29 August 1998

Dire need for enhanced monitoring and support towards private hospitals

(Keywords:- private hospitals, mishaps, criminalisation, defense medicine, ambulance, clinical waste)

          The recent addition of medical mishaps in a private hospital understandably raised hue and cry. It is inconceivable that three  patients could lose their life and three maimed within minutes during a routine dialysis. Unlike what one might have perceived, haemodialysis today is a non-complicated well-accepted benign and common-a-garden treatment process. Most are done with minimal or no supervision. In Hong Kong, home dialysis where the family members perform the procedure with the patient has been in practice for over 20 years. Globally people are advocating minimal supervision dialysis centre where the patients are call in on the day of dialysis, pick up their dialysis software and ¡§hook¡¨ himself up in a designated machine.

          No stone should be left unturned to uncover the causes of this mishap. Through such, it is expected that lessons could be learnt to prevent similar incidence from further occurring not just in that dialysis unit, but many others both within the private and public sectors. Any report so produced must be done as quickly as possible, in a fair and unbiased fashion and made transparent to the public. For it is only through such that public confidence in that hospital, in dialysis and perhaps in the whole health care system could be regained!

          Whilst it may be premature or even inappropriate to make speculation of the causes of this particular disaster, the incidence raise many other areas for serious consideration for future good -- in particular the monitoring of private hospitals and medical institutions, or the lack of it!

          At present, Government, through the Director of Health, is the licensing authority for private hospitals. The Director is empowered by law to set registration conditions, to inspect, or to receive reports of these institutions as a monitoring mechanism. Have these been executed diligently? The Director must answer to these questions. It is the Administration¡¦s responsibility to ensure that each individual private hospital meets the basic standards, both in manpower, hardware and software of health care delivery.

          Our health chiefs have come out with off-the-cuff statement implying that the licence of the hospital concerned may be at risk.  To most, this is a jittery response to a seemingly lack of responsibility in Government¡¦s monitoring role of private hospitals. In any case, such response does little to convince the public of Government¡¦s determination to play its expected part.

          Yet, neither can private hospitals shirk their responsibilities. Each private hospital must have its monitoring body or medical committee that set guidelines and audit its performance. Such body must not only be fair and unbiased, but seen to be so. Its membership should not only be the directors of the hospital alone, but outsiders, be they professionals or otherwise, to ensure that the auditing is made as transparent as possible. Transparency adds accountability and  confidence, thus help enhance marketing power, as private patients can choose and in many ways they do influence their doctors to patronise those hospitals they feel safe.

          Attention has also been focused on penalties for health care profession found responsible for medical blunders. There are  those who would advocate criminalisation for medical blunders. This cannot be the way forward. Relieving a patient of illness and suffering must be the only aim in the mind of any health care personnel. It must be on this trust that a doctor-and-patient relationship is built. It is on such bondage that a doctor provides treatment with his experience and knowledge without constraint.

          But medicine can never guarantee a cure. Furthermore, complications can occur along the difficult path of treatment of which neither the health care personnel nor the patient expects, many of which are documented in medical literature. Also, the more intricate the treatment process of the cutting edge of medicine, the higher the chances of complications. To put the patient and the health care profession in opposition partly through imposition of criminalisation amounts to tying the health care professional¡¦s hands and putting a pressure on him before the healing process even begins. More, in the extreme, doctors may be forced to play safe and practise ¡§defensive medicine¡¨, requesting for all sorts of testing albeit a minor ailment. All these are definitely not to the advantage of the patient.

          It must be remembered that all health care professionals are closely monitored in their professional activities by their peers through the relevant boards or councils which lay members also play a part. Any inexcusable mistake could land the professional into professional discipline which could amount to the grave penalty of removal of the right to practise. More, there is always the channel of justice through civil litigation, should a party feel aggrieved.

          Finally, in defense of private hospitals, whilst they are business orientated, they are at the same time providing a well earned and very much needed complementary service to the public health care system. The patients, who are taxpayers too, do relieve public coffer burden via self financing their own health care. Regrettably, both these hospitals and their patients are very much discriminated.

          The Government¡¦s sudden change in policy of not providing non-emergency ambulance transfer service to private hospital patients, with no consideration for proper alternatives, is an obvious example. Many patients are facing difficulties in transfer from hospital to hospital or returning home, being on an enormous plaster cast or on a stretchers that no other private transport means can help.

          More, in the disposal of clinical waste, private hospitals have been facing bureaucratic steeplechase. They have never been given a long term solution. Instead they were put on a merry-go-round by various government departments.

          A better health care service can only be achieved with improvement both in the public and private sectors, both of which Government must offer its very much needed support!

(Hongkong Standard)