Provisional Legislative Council

PLC Paper No. CB(2)403
(These minutes have been seen
by the Administration and
cleared with the Chairman)

Ref : CB2/PL/HS

Provisional Legislative Council
Panel on Health Services

Minutes of Meeting held on Tuesday, 19 August 1997 at 8:30 am 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 WONG Siu-yee
Hon MOK Ying-fan
Hon CHAN Yuen-han
Hon Howard YOUNG, JP

Members absent :

Hon Allen LEE, JP
Hon Henry WU
Hon CHEUNG Hon-chung

Public Officers attending :

For all items

Mr Gregory LEUNG, JP
Deputy Secretary for Health and Welfare

Mrs Maureen CHAN
Principal Assistant Secretary for Health and Welfare

Ms Jennifer CHAN
Principal Assistant Secretary for Health and Welfare

Mr Edward LAW
Assistant Secretary for Health and Welfare

For item III only

Dr Lawrence LAI, JP
Deputy Director of Hospital Authority

Dr Che Kit LIN
Hospital Chief Executive of Hong Kong Red Cross Blood Transfusion Service

For item IV only

Acting Deputy Director of Health

Clerk in attendance :

Ms Doris CHAN
Chief Assistant Secretary (2) 4

Staff in attendance :

Mr Stanley MA
Senior Assistant Secretary (2) 7

Withdrawal of members

The Chairman informed the meeting that Dr TSO WONG Man-yin and Mr CHENG Kai-nam had resigned their membership of the Panel.

I.Confirmation of minutes of meeting and matters arising
(PLC Paper No. CB(2)149)

2.The minutes of meetings held on 22 July 1997 were confirmed.

Researches to be conducted by the Research and Library Services Division (RLSD)

3.Members noted the revised outlines of the three research topics prepared by RLSD of the PLC Secretariat and tabled at the meeting. The proposed completion dates for the three projects would be early October 1997 for "Long-term health care policy", mid-October 1997 for "Policy on health care services for the elderly" and end of 1997 for "Health care financing". In response to Mr WONG Siu-yee's enquiry, Dr LEONG Che-hung explained that the target completion dates were set having regard to the manpower situation of RLSD, the scope of the research projects, the Chief Executive's policy address in early October 1997 and the Administration's review of health care financing which would be completed in October 1998.

II.Date of next meeting and items for discussion

Items for discussion at the next meeting

4.Members agreed to discuss the following items at the next Panel meeting on 8 September 1997 -

  1. Student Health Service; and

  2. Assessment criteria for Samaritan Fund.

Transfusion of wrong types of blood at Queen Mary Hospital

5.Deputy Director of Hospital Authority (DD/HA) gave a brief account of the case involving transfusion of wrong types of blood to a seriously wounded traffic accident victim. He pointed out that the responsible duty medical consultant had, upon the death of the patient, explained the incident in detail to the patient's family members in the presence of two nurses. DD/HA added that the incident had been referred to the Coroner Court for an investigation and stressed that Queen Mary Hospital (QMH) had made no attempt to cover up the incident. To prevent recurrence of similar mishaps, QMH had adopted a number of remedial measures which included that only "O" type of blood would be stored in the Intensive Care Unit (ICU) and be used for urgent transfusion to patients with unknown blood groups .

6.Dr LEONG Che-hung enquired about the work schedule and transparency of the independent inquiry into the incident. DD/HA replied that a committee of inquiry would be formed to conduct the inquiry and report on the incident as soon as practicable. In parallel with this inquiry, the existing work procedures and mechanism governing blood transfusion would be exhaustively reviewed and remedial and preventive measures would be proposed to HA management for consideration. He assured members that both HA and the Hospital Governing Committee of QMH would follow up the findings and recommendations of the committee. In order to ensure the objectivity of the inquiry, members of the committee would comprise medical experts and personnel from public hospitals other than QMH and the private sector. In reply to Miss CHAN Yuen-han's follow up enquiry, DD/HA said the committee of inquiry would be established in a week's time and in view of the urgency of the matter only local health care professionals would be considered for its membership. He re-assured that members of the committee would be carefully selected to ensure the impartiality of the inquiry.

7.Responding to members' enquiries, DD/HA confirmed that HA had issued a set of guidelines on blood transfusions to all public hospitals on 1 August 1997 which required all public hospitals to establish an internal Blood Transfusion Committee (BTC) to oversee the operation of laid-down procedures. It also required that all blood transfusion incidents be reported to respective BTCs for necessary follow up. All Hospital Chief Executives of public hospitals with an Accident and Emergency Department had also been reminded of the importance of ensuring staff's strict adherence to the blood transfusion procedures. In reply to Mr WONG Siu-yee's enquiry, DD/HA said doctors posted to work at ICU had received general professional training in a variety of medical specialties including anaesthesiology.

8.The Chairman summed up members' concerns on the matter and emphasized that it was imperative to ensure no reoccurrence of similar incidents. He also urged HA to ensure the independence of the investigation to be conducted by the committee of inquiry.

The pumping of air into a patient's vein at QMH

DD/HA described the operational setting which had caused the inadvertent pumping of air into the veins (instead of an air cushion put under the patient's shoulder to facilitate operation on the neck) of an 82-year-old woman patient who subsequently died at QMH in April 1997. He stressed that the case had been explained to the patient's relative on-the-spot and referred to the Coroner Court for an inquest.

9.Miss CHAN Yuen-han queried why two medical devices connected with tubes (the anaesthetic tube and the air tube) of the same colour had been used for an operation. She urged HA to conduct an overall review of all operational arrangements and procedures in force at public hospitals. DD/HA replied that QMH had stopped using the air cushion in question and all medical personnel had been alerted of the professional standards required. Mr MOK Ying-fan opined that HA should use medical instruments and tools which were designed in such a way that operational errors could be prevented. In reply to the Chairman's request, DD/HA undertook to report on whether similar accidents arising from the use of the three-way-valve in question had occurred before.

10.In response to Dr LEONG Che-hung's queries, DD/HA responded that HA would not cease to use medical instruments and tools just for reason that they might give rise to human errors. As far as clinical management was concerned, he informed members that Clinical Management Teams (CMTs) had been established in all 41 public hospitals. These CMTs were responsible for the success of front-line operating units in providing services to patients and were empowered to provide health care services in line with the expectations of the community. As most front-line operating units were headed by experienced medical consultants of the specialties concerned, the quality of clinical management would be maintained at a satisfactory level. To satisfy members' request for a better understanding of how HA could ensure the quality and standards of its patient care services as well as the professional accountability on the performance of its clinical staff, DD/HA agreed to provide the Panel shortly with an information paper on HA's clinical management structure and systems in place to safeguard professional practice and enhance professional accountability.

11.Regarding the rights of the public to know, Dr LEONG enquired on whether HA had in place a set of criteria or guidelines governing the disclosure of information on major medical incidents with due regard to the privacy of the patients concerned. DD/HA assured members that HA had always aimed at striking a right balance between the interests of the public and the patients. In any circumstances, the patient or his/her immediate family members would be informed of the situation as soon as practicable. For cases where a patient died as a result of medical operations involving a potential element of human error, HA would refer the cases to appropriate authorities such as the Coroner Court for an inquest to be held.

III.Screening of blood and blood products for AIDS and other infectious diseases
(Paper No. CB(2)152(01))

12.At the request of the Chairman, DD/HA briefed members on the pre-donation and pre-transfusion measures adopted by HA and the Hong Kong Red Cross Blood Transfusion Service (BTS) to prevent the transmission of communicable diseases through blood transfusion. He stressed that donors whose blood were considered unsuitable for transfusion were barred from donation and all donated blood were subject to stringent screening tests for Syphilis, Hepatitis B and C, Human Immunodeficiency Virus (HIV), Cytomegalovirus and Human T-lymphotrophic Virus in accordance with internationally accepted practices. In addition, a panel consisting of microbiologists, hematologists and experts on AIDS had been formed to regularly monitor the procedures and practices adopted for the blood transfusion process. On public education, the Administration would continue to remind persons with at-risk behaviors not to donate blood and in particular not to use blood donation as a means of testing whether their blood had been infected. As blood donations were voluntary and without financial rewards, the risk of acquiring HIV through blood transfusion in Hong Kong was extremely remote. Copies of the "Guidelines for Prospective Donors and the Blood Donation Registration Form" were tabled for members' information.

13.Referring to the recent case in which a patient after receiving blood transfusion for therapeutic purposes at a public hospital had been confirmed to be HIV positive, Dr LEONG asked whether BTS would employ other blood screening tests to address the "Window Period" of HIV tests and what compensation the Government would give to victims of this nature. Hospital Chief Executive of Hong Kong Red Cross Blood Transfusion Service (HCE/BTS) explained that BTS had been using an automated state-of-the-art system to conduct screening of donated blood for HIV antibodies since 1985 to determine whether they were infected with AIDS virus. He explained that normally a person would generate HIV antibodies approximately three weeks after being infected and for this reason the HIV test would not be accurate if it was performed within these three weeks of "Window Period" after the donor was infected. He clarified that there were two other HIV tests for AIDS virus, namely, P24 and PCR, which could detect the virus after shorter window periods of 16 and 11 days respectively. However, both tests had major shortcomings. Given the low incidence of infection by AIDS virus and that donors gave blood on a voluntary basis, HCE/BTS said BTS had no plan at present to use either test for blood screening against AIDS virus. He added that P24 was used as a supplementary HIV test in countries with a high infection rate and PCR so far had not been used in any country. As regards compensation, Deputy Secretary for Health and Welfare (DS/H&W) pointed out that the AIDS Trust Fund could provide financial assistance to patients who were infected with AIDS virus through blood transfusion before August 1985. In response to Dr LEONG's further enquiry, he added that the Government might consider other means to help patients infected with AIDS virus through blood transfusion on a case-by-case basis. DD/HA supplemented that a victim having contracted infectious diseases through blood transfusion at a public hospital would be covered by HA's insurance policy if there was proven professional negligence on the part of HA.

14.In response to Mr Howard YOUNG's enquiry, HCE/BTS clarified that different components of donated blood had different effective periods varying from one day to 42 days for transfusion purposes. BTS would re-check particulars of packs of donated blood before they were delivered to hospitals. He added that blood which was donated within the window period would not contain the HIV antibodies even after the lapse of the window period and for this reason further testing for AIDS infection afterwards was useless. DD/HA supplemented that all potential donors were asked about their health history and chances of being exposed to HIV virus. Those who might have been exposed would be asked to refrain from giving blood and not to use blood donation as a way to check whether they had acquired HIV. He emphasized that in all respects concerning blood collection and testing, Hong Kong would continue to follow up-to-date internationally accepted practice.

15.Mr MOK Ying-fan enquired about public education against the spread of AIDS virus through blood transfusion. HCE/BTS replied that various programmes and information leaflets had been in place for such purpose. While blood donation in Hong Kong was collected on a voluntary basis, donors were subject to the pre-donation screening process and were reminded to inform BTS if they felt on reflection that the blood they had donated could be of risk to recipients. Acting Deputy Director of Health supplemented that the Department of Health (DH) would continue to publicize the risk and channels of HIV infection and to provide free HIV testing service and counseling to members of the public. At a member's request, she agreed to provide statistics on the number of persons using the free service offered by DH.

IV.Manpower Review of Medical Doctors
(Paper No. CB(2)152(02))

16.At the Chairman's request, DS/H&W briefed the meeting on the salient points of the Administration's paper on the subject -

  1. a total of 7 954 medical practitioners were registered on the resident list of the Hong Kong Medical Council (HKMC) as at end of May 1997 and about 47% of them were working in HA and DH;

  2. the two local medical schools produced 270 to 295 new graduates each year;

  3. an annual average of 303 additional medical practitioners in the past five years were supplied from three other sources, namely, graduates from recognized overseas medical schools, applicants passing the licensing examination, and finally returnees restored to the resident list of HKMC;

  4. the mean age of doctors according to a manpower survey conducted by DH in 1996 was 41.2 which meant that the wastage of doctors due to retirement would unlikely increase significantly in the years to come; and

  5. given the present trends and maintaining the present doctor to population ratio of 1.24 per 1000 population, there would be a surplus of 3 364 doctors by 2010.

17.Mr Howard YOUNG was concerned about the balanced supply of medical practitioners in both the public and private sectors and enquired whether there was a commonly accepted doctor to population ratio. DS/H&W said that there was in fact an imbalance of health care service between the public and the private sectors. He anticipated the review of health care financing which was in progress could provide useful analysis. As far as the supply of doctors was concerned, he pointed out that reducing the annual intake of medical students in the two local universities would take six to seven years for the effect to be felt. On doctor to population ratio, he said that there was no universally accepted standard. Besides, when comparing the ratios of different countries, one should be mindful of the fact that the published ratios might cover different types of hospital beds and of the way health care services were being organized and delivered in different countries. He opined that in comparison with other developed countries, the current doctor to population ratio in Hong Kong could be regarded as satisfactory. In addition, there were some 7 000 practitioners in Chinese medicine providing another source of health care service to the public. In view of the long waiting time for public health care services, Mr YOUNG expressed reservations about the oversupply of medical doctors

18.In reply to Dr LEONG Che-hung's enquiries, DS/H&W pointed out that public health care services took up 14.4 percent of the Government's annual recurrent expenditure in 1997/98 financial year. After completion of the review of health care financing, there will be more details on the relative share of the public and private sectors in health care expenditure. As regards the determination of an overall optimal doctor-to-population ratio, DS/H&W opined that it would depend on a number of social factors including the expectations of the community. Since it took six years to train up a medical student, it would be a waste of social resources if qualified medical graduates were not able to pursue a satisfying career.

19.The Chairman summed up discussions and urged the Administration to keep in view the on-going developments of the issue.

V.Any Other Business

20.At the Chairman's enquiry, DS/H&W replied that unless a justified need arose, no new legislation relating to health services would be presented to PLC.

21.The being no other business, the meeting ended at 10:55 am.

Provisional Legislative Council Secretariat
6 October 1997