A Hospital Authority review is more critical than a government-appointed panel, but singles no one out for blame An internal inquiry into the Sars outbreak at public hospitals found that health authorities were unprepared for a crisis of that magnitude, and delays in isolating patients at Prince of Wales Hospital put the community at greater risk. The 217-page report by the Hospital Authority review panel was more critical of the government's handling of the outbreak than the government-appointed Sars Expert Committee, but neither report singled out anyone for blame. In response, the authority said that while it accepted the report's 45 recommendations - including the need for a multi-agency response plan - some of the panel's conclusions 'might have been affected' by time constraints in conducting the probe. Authority chairman Leong Che-hung insisted no one would be asked to resign and said the Hong Kong public should move on from the outbreak. The internal inquiry said the outbreak was 'unexpected' and caught the government flat-footed. 'There was no strategy or contingency plan suitable for dealing with a major disease outbreak,' the seven-member review panel's report concluded. There were early warning signs as patients were treated at several hospitals from late February, it said. But the authority's head office did not raise the alarm and failed to alert other hospitals, it said. When the outbreak at Prince of Wales Hospital started on March 10, ward 8A was closed. But it was reopened to visitors a day later, 'potentially exposing' the wider community to infection. It said the decision to discharge a patient from the ward was a lapse which triggered the Amoy Gardens outbreak. From March 10 to 24, as the virus was spreading, 'weaknesses in the system were exposed'. There was no clear chain of command, preventing effective co-ordination between the authority, the Department of Health and the Health, Welfare and Food Bureau. Designating Princess Margaret Hospital as a Sars hospital 'turned out to be a mistake'. The panel also criticised the authority's unclear communication to staff about taking precautions against the spreading disease. It said the authorities did not get their act together until authority chief executive William Ho Shiu-wei was confirmed with Sars on March 24. It said that if a higher alert had been triggered as early as March 15, the disease would not have spread as much. 'The government could have acted sooner and with greater clarity to warn the community.' 'By March 15, if the information on the growing number of cases being admitted to hospitals, the number of health-care workers infected in Hong Kong already and other information on the situations in Guangdong, Hanoi, Singapore and other countries had been assembled and considered by those at the highest levels, then it would have been clear that an escalation in response was required.' The report also said the authority board was not formally told of, and did not take any specific action over, the Prince of Wales outbreak. Asked repeatedly how the authority could justify accepting the recommendations but not any criticism, Dr Leong stressed that it should 'look forward' to improving itself rather than taking retrospective action. 'When we have to look at the spirit behind this report, we feel that this would not bring any benefits if we still insist on debating on what we had done in the past,' he said. Dr Ho said no one should be asked to resign. 'It would be more important for our staff to see what lessons the authority has learned from the outbreak and identify the problems so we can make improvements,' he said.