Provisional Legislative Council

PLC Paper No. CB(2) 1480
(These minutes have been
seen by the Administration)

Ref : CB2/PL/HS

Provisional Legislative Council
Panel on Health Services

Minutes of meeting held on Monday, 30 March 1998 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 Henry WU
Hon CHAN Yuen-han

Members absent :

Hon CHEUNG Hon-chung
Hon MOK Ying-fan
Hon Howard YOUNG, JP

Member attending :

Hon Mrs Sophie LEUNG LAU Yau-fun, JP

Public officers attending :

Health and Welfare Bureau

Mr Gregory LEUNG, JP
Deputy Secretary for Health and Welfare

Miss Eliza YAU
Principal Assistant Secretary for Health and Welfare (Medical) 1

Ms Jennifer CHAN
Principal Assistant Secretary for Health and Welfare (Medical) 2

Mr Edward LAW
Assistant Secretary for Health and Welfare (Medical) 3

Ms Manda CHAN
Assistant Secretary for Health and Welfare (Medical) 2

Department of Health

Deputy Director of Health

Assistant Director of Health (Special Health Services)

Dr Thomas TSANG
Principal Medical & Health Officer

Hospital Authority

Deputy Director (Operations)

Urban Services Department

Mr PO Pui-leong
Assistant Director (Environmental Health) 1

Mr KWAN Ka-lun
Senior Staff Officer (Public Health) 2

Regional Services Department

Mr LAI Kwok-tung
Assistant Director (Environmental Health Policy)

Clerk in attendance :

Ms Doris CHAN
Chief Assistant Secretary (2) 4

Staff in attendance :

Mr Stanley MA
Senior Assistant Secretary (2) 7

Closed Meeting

Members went over the agenda items and agreed on issues to be discussed with the Administration.

Open Meeting

I Confirmation of minutes of meeting held on 12 January 1998
(PLC Paper No. CB(2)1280)

2. The minutes were confirmed.

II Dispensing error at Central Kowloon Health Centre
(PLC Paper No. CB(2)1332(04))

3. At members' request, the Administration agreed to discuss the dispensing error at Central Kowloon Health Centre (CKHC) first.

4. Assistant Director of Health (Special Health Services) (ADH(SHS)) briefed members on the Administration information paper on the subject.

5. Noting that the qualified dispenser involved in the incident was employed on a temporary basis, Miss CHAN Yuen-han enquired whether the Department of Health (DH) had in place guidelines and procedures governing the supervision of new and temporary dispensers at the work place. She opined that newly recruited staff members should be sufficiently briefed on the related work procedures before they were assigned to perform dispensing duties in a dispensary. Noting that many countries had abandoned the use of chloroform spirit or chloroform water in drugs because of its possible side-effects to human bodies, she asked whether the DH would follow the practice. ADH(SHS) replied that the results of some medical experiments on animals conducted in the United States had suggested that chloroform might cause cancer to the animal subjects under test and as a result, the mixing of chloroform with food and drugs had been forbidden in the United States. However, countries such as the United Kingdom had not banned the use of chloroform in drugs. Due to historical reasons, the formulae of cough medicines in dispensaries of the DH had all along followed the practice and standard of the United Kingdom. However, the DH had adopted an incremental approach to replace the use of chloroform in dispensing of medicines. As of today, only two medicines in its dispensaries, including the cough medicine (Expectorant Stimulant) in question, were still diluted with chloroform water for bottles of 500 ml and one litre in capacity which were intended for use by individual patients for a period of two to six weeks. She added that subject to the test results of the selected substitutes, the use of chloroform in the dispensaries of the DH would be discontinued by the end of 1998. Deputy Director of Health (DDH) supplemented that following the incident in Cheung Sha Wan Jockey Club Clinic Dispensary, the DH had taken measures to reinforce supervision on the work of dispensers and currently all prepacking work carried out by a dispenser had to be cross-checked and certified correct by a senior dispenser. As for the major cause of the dispensing error in question, it was believed that the senior dispenser had presumed that a qualified dispenser should be conversant with such basic use of chloroform for dilution of cough medicines In the light of this incident, the DH was reviewing the manpower requirements with the aim of ensuring sufficient supervision on the operation of dispensaries in public clinics. In this connection, the need for the posting of qualified pharmacists at clinic dispensaries would also be considered. More importantly, all staff members involved in dispensing of medicines understood that they owed a duty of care to patients. In order to ensure consistent standards of practice, the DH had prepared a manual of good dispensary practice and was now consulting the opinions of its dispensing staff. He highlighted that apart from ensuring understanding of the need to follow correct dispensing practices, the DH anticipated that the manual could inspire and establish among dispensing staff a commitment towards their duty of care in dispensing work. Responding to Miss CHAN's follow-up question on the target date for replacing chloroform with an appropriate substitute in the two medicines concerned, ADH(SHS) explained that there were technical considerations as well as patients?psychological response in relation to a change of dispensing formula for a particular medicine. DDH supplemented that in assessing the suitability of a substitute to replace chloroform for dilution of cough medicines, the DH would have to conduct a series of tests and observations to determine the effects of various mixing proportions such as the stability of colour and smell of the dispensed medicine which could only be accurately evaluated after an adequate period of time. In response to the Chairman's enquiry, DDH stressed that notwithstanding the incident, the DH had proactively taken steps to progressively phase out the use of chloroform as well as other medicines suspected to have adverse effects on patients.

6. Referring to the recent series of medical blunders, Dr LEONG Che-hung commented that to prevent recurrence of similar incidents, the DH should prepare procedural guidelines and code of practice for new recruits of all posts to note and follow. On manpower planning, he opined that the DH should constantly review its staffing establishment in anticipation of needs to provide new and enhanced health care services to the community in the future and submit resources allocation bids to the Administration at the earliest opportunity. In response, DDH said that there were written procedural guidelines for each operational post within the DH for jobholder's reference. He however pointed out that most of these existing guidelines provided a list of actions to be followed for different tasks, without elaboration on why such actions were required. In preparing the manual on good dispensary practice, the DH had aimed at explaining to the dispensers why correct procedures for carrying out dispensing work were necessary and how remedial measures should be executed under different contingent situations. As all dispensing staff of the DH had expressed regret over the two unfortunate incidents of wrong dispensing and understood that they shared a duty of care to patients, DDH was confident that they would try their best to ensure the quality of their services in the future. Along with advances in medical science and technologies, the DH would continue to review its manpower resources with particular emphasis on how dispensing work should be supervised. Dr LEONG commented that while it might not be possible to have a pharmacist at each dispensary at present, the DH should consider having all mixing of medicines done centrally under the supervision of pharmacists. DDH said that the fitting-out work of a central drug manufactory was in progress. In the meantime, the DH would consider the procurement of proprietary cough medicines from drugs manufacturers direct. Responding to the Chairman's remark regarding the need for a comprehensive monitoring mechanism, DDH explained that the DH reviewed existing operational arrangements for its delivery of health care services on a continuous basis. In particular, the DH had taken steps to improve communication and co-operation among doctors, nurses and other allied medical personnel in a clinic setting, to strengthen orientation programmes for temporary dispensary staff and new recruits, and to enhance the in-service training of dispensers. In concluding the discussion, the Chairman commented that overall, he considered that there was a need to rejuvenate the services provided by the DH.

III The Hospital Authority budget for 1998/99
(PLC Paper No. CB(2)1332(01))

7. Deputy Director (Operations) of the Hospital Authority (DD(O)/HA) briefed members on the salient points of the Administration's paper on the recurrent budget of the HA for 1998-99.

8. Dr LEONG Che-hung declared interest as a member of the Hospital Authority Board. In reply to his enquiries, DD(O)/HA clarified that the HA's recurrent subvention, given in the form of a one-line vote, covered expenditure on both existing and new services. Under the present funding arrangement, the HA had flexibility to vire funds within this vote for the purposes of improving its existing services as well as establishing new services. Through a continuous process of improving resources management, re-engineering work processes, streamlining procedures and eliminating non-value added work in various aspects of hospital operation and specialist out-patient services, the HA had been able to achieve savings to fund its various service improvement programmes and new initiatives. He added that compared to the HA's recurrent allocation, the allocation for HA's new services was relatively insignificant. As regards employment benefits, DD(O)/HA said that the HA was in support of the principle that the costs of the remuneration packages of civil servants and HA employees should be broadly comparable. In line with a decline in the cost to the Government of civil servants?fringe benefits in the past years, a corresponding adjustment should be made in the HA. While current fringe benefits for in-service staff members would remain unchanged, the HA would, having regard to the feedback from its staff, work out a new fringe benefits scheme in anticipation that it would be accepted by future new recruits. As for the new initiatives for 1998-99 as listed in paragraph 3 of the Administration's paper, DD(O)/HA said that the list was not exhaustive and clarified that the operation of the Institute of Nephrology and Urology at Princess Margaret Hospital was an improvement to existing service and was therefore funded by recurrent subvention. Regarding the previous study about the unit cost of providing specialist services, DD(O)/HA said that apart from assisting in hospital resources management, the study provided useful references for medical specialists working in the 11 acute hospitals. Dr LEONG commented that despite the various productivity gains initiatives, it was unlikely that the specialist out-patient services could be substantially improved in the absence of additional resources allocation. He opined that the current improvements in the provision of specialist out-patient services such as shortening the queuing time for first appointment had in effect transferred the service bottlenecks to another area of the respective services. DD(O)/HA responded that without a major change in demand trend of individual specialist out-patient services, the HA would be able to provide satisfactory services to patients at its existing level of resources. Referring to the proposed reduction of allowance for new medical officers in public hospitals, Dr LEONG was concerned about the long-term competitiveness of the HA to recruit and retain quality medical staff. Deputy Secretary for Health and Welfare (DS/HW) replied that the principle of cost comparability between HA staff's and civil servants?remuneration package had been adopted since the HA took over the management of public hospitals in 1991. Now that the cost to the Government of civil servants?fringe benefits had declined in the past years, it was reasonable that the HA Management would, in accordance with the Staff Costs Ready Reckoner, strive to work out a new salary and benefits package which could attract new medical graduates to join the HA in the years ahead.

9. Responding to Mr Henry WU's enquiries, DD(O)/HA said that the budget allocation 1998-99 as listed in Annex C had not included the annual salary revision, the percentage of which would be confirmed in late July and the effective date of adjustment would date back to 1 April 1998. When the proposed adjustment rates for various categories of posts were approved, the Administration would provide the HA with the additional resources in the form of supplementary provisions in due course. In respect of new services which would be provided to public in the 1998-99 year, he pointed out that the initiatives as listed in paragraph three of the Administration's paper was not exhaustive. Most hospitals would have plans to improve its existing services as well as to introduce new services in the new financial year and the HA would take these into account in its annual resources allocation exercise. In the case of an outbreak of an epidemic for which some hospitals might had to give extra efforts, the HA would consider and arrange the provision of additional resources to the hospitals concerned on a case-by-case basis.

10. Responding to the Chairman's enquiry about the HA's approach on productivity gains, DD(O)/HA said that for 1998-99, the HA had adopted a flexible approach under which individual medical institutions could propose percentages of productivity gains in accordance with their targeted clinical outcome and service improvements. He explained that experience had proved that the work of many hospital services were inter-related and a productivity improvement in a department would usually facilitate the work of other departments. In this connection, the setting of an across-the-board percentage (1.5 to 2% in 1997-98 year) of productivity gains for all departments within the same hospital was not a fair means to enhance overall service improvements and operational efficiency.

IV Prevention and control of cholera
(PLC Paper No. CB(2)1332(02))

11. DDH briefed members on the main points of the Administration's paper on the subject. In response to the Chairman's enquiry, he clarified that although the health authority in Thailand had said that vibrio cholera was regarded as a diarrhoea in Thailand, it was basically a type of cholera disease which required proper medical treatment similar to other types of cholera diseases.

12. Noting that a total of 15 cholera cases were confirmed in the first three months of the year, Dr LEONG Che-hung enquired about the Administration's surveillance efforts on the prevention and control of cholera. Referring to the previous outbreak of cholera in 1994, he asked whether the Urban Services Department (USD) and Regional Services Department (RSD) had implemented the then recommended measures, including regular checks on quality of sea water for keeping seafood, to minimize the occurrence of cholera cases. DDH pointed out that 12 of the 15 infected patients had indicated that they had taken fresh seafood which were not properly cooked. He agreed with Dr LEONG's comment that withholding consignments of imported food was not a practical means to prevent the occurrence of cholera cases. Actually, the World Health Organization (WHO) did not recommend its members to place restrictions on food import as a means to combat against cholera. In an attempt to prevent the spread of cholera, the DH had recently taken test samples from more than 600 consignments of imported shellfish and so far more than 500 consignments had been proved to be free from cholera infection. He stressed that the most effective way to avoid cholera infection was to maintain a high standard of personal and food hygiene.

13. On the control of the quality of sea water for keeping seafood at catering establishments, Assistant Director (Environmental Health Policy) (AD(EHP)) of the RSD and Assistant Director (Environmental Health) 1 (AD(EH)1) of the USD said that following the incident in 1994, both departments had reinforced control on the quality of sea water for keeping seafood. In 1997, the two municipal departments had conducted more than 6 000 sample tests on sea water collected from catering establishments and a total of 17 samples were found to fall below the acceptable safety standard, i.e., the amount of E. coli present should be less than 610 per 100 ml and other pathogenic organisms should be absent, and led to prosecutions. The use of ultra violet light to reduce the number of micro-organisms in seafood tanks had been proved as an effective means but such installation was not legally required. The Interdepartmental Coordinating Committee on the Prevention and Control of Cholera (the Committee) was considering feasible options to tighten the control on the quality of sea water for keeping seafood. USD was considering imposing a licensing condition in respect of market stalls and fresh provision shops selling seafood against the use of flushing water from toilet flushing cisterns to keep live seafood. In response to Dr LEONG's follow-up question, DS/HW said that the Committee, chaired by the DH and comprising members from various departments, was responsible for the on-going prevention and control of cholera in Hong Kong.

14. Mrs Sophie LEUNG LAU Yau-fun and Mr Henry WU described the various operational difficulties encountered by restaurant operators in ensuring the quality of sea water for keeping seafood. Speaking from personal experience, Mr WU pointed out that there was no guideline provided. Restaurant operators did not know where the sea water came from and it took several days for tests on the sea water to be completed. The departments concerned were also unable to offer definitive advice on the use of ultra violet lights and filters to solve the problem of contamination of water. Mr WU considered that the Administration should discuss the matter with fish traders and restaurant operators and provide a set of clear administrative guidelines for them to follow. AD(EH)1 replied that the Committee was considering the matter and would propose various options to solve the problem. He stressed that seafood must be properly cooked before consumption. Mrs LEUNG requested the Administration to consider the disinfecting methods such as ozone cleaning, which had been adopted in countries like the USA and Japan. Dr LEONG expressed reservations about the efficiency of the Committee in co-ordinating efforts of the departments concerned to prevent and control the spread of cholera. In reply to the Chairman's enquiry, DDH said that inoculation against cholera was not recommended by the WHO since it was only 50% effective and those who had been inoculated and then became infected with cholera might become carriers of the disease.

15. Both Dr LEONG and Mrs LEUNG LAU Yau-fun were in support of establishing a local authority to oversee all issues related to the control of imported food and drugs similar to that performed by the Food and Drugs Authority in the USA. DDH said that the Public Health Laboratory Centre which would be operational in mid-2001 could to some extent serve the role of such a centralized authority. Responding to Mrs LEONG's suggestion that Hong Kong should consider the control systems adopted by the USA and Japan insofar as control of imported live seafood was concerned, DDH undertook to relay her opinion to the DH for consideration. Adm

V Possible Influenza epidemic
(PLC Paper No. CB(2)1332(03))

16. DDH briefed members on the main points of the Administration's paper on prevention of influenza.

17. Responding to Dr LEONG Che-hung's enquiries, DDH said that the DH had in the first half of February 1998 arranged an influenza vaccination of Wuhan strain, a subtype of influenza A H3N2 which was the predominant strain in previous years, for about 40 000 elderly people living in some 500 public and private elderly homes. These vaccines were ordered in the fall of 1997 when cases of the Sydney strain were few in Hong Kong. Since the beginning of the year, cases of Sydney strain had substantially increased to become the most predominant influenza in Hong Kong. It was estimated that the efficacy of a type of influenza vaccine ranged from about 60% to 80%, depending on the match between the vaccine and the circulating strain. While vaccine injection was one of the effective methods in protecting elderly influenza patients having a history of chronic diseases from developing complications such as pneumonia, there was no evidence that it could prevent the development of influenza epidemic. He agreed to Dr LEONG's comment that in planning and arranging the annual influenza vaccination programme for Hong Kong people, the Administration should consider both the recommendations of the WHO and the local medical experts on epidemic diseases. As regards the dissemination of up-to-date influenza-related information to private medical practitioners who collectively shared about 70% of the primary health care expenditure of the community, DDH said that forecasts on the trends and possible outbreak of influenza epidemic in Hong Kong were detailed in the Public Health and Epidemiology Bulletin issued by the DH on a quarterly basis. For any sudden outbreak of influenza epidemic, the DH would rely on public media to instantly disseminate relevant information to private health care sector and members of the public. In such circumstances, the DH would also ensure the regular uploading of latest information onto the Internet to enhance communication between the DH and private medical practitioners.

18. Responding to the Chairman's concern about the supply of vaccines for Influenza A Sydney to private medical practitioners, DDH said that there was no demand for the vaccines in the past. He opined that as commercial institutions, the supplier and its agents in Hong Kong would promptly arrange delivery of the vaccines to private medical practitioners upon receiving their orders.

VI Any other business

19. As this was the last meeting of the PLC Panel on Health Services, the Chairman thanked members, representatives of the Administration and the Panel Clerk for their contribution to the work of Panel. He hoped that the various medical incidents would become a thing of the past.

20. On behalf of the Administration, DS/HW thanked members for their valuable feedback on various policy issues which had been discussed at the meetings of the Panel.

21. The meeting ended at 10:50 am.

Provisional Legislative Council Secretariat
8 June 1998