Hong Kong's overstretched public medical sector has been dealt another blow with a major report revealing an "unsettling" death rate at one of the city's biggest public hospitals and expressing concern at the number of post-surgery deaths at two others.
The latest annual Hospital Authority report into surgical outcomes across the 17 public hospitals it oversees, found that the 25-year-old Tuen Mun Hospital recorded a "high" death rate for the fifth year in a row.
The hospital's continuing shortcomings led Dr Kenneth Fu Kam-fung, the head of the Public Doctor's Association, to pinpoint overcrowded surgical wards and a lack of intensive-care beds as potential problem areas.
He said the situation at Prince of Wales Hospital in Sha Tin and Queen Elizabeth Hospital in Yau Ma Tei, which recorded the highest death rates along with Tuen Mun, was due to the same problems.
Tuen Mun rated poorly in both emergency and non-urgent surgery in a 12-month period to June 30. Prince of Wales for the first time showed a split performance with its death rate in non-emergency surgery being one of the lowest, while that for emergency procedures had risen for the past four years.
Queen Elizabeth showed signs of improvement, according to the Hospital Authority's surgical outcomes monitoring and improvement programme, which has conducted the study since 2008.
"Tuen Mun Hospital has rated poorly for five consecutive years. This is unsettling to us," programme director Dr Yuen Wai-cheung said.
"What went wrong with Prince of Wales Hospital this year? The difference in its emergency and elective performances is very strange. No other hospital has had this difference and such polarisation is seen for the first time."
The death rates in the report were calculated by the ratio between actual and expected death rates in the 30 days after surgery. Yuen said this eliminated the effect of risks from the patient's condition before surgery.
The ratio of actual to expected deaths in emergency surgery was 1.33 at Prince of Wales and 1.28 at Tuen Mun, with figures below zero indicating a lower rate.
The report said Prince of Wales had the lowest rate of patients being sent to intensive care after emergency surgery, meaning some might not have received the care they needed. The rate was 19 per cent, compared with 54 per cent at Queen Mary Hospital in Pok Fu Lam.
Fu, president of the Public Doctors' Association and a urology surgeon at Queen Mary, said not all major emergency surgery required intensive care.
Yuen suggested that Prince of Wales consider introducing a high-dependency unit like that in Queen Mary for elective cases, to make room for emergency cases in intensive care.
The report found a strong correlation between the high death rate and high use of surgical beds in hospitals - with the average at Tuen Mun being 106 per cent, with the use of temporary beds the most of all hospitals.
Tuen Mun Hospital said it would add more beds in the surgical ward. Studies would be made on improvements to operating theatres and a reduction in the waiting time for operations.
Fu did not think crowded wards would increase the death rate but said a lack of experienced doctors or ample supervision of junior doctors could be factors.