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SCMP Reporter

Three kidney patients were killed and three left critically ill when contaminated fluid was pumped into their blood during treatment yesterday.

 The accident happened at the private Hong Kong Sanatorium and Hospital in Happy Valley, when a water filter that was being cleaned was turned on.

 It pumped contaminated, instead of purified, water into a dialysis machine and into the patients.

 Chik Sang, 69, Leung Shuk-king, 59, and Chan Wai-kei, 80, died.

 Yim Cho-yiu, 82 and Cheung Siu-chun, 60, were in intensive care last night while Wong Ah-kiu, 71, was in a general ward. All were in stable condition.

 A maintenance worker who went to inspect the water filter has emerged as a key figure in the probe into the latest in a string of hospital blunders.

 A taskforce comprising medical experts and legislators will scour log books and reports today to attempt to discover why the machine started.

 A criminal investigation by police is under way.

 The Government said that it would launch its own inquiry.

 Furious relatives said hospital staff left them in the dark.

 Mr Yim's distraught son stormed into a hospital press conference to shout questions at staff in the hope that he might get some answers.

 Problems were traced back to Wednesday night when an alarm sounded on a reverse osmosis system - a central water treatment machine purifying tap water being supplied to the seven dialysis devices in the haemodialysis unit on the second floor of the hospital's Li Shu Fan Block.

 Responding to the report, the machine's supplier, Gambro China, sent an engineer to check and clean the system at 8am yesterday.

 The hospital switched to a back-up filtering system when the first patient arrived for a routine four-hour dialysis session at about 7.30am.

 Five other patients came in later, with the last session beginning at 8.55am, according to the hospital's log books.

  They were being taken care of by four nurses in the unit while the machine cleaned their blood of impurities which their malfunctioning kidneys could not process.

  Hospital matron Manbo Man Bo-ling said: 'The treatment went wrong at about 9.30am when the patients, one after the other, suffered convulsions and vomiting.

 'Nurses and doctors were called in for emergency treatment while a colleague went to check the filtering machine in a neighbouring room. She was told by the engineer that the system being repaired had been turned on.'  The hospital's deputy medical superintendent, Dr Walton Li, declined to speculate on who had turned the system on or why it was linked to the dialysis devices when it was under repair.

 Dr Li said: 'This was a break in procedure.

 'Under normal procedure, this should not have taken place. There is a possibility of human error.'  A taskforce, chaired by Hong Kong University's Professor Lai Ka-nan, will examine the log books and see whether it was a procedural mistake or a machine problem.

 Dr Li said: 'Contaminated liquid was pumped into the patients' blood. Three of them died despite an hour's emergency treatment.'  Samples of the liquid were tested, said Dr Li, who believed the contaminants would probably be detergents or sterilisers used to clean the filtering system.

 'We immediately reported it to the health authorities and the police,' he said.

 Gambro China, a Swedish company, is expected to submit a report to the hospital.

  Staff from the company were tight-lipped.

 'Our boss has gone. We are about to close the gates. Please call back tomorrow,' a worker at its Fo Tan headquarters said.

 Tung Chee-hwa said he was shocked and distressed. 'We know that we need to restore public confidence in our health services. We will do everything that is required to do so,' he said.

 Secretary for Health and Welfare Katherine Fok Lo Shiu-ching visited the patients last night and said the Government would review the hospital's report and conduct its own inquiry.

 Sophie Leung Lau Yau-fun, who with fellow legislator Dr Leong Che-hung, was appointed to sit on the taskforce, pledged to dig out full details and find out who was to blame.

  But a former legislator, Dr Huang Chen-ya, questioned whether the inquiry team was truly independent, given that Dr Leong treats patients in a different part of the hospital.

 'If it is going to have any credibility, it should be completely independent.' 



Kidney patients die as dirty water is pumped into blood