Victim of truth

PUBLISHED : Friday, 23 July, 2004, 12:00am
UPDATED : Friday, 23 July, 2004, 12:00am

For two years, Professor Albert Chui Ka-keung fought to keep the liver transplant centre open at the Chinese University of Hong Kong. He lost the battle - and his job, but remains adamant that tackling the Health Authority head-on was the right thing to do.


The former head of the Chinese University's liver transplant team became a public figure in August 2002, after blowing the whistle on the waste of a donor liver which could have saved a life had budget-conscious health officials not said the operation exceeded a monthly quota.


While it may be excessive to compare him with Jiang Yanyong, the military doctor detained for exposing the mainland's Sars outbreak, there are similarities: both suffered for speaking out in the interests of the public.


Dr Jiang was released from a seven-week detention, while Professor Chui had some of his clinical duties removed in 18 months following his criticisms of the health system, in what he described as 'political persecution' - an allegation that has never been proven.


Earlier this month, he left the Chinese University after his contract was terminated - not by his own choice. He said the university did not renew his contract, adding 'if the university renewed my contract, I would have stayed on to continue the battle'.


The university's liver transplant centre at the Prince of Wales Hospital was officially shut on July 5, and about 20 patients on the waiting list were transferred to the clinic run by the University of Hong Kong at the Queen Mary Hospital.


'The closure of the centre is a loss to all Hong Kong people. Patients now have no choice and one transplant centre will not be able to cope with the demand. But I don't consider myself a loser for what I did. I gained more than I lost,' the liver surgeon said at his new private clinic in Central.


'I believe that what I have done for the past two years has raised people's awareness about the issue. I received many e-mails and letters from people who support me. I have no regrets, I am happy that I have done my best to fight for my patients.'


Professor Chui is both hero and troublemaker, depending on who you talk to. His patients look to him as their saviour. But many health officials think differently.


On several occasions he accompanied dozens of angry liver patients into press conferences to express anger over the centre's closure. The same shoot-from-the-hip style also sparked a war of words with the authority's deputy director, Ko Wing-man, on a radio programme about the merger.


'I know some people dislike me, and think I'm a troublemaker. But more people respect me,' he said.


Professor Chui grew up in a Yuen Long village, later moving to Australia, where he finished the last year of secondary school study and received medical training at the University of New South Wales. He then worked as a liver surgeon at the Royal Prince Alfred Hospital, the teaching hospital for Sydney University, for eight years. His considerable abilities saw him appointed deputy director of Australia's National Liver Transplant Unit at the hospital, before he left for home and a career at the Chinese University in 1999. Since then, he has conducted liver transplants for more than 40 patients in Hong Kong.


But the doctor's life changed dramatically after he revealed in August 2002 that a donated liver was wasted. The scandal outraged patients and other transplant doctors who learned how the organ was not used to save one of the 100 patients on the waiting list. It is estimated 40 people on the list will die while waiting for a transplant.


The organ was wasted on June 16 that year, after the Prince of Wales Hospital capped the number of liver transplants to just one a month. The University of Hong Kong's liver transplant team at the time was also occupied. Professor Chui's repeated request to the hospital to allow his own team to use the organ was turned down.


A day after the South China Morning Post reported the scandal, Secretary for Health, Welfare and Food Yeoh Eng-kiong ordered the immediate scrapping of the quota system. 'I don't agree with it. It is impossible to set a quota on life-saving operations,' Dr Yeoh said.


But speaking out in the interests of the community didn't help Professor Chui's career. A few months later he had some of his clinical duties removed. The management of the medical faculty said Professor Chui had been spared from other liver surgery so he could concentrate on liver transplants, an explanation he regarded with suspicion.


He also revealed that two 'senior people from the top' had warned him to rein in his criticisms. 'They said - be careful or you will ruin your career. Of course I ignored their warnings.'


In April this year, the authority completed an investigation into his complaint and found his allegations could not be substantiated.


Criticising the investigation led by an authority board member as biased, Professor Chui said he 'refused to comment on the investigation findings when they were first released because I found it a joke. I did not want to drag on the debate forever'.


The authority decided to merge the two centres, saying the University of Hong Kong centre was of a higher standard and it was better to concentrate patients there. The merger would also achieve higher cost effectiveness, it said.


Professor Chui and his patients argued, to no avail, that the Chinese University centre was of a high standard and leaving only one centre for the city meant no choice for patients.


'Since the very first day I started this battle, I have prepared for this ending. I expected that the university would not renew my contract. And the authority fails to listen to the patients. So why do I still fight on? Because if I did not do it, who else could the patients count on? I was the head of the transplant team and I had a responsibility to speak for them.


'If a doctor can easily give up the mission of helping his patients, how can he still call himself a doctor?'


The liver transplants saga has also exposed the sour relations between the two medical schools. During its lobbying effort, the Hospital Authority earlier said that after the merger, doctors from both teams would provide the services together. But the plan never worked out.


In January last year, head of the University of Hong Kong transplant team, Professor Fan Sheung-tat, warned that his team's high success rate at Queen Mary Hospital could be sacrificed if the Prince of Wales team joined them.


At a press conference, Professor Fan said: 'It will create a big problem if medical staff from the Chinese University are transferred to work at Queen Mary Hospital.


'We have very high expectations of co-operation within our team. So we prefer doctors who were trained by us. We welcome doctors who share our stance and surgical methods. But we already have enough manpower to handle the additional surgery and we do not need extra doctors.'


Professor Fan's high-profile rejection angered the Chinese University's former dean of medicine, Sydney Chung Sheung-chee, who threatened at the time to call off the merger.


Recalling the public row, Professor Chui said Professor Fan's remarks did not bother him much. 'I don't mind being rejected. In fact, I should thank him for letting the public know the reality. The Hospital Authority kept claiming the two teams could co-operate, but that was not the case. I hope the situation will improve in the future and there will be more co-operation between the two universities.'


He said his own story showed the need for an overhaul of the public health care system. 'Morale is very poor at public hospitals and some patients have to wait for months and months for a consultation.


'Please look at my case. As a doctor, I want to save lives. But for the past year, I was only able to take care of some private patients for the university. I was on the public payroll and it was unfair to the taxpayers.


'The public health care system needs a revamp, I'm not an expert in this aspect, but certainly I think that is the case. I hope the new leaders can bring in new ideas.'


Professor Chui said Dr Yeoh and authority chairman Leong Che-hung had made the right decision to step down over the handling of the Sars outbreak. The two resigned after the Legco Sars inquiry found their performance unsatisfactory.


'But if Dr Yeoh had decided to leave earlier, perhaps the government policy on liver transplants would have changed, and my story would have been very different,' Professor Chui mused. 'Perhaps I was in the wrong place, at the wrong time.'