New safety code for private births

PUBLISHED : Thursday, 18 September, 2008, 12:00am
UPDATED : Thursday, 18 September, 2008, 12:00am

Two maternity deaths prompt government to issue guidelines for private hospitals

Doctors must respond to maternal emergencies within 15 minutes and have specialists in anaesthetics, obstetrics and surgery on call at all times under the government's new code of practice for private hospitals.

Deputy Director of Health Gloria Tam Lai-fun said in an interview with the South China Morning Post the guidelines also required operators to have a specialist in emergency medicine to oversee accident and emergency services.

The guidelines - to be issued later this month to Hong Kong's 12 private hospitals for consultation - come after two maternal deaths at the facilities this year.

'Hong Kong's maternal mortality is always one of the lowest in the world, even one case a year is too many,' Dr Tam said.

Under the code, private hospitals would have to make a doctor - either a general practitioner or a specialist - available to attend a mother with foetal distress or maternal bleeding within 15 minutes.

The hospitals must also have a doctor rostered on at all times in three specialities: anaesthetics, obstetrics and surgery - three areas key for maternal emergencies where two lives can be at risk at one time. Nine out of the 12 private hospitals provide maternity care.

Currently, private hospitals must occasionally depend on visiting doctors - who are not on staff - during emergencies if resident doctors are not available. Visiting doctors have no contractual duty to help during an emergency, whereas rostered on doctors do.

Some senior doctors have told the Post that when a patient's attending doctor was not available, it was like a 'lucky draw' to find another doctor to deal with emergencies. Some were reluctant to take the risk.

Senior doctors have also called for urgent action to improve private hospitals' handling of emergencies after a mother bled to death at the Hong Kong Adventist Hospital four hours after giving birth on January 10. It was one of two maternal deaths at private hospitals in three months.

A woman who gave birth at Canossa Hospital on February 26 suffered from severe bleeding and died on March 2.

A maternal death is defined as the death of a mother within 42 days of giving birth and the cause of death is directly related to maternity.

The new guidelines also come five months after an inquest returned a verdict of accidental death for former Swire Beverages general manager Ng Keong-ching, who lost 10 litres of blood during keyhole surgery. In May, a jury heard that it took 45 minutes for another surgeon and anaesthetist to arrive at the Adventist Hospital to help surgeon John Boey after he accidentally cut a major vein. Ng died of heart failure on June 9, 2005, two days later.

The jury said all private hospitals should establish rosters of surgeons and anaesthetists who could respond quickly in emergencies.

The new performance pledge is based on the minimal standards adopted by Britain's health services system. There were between one to three maternal deaths in Hong Kong each year in the past decade.

The latest code is the second one, following one issued in 2003.

Dr Tam said in view of the trend where more private hospitals may open up accident and emergency clinics, they had to hire an emergency medicine specialist to supervise these services. They also have to be well equipped with supportive services such as X-ray, pathology and pharmacy.

Dr Tam admitted that the code was only advisory and not legally binding.

'But of course if hospitals fail to comply, we will take it into consideration when we review their licence renewal applications.'