Hospital response inadequate: report

Combination of factors blamed in death of man outside Caritas Medical Centre

A catalogue of hospital mis-steps - combined with a series of unfortunate circumstances on the fateful Saturday afternoon - claimed the life of a 56-year-old logistics company owner at Caritas Medical Centre last month, according to an investigation report released yesterday.

First the van bringing Yeung Tak-cheung to the hospital missed the turn to the accident and emergency department, arriving at a non-clinical department. Then staff did not treat the case with sufficient urgency, leading to delays in treatment.

The 14-page bilingual report, prepared by the hospital's chief executive, Ma Hok-cheung, chronicled what went wrong in the hospital's response to the December 20 medical emergency just outside one of its buildings, and contained recommendations on five areas to prevent a recurrence.

Dr Ma refused to resign last night despite findings in the report that the hospital's response on several fronts had been inadequate.

Yeung, who had suffered a heart attack, was found 'without pulse' by a passing surgeon two minutes after arriving unconscious in his own company van, driven by a colleague and accompanied by his son, which stopped at the hospital's Wai Ming Block on Wing Hong Street.

Despite his being right outside the hospital, the first rescuers to arrive were from the Fire Services Department, 10 minutes after Yeung was brought to the building's entrance.

His son, Yeung Fei-lung, said: 'It is not mentioned in the report if anyone should be held responsible for my father's death. The report only said it hoped the hospital could have a better future, but it has mentioned little about my family.'

Proposed improvements include:

An extra 200 portable Automated External Defibrillators (AEDs) at a cost of HK$4 million will be bought in the coming months to supplement some 1,600 bulky life-saving devices at public hospitals and clinics.

A one-page set of guidelines, 'General principles for handling emergency cases in the vicinity of HA hospitals and clinics', was issued yesterday underscoring that 'saving people's life (sic) is the authority's first priority'. All staff on duty will 'render all reasonable assistance ... to anyone who requires emergency medical assistance at any time'.

A designated response person or team to provide basic life support to people in medical distress in the hospital's vicinity will be set up urgently.

Road signs to the hospital's seven blocks will be improved.

The media and several patients have been calling for the head of the hospital to resign since the incident.

Hospital Authority chief executive Shane Solomon said a high-level special review committee chaired by him would assess responsibilities for the incident and determine any action against staff within six weeks.

The report singled out a junior receptionist - who told a colleague accompanying the dying man to dial 999 - the Accident and Emergency Department, and 'all concerned staff who did not report the incident to hospital management'.

It was also critical of the efforts by Dr Ma and the accident and emergency department's chief of service to explain what had happened.

Dr Ma said the receptionist, who has returned to work after sick leave, would undergo training, as would security guards so they could immediately report and respond appropriately to any medical emergencies in the hospital grounds. He said his 'most important mission now' was to uphold the morale of staff.

Hospital Authority director (quality and safety) Leung Pak-yin admitted only some hospitals had mechanisms to deal with emergencies outside their doors and he hoped they would all develop such guidelines.

'To all our colleagues in hospitals, saving lives is a priority. This is an isolated incident that we need to deal with,' he said.

Legislator Albert Chan Wai-yip of the League of Social Democrats, who is helping the Yeung family seek legal advice, said there was no mention of compensation and responsibility in the report, and that some of its contents could make the Yeung family 'very angry'. To say the authority would deal with the matter according to set procedures was 'simply rigid, inhumane and bureaucratic'.

Mr Yeung, who has a younger brother and sister, started a company with his father, who he said was the financial pillar of the family - and so all family members had become victims of the incident. 'I am already confused about managing the company. I am afraid if anything happens to me, my family will suffer more.'

The sequence of events, according to the report

2.43pm Patient is brought to entrance of Caritas Medical Centre's Wai Ming Block in van

2.44pm Van driver seeks help from clerk at inquiry counter and to told to call 999

2.45pm Surgeon passes by and calls operator, who relays call to A&E department. But noisy background disrupts call. Surgeon asks son about patient's medical history

2.47pm Clerk calls ambulance controller at A&E department

2.51pm Security guard sent by A&E department nurse to find exact location of incident

2.52pm Surgeon makes another call to A&E department while police officer continues cardiac massage

2.53pm Firefighters arrive with defibrillator

2.55pm Patient receives first defibrillation shock

2.57pm Second shock administered

2.58pm Emergency medical assistant arrives by motorcycle and joins resuscitation effort

3pm Ambulance arrives

3.06pm Patient taken away in ambulance

3.09pm Ambulance arrives at A&E department

3.26pm Patient certified dead