LC Paper No. CB(2)1993/98-99
(These minutes have been seen
by the Administration)
Ref : CB2/BC/18/98
Bills Committee on Chinese Medicine Bill
Members present :
Minutes of meeting
held on Tuesday, 30 March 1999 at 10:45 am
in Conference Room A of the Legislative Council Building
Prof Hon NG Ching-fai (Chairman)
Hon David CHU Yu-lin
Hon Cyd HO Sau-lan
Hon Mrs Selina CHOW LIANG Shuk-yee, JP
Hon LEE Kai-ming, JP
Dr Hon LUI Ming-wah, JP
Hon Ronald ARCULLI, JP
Hon CHAN Yuen-han
Dr Hon LEONG Che-hung, JP
Dr Hon Philip WONG Yu-hong
Hon YEUNG Yiu-chung
Hon Ambrose LAU Hon-chuen, JP
Dr Hon TANG Siu-tong, JP
Hon LAW Chi-kwong, JP
Members Absent :
Hon HO Sai-chu, JP
Hon Michael HO Mun-ka
Hon CHOY So-yuk
Hon SZETO Wah
Public Officers Attending :
Clerk in Attendance :
- Dr P Y LAM
- Deputy Director of Health (2)
- Miss Eliza YAU
- Principal Assistant Secretary for Health and Welfare (Medical) 1
- Miss Miranda NG
- Senior Assistant Law Draftsman
Department of Justice
- Dr LEUNG Ting-hung
- Assistant Director of Health (Traditional Chinese Medicine)
Staff in Attendance :
- Ms Doris CHAN
- Chief Assistant Secretary (2) 4
- Mr Stephen LAM
- Assistant Legal Adviser 4
- Ms Joanne MAK
- Senior Assistant Secretary (2) 4
I. Confirmation of minutes of meeting held on 4 March 1999
(LC Paper No. CB(2)1599/98-99)
The minutes of the meeting held on 4 March 1999 were confirmed.
II. Meeting with the Administration
Regulation of dispensers of Chinese herbal medicine
(LC Paper No. CB(2)1604/98-99(01))
2. With reference to the Administration's paper on the subject, Deputy Director of Health (2) (DD(H)2) informed members that the Administration did not propose to introduce a statutory scheme to regulate dispensers of Chinese herbal medicines. Instead, it proposed a number of safeguards, as detailed in paragraphs 8(a) to (c) of the Administration's paper, to ensure that dispensation of Chinese herbal medicines was carried out in a proper manner. In addition, the Administration would encourage the educational institutions to organise courses for the existing dispensers which would be tailored to meet their operational needs. He was pleased to note that an external studies course was being provided by a tertiary institution for the training of existing dispensers. He said that given there were possibly 3,000 dispensers in Hong Kong, it would take a few years to complete the first round of training for them. Upon completion of the first round of training, the Administration would explore the option of imposing specific requirements on the qualifications of the person "nominated to supervise the dispensing of Chinese herbal medicines" provided for in clause 114(2)(b)(i).
|3. In response to Mr YEUNG Yiu-chung's enquiry about the training provided to dispensers, DD(H)2 said that the Administration would have a better grasp of the appropriate length and content of the courses after organising more of such courses and in the light of participants' responses and experience gained. Regarding a suggestion of engaging educational institutions in the Mainland to provide training courses for existing dispensers to attend during holidays, DD(H)2 said that the Administration would consider the option.
|4. Referring to clause 114(2)(b)(i), Miss Cyd HO considered that since there were no specific requirements on the qualifications of the dispenser in charge, this provision served no purpose in safeguarding the interest of public health. In response, DD(H)2 explained the purpose of this provision was that since a licence holder might not station all the time at his Chinese herbal medicines retail shop, this provision served to ensure that there would be at least an experienced person in the shop to look after the dispensing work. After discussion, DD(H)2 agreed that details of the requirements for this nominee could be further worked out and specified in the relevant subsidiary legislation.
5. Miss Cyd HO enquired why a registration system, similar to the one for Chinese medicine practitioners, could not be put in place for existing dispensers based on their years' of experiences. In reply, DD(H)2 explained that since the Administration had not conducted any survey to collect data on the years of experience of existing dispensers, it had no basis to recommend the required years of experience for the registration of them.
6. Mrs Selina CHOW took the view that given the large number of existing dispensers and that a majority of them were quite experienced in dispensing work, a gradual approach should be adopted for the introduction of a statutory scheme to regulate them. In response to Mrs Selina CHOW's enquiries, DD(H)2 said that in the cases where a Chinese medicine practitioner dispensed Chinese herbal medicines for his patients only, he needed not apply separately for a retailer licence. Principal Assistant Secretary for Health and Welfare (Medical) 1(PAS(HW)(M)1) pointed out that as provided for in the Bill, a Chinese medicine practitioner could also apply for a retailer licence for the sale of Chinese herbal medicines and, in applying for a retailer licence, he could nominate himself to be the person responsible for the supervision of the dispensing of the medicines.
7. Mr David CHU Yu-lin expressed support for the Administration's approach to strengthening the control of the dispensing of Chinese herbal medicines as proposed. In response to Mr CHU's concern about the control of the sale and dispensation of the potent Chinese herbal medicines, DD(H)2 explained that there were provisions in the Bill for the control of retail and wholesale of 31 potent Chinese herbal medicines, which in the future could only be sold or dispensed on prescription by registered Chinese medicine practitioners.
8. Mr LUI Ming-wah considered that it was important to ensure the standards of existing dispensers and suggested that a screening test be put in place for them. He opined that it would be impractical to require existing dispensers to attend training since most of them were already quite experienced. In reply, DD(H)2 pointed out that it would be difficult to put in place a screening test since it had not been specified so far as to what a dispenser must know in order to perform his job. He considered that existing dispensers were quite experienced but training would be beneficial to them in enhancing their knowledge of work and helping them keep abreast of the new developments in Chinese medicine.
|9. Mr Philip WONG Yu-hong took the view that it might be difficult for existing dispensers to spare time to attend the training courses and it would be desirable to allow them to complete the required training by self-studies. Moreover, the dispensers should be required to pass an examination at the end of the course. DD(H)2 agreed to consider the suggestion.
10. Mrs Selina CHOW objected to requiring existing dispensers to sit for any examinations given the fact that many of them had learnt dispensation of Chinese herbal medicines by apprenticeship which did not include any examinations. Moreover, she considered that the age factor of the majority of the existing dispensers should be also taken into consideration. In response to Mrs CHOW's enquiries, DD(H)2 confirmed that details of the "prescribed licensing requirements" in clause 114(3) would be further worked out and specified in the subsidiary legislation.
11. Miss CHAN Yuen-han also disagreed that existing dispensers should be required to sit for any examinations. However, she considered that the Administration should further consider how to regulate dispensers and to draw up a time-table for the purpose. In response, DD(H)2 said that given the professional nature of the dispensers' work was not high, and the fact that only limited training opportunities were available at the moment for existing dispensers, the Administration considered that a statutory scheme to regulate dispensers would only be introduced in the long run.
|12. Dr LEONG Che-hung reiterated the importance of regulating dispensers of Chinese herbal medicines in safeguarding the interest of public health. He pointed out that it was no use to have drawn up the list of the 31 potent Chinese herbal medicine in Schedule 1 and control their sale and dispensation if there were no safeguards to ensure that existing dispensers had the knowledge to distinguish the potent Chinese herbal medicines from other Chinese herbal medicines. He requested the Administration to provide a time-table for the implementation of a mechanism for the regulation of dispensers in the long run. In response, DD(H)2 said that the Chinese medicine practitioners actually seldom prescribed the listed potent Chinese herbal medicines to patients. Nevertheless, he agreed that the Chinese Medicine Council (CMC), after its establishment, should further deliberate the need to regulate dispensers of Chinese herbal medicines and he undertook to convey members' concerns and suggestions to CMC for consideration.
13. Dr LEONG Che-hung was concerned about the liability borne by the licence holder of a Chinese herbal medicines retail shop if a dispenser of that shop committed gross negligence in dispensing and caused damage to the customers. In reply, DD(H)2 said that the licence holder concerned could be subject to disciplinary action and, in a severe case, the retailer licence could be revoked. Furthermore, the licence holder might be subject to civil liability under common law. As for those cases where a registered Chinese medicine practitioner was proved to have committed professional misconduct, Senior Assistant Law Draftsman (SALD) said that the Practitioners Board could order de-registration of the practitioner concerned. Dr LEONG Che-hung commented that in the quoted cases, the degree of penalty imposed on the licence holder seemed to be very different from that imposed on the registered Chinese medicine practitioner. He said that in the latter case, the Chinese medicine practitioner would lose his livelihood after de-registration whereas the retailer in the former case could apply for a retailer licence again just by nominating another person to be responsible for the supervision of the dispensing work. PAS(HW)M1 pointed out that by clause 139, the Medicines Board was authorized to reprimand, suspend or revoke a retailer licence and these measures should have considerable impact on the retail shop concerned.
Administration's response to the written submissions received
(LC Paper No. CB(2)1604/98-99(02))
14. With reference to the Administration's paper, DD(H)2 pointed out that the major concerns expressed in the submissions were related to -
- the basis for regulating Chinese medicine practitioners and Chinese herbal medicines;
- the details of the statutory framework of Chinese medicine in Hong Kong;
- the definition of "practising Chinese medicine";
- the need to prohibit Chinese medicine practitioners from practising Western medicine;
- the proposed transitional arrangements;
- the details of the Licensing Examination;
- the restrictions on the use of titles;
- the arrangements of Limited Registration;
- the purpose of the practising certificate;
- the penalties for fraudulent representation in the application for registration as a registered Chinese medicine practitioner;
- the integration of Chinese and Western medicines; and
- the regulation of proprietary Chinese medicines.
15. DD(H)2 explained to members that the Administration did not consider it necessary to introduce legislation to regulate the practice of "qigong" as it had yet to be developed to be a complete health care system. He said that the Administration considered that "qigong", as well as Chinese manipulative therapy and acupressure massage, were some kinds of medical treatments applied in Chinese medicine. Therefore, the Bill did not propose to prohibit a Chinese medicine practitioner from using "qigong" in the treatment of his patients. On the other hand, a "qigong" practitioner who was trained in Chinese medicine could apply for registration as a registered Chinese medicine practitioner if he met the prescribed requirements.
Clauses 83-89 - Limited registration
|16. Dr LEONG Che-hung and Mrs Selina CHOW were concerned about the definition of an "educational or scientific research institution" in clause 83. Dr LEONG Che-hung considered that it was essential to define clearly the term to avoid abuses of the system. Mrs Selina CHOW pointed out that there were already many Chinese medicine institutes in existence and enquired whether the Administration would draw up a Schedule setting out which of the institutes fell into the category of "educational or scientific research institution". In response, PAS(HW)M1 explained that the Administration did not intend to provide such a Schedule in view of the large number of these institutes and the need to give CMC some flexibility to decide on the matter. She suggested that with the establishment of CMC, it could issue some guidelines to explain what criteria it used in the screening of these institutes. However, Mrs Selina CHOW considered that this issue was important and suggested that the details of the criteria should be set out in the subsidiary legislation. DD(H)2 agreed to consider the suggestion.
Clause 111 - Restriction on sale, etc. of Schedule 2 medicines
17. DD(H)2 informed members that pursuant to Mrs Selina CHOW's request, the Administration would provide by the next meeting a list of products (mainly the pre-packed soup ingredients) being sold in supermarkets which contained Schedule 2 Chinese herbal medicines.
18. Dr LEONG Che-hung referred to the case of "Radix Ginseng and Chicken Essence" and enquired whether these products in the future would have to be sold only in those Chinese herbal medicines retail shops which had obtained a licence for the sale of the listed Chinese herbal medicines. In reply, PAS(HW)M1 explained the Administration's policy and pointed out that for those products like the pre-packed soup ingredients which contained Schedule 2 Chinese herbal medicines, they would have to be sold in retail shops which had obtained a retail licence in respect of the listed Chinese herbal medicines. However, for those proprietary products which composed of Chinese herbal medicines and claimed or known to be used for treatment of diseases and so on, they would be classified as proprietary Chinese medicines, the sale of which would not be subject to the restrictions spelt out in clause 111.
|19. Dr LEONG Che-hung noted that there were many products such as "Imedeen" which neither belonged to Western medicine nor Chinese medicine but were classified as health food at the moment. He urged the Administration to formulate policies to regulate this kind of products. In response, DD(H)2 said that public demand for the regulation of these products was quite clear and the Administration would actively explore how to take the issue forward.
|20. Mrs Selina CHOW was concerned about the distinction between Chinese herbal medicines and proprietary Chinese medicines. In response, PAS(HW)M1 explained that there were three criteria adopted to define proprietary Chinese medicines which were set out under "Interpretation" in clause 2. She considered that in most cases there would be no problem in the distinction and if there were any difficulties, the Medicines Board would consider on a case-by-case basis. SALD drew members' attention to clause 122 setting out the three factors which would be taken into consideration by the Medicines Board in determining an application for registration of a proprietary Chinese medicine. However, Mrs Selina CHOW considered that the Medicines Board should further make provisions under the subsidiary legislation for defining proprietary Chinese medicines because in so doing, the sector concerned could have an opportunity to express their views to the Medicines Board. DD(H)2 replied that the Medicines Board could issue some guidelines to the sector to explain clearly matters related to the applications for registration of proprietary Chinese medicines.
21. Dr LEONG Che-hung pointed out that some importers of the food stuff containing Schedule 2 Chinese herbal medicine might not be aware of the proposed restrictions on the sale of these products. In response, DD(H)2 said that with the passage of the Bill, the Administration would promote the general awareness in the sector of the new requirements. The Administration would also ensure that sufficient channels were in place for the traders to obtain information or to give their views on the arrangements under the new regulatory framework.
22. Mr LAW Chi-kwong enquired about details of the regulation of Chinese Herbal tea shops. In reply, DD(H)2 explained that under existing legislation, these shops were subject to licensing control by the two provisional municipal councils while Department of Health (DH) was responsible for providing professional expertise to ensure safety of the products containing Chinese herbal medicines sold in these shops. If a Chinese herbal tea shop introduced the sale of a new type of Chinese herbal tea based on a new formula, it had to submit the formula to DH first for examination to ensure safety. In addition, if there were complaints against the products sold in these shops, DH would conduct investigations. DD(H)2 explained that as the Administration considered that there were sufficient safeguards to regulate these shops and the products sold there, they should be exempted from the regulation as proposed in the Bill to avoid double-regulation. However, some members were dissatisfied as to why Chinese herbal tea shops selling products composed of Chinese herbal medicines would not be covered in the proposed regulation. They further considered that it would be more appropriate for DH to issue licences to the Chinese herbal tea shops since the Department had the expertise to examine the safety of the products sold there.
23. The Chairman enquired whether there were provisions to prohibit Chinese medicine practitioners from using western medical instruments such as stethoscopes and electrocardiogram in the treatment of patients. In response, DD(H)2 said that Chinese medicine practitioners should be allowed to use modern medical instruments if they had such a need in the diagnosis of a disease. He considered that there was a need for modernization of Chinese medicine and in this connection the Western medicine sector should be consulted to seek their views. He pointed out that if it was agreed that Chinese medicine practitioners should be allowed to use modern medical instruments in the treatment of patients, the Licensing Examination should include the subjects for examination. Dr LEONG Che-hung took the view that it was essential to ensure that only Chinese medicine practitioners who had been trained in the use of modern medical instruments were allowed to use them and that they should use the instruments only if they had a real need to use them.
24. In response to the Chairman's enquiry, DD(H)2 explained that Chinese medicine practitioners would not sign death certificates due to the fact that the use of medical terms in Chinese medicine for descriptions of illnesses were different from those used in the International Classification of Diseases, which had been based on in the compilation of statistical information on the causes of deaths.
III. Date of the next meeting
25. Mrs Selina CHOW informed the meeting that she would be unable to attend the next meeting scheduled for 7 April 1999 at 8:30 am and requested cancellation of the meeting. After discussion, the Bills Committee decided not to cancel the meeting taken into account the facts that the number of members (10 members) who had confirmed their attendance at the next meeting would be sufficient to form a quorum and that there was a need to expedite the scrutiny of the Bill.
26. The meeting ended at 12:45 pm.
Legislative Council Secretariat
11 May 1999