Hospitals chief backs negligence procedures
The Hospital Authority will only refer incidents involving very serious professional negligence by doctors to the Medical Council for investigation, but not 'everyday minor cases', its chief executive says.
Shane Solomon also said in an interview that the authority may not be able to release medical records to the council without patients' consent.
His comments came after Medical Council chairwoman Professor Felice Lieh Mak said that the professional watchdog would proactively look into cases - including those that take place at public hospitals - even without receiving patients' complaints.
The council seldom deals with cases involving public doctors, as incidents are investigated by the Hospital Authority. Most complainants in public-sector cases do not file their cases to the council, having reached a settlement with the authority.
The council's preliminary investigation committee will in future act on inquest findings or media reports.
'The council has the responsibility to uphold the standard of all doctors, public or private. It is clear,' Solomon said. 'But I think there would be some difficulties, as they said themselves, pursuing a case without complaints. For example, if we release records, we need consent from somebody.'
The authority, which runs more than 40 public hospitals, hires about 5,000 doctors, or half of the total in Hong Kong.
While the authority as an employer can impose disciplinary action against its doctors, including warnings, barring them from promotion, and dismissal, the Medical Council as the professional watchdog can suspend doctors' practices or even delist them from the medical registry.
In September, the authority announced six ways to improve patients' safety after a series of medical blunders. One of them is to unify disciplinary procedures and punishment of staff.
Solomon said the standards used by the authority's internal investigation were as thorough and fair as those of the council. The reform in disciplinary procedures would make actions more consistent.
'I can see a situation that we investigate into doctors, and let's say we fire them for something very terrible. The Medical Council may also want to investigate the doctors and delist them. But I will be very surprised if the council will delist someone without our first having taken strong action.'
He said the authority did not see the need to refer 'everyday minor cases' to the council.
Meanwhile, the authority will work out a settlement package to compensate doctors on call away from hospitals during holidays.
The Court of Final Appeal ruled last month that public doctors were entitled to a day off or a full day's pay for being on call on these days, even though they might not receive any phone calls or need to work. The court rejected doctors' claims for pay or time off in lieu for working overtime. In March 2006, a lower court ruled that public doctors could only claim compensation for time actually worked on rest days, public and statutory holidays. After that ruling, the authority offered a HK$629 million settlement to 4,600 doctors.
Solomon said there were two parts of the compensation for on-call duties away from hospitals: one for the past and one for the future.
'For the past, it is a one-off compensation. I am suggesting we come up with a settlement package after talking to doctors rather than have doctors going individually to the Labour Tribunal, which will be destructive to them because they'll have to prove when they were on call.' Medical professionals familiar with the situation say the compensation package for on-call duties away from hospitals is expected to cost more than HK$300 million.
Solomon believes that the community does not want to see some people being paid a lot of compensation for just being on the roster. He said some department heads and consultants were put on call 365 days a year and there was little chance they would be called back to work.
'In one hospital, all their 34 physicians are on call. Is it fair to say we should compensate the doctors only because their names are on the roster? I think doctors are reasonable. We can come up with a compensation package which is reasonable. How much we have to pay for the future depends on how we revamp the roster, such as how many layers of calls we genuinely need.'
Solomon said the authority was still uncertain how it could get the extra funding to pay for on-call duties in the future.
'The on-call system is under review to make it more sensible. If some people do not need to be on the roster, they won't be. If we need their help, we compensate them either by time off or money.'
Solomon said the court ruling had confirmed that doctors should not work on statutory holidays, and that public doctors were unhappy.
'Leung Ka-lau has succeeded in letting the Hospital Authority management know doctors are unhappy, they are angry. We cannot abuse them and take advantage of them. It is not about the law, but management culture and our committee men.' Leung, former president of the Public Doctors' Association, was the lead plaintiff of the lawsuit.
Solomon said the authority had been working towards capping doctors' working hours at less than 65 a week. The next step would be to cut their continuous working hours.