A difficult operation

Five months after his abrupt resignation put the University of Hong Kong's medical faculty in the media spotlight, life goes on for former dean Lam Shiu-kum.

Friends and former colleagues, including Betty Tung Chiu Hung-ping, the wife of former chief executive Tung Chee-hwa, came to wish him well at the opening of his private clinic in Central earlier this month.

However, Professor Lam refused to speak to reporters outside the clinic. The sixth-floor lobby at Central Building was sealed off by a sliding door manned by staff who made sure only invitees were allowed in for the opening of the Centre of Alimentary Research, Education and Care.

In an e-mail, Professor Lam declined a request for an interview on the opening of his clinic, saying it was 'not an appropriate time for me to meet the press'.

On March 7, Professor Lam resigned amid a University of Hong Kong investigation into billing arrangements for private patients at Queen Mary Hospital, the faculty of medicine's teaching hospital. His resignation - 17 months before the end of his five-year term - sparked two inquiries and the case has been referred to a law enforcement agency.

But questions remain about the controversy and legislators are warning that the university is risking its reputation with its poor handling of the affair.

When Mr Tung resigned in 2005, citing pains in his legs as one of the reasons, Professor Lam was reportedly the person in charge of Mr Tung's comprehensive health check at Queen Mary Hospital.

An expert in gastroenterology, Professor Lam, 65, has had more than 300 research papers published by international journals.

He was elected as dean in 2001, but during that three-year term a move was made to fill the position by appointment. Professor Lam was appointed in 2003 for a five-year term that was due to end in August next year and carried a six-month notice period. Staff discontent had been rife during his tenure. It was during this time that the faculty of medicine was controversially renamed after Li Ka-shing following the tycoon's HK$1 billion donation. The move outraged alumni, sparking a campaign of protest letters and fundraising to buy back the faculty name. His plan to set up a private medical centre at HKU also angered staff.

The billing scandal unfolded when a staff member told Vice Chancellor Tsui Lap-chee about a complaint from a private patient on January 3. The university council set up a committee of inquiry, chaired by council member and Executive Councillor Edward Leong Che-hung on January 25 after it received the complaint about 'certain billing arrangements'.

Professor Lam's resignation, citing personal reasons, was revealed to faculty staff through an e-mail from the chairman of the board, Chow Shew-ping. Professor Lam was out of town on holiday when he resigned.

On March 20, the council accepted Professor Lam's resignation and designated Raymond Liang Hin-suen as acting dean. A search is on for a new dean.

On the same day, the university's committee of inquiry also revealed it had referred the complaint to a law enforcement agency. It did so after concluding there was 'prima facie evidence' suggesting the matter should be referred to 'the appropriate external authorities for investigation'. The name of the law enforcement agency has not been revealed.

The four-member committee then reviewed the procedures and arrangements for billing private patients. In a report made public on July 11, the committee identified areas where improvements were needed.

Dr Leong said he did not think their hands were tied after they referred the original case to a law enforcement agency. 'We looked at the system and identified areas that need to be improved,' he said.

The committee of inquiry also asked Professor Lam to attend a hearing. He submitted a statement providing information and comments on the billing arrangements for private patients.

Legislator for the medical sector, Kwok Ka-ki, said he was not satisfied that a crucial question had been answered in the two reports by the HKU panel and a Hospital Authority audit team into the university's private patients billing system.

'They stopped at telling the truth and also they did not reveal what was the major problem within the HKU faculty of medicine,' Dr Kwok said.

He urged the university to 'give us the facts' and for patients who might have encountered the alleged malpractice to report to the Independent Commission Against Corruption or to the police.

'We do not know how extensive the problem is. We do not even know how many staff are involved. Is it only an incidental case or is it more widespread?' he asked.

Dr Kwok warned that the university had jeopardised the reputation of the faculty of medicine by not managing the issue properly.

He said he would press for a meeting of the Legislative Council's health services panel on the billing report after the summer break.

But Dr Leong defended the university's handling of the matter. 'First of all, the case was referred to a law enforcement body and it is up to [that agency] to come up with their recommendation. Secondly, our report went into details on the loopholes of the system that could pave the way for irregularities,' he said. It was up to the university to see how these loopholes could be removed.

'If these loopholes are not plugged, people can take advantage of them. I am not incriminating any person or persons. We are saying these loopholes are there,' he said.

Dr Leong said he expected the university to improve the system.

The inquiry report said the arrangements made it possible for individual staff to ask patients to pay fees to an account not belonging to the Hospital Authority or the university.

Discrepancies were also possible in that a clinical professor could put in billing form procedures that were different from the clinical procedures.

On the suggestion of the inquiry panel, the university set up a new working group chaired by York Liao, a council lay member who is also a non-executive director of the Securities and Futures Commission. Its role is to plug the deficiencies and update the system, as outlined in the inquiry report. It will hold its first meeting later this month.

The Hospital Authority internal taskforce's review of billing procedures, contained in its July 26 report, found that loopholes in billing procedures for granting professorial fee waivers to private patients at Queen Mary Hospital made it difficult to detect if doctors had pocketed part of the bills.

The audit report found three major weaknesses in the private patient billing system at public hospitals: incomplete billing cycles, poor fees and charging policies and practices, and unclear professorial fee waiver arrangements.

Allowing professors to accept private patients at Queen Mary Hospital has been a long-standing practice, with the university saying patients could benefit from the specialist experience of professors.

In 1948, an agreement was set out between the government and the university to govern the sharing of income collected from these patients in major specialities. Agreements for other clinical specialities followed later.

Fees for professors' treatment of private patients are shared between Queen Mary Hospital and the university, with the Hospital Authority retaining 25 per cent and paying 75 per cent to the university. The same applies to the Prince of Wales Hospital and Chinese University.

In 2006-07, Queen Mary received HK$158 million in total fees for medical services to private patients, of which HK$38.1 million in so-called professorial fees was paid to HKU. Prince of Wales received HK$68 million in fees for private services, with HK$21.1 million going to Chinese University.

Dean of Chinese University's faculty of medicine Fok Tai-fai said it had clear rules on private patient billing. 'We have been improving [the system] all along. The major overhaul was done last year, but of course with this [HKU] development, we have become more vigilant,' Professor Fok said.

For example, the faculty concentrated all its private medical practice in one clinic 'so that accounting and checking will become easy', he said. 'There is a clear division of income between the Hospital Authority and the university based on the agreed terms. We also computerised all the private patients [information].'

The HKU maintains that there is no evidence of a widespread problem of billing irregularities. Teachers must submit an annual report listing all outside practices, time spent on such work, remuneration and levies to be payable to the faculty.

'There had not been any report of irregularity in respect of the existing arrangement before we received a report about a possible irregularity in January this year,' a spokeswoman said.