Medical Council reforms delayed years by disputes
The Hong Kong Medical Council has had proposals on the table for almost a decade to increase the ratio of its non-medical members but its chairwoman says they are impossible to implement in the council's current highly politicised environment.
Felice Lieh Mak said having more lay members would counter a 'protectionist tendency' in the doctor-dominated council and enable it to see broader issues, but as matters stood no agreement could be reached on the issue.
The Medical Association, representing doctors, strongly opposes any increase without a complete overhaul of membership. It said lay members appointed by the government did not represent the views of the public, and not all overseas medical watchdogs have lay members.
Lieh Mak was speaking after the council earlier this month endorsed a watered-down reform under which non-medical people will be recruited to help handle a growing number of complaints without being given formal council membership.
The council - which has 28 members of whom four, or 14 per cent, are lay people - found in research earlier this year that this level of lay membership was low compared to councils in some developed countries.
The comparable ratio is 50 per cent in Britain, 47 per cent in California and Michigan in the US, 33 per cent in Australia and New Zealand, and 52 per cent in Ireland. There are no lay members in Singapore.
'Lay members can give us valuable input of public views during both disciplinary hearings and policymaking. The role of the council is to protect the public. It will be good if we can have more public representation ... they can counterbalance the protectionist tendency and can see broader issues,' Lieh Mak said.
Of the council's 28 members, 14 are appointed by the government - the four lay members and 10 representatives of various parties, including the two medical schools, Hospital Authority, Department of Health and Academy of Medicine. The other 14 are seven doctors nominated by the Medical Association and seven elected by the profession. Under the 2001 plan at least four more lay members would have been added to push the lay ratio to about 25 per cent.
Medical Association president Tse Hung-hing, a council member, said adding appointed lay members without changing the whole council composition would mean the number of appointed members exceeded half the total membership.
'We have no objection to lay members but at the same time, the council should also increase the number of elected members. There are many ways to change the composition, such as making all doctors in the council elected by the profession,' Tse said.
Under the latest changes made earlier this year, four to six lay people will be recruited to sit on the council's preliminary investigation committee, which handles complaints and decides which should go to a full hearing. They would not have the power of general council members to vote on key policies or hold disciplinary hearings on doctors.
The change will require legislative amendment. The law requires at least one lay member to be involved in screening cases.
Asked if she was disappointed that the 2001 reform could not be realised, Lieh Mak said it was 'a reality we have to face'.
'We have three different voices here - those on the side of the doctors, those wanting to help the public, and those wanting to be fair to both sides,' she said. 'We have faced strong opposition from some doctors for increasing the number of lay members on the council. Adding lay members to the preliminary investigation committee is a practical solution to an urgent problem.'
Patients' Rights Association spokesman Tim Pang Hung-cheong said the failure to increase the council's lay ratio was disappointing.
Fellow council member and former medical association president Choi Kin said lay members appointed by the government could not represent the general public.
'The appointed lay members are not men in the street. Most of them have prestigious backgrounds such as people with JP (justice of the peace) or BBS (Bronze Bauhinia Star) titles. They can't give us views as ordinary patients we are used to dealing with. I myself have problems communicating with them.'
Choi also asked why the council should follow overseas counterparts. 'Why must Hong Kong follow the UK or the US experience? The medical watchdog in Singapore has no lay members at all and many professional bodies have no lay members.'
A private surgeon from Britain and an advocate for Medical Council reform, Darren Mann, said the lay membership of the Hong Kong Medical Council remained considerably lower than that in Britain (50 per cent) and many American state medical boards (around 30 per cent).
'In this respect the composition of the Medical Council of Hong Kong appears to be regrettably out of step with much of the rest of the developed world, with the exception of the Singapore Medical Council,' he said.