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Jane Moir

Public in danger, say doctors, but  no one prosecuted despite ICAC raids

Family doctors have been found taking kickbacks from specialists for patient referrals, prompting an ICAC investigation, complaints to the Medical Council and condemnation from doctors.

The widespread practice, which critics have called ethically reprehensible and a danger to patients, involves  general practitioners taking a cut of around 35 per cent of specialists' fees when they make referrals. Private hospitals are fuelling the graft by offering sweeteners to specialists, such as subsidised accommodation, to ensure they provide a steady flow of patients, according to medical sources.

Patients are oblivious to the inducements.

Complaints have been filed by both doctors and patients with the Medical Council and the Independent Commission Against Corruption.

The anti-corruption body last year raided two general practices and a surgeon, seized records and accounts and interviewed patients. Private hospitals' accounts were also inspected. The case was passed to the Department of Justice, which vetoed a prosecution, citing insufficient evidence. The ICAC appealed against the decision through an internal review committee, but was unsuccessful.

Earlier this year, the doctors involved were informed in writing that no action would be taken, sources said.

Under Medical Council ethics rules, doctors are forbidden from receiving fees in any form for a patient referral. They are moreover prohibited from sharing fees with people who are not bona fide partners of a practice.

However, as part of a general investigation into these kickbacks, the ICAC taped conversations with doctors in which specialists and GPs discuss 'referral' or 'management' fees to be paid when patients are passed along for treatment. Copies of the recordings and  transcripts have been seen by the South China Morning Post.

In one of the discussions, a surgeon describes the relationship between GPs and specialists: 'If they feel they [GPs] can make a buck out of the specialists irrespective they will try and go down that route until they get their fingers burned.' He  admits: 'As altruistic as I am about wanting the best for my patients, I also have to run a business.'

Later in the transcript, doctors discuss whether the practice is an outrage, or part and parcel of running a successful practice.  One  says:  '... If  word got around that we were offering kickbacks the patients would dry up immediately.' He adds: 'In the expat circuit, if you were in the South China Morning Post we are done for.'

Concerns about the practice were fuelled by a recent case involving a cancer patient. He was operated on and later questioned why he was referred to a surgeon who was working outside his area of expertise. Some members of the profession worried that  a 'referral fee'  might have been involved.

It is understood a complaint was lodged by the patient with the Medical Council, but he later  died.

Doctors have also complained to the professional body, but no action has been taken. The council said it would not comment on individual cases, but that if it received information that its professional code had been breached, it would 'deal with the complaint in compliance with the Medical Registration Ordinance'.

Surgeons such as Darren Mann have urged tough action by the council and the government to 'restore public confidence in this still noble profession'.

'I trust I am not alone in finding it morally and ethically reprehensible to sell or trade patients as if they were commodities ... these are trusting individuals who have been betrayed by the general practitioner, specialist and the hospital,' Mr Mann said.

Ear, nose and throat surgeon Brian O'Reilly for years refused to get involved with the kickbacks.

'It's a big-money situation for these guys ... but it endangers people's lives,' he said from his practice in Australia. Mr O'Reilly moved back there after his refusal to play along all but  put him out of business.

'I refused point blank. I never received any more operative work.'

The Department of Justice said it does not comment on individual cases. It said it uses guidelines when assessing whether a case warrants  a prosecution.

The ICAC declined to comment, saying it does not comment on individual cases.



GPs taking kickbacks for passing patients to specialists