Provisional Legislative Council
PLC Paper No. CB(2) 839
(These minutes have been
seen by the Administration)
Ref : CB2/PL/HS
Provisional Legislative Council
Panel on Health Services
Minutes of meeting
held on Tuesday, 9 December 1997 at 2:30 pm
in Conference Room B of the Legislative Council Building
Members present :
Dr Hon TANG Siu-tong, JP (Chairman)
Dr Hon LEONG Che-hung, JP (Deputy Chairman)
Hon CHEUNG Hon-chung
Hon CHAN Yuen-han
Members absent :
Hon WONG Siu-yee
Hon Henry WU
Hon MOK Ying-fan
Hon Howard YOUNG, JP
Member attending :
Hon CHAN Choi-hi
Public officers attending :
Health and Welfare Bureau
Department of Health
- Mr Gregory LEUNG, JP
- Deputy Secretary for Health and Welfare
- Mrs Maureen CHAN
- Principal Assistant Secretary for Health and Welfare (Medical) 1
- Miss Candy LEUNG
- Assistant Secretary for Health and Welfare (Medical) 1
Clerk in attendance :
- Dr P Y LAM, JP
- Deputy Director of Health
- Mr TSE Man-shing
- Head, Boards and Councils Office
- Hospital Authority
- Dr W M KO
- Deputy Director (Operations) 4
- Dr K M CHOY
- Executive Manager (Professional Services)
- Dr W N TANG
- Chief of Service, Department of Psychiatry
- Pamela Youde Nethersole Eastern Hospital
Staff in attendance :
- Ms Doris CHAN
- Chief Assistant Secretary (2) 4
- Mr Stanley MA
- Senior Assistant Secretary (2) 7
Members agreed on items to be discussed at the next regular meeting. As regards the issues relating to manpower and working hours of medical staff in public hospitals raised by Kowloon City Provisional District Board members at their meeting with PLC Members on 9 October 1997, members were of the view that these issues had been thoroughly discussed by the Panel earlier and further discussion should be pending until the results of the Administration's comprehensive review on health care financing were available.
I.Confirmation of minutes of meeting held on 9 October 1997
(PLC Paper No. CB(2)640)
2.The minutes of the meeting held on 9 October 1997 were confirmed.
II.Date of next meeting and items for discussion
3.The Chairman informed the Administration that members would like to discuss the following items at the next meeting to be held on 12 January 1998 at 8:30 am -
II.Medical rehabilitation service for ex-mental patients
- Implementation of the Smoking (Public Health) (Amendment) (No.2) Ordinance 1997;
- Report by the Hospital Authority on remedial measures for medical incidents and review of complaints management; and
- Hepatitis A.
[Paper No. CB(2)705(01)]
4.Deputy Director (Operations)4 of Hospital Authority (DD/HA) highlighted that most mental illnesses were chronic in nature and successful rehabilitation of mental patients depended on both medical and social rehabilitation services. As far as medical rehabilitation was concerned, HA provided a wide variety of follow-up services covering in-patient, out-patient, day hospital, community care and outreaching to ex-mental patients. There was no preset target success rate of medical rehabilitation in HA. Cases in which the ex-mental patients had not been re-admitted for psychological and drug treatment within 28 days of discharge were considered as successful ones. According to past statistics, the rate of re-admission of ex-mental patients due to relapse within 28 days of discharge had remained at 3% in recent years which indicated that the success rate of medical rehabilitation in Hong Kong was comparable to that of other countries having more developed psychiatric services.
5.Miss CHAN Yuen-han enquired about the feasibility of providing evening out-patient services to ex-mental patients at the 17 psychiatric specialist clinics and the implementation progress of providing psychiatric services to mental patients on public holidays in three selected public hospitals, namely, the Kwai Chung Hospital, Pamela Youde Nethersole Eastern Hospital and United Christian Hospital. DD/HA responded that the trial scheme providing extended hours depot injection services was targeted to improve services to mental patients. As regards member's comments that many mental patients would prefer to use the out-patient service at night for reasons of privacy and convenience of transport, Executive Manager (Professional Services) of HA ((EM(PS)) explained that after considering the feedback of mental patients and having regard to factors such as availability and convenience of transport, etc., HA had decided to implement the above trial scheme on Sundays and would review the situation in the light of actual experience after six months of operation.
6.In reply to Dr LEONG Che-hung's enquiry about the distribution of the additional 670 psychiatric beds available within the next five years, EM/PS replied that these included provisions in United Christian Hospital, Tai Po Hospital, Pamela Youde Nethersole Eastern Hospital and the North District Hospital. As regards whether the period of 28 days after discharge was a commonly accepted standard for calculation of success rate of medical rehabilitation, Chief of Service, Department of Psychiatry in Pamela Youde Nethersole Eastern Hospital, (CS/DP) pointed out that the period of 28 days was used by many countries for calculation of success rate. EM/PS informed the Panel that the return rate of 3% in respect of a period of 28 days after discharge was considered a satisfactory figure in the present circumstance, and HA was aiming to achieve a higher rate of success in the years to come. HA would continue to coordinate with Social Welfare Department (SWD) for the provision of prompt and quality social rehabilitation services to ex-mental patients. In response to the Chairman's follow-up enquiry, Dr TANG pointed out that prior to his/her release from hospital, a recovering mental patient normally would be arranged to live with his/her family members for a few weeks so that his/her abilities to get along with them as well as other people in the community could be assessed. Depending on individual merits, the period of leave might last from two to five weeks. At members' requests, DD/HA agreed to liaise with SWD to provide the Panel with the following information -
- HA's recent evaluation report on its requirement of places in half-way houses for ex-mental patients and the future development plan for half-way houses in relation to such requirement;
- the success and return rate of ex-mental patients who were referred to half-way houses; and
- report of the review of the service of public holiday depot injection service for ex-mental patients to be conducted after six months of operation.
7.Referring to the potential threats posed to members of the public, Mr CHEUNG Hon-chung was concerned about the provision and implementation of rehabilitative services for ex-mental patients. EM/PS stressed that successful rehabilitation of ex-mental patients depended not only on HA's medical rehabilitation services, but also on SWD's social rehabilitation services as well as care and support from the patients' family members and the community. He assured members that staff of the psychiatric clinics of HA would follow up the provision of proper medical rehabilitation services to ex-mental patients. Responding to Mr CHEUNG's follow-up question, CS/DP said doctors working in public hospitals would arrange injection for elderly mental patients who for some reasons did not take drugs on schedule. In reply to the Chairman's enquiry, DD/HA reiterated that it was the aim of all psychiatric units that mental patients should be properly rehabilitated before they could be released to re-enter the community. HA would maintain contacts with ex-mental patients as well as their family members to keep abreast with the progress of these patients and this included where appropriate, members of HA's Community Psychiatric Teams, consisting of psychiatrists, community nurses, psychotherapists, occupational therapists and medical social workers, following up individual ex-mental patients and providing them with appropriate treatment as soon as practicable. Lastly, ex-mental patients and their family members could make use of HA's 24-hour telephone enquiry service on mental illness to seek professional advice from duty qualified medical and nursing staff.
8.Referring to the recent incident in which a woman patient suspected of suffering from postpartum depression was diagnosed as fit for discharge after being given an injection of tranquilizer at a public hospital and subsequently threw her four-month-old baby daughter from a high-rise building to the street, Dr LEONG enquired about follow-up measures taken by HA to prevent recurrence of similar incidents. CS/DP said that HA had arranged psychiatric experts to conduct seminars for all medical and nursing staff working in accident and emergency departments of public hospitals. The contents of these seminars included the symptoms and probable behaviour of psychiatric patients who had an inclination to commit suicide or behave in a disorderly manner and the approaches and ways to counsel them. Based on the feedback from participants, arrangement might be made for staff working in other departments to attend similar seminars.
9.Referring to the concerns of members of the former LegCo Panel on Welfare Services raised at the meeting held on 14 March 1997, the Chairman enquired whether HA had developed targets for improving the average waiting time for first appointments in psychiatric specialist clinics and increasing the number of beds in psychiatric units of public hospitals. DD/HA replied that HA had been working towards improving services provided by public hospitals, having regard to the overall demand of individual services and the resources allocated for such services. While the present average waiting time was considered satisfactory at the existing level of allocated resources, he said HA was aiming at improving the average waiting time to four to six weeks for the first appointment of all specialist services in the long run. He added that mental patients requiring urgent psychiatric services in public hospitals would continue to be treated as soon as practicable. As regards the number of beds, EM(PS) said the long-term target was to achieve a standard ratio of 0.9 beds for 1 000 patients. He added that HA would collaborate with SWD to enhance rehabilitative services for ex-mental patients to successfully re-integrate into the community. As a result of such enhancement of services, the demand for in-patient hospitals and psychiatric wards in public hospitals might decline.
III.Monitoring of dispensaries at general outpatient clinics
[Paper No. CB(2)705(03)]
10.At the Chairman's request, Deputy Director of Health (DDH) briefed members on the facts and follow-up measures taken in relation to the incident of wrong dispensing of medicine at Cheung Sha Wan Jockey Club Clinic (CSWJCC) and the dispensing service of the Department of Health (DH) as follows -
- on 25 November 1997 a number of 60-milliliter bottles containing anti-fever syrup in CSWJCC were found to be contaminated with a mouthwash which was of the same pink colour as that of the anti-fever syrup. The medicine was mainly given to children between the age of two months and two years for treatment of fever that might arise after immunization;
- the anti-fever syrup and mouthwash were manufactured centrally by DH's manufactories and distributed to individual dispensaries in containers of capacities varying from 3.5 litres to 17 litres to individual dispensaries where they would be poured into small bottles by dispensers with the assistance of workmen. According to initial findings, the incident of wrong dispensing could have occurred during the bottling process in CSWJCC on 17 November 1997 and a total of 146 clients had been given the contaminated syrup;
- DH had successfully contacted 145 affected clients. 77 of the 117 clients who had taken the medicine had some symptoms of sickness which were generally mild and transient. Three of them had been taken to hospitals and were discharged and confirmed to be well by attending doctors;
- on 29 November 1997 the incident was publicized in the mass media. A telephone hotline manned by doctors was set up to provide counseling to parents and the consultation hours of Cheung Sha Wan Maternal and Child Health Centre was accordingly extended to provide medical assessment for the clients. Anti-fever syrup collected from parents was sent for testing;
- on 3 December 1997, two samples of the anti-fever syrup dispensed on 15 November 1997 at CSWJCC were tested to be lightly contaminated with the mouthwash. In the light of this finding and other allegations it was considered necessary to broaden the scale of investigation to include children who received the same kind of medicine from CSWJCC from 1 November 1997. A special working group comprising members from outside DH and supported by Assistant Director (Administration) of DH as the convenor had been set up to conduct a full-scale investigation into the causes of the problem from an independent perspective. Its terms of reference were -
- to investigate thoroughly the incident of wrong dispensing of medicine at the Cheung Sha Wan Clinic Dispensary (CSWCD);
- to review the procedure and practices in CSWCD; and
- to recommend to the Director of Health on measures to prevent recurrence of similar incidents in the future;
- DH had immediately after the incident instituted a number of measures to safeguard the quality of medicines dispensed. Dispensary staff were reminded to exercise due care in all processes of work. The mouthwash was discontinued from use and alternatives were provided until a new stock of mouthwash in blue colour was available;
- the dispensaries of DH were manned by Dispensers and Senior Dispensers with the support of Workmen II. As at 1 November 1997, the total set-up for 88 dispensaries consisted of 214 Dispensers, 74 Senior Dispensers and seven Chief Dispensers. The service was supported at the Headquarters level by pharmacists who monitored the consumption of medicines and assisted in their procurement. Dispensers were certificate holders of the Technical Institute of the Vocational Training Council who had been properly trained in general pharmaceutics and related subjects with on-the-job practices; and
- the special working group held its first meeting on 8 December 1997 and would interview affected parents to obtain direct feedback from them. It was expected that the investigation would be completed within three to four weeks and the findings of the special working group would be made public.
11.Mr CHEUNG Hon-chung enquired whether a Workman II had involved in the process of dispensing and commented that a change of colour for the mouthwash was not a long-term solution to avoid recurrence of similar incidents. DDH responded that the anti-fever syrup was stored in containers with a maximum capacity of 17 litres and the assistance of workman in dispensing work was necessary. However, the Dispenser in charge of the dispensary at CSWJCC should supervise the work of the Workman and was accountable for the proper operations of the dispensary. He stressed that the special working group would find out the exact cause of the incident and recommend appropriate follow-up actions and assured members that DH would also review the procedures adopted for distribution and dispensing of medicines in clinics for a long-term solution.
12.Referring to the recent series of medical blunders in public hospitals and clinics, Miss CHAN Yuen-han was concerned about the effectiveness of monitoring mechanisms and the manpower shortage problems in public health care sector. DDH responded that depending on size, the daily operations of dispensaries in public clinics were managed by Senior Dispensers or Dispensers. Senior Dispensers were staff members having at least seven to 10 years of experience in the field. In addition to operational duties, they performed administrative work relating to their assigned dispensaries as well. Chief Dispensers were responsible for the performance of a number of dispensaries. They conducted regular inspections on site to ensure acceptable standards of dispensing work and arranged re-deployment of staffing resources as and when the needs arised. At the Headquarters level, Senior Pharmacists and Pharmacists would keep watch of the consumption of medicine by individual clinics and the finance management unit would check the financial expenditure and ensure adherence to correct accounting procedures. As regards manpower shortage problem, DDH said that the standard dispenser-to-doctor ratio and the job specifications of dispensers established in 1990 had been followed since 1993. He added that before the incident of wrong dispensing, DH had already discussed with its dispensary staff on a review of these standards. In response to Miss CHAN's follow-up question on improving supervision on dispensing work, DDH assured members that DH was determined to improve the services of its dispensaries and would implement the recommendations of the special working group wherever practicable.
13.Dr LEONG enquired how two different medicines could be mixed up at the dispensary in CSWJCC and about the share of responsibilities among dispensers, pharmacists and doctors in dispensing of medicine. DDH replied that the exact cause of wrong dispensing could only be concluded when the statements of the personnel concerned had been taken and carefully analyzed together with other environmental factors. Since the two medicines were of the same colour, it was suspected that they were inadvertently poured into the same set of small bottles at the dispensary on one or more occasions from early November 1997. As investigation was still in progress, he advised members to wait for the conclusion of the special working group's report. As regards the line of responsibility, he reiterated that dispensaries were managed by Dispensers who were supervised by Senior Dispensers and Chief Dispensers at the next two higher levels. Pharmacists and Senior Pharmacists served a monitoring and control role on the consumption of medicine at each clinic. Doctors working in public clinics played no part in supervising the dispensing of medicine but better communication and co-operation between doctors and dispensers could certainly contribute to reduce the number of wrong dispensing. In respect of public liabilities, the Government would be responsible for any successful claims for compensation from members of the public arising from wrong dispensing of medicine and disciplinary action could be instituted against dispensing staff concerned in accordance with the relevant terms of Public Service (Administration) Order. As for the recruitment criteria for dispensers, DDH said the existing requirements for recruiting dispensers could be reviewed in light of changing circumstances and increased complexities involved in dispensing work. Deputy Secretary of the Health and Welfare Bureau (DS/H&W) supplemented that one of the performance pledges of the Health and Welfare Bureau in 1998/99 was to thoroughly review the Pharmacy and Poisons Ordinance (Cap. 138), the Dangerous Drugs Ordinance (Cap.134) and the Dangerous Drugs Regulations (Cap. 134A). In response to the Chairman's follow-up enquiry, DDH said that there were now one Chief Dispenser stationed at CSWJCC to supervise the work of two Senior Dispensers and two Dispensers who were collectively responsible for the day-to-day operation of the dispensary there.
IV.Influenza A H5N1 Virus
14.DDH briefed members on the operation of the global influenza surveillance network maintained by the World Health Organization (WHO) of which the local health authority had been a member since some thirty years ago. Within the network a reporting and testing system was established to monitor and update the composition of influenza vaccines in response to any detected antigenic changes of influenza virus. With such a system, the new strain of influenza H5N1 was detected by the Centres for Disease Control and Prevention (CDC) in Atlanta, USA at an early opportunity. DDH also briefed members on the details of the four confirmed cases of H5N1 infection in Hong Kong. Experts from CDC were now in Hong Kong to assist DH in surveillance, case detection and investigation into this new strain of influenza A virus. The prime task at present was to find out whether the virus could be transmitted from human to human. WHO had been requested to alert vaccine production centres in the world to follow developments here with a view to preparing the necessary vaccines if required. DH had also stepped up the influenza surveillance activities to cover all public hospitals and general out-patient clinics in Hong Kong. While a new laboratory test for detection of H5N1 viral infection would be developed by experts at CDC soon, such test would take a few days to complete and hence it was not practical to be used by medical practitioners to test whether a patient had been infected with H5N1. DH would continue to disseminate up-to-date information as well as management guidelines to doctors, medical professionals, colleges and health care workers on the virus through letters and DH's homepage on the Internet. At the Chairman's request, DDH agreed to consider sending such information to all private practitioners by post as well. DD/HA reiterated that HA's guidelines had been sent to all private hospitals and would be made available to Hong Kong Medical Association as well. At this stage human-to-human transmission of the H5N1 virus had not been proven and there was no evidence suggesting that the disease was widespread. The fact that the virus had been known to be infectious to human at its early stage of development was beneficial to our pursuit of an effective vaccine against its infection. On public education front, DH would coordinate with Government Information Services to promote public awareness of the virus as well as the importance of keeping a healthy body which would provide immunity against infection of any influenza virus.
15.Dr LEONG Che-hung enquired whether a mass survey on patients of influenza could be conducted to assess the spread of H5N1 up to now and whether guidelines were available for distribution to private medical practitioners in the management of virus. He also asked whether the public hospitals had sufficient resources and medicine in the event of a major outbreak of this influenza strain. DDH responded that people who had developed influenza-like illness should seek medical consultations promptly. While mass production of the laboratory test for identifying H5N1 infection in human body would be difficult at this stage, he said that experts from CDC would in collaboration with DH's medical specialists work out study designs to assess whether the H5N1 virus was transmissable among humans. In view of the small number of confirmed infections so far, family members and contacts of the infected patients would be the targeted group of subjects for the test. As for guidelines for private medical practitioners on detection of H5N1, DDH said that the use of amantadine should be recommended with care and DH would continue to upload the latest information on the management of H5N1 infection onto the Internet once available. If an outbreak of H5N1 occurred, DH and HA would make the full use of available resources to cope with the situation. He added that the primary health care services provided by private practitioners would play a substantial role in tackling the disease and hospitalization was necessary when the patients had complications arising from H5N1 infection. In response to Dr LEONG's follow-up question on a mass survey on the virus, DDH clarified that mass production of the virological test developed by CDC was not feasible at this stage and for this reason DH had adopted a centralized approach for collecting blood samples for testing purpose.
16.Responding to the Chairman's enquiries, DD/HA replied that blood samples of HA's medical and nursing staff who showed symptoms of influenza diseases after contact with infected patients had been sent to DH. Should a major outbreak of H5N1 occur, HA would collaborate with DH and all private practices and make use of all available resources to fight against the disease. In reply to the Chairman's follow-up question, DD/HA said HA would continue to cooperate with DH on surveillance of H5N1 and had adopted infection control measures for staff who had contacts with patients infected with H5N1. The Infection Control Unit, consisting of microbiologists, epidemiologists and clinicians of various departments, in public hospitals would closely monitor the possible side effects of amantadine treatment. It would also educate staff and patients concerned so that they would have a better understanding of the related procedures for management of the disease and its prevention. He stressed that early diagnosis and treatment of complications caused by H5N1 was most important and regular updates on information and guidelines relating to the management of H5N1 would be made as soon as possible. He added that HA's microbiologists and virologists had already held a meeting with experts from CDC on 8 December 1997 and HA was ready to offer assistance upon request from DH.
17.Miss CHAN Yuen-han commented that the Administration should adopt a more open approach in disclosing information on H5N1 and urged the Administration to set up a special working group to publicize up-to-date information as well as to educate people on precautionary measures against infection of the virus. DDH responded that DH would arrange press briefings and upload the latest findings and progress of investigations into H5N1 onto the Internet more frequently. As for prevention measures for H5N1, DH would cooperate with the Information Services Department to educate the public to maintain a proper diet with adequate rest and physical exercise and to seek medical consultations promptly if they had developed influenza-like symptoms.
18.In view of the serious consequence of the spread of a new strain of influenza as recorded in the past, Mr CHEUNG Hon-chung urged the Administration to adopt a crisis management approach to tackle the issue of H5N1. DDH responded that DH was arranging experts of CDC to conduct seminars and briefings on H5N1 for private practitioners. He assured members that DH had been proactive and serious towards H5N1 and had been working closely with experts from CDC and WHO to combat against the spread of the virus. He reiterated that the prime task now was to confirm whether the virus could be transmitted from human to human and henceforth decided on the way forward. In case of a wide spread of the virus, he was confident that both the public and private health care sectors would do their utmost to fight against the disease . DS/H&W supplemented that the Health and Welfare Bureau was also very concerned about the infection of H5N1 in human and had ensured that appropriate actions and measures had been taken by the authorities concerned.
19.Mr CHAN Choi-hi opined that private practitioners should be kept informed of the latest progress on matters relating to H5N1 as soon as possible. DDH reiterated that all information relating to H5N1 would be uploaded onto Internet as soon as practicable. DH would continue to send updated guidelines to private practitioners by fax and/or by post and arrange press briefings on latest developments as and when necessary.
20.Dr LEONG reiterated the need to conduct a mass survey on patients suffering from influenza and enquired about whether similar infections of H5N1 had been found in the Mainland. DDH replied that due to technical constraint, Hong Kong could detect the existence of the H5 virus but not the N1 virus. He reiterated that once it had been confirmed that H5N1 could be transmitted from human to human, the production of vaccine would be arranged by WHO immediately. As regards H5N1 in the Mainland, he said that blood samples had been collected and sent to CDC for investigation as well as for production of vaccine and a professor in Hong Kong suspected that human infection of H5N1 had also occurred in China but so far no official record was available. DD/HA supplemented that a large scale survey on patients suffering from influenza through the antibody test was at present not feasible as it required a large quantity of the H5N1 virus which was not available for the time being. The existing test for H5N1 was to foster the growth of the virus in the blood sample taken from the patients concerned and it normally would take a few days to complete the test process. In response to Mr CHEUNG Hon-chung's follow-up question, DDH said that the production of an effective vaccine would normally take six to eight months. He added that maintaining body immunity was more effective than relying on the injection of a vaccine for prevention against the infection of influenza virus. He also undertook to relay Dr LEONG's views to colleagues in DH for consideration.
V.Regulation 26 of the Radiation (Control of Irradiating Apparatus) Regulations
[Paper No. CB(2)705(01)]
21.Head, Boards and Councils Office (HBCO) briefed members on the following -
Supplementary Medical Professions Ordinance (Cap.359)
- The Supplementary Medical Professions Ordinance (Cap 359) provided for the registration, discipline and management of persons engaged in professions supplementary to medicine. The Radiographers Board was established under section 5 of Cap.359 to promote adequate standards of professional practice and conduct among radiographers. The registration and discipline of radiographers were provided for under the Radiographers (Registration and Disciplinary Procedure) Regulation made under Cap. 359 in 1995 and statutory registration of radiographers commenced on 1 July 1995. With effect from 1 November 1996, no person should practise as a radiographer without being registered, except those specifically exempted under the Regulation.
Radiation Ordinance (Cap.303)
- The Radiation Ordinance controlled the import, export, possession and use of radioactive substances and irradiating apparatus and the prospecting and mining for radioactive minerals, and for related purposes. The Radiation Board was set up under section 3 of Cap.303 as the authority to administer the Ordinance. In accordance with section 7, a person who used irradiating apparatus should hold a licence issued by the Radiation Board. As regards the use of irradiating apparatus affecting the human body, Regulation 26(1) of the Radiation (Control of Irradiating Apparatus) Regulations stipulated that no person other than a medical practitioner or a person acting under his personal supervision should operate an irradiating apparatus for any purpose affecting human body. It followed that a person operating an irradiating apparatus under the personal supervision of a medical practitioner who held a licence to use the irradiating apparatus was not contravening Regulation 26(1).
The way forward
- The Hong Kong Radiographers' Association (HKRA) and the Radiographers Board were concerned that under Regulation 26(1), unregistered persons would be allowed to practise radiography as long as they were working under the personal supervision of medical practitioners and therefore rendered the statutory registration of radiographers meaningless. The Administration's legal adviser was of the opinion that whether such unregistered persons were regarded as practising radiographers would depend on the scope of work they performed and in any event, Regulation 26(1) did not empower any unregistered persons to practise the radiographers' profession, regardless of whether they were under the personal supervision of medical practitioners. Therefore there did not exist an anomaly between the two Regulations.
- Given that medical practitioners concerned would be held clinically responsible, the Radiation Board considered that the flexibility of allowing unregistered persons to operate irradiating apparatus under the personal supervision of medical practitioners should be retained to cater for some practical clinical situations. To address the concern of the HKRA, the Radiation Board had proposed to amend Regulation 26(1) along the line that "No person shall operate an irradiating apparatus for any purpose affecting the human body except a registered medical practitioner or a person acting under the personal supervision of a registered medical practitioner who is present on the premises in which the examination is taking place at the time it takes place".
22.Miss CHAN Yuen-han enquired whether a registered medical practitioner could operate an irradiating apparatus and supervise unregistered persons to operate such apparatus without completing the relevant professional training. HBCO replied that medical practitioners who did not hold a licence to use the irradiating apparatus should not operate the apparatus and should employ persons who hold a licence to operate the apparatus.
23.Referring to HKRA's allegation that some nurses in the Accident and Emergency Departments of HA Hospitals were allowed to order x-rays by using referral forms pre-signed by doctors, Dr LEONG enquired about whether such practice had been stopped. DD/HA explained that under the triage system and for enhancing operational efficiency, HA had previously implemented a trial scheme in which experienced nurses in selective hospitals were allowed to order X-rays on behalf of the doctors for specified categories of patients such as bone disjoint on their own. While such practice was aimed at reducing patients' waiting time and was also adopted by some hospitals in overseas countries, DD/HA agreed that the concern of HKRA was understandable. He advised members that the trial scheme had been completed and would be reviewed in light of the feedback from patients, medical and nursing staff and other parties. All nurses in public hospitals had now been advised to obtain the attending doctors' approval before ordering X-ray photos for patients. At the request of Miss CHAN Yuen-han, DD/HA agreed to keep the Panel informed of the results of the review in due course.
VI. Any other business
HA's double payment of an advance of $202.35 million to the Government
24. DS/H&W briefed members on how the double payment was mistakenly made. He assured members that both parties had reviewed their internal financial control procedures and the procedures governing the disbursement of Government funds to HA. A list of counter-checking measures would be implemented to prevent the recurrence of similar incidents. In reply to Miss CHAN Yuen-han's queries, DS/H&W explained that the officers concerned had, under work pressure in connection with the closing of the Government*s 1996-97 accounts, acted in good faith to effect HA*s payment before the end of the financial year. The oversight could partly be attributed to the lack of sufficient documentation on accounting transactions between the Government and HA. DD/HA agreed that both HA and the Administration should review their existing accounting systems but stressed that both parties had made no attempt to cover up the error. As regards payments to suppliers of HA, he highlighted that the existing accounting procedures were sound and on many occasions, suppliers had complained that HA was a little too cautious in making payments to them.
25.In reply to Dr LEONG 's question on the financial strength of HA, DD/HA explained that the payment was made through the use of cashflow and in no way indicated that HA had surplus funds.
26.The meeting ended at 5:00 pm.
Provisional Legislative Council Secretariat
8 January 1998