Hong Kong police made an unprecedented move last Wednesday when officers arrested two public hospital doctors and charged them with manslaughter over the death of a patient in 2017 after a medical blunder. While some doctors at private practices in recent years have found themselves on the wrong end of the law for beauty treatments gone badly wrong, the latest incident has prompted debate on whether those in the public sector can be held equally liable. The Post has spoken to several criminal lawyers and academic specialists in medical law to get to the heart of the matter and break down the facts. What happened in last week’s case? The current case concerned Lam Chi-kwan and Chan Siu-kim, doctors at United Christian Hospital in Kwun Tong. Police last Wednesday charged them with manslaughter over the death of Tang Kwai-sze, 44, in 2017. Tang, who suffered from a kidney condition, was treated at the hospital between January and February that year and it is alleged that she died after she suffered liver failure following procedures carried out by the two doctors. The pair will make their first appearance at Eastern Court on Monday. Can doctors be held criminally liable for a patient’s death? Professor Calvin Ho, director of the Centre for Medical Ethics and Law at the University of Hong Kong (HKU), said there was “no differentiation” between a doctor and an ordinary person when it came to manslaughter. Barrister Albert Luk Wai-hung said if a doctor faced a charge defined as gross negligence, one of the three types of manslaughter, it would need to be proved that they owed the victim a duty of care and had committed a very serious breach in that regard. Hong Kong health secretary ‘disheartened’ by doctors’ arrests Ho, however, said a doctor-patient relationship could match the definition of duty of care, which could also exist in a workplace setting or situations involving custody of an individual. “So long as the principle of these elements of gross negligence manslaughter are satisfied, the charge could be raised,” he explained. When does a fatal medical error warrant prosecution? Luk said not every error by a medical professional constitutes gross negligence. “Whether something amounts to gross negligence is for the jury to decide,” he said. Stephen Hung Wan-shun, a lawyer specialising in criminal trials, said prosecutors during such trials were likely to call on medical experts to testify and give their professional views. He cited an example, such as when “nine out of 10 doctors agree that 10 procedures have to be performed, but a doctor has only done nine of them”. The lawyer, however, also said there was always the possibility that a patient could have died regardless of whether any medical blunder had happened. “It boils down to whatever act done or not done has caused the death of the patient,” Hung added. Medical blunder ‘linked’ to health care sector’s patient overload How have doctors fared in past cases? Simon Young Ngai-man, a HKU professor who specialises in criminal law, highlighted a manslaughter case in 2017 that was brought before the city’s Court of First Instance. The case involved two doctors and a technician at beauty clinic chain DR Group, whose treatment led to several patients in 2012 developing severe bacterial infections in their bloodstreams, killing one and leaving another three in critical condition. Later investigations revealed the products injected into their bloodstream were never tested for bacteria. Young said the case established that since all instances of manslaughter under the category of gross negligence were subject to the same threshold, it was irrelevant whether a doctor could foresee a risk of death when carrying out medical procedures. After a long trial and only partly successful appeal, chain owner Dr Stephen Chow Heung-wing and technician Chan Kwun-chung were jailed for 10 and eight years respectively. The second doctor, Mak Wan-ling, was imprisoned for 3½ years. Ho said a landmark case from 1994 in the United Kingdom had established many of the currently applied principles, which led to the conviction of public hospital anaesthetist Dr John Adomako for the death of a patient during a procedure where a crucial tube was disconnected from the ventilator. Ho added that the UK had demanded greater accountability from doctors in recent years, rather than leaving disciplinary action to regulatory bodies and that the trial involving Chow, Chan and Mak had fostered similar attitudes in Hong Kong. Hong Kong may need up to 10 years to overhaul healthcare system, officials admit How has the industry reacted to last week’s incident? The arrest of Lam and Chan last Wednesday has sparked discussions on the extent to which doctors can be held accountable for medical mistakes, as well as the immense strain placed on Hong Kong’s public healthcare system. Health secretary Lo Chung-mau on Friday broke his silence and said he was disheartened and had discussed supporting the defendants with the relevant authority. “We know frontline doctors are worried about breaching the law inadvertently during daily work and it may affect the efficiency and professional development of our healthcare services,” he said. Dr David Lam Tzit-yuen, a lawmaker who represents the medical sector, said members of the profession had found the situation unacceptable, adding that mistakes often happened when hospitals were always short-staffed and overloaded. The strain on public hospitals meant doctors did not have enough time to properly consult each patient, he argued. Alex Lam Chi-yau, chairman of advocacy group Hong Kong Patients’ Voices, said he was concerned that the case could have an impact on the public healthcare system, with both doctors and patients paying the price. “Will doctors choose to put themselves before patients and give longer consultation sessions?” he asked.