts bearing on causation and on the care exercised by the defendant are at the outset unknown to the plaintiff and are or ought to be within the knowledge of the defendant.” (para 45)

How about the scope of the decision?  Does it apply to all medical negligence cases?  Mr. Justice Ribeiro PJ said, “Although the approach will not be important in medical negligence cases where the issues of causation and negligence are wholly fought out on competing evidence, it seems to me obvious that in a significant number of such cases -particularly where the patient is unconscious when the injury is incurred- the res ipsa loquitur or prima facie case approach will be indispensable.” (para 46)  Thus this decision might affect many medical negligence cases concerning procedures under anesthesia.

---

[1] (1865) 3 H&C 596 at p 601; 159 ER 665 at p 667

 (Source: HKMA News March 2009)

恭喜發財！

In January, we had the Chinese New Year.  I would like to wish everyone a prosperous year of Ox.  Apart from lion dance, another ritual was the worshiping of Che Kung (車公) on the second day of the New Year.  On January 27, Mr. LAU Wong Fat, Chairman of Heung Yee Kuk, drew a fortune stick for Hong Kong at the Che Kung Temple in Shatin.  It read:

君不須防人不肖 眼前鬼卒皆為妖

秦王徒把長城築 禍去禍來因自招

The unlucky fortune stick No. 27 was about the story of Qin Shihuang (秦始皇).  It said that there was no need to be aware of misbehaved people, because those serving you could all be considered evil.  Emperor Qin failed to protect his Empire by building the Great Wall, because it was himself who caused the Empire’s downfall.

Che Kung was a great generalissimo of the Song Dynasty (宋朝).  He was worshipped in Hong Kong mainly because of his act as a doctor.  He was famous for removing epidemics in Sai Kung and for curing people.  It would be interesting to look at the fortune stick from the viewpoint of a medical practitioner.

The first two sentences reminded me of the handling of patients with infectious diseases and the collection of specimens.  In the 1980s, blood samples from patients known to have HIV or hepatitis B were tagged with red labels to alert handlers of the infectious nature.  Then starting from the 1990s, this practice was stopped.  The reasons behind were mainly that all specimens should be handled with care for the potentially infectious nature, and that privacy of patients should be respected.  I think this attitude should also be adopted by leaders.  Advices and proposals should be handled with care and assessed by objective means no matter by whom the advices are given.  While doctors and laboratory technicians are protected by gloves and gowns, leaders should be protected by the general principles of “doing no harm”, “doing good” and “being evidence-based”.

In February (starting Feb 9, 2009), police officers in uniform can require a person who is driving or attempting to drive a vehicle on a road to conduct a breath test without the need for reasonable suspicion.  The Road Traffic Legislation (Amendment) Ordinance 2008 (No. 23 of 2008) had been passed to amend the Road Traffic Ordinance, the Road Traffic (Driving Licences) Regulations and other subsidiary legislation under that Ordinance and the Road Traffic (Driving-offence Points) Ordinance so as to - 

• (a) increase the term of imprisonment of the offence of causing death by dangerous driving under section 36 of the Road Traffic Ordinance from maximum of 5 years to 10 years;
• (b) increase the penalties on offences under sections 39, 39A, 39B and 39C of the Road Traffic Ordinance (disqualification from driving for not less than 3 months on first conviction and not less than 2 year on second and subsequent convictions), and provide police officers with a general power to conduct screening breath tests;
• (c) introduce a pre-screening device for the purposes of the new section 39B(1)(a) of the Road Traffic Ordinance; 
• (d) provide that certain traffic offenders are required to attend driving improvement courses; 
• (e) extend the probationary driving licence scheme to novice drivers of private cars and light goods vehicles; 
• (f) provide for the review by a Transport Tribunal of certain decisions made by the Commissioner for Transport to refuse to issue, reissue or renew driving licences or driving instructor's licences or to cancel those licences; and 
• (g) make related, consequential and other minor amendments. 

(The Government of the Hong Kong Special Administrative Region Gazette, Legal Supplement No. 1 to No. 27, Vol. 12, 4 July 2008, pp. A961-A1059)

An interesting document to compare was the “Review of Drink Driving Legislation” by the Panel on Transportation of the Provisional Legislative Council in January 1998.:

“The Administration maintains its view that random testing should not be introduced at this stage due to the following reasons: 

1. the setting up of road blocks for random testing causes further congestion to our busy roads;
2. substantial additional Police resources will be required (additional capital and recurrent cost are estimated to be $2.4 million and $20 million respectively); and
3. the legal advice that although it is debatable whether the practice involves an interference with privacy within the meaning of the Bill of Rights and therefore should not be ruled out completely on human rights grounds, the introduction should only be seriously considered if there is clear evidence, which there is none, that the current drink driving laws are not proving effective.”

Doctors need to be alerted about this recent change, as this may be related to professional misconduct and may endanger our registration.  Section 27 of the Code of Professional Conduct 2009 concerns criminal conviction.  S.27.1 reads: “A doctor convicted of any offence punishable by imprisonment is liable to disciplinary proceedings of the Medical Council, regardless of whether he is sentenced to imprisonment.  A conviction in itself will invoke the Council’s disciplinary procedure even if the offence does not involve professional misconduct.  However, the Council may decide not to hold an inquiry where the conviction has no bearing on the doctor’s practice as a registered medical practitioner.”  And s.27.2 reads: “A particularly serious view will likely be taken in respect of offences involving dishonesty (e.g. obtaining money or goods by deception, forgery, fraud, theft), indecent behaviour or violence.  Offences which may affect a doctor’s fitness to practise (e.g. alcohol or drug related offences) will also be of particular concern to the Council.”  Section 11 of the Code concerns abuse of alcohol and drugs.  S.11.1 reads: “Convictions for offences arising from drunkenness or abuse of alcohol or drugs (such as driving under the influence of alcohol or drugs) are likely to be regarded as professional misconduct.”

(Source: HKMA News February 2009)

Where do I go from here?

 

“My world has changed, and so have I

I've learned to choose and even learned to say good-bye

The path ahead, so hard to see

It winds and bends, but where it ends depends on only me

In my heart I don't feel part of so much I've known

Now it seems it's time to start a new life on my own

But where do I go from here?

So many voices ringing in my ear

Which is the voice I was meant to hear?

How will I know, where do I go from here?” 

(Lyrics from Where Do I Go From Here? Pocahontas II: Journey To A New World)

Last year, it was decided that the two medical schools would increase the intake of medical students to 160 each every year despite the concern raised by the HKMA that there had not been and would not be enough structured training for the graduates.

In December last year, a Year-Three medical student committed suicide by jumping off a building.  She was offered university place through the Early Admissions Scheme after achieving 7As in the HKCEE.  She entered the medical school at the age of 17.  She left a death note, revealing her difficulties towards academic and financial issues.   

Also in last year, a medical student convicted of sexual offences made an application for registering as a medical practitioner with the Medical Council of Hong Kong after completing his studies and internship.  A hearing under camera was conducted to consider his application.  There were concerns about his fitness to practice and his mental status.  How to strike a balance between patient protection and giving chances to students who had made mistakes?  The decision is still pending.

Where do medical students go from medical schools?  There is a famous quote by Tom Bodett,

“The difference between school and life:   

In school, you're taught a lesson and then given a test.   

In life, you're given a test that teaches you a lesson.”

We have invited Professor LEE Sum Ping, Dean of the Li Ka Shing Faculty of Medicine of the University of Hong Kong, as our special guest of Council Dinner.  Prof. LEE was concerned about the discontinuation of medical services provided to citizens because of the plead by the Hospital Authority that there would be a lack of doctors.   However, as an adorable scholar, Prof. Lee admitted that medical schools should also be responsible for ensuring graduates to have opportunities of medical training.  Our President pointed out the situation several years ago when there were problems of not enough placement in the Hospital Authority for doctors after housemanship.   Ernie and Kingsley shared their experience of temporary contracts and service posts of junior doctors around the year 2000.  In view of these, I proposed to do a survey on the career of graduates of recent years.  The idea was supported by Prof. LEE and the Council as evidence would be invaluable in guiding the direction of undergraduate and postgraduate training.

I have also arranged an interview with Professor FOK Tai Fai, Dean of the Faculty of Medicine of the Chinese University of Hong Kong.  Our President, Vice Presidents, Immediate Past President and I will meet Prof. FOK at the newly opened Salon de Ning.  While enjoying the environment of old Shanghai and the legend of Madame Ning, we shall again discuss with Prof. FOK about the intake of medical students, undergraduate and postgraduate training, and the survey of the careers of graduates.   This will all appear in the next issue of the HKMA News.

The interview in this issue is with three current medical students.  Apart from enjoying the eye-catching pictures taken by Amy and me, please read the article written by the three girls.  They share with us their worries as medical students.  But at the same time, you can surely feel the confidence and energy of our next generation.

(Source: HKMA News January 2009)

Happy New Year

It’s December.  Merry Christmas and Happy New Year.

You will find a Christmas and New Year gift going with the HKMA News in this issue.   It is a diary and log book from the CME Committee tailor-made for doctors.  It contains useful information like hospital telephone numbers, and practical tips for safe practice from the Medical Protection Society.  Most importantly, there is a schedule of CME activities for family doctors for the upcoming year, featuring the newly introduced family medicine seminars on a Sunday of each month.  You will surely find these seminars very interesting and useful.  At the end of 2009, you will also find yourself one big step nearer to get a Certificate of Family Medicine.

It is tradition to review events of the past year.  The following are some major medically related events that come across my mind:

Dr. KWONG Kwok Hay v. the Medical Council of Hong Kong

On January 24, the Court of Appeal handed down the judgment and confirmed that some of the sections of the Code of Practice were against basic human rights.  This had great influence on the dissemination of information by doctors including advertising, and the investigation and inquiry for professional misconduct by the Medical Council.

Health Care Reform

On March 13, The Food & Health Bureau published a Healthcare Reform Consultation Document entitled “Your Health Your Life” to seek public views on the healthcare system and financing arrangements.  The first stage of public consultation ended on June 13.  The community generally agreed that increased resources should be best utilized to enhance healthcare services.  However, there were contentious and skeptical views about the supplementary financing options. 

Sichuan Earthquake

On May 12, a magnitude 8.0 earthquake occurred at 14:28 in Sichuan province of China: the “Great Sichuan Earthquake”.  From official figures, 19,065 school children died, and there were more than 90,000 deaths or missing.  The Hong Kong Medical Association and the Hong Kong Medical Association Charitable Foundation Limited launched fundraising appeal without delay.  Many doctors of different specialties also volunteered to work at various sites.

2008 Olympic and Paralympic Equestrian Events

Hong Kong was privileged to be a co-host city for the Beijing Olympics in August.   Led by the Director of Health, Dr. P Y Lam, who was also the Chief Medical Manager of the Equestrian Event, a 2000-strong medical professional team fully supported the events.  The medical team had set up contingency plans to deal with various emergencies like infectious disease outbreaks, poisoning, mass casualties and disasters.

2008 Legislative Council Election

On September 7, the election battle finally ended after months of campaigns and forums.  Dr. K L LEUNG was elected for Medical Function Constituency.  He received 2,217 votes for approximately 33%, defeating the other three nominees.

Melamine Scandal

On September 11, Mainland’s Sanlu brand of infant formula was found to be contaminated with melamine.  Screening reviewed over thousands of babies across the country who developed urinary problems after consuming tainted milk powder.   On September 20, the first case of renal disease associated with contaminated milk product was reported in Hong Kong.  On October 11 & 12, affiliates from the Hong Kong Medical Association visited Guangzhou and Jiangmen to examine the conditions and to study the management of children suffering from renal stones.

 

World Economic Turmoil

Starting with the federal takeover of mortgage finance giants Fannie Mae and Freddie Mac in early September, there were unfavourable occurrences all around the world.  Lehman Brothers filed for bankruptcy protection and the mini-bonds issued were affected.  Doctors themselves suffered financial loss and some might be emotionally disturbed.  At the same time, we need to look after patients and addressed effects from the economic turmoil.

Policy Address 2008-2009

The Policy Address 2008-2009 was delivered by our Chief Executive on October 15.   Under the heading of “Healthcare Reform”, there were four main categories: consultation, promoting the development of private healthcare, district medical facilities and enhancing primary care services.

Influenza Vaccination Subsidy Scheme

On November 1, the Government launched the Influenza Vaccination Subsidy Scheme.  This was the first implementation that the government roped in private doctors to help in prevention measures of the community.

Avian Influenza

On December 8, the Food and Health Bureau confirmed that up to 60 chickens died from H5N1 viral infection in one chicken farm in Yuen Long.  Again, we will have no chicken for New Year.   

My Big Ten might not go with yours.  Year 1 students might find their admission to the Medical School memorable.  2008 is the year for more than two hundred new housemen and new registered doctors.  Some doctors passed part or all of their fellowship examinations.  Some doctors got married.  Some gave birth to children.   And sadly, some of us had to separate with our beloved ones.

The biggest event for my signature bear is the co-organizing of the Certificate Course in Family Medicine with the Chinese University of Hong Kong.  The kick-off seminar will be held on January 18, 2009.  Your diary will also serve as a log book for recording your attendance of the family medicine core seminars together with other CME activities.

 (Source: HKMA News December 2008)

Keep the Change......

A great change has come to America in November.  On November 6, 2008, Barack OBAMA was elected US President.  OBAMA, a first-term Democrat, defeated his Republican rival, John McCAIN, with 52.5% and 46.2% votes respectively.  The President Election day attracted a voter turnout of 64%, a high level unseen for a century.  And, OBAMA was the first black man elected US president.  “It’s been a long time coming, but tonight, because of what we did on this day; in this election, at this defining moment, CHANGE has come to America,” said OBAMA in his victory speech.

Ever since OBAMA announced his candidacy for President of the US in February 2007, it had been addressed by the press and the media that, “Something is happening.”   During the movements for the past 21 months, OBAMA’s platform rested upon tremendous change in the United States and the establishment of a new path for the American government.  His election campaign, his speeches and his weblog were all highlighted on change: “It’s About Time… It’s About Change…”  As reported by the New York Times, he identified the issues of rapidly ending the Iraq War, increasing energy independence and providing universal health care as his top three priorities.  

Doctors might be a bit more interested in health care issue.  On January 24, 2007, OBAMA spoke about his position on health care at Families USA, a health care advocacy group.  He said, "The time has come for universal health care in America…. I am absolutely determined that by the end of the first term of the next president, we should have universal health care in this country."  OBAMA cited cost as the reason why many Americans did not have health insurance.  He proposed to provide affordable health care for all Americans.  This would be paid for by insurance reform, cost reduction, removal of pharmaceutical patents, and requiring employers to provide insurance coverage or to contribute to a new public plan.  For those not insured through employment, he proposed a National Health Insurance Exchange that would include both private insurance plans and a government-run option.  Coverage would be guaranteed regardless of health status, and premiums would not vary based on health status.  Mandatory health care insurance for children would also be provided.

In Hong Kong, we also face changes in the medical environment.  The first stage of the public consultation on healthcare reform ended on June 13, 2008.  Chapter one of the Healthcare Reform Consultation Document entitled “Your Health Your Life” spelled out “The Need for Change”.  Correspondingly, the ending of this chapter emphasized that “the time for reform is now….”

On June 13, 2008, Dr. York CHOW, Secretary for Food and Health, said in the press release that: “The consultation showed that the public generally supported the healthcare reform proposals, including enhancing primary care, promoting public-private partnership, developing electronic health record sharing, and strengthening existing public safety net.”  However, healthcare financing was not mentioned, except that: "To the public, a major concern is what kind of healthcare protection they can gain by contributing to a financing option."  Regarding service reform, Dr Chow reported that there were three areas drawing great public concern: “how to further upgrade public healthcare service quality, resource management and cost-effectiveness to ensure the public healthcare system can continue covering the public's basic health needs, particularly the disadvantaged; how to ensure fees paid by the public for private healthcare services and health insurance are value for money, including upgrading the private sector's charging mechanism's transparency and boosting service quality monitoring; and, how to ensure both the software and hardware of the healthcare system can meet future rising demand, including training of healthcare professionals.”

Another important document which talked about changes was the Policy Address 2008-2009.  This was delivered by our Chief Executive on October, 15 2008.   Unexpectedly, the focal point of discussion was the introduction of a means test for candidates eligible for the raised Old Age Allowance.  The public reaction was overwhelmingly negative.  Around 60% of respondents fought against the means-testing option.  On October 24, 2008, a week after the delivery of the Policy Address, our CE modified his original proposal by shelving the idea.  Again, as doctors, we might be more interested in medical related issues of the Policy Address.  It seemed that the focus was on “Healthcare Reform”, which was one of the three titles under “Care for the People”. “Healthcare Reform” covered four areas: “Consultation”, “Promoting the Development of Private Healthcare”, “District Medical Facilities”, and “Enhancing Primary Care Services”.

On October 16, 2008, a meeting was held by the HKMA with Dr. the Hon. LEUNG Ka Lau to discuss the Policy Address.  Much concern was expressed on how the government was going to enhance primary care services.  According to the Policy Address, a “Working Group on Primary Care” would be set up “to introduce basic primary care service models focusing on preventive care and a primary care register based on the family-doctor concept.”  A primary care delivery model -the “community health centre”- would be explored “to coordinate the efforts of different service units in the delivery of primary care services.”  Would these lead to further expansion of services provided by the government against the private market?  Would these policies favor HMOs and large group practices?

Are changes always necessary and good?  Well, it’s about time; and it’s about change……

(Source: HKMA News November 2008)