The large number of medical blunders committed recently, and their sheer magnitude, have cast doubt over the quality of health care in Hong Kong. If anything, they seem to provide evidence of its decline.

To name just a few: air was pumped into a patient's bloodstream, instead of an inflatable pillow; a girl admitted for an appendectomy had part of her reproductive organs removed instead; and, this week, there was a recall of cough syrup after excessive amounts of chloroform were discovered in the mixture.

'When you look at the medical blunders individually, different factors contributed to each one. But, if staff are overworked, there is a higher chance of making mistakes,' says Dr Poon.

In an announcement placed in the Chinese press last year, the association apologised for mistakes that had resulted in death or disability. But Dr Poon says there is little that can be done to boost public confidence, or even staff morale, because of the lack of sufficient resources in hospitals.

In part, doctors have blamed the authority's mission statement, introduced four years ago, for prompting 'productivity gains' (now known as 'quality gains'), which forced departments in each hospital to save a fixed percentage of their budget.

The savings - an estimated $2 billion over three years - are reserved for new services or other perceived necessities, subject to the authority's approval.

While Dr Poon says this strategy has achieved some of its aims, it has meant depriving departments of some supplies. And staff cannot continue working under tight conditions without some harm to hospital services.

'Larger hospitals with budgets to match their size are suffering, but the smaller hospitals are suffering the most because they have so little to work with already. This has got to stop.' As part of the cost-cutting exercise, he recalls how last year the authority sent representatives to the orthopaedic clinic run by Queen Mary Hospital, housed in the Sai Ying Pun Jockey Club Polyclinic, to calculate the amount of work plaster technicians were doing.

'They would check what they were doing every five minutes. And afterwards, they said, 'Cut back four staff.' We have had to reschedule timetables, shift people around. But they say they aren't laying off staff, just transferring and retraining them,' Dr Poon says.

In some cases the measures have forced public hospitals into a Catch-22 situation. Improved services have also led to greater demand, stretching already limited resources.

A few years ago, for example, the waiting time at the orthopaedic clinic averaged three months, says Dr Poon. Following the authority's demands for efficiency, staff obliged by working overtime to see more patients, cutting waiting time down to two weeks.

But pressure on clinic staff to be more resourceful resulted in an increased workload for the laboratory, the pharmacy, and the x-ray department, which had neither a corresponding budget increase, nor additional staff to cope with the extra work. The three departments became inundated, the clinic built up a backlog again and the waiting time has since bounced back to three months.

Even supplies are dwindling, says Dr Poon, thumbing a prescription pad and gesturing at the aged, wood furniture in the clinic office. As a Queen Mary orthopaedic specialist he divides his time between there and the main hospital.

Bulk purchasing - another authority measure - is not always effective, he says. Having too many supplies can be as bad as not having enough. Supplies can expire, and have to be thrown out.

It has not been uncommon for one hospital department to run out of supplies, forcing them to borrow from another, he says.

'When we have to estimate expenditure so tightly, the last few days of the financial year become quite scary. That has become our daily life.' The authority now oversees 93 per cent of hospital-based services, with 60 per cent of all doctors in Hong Kong working for them, says Dr Poon. The other 40 per cent are in the private sector.

Doctors in public hospitals are finding their patient load increasing, but the number of staff is not increasing with it. In fact, some staff have been forced to stretch their own services, dividing their time among different departments.

All this means a grim future for new doctors, who already face a number of problems, including a 'restructuring' of their pay packages.

Dr Poon says he has raised his concerns with the authority's chief executive, Dr Yeoh Eng-kiong, but to no avail.

'This will work for a while to achieve efficiency, so to speak, but if this goes on year after year it will reach a point where we are stripped to our bare bones.' The bleak picture he paints is one that can be improved only if more resources are put back into hospitals, he says.

'As a whole, this is efficiency and the Hospital Authority can be proud of saving so much. But for front-line workers, they do not share the same pride and the feeling is not one of satisfaction.'