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Hong Kong health care and hospitals

Call to clearly define roles of Hong Kong doctors and nurses after surgical blunder ruling

Medical watchdog decision banning specialist from practising for six months decried as ‘regression’ and ‘trampling’ on all the sector’s professions

PUBLISHED : Sunday, 13 May, 2018, 8:32am
UPDATED : Sunday, 13 May, 2018, 10:27am

Medical groups and unions in Hong Kong urged their sector’s watchdog and the Hospital Authority on Saturday to clearly define the roles of doctors and nurses after a ruling saw a specialist banned from practising for six months bear “disproportionate” responsibilities for a surgical blunder.

The associations planned to meet senior Hospital Authority officials, including possibly its chief executive, Leung Pak-yin, next Wednesday to voice their concerns.

Their calls came as the Medical Council on Wednesday ruled Dr Wong Cheuk-yi guilty of two charges of professional misconduct in a blunder involving Wang Keng-kao, 73.

Wang died at Kowloon Hospital in November 2011 after his only airway was blocked by gauze.

The council found Wong guilty of failing to take proper steps to prevent Wang’s permanent tracheostomy – an opening in his windpipe – being treated.

He was also found guilty of failing to alert or instruct nursing or other medical staff that the wound was permanent and not temporary.

Holding a press conference accompanied by medical sector lawmaker Pierre Chan, Frontline Doctors’ Union president Catherine Wong Ka-yan said teamwork was important in the industry as doctors and nurses both had their own duties. She described nurses as not subordinate to doctors.

Does it mean a doctor’s responsibility should be extended without limit?
Cathering Wong Ka-yan, Frontline Doctors’ Union

The ruling was a “regression”, she said, for implying doctors should monitor nurses’ performance, which could lead to distrust between the two parties and cut into time doctors spend taking care of patients.

“I admit the doctor should bear basic responsibility in this case. But does it mean a doctor’s responsibility should be extended without limit and he or she shoulders the remaining responsibilities?” Wong asked, in the presence of medical professionals and representatives from the Medical Association and the Doctors Union.

“I urge the council and Hospital Authority to state clearly how doctors, nurses and other professionals are to divide their work as well as monitor their duties and responsibilities.”

The union stressed that taking care of patients’ interests was a doctor’s utmost duty but that the ruling meant doctors should actively look for others’ mistakes.

Registered nurse David Ho Kwok-wai said doctors should not monitor the work of nurses or others, as it would amount to “trampling” on all medical professions.

“Doctors are strong in medical treatment while nurses focus on nursing,” he added. “I don’t think doctors can monitor all other professions.”

Medical Association vice-president Dr Ho Chung-ping raised similar concerns, saying he had never treated nurses as his subordinates in his 40-year career.

“Otherwise I would have been kicked out of the ward.”

The union said it had collected about 5,500 signatures after launching an online petition on Thursday.

And on Friday, Professor Lau Chak-sing, president of the Academy of Medicine, sent a letter to over 7,000 fellows to convey the group’s concern with the council’s verdict.

“As contemporary health care has become increasingly complex, the academy considers it necessary to adopt an interdisciplinary and interprofessional approach in service delivery,” Lau said.

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He believed that clearer guidance delineating roles between professional disciplines would be necessary to ensure better accountability for improving patient safety and practice standards.

In the blunder, Wong was responsible for Wang’s care at Kowloon Hospital between October and November 2011.

Wang initially had surgery at Queen Elizabeth Hospital in Yau Ma Tei, where a permanent tracheostomy was performed. He later suffered a stroke and was transferred to Kowloon Hospital for rehabilitation. He later died.

Following Wang’s death, gauze was found covering the opening in his throat – the only channel through which he could breathe – and taped down at all four edges by nurses.

Three nurses involved in the case were found guilty of professional misconduct by the Nursing Council in 2016. They were banned from practising for one month. Nine colleagues were cleared.