12 September 1998

Government to learn of monitoring role from dialysis saga lessons

(Keywords:- dialysis mishap, investigation committee, private hospitals, monitoring)

          With the completion of the work of the Independent Investigation Committee set up by the Hong Kong Sanatorium and Hospital, the fatal saga of dialysis in that hospital has in no way come to an end. At best, it is only the end of the beginning. Many questions need to be answered, in particular why had that mishap occurred; who were responsible; their obligation for the bereaved families and those suffering from the aftermath of the disaster.

          It is thus of no surprise that hospital critics, patient rights' advocates, affected patients, their relatives, and even health care professionals are not satisfied with what have made public so far -- they want more. The more radical critics even go so far as to label the Committee as being ¡§irresponsible¡¨ or even ¡§protecting the interest of the hospital¡¨.

          There is therefore a dire need to set the scene properly, to dispel misunderstanding.

          As a start, the Committee is but a working body commissioned by the hospital concerned to produce an independent report to comply with the law for the Department of Health (DH) -- the licensing authority of private hospitals. As such, it has no legal status nor true investigatory power. To wit, the Committee was not even provided with the post-mortem reports, nor the results of test samples taken by the police of the solution used for dialysis at the scene of the mishap. The dialysate is, as all will agree, so obvious the ¡§culprit¡¨. At one point in time, there was also a dispute by the police of the rights of the Committee to question the ¡§witnesses¡¨ -- staff of the hospital that work in the dialysis unit.

          Needless to say, since the ¡§witnesses¡¨ were not giving evidence to this Committee under oath, there is no way to verify the authenticity of their statements. With such constraints and restraints, coupled with the warning that any careless comments may lead to possible sub-judice in the forthcoming Coroner investigations, it would be technically impossible, irresponsible and perhaps even unethical if the Committee were to come forward with direct accusations of what had happened and who were the culprits.

          Yet, the Committee has the responsibility to promptly gather lessons learnt and come out quickly with suggestions that could maximise safety and minimize risk for the future, not only for the involved hospital, but also for all dialysis centres -- private and public -- for common good. This the Committee has dutifully done proposing recommendations for improvement of the dialysis system; the operation manual of dialysis machines and system; the working principles and attitude of involved personnel -- health care and technical staff alike; the management structure of hospitals; and the overall monitoring and auditing of service quality and safety.

          The ball is now in the Government¡¦s court. The DH, through its expertise, through the availability of official finding of tests and investigation, must work with haste with the Coroner to complete the jigsaw. It is only with a total transparency of the investigations, a definitive identification of why the disaster happened that public confidence would return -- not only to that hospital, but also to various dialysis centres and perhaps the overall health care system of Hong Kong.

          Attention should also be focused on the improvement of monitoring of private medical institutions. The machinery is there imbibed in the law, and is for the comptroller of these institutions -- the DH -- to implement, if not strengthen, the role expected of it. Proper guidelines must be set to ensure that the basic standards of manpower, facilities and outcome performances are complied. Without such basic yardstick, the Department¡¦s annual ¡§inspection¡¨ to these private institutions would be no more than a merry-go-around exercise.

          Yet, the health of our health care system relies on proper cooperation of the Government and private sector. Commitment to attain higher and higher goals in standards is the responsibility of both sides for public good.

(Hongkong Standard)