The government’s proposed Medical Council reform package has practitioners up in arms. Doctors worry that a plan to change the proportion of appointed to elected members will dilute their voice With the government and patient groups standing firm, the conflict is getting messy.
The government has big plans for the Medical Council of Hong Kong (“the Council”), the territory’s statutory body in charge of quality control for the medical profession. The Medical Registration (Amendment) Bill 2016, released in February, calls for increasing lay participation in the Council, improving that body’s complaint investigation and disciplinary inquiry mechanism, and facilitating the admission of non-locally trained doctors.
The government hopes the Bill will be passed in June or before the fifth LegCo’s term ends in mid-July. However, concerned about their decreased voice in the Council following the changes, many doctors are determined not to let the Bill be passed smoothly. Meanwhile, patient representative groups, who would gain under the government’s plan, fervently wish for its passage.
Hong Kong residents who are unfamiliar with the dispute may be surprised by the intensity of emotions the issue has elicited. In fact, arguments on both sides are complicated, as those who read further may appreciate.
The Bill’s most controversial element involves the proposed ratio between the Council’s elected and appointed members. The body is currently composed of 24 members. The elected members include seven doctors chosen by all full and limited registered doctors in Hong Kong plus seven doctors picked by Council members of the Hong Kong Medical Association (HKMA). This gives, doctors control over half of the Council.
The other 14 members are appointed by the Chief Executive (CE). Ten of those appointees are selected from nominees of the University of Hong Kong, The Chinese University of Hong Kong, the Director of Health, the Hospital Authority, and the Hong Kong Academy of Medicine (HKAM). The remaining four are lay members directly chosen by the CE.
The Bill would increase the number of CE-appointed lay members by four, thereby raising the Council’s total membership to 28 from 24 and relegating the board’s doctors to a minority status. The government claims that this ‘4+0’ proposal will help “bring in fresh views and offer wider perspectives” to the Council .
In contrast, medical groups, such as the HKMA, the Hong Kong Doctors Union, the Hong Kong Public Doctors’ Association, and the Association of Hong Kong Nursing Staff, object to the reduction of democratically elected medical representation on the Council.
In response to this opposition, the government has suggested a ‘4+2-2’ proposal, under which the HKAM’s two appointed-member seats would be transformed into seats that would be directly elected by the HKAM. This would maintain the equal ratio between elected members and appointees, although the two newly elected seats would only be elected by a single body.
However, the HKMA, together with its LegCo representative Leung Ka-lau (梁家騮), the Hong Kong Public Doctors Association (HKPDA), and the post-Umbrella medical group Médecins Inspirés are against the ‘4+2-2’.
“Not all registered medical practitioners are the members of HKAM, which means the proposed two extra elected seats in [the Council] cannot fully represent the doctors,” Dr Leung says.
Dr Leung suggests a ‘4+4’ proposal or a ‘6+6’ proposal, meaning both four or six appointed lay members and four elected medical members should be added to maintain the 1:1 ratio between elected and appointed members in the Council. However, the government simply rejects Dr Leung’s proposal on the basis that ‘there are already 24 doctor members in the current MCHK’.
Louis Shih (史泰祖), former Chairman of the HKMA, supports ‘4+2-2’.
“I am open to all proposals, including ‘4+2-2’, ‘4+4’ and ‘6+6’, but ‘4+2-2’ is the one accepted by most stakeholders, so I show my support in it,” he explains. Before his resignation, Dr Shih agreed with HKMA that ‘4+4’ was the best proposal.
“If the Bill is passed without HKMA’s [‘4+4’ or ‘6+6’ proposals], HKMA will count it as CY Leung’s poor policy,” Dr Choi the powerful medical veteran warns.
Gabriel Choi: HKMA being broken up by political force
Outspoken and powerful medical veteran Gabriel Choi (蔡堅), who is planning to run for the office of HKMA Chairman for the fourth time in July, accuses Dr Shih of ‘having ulterior motives’ (心懷不軌). “During Dr Shih’s office, HKMA agreed to support Dr Leung’s ‘4+4’, but after Dr Shih met with [Secretary for Food and Health] Ko Wing-man, he completely changed his stance.”
Dr Shih was forced to resign from his Chairman post on 1st May, after his unpopular suggestion about holding a referendum within HKMA to decide how the seven Council seats that the HKMA’s governing body selects are chosen. Dr Choi and HKMA Council member Cheng Chi-man (鄭志文) both emphasise that the seven HKMA seats on the Council maintain the unity of the HKMA as well as of medical circles.
“The then-Chairman Edward Leong (梁智鴻) in 1996 helped [the Council] fight for the seven seats in [the Council]. His purpose was to strengthen the bargaining power of HKMA when dealing with the government in medical policy discussions,” Dr Choi states.
HKMA, having 9,000 out 13,000 registered doctors, is the medical group with the largest membership in Hong Kong. The group took 15 out of 30 seats in the medical subsector of the Election Committee (EC) in both 2006 and 2011.
“If the Bill is passed without HKMA’s [‘4+4’ or ‘6+6’ proposals], HKMA will count it as CY Leung’s (梁振英) poor policy and [this will] surely affect our decision in picking CE candidates,” warns Dr Choi.
Lay persons alone are not enough
Another strong argument for adding lay Council members, according to the government, is to improve its complaint investigation and disciplinary inquiry mechanism. It claims that, by adding members and increasing the frequency of investigations and inquiries, the proposal will help to reduce the processing time of complaints against doctors from the current 58 months to 36 or even 24 months.
The Bill calls for restructuring the composition and quorum of Preliminary Investigation Committees (PIC) and inquiry meetings, both of which are part of the Council’s institutionalised mechanisms to handle complaints against medical practitioners in Hong Kong. The restructuring would raise the voice of lay members in complaint-investigation mechanisms. The government expects two PICs can be formed once the size of the Council is increased.
HKMA, HKPDA, Dr Leung and Dr Choi all defend their ‘4+4’ proposal, i.e. four elected medical Council members should be added correspondingly when lay appointed members are added by four.
But, defending the ‘4+4’ proposal, the HKMA and Dr Choi both emphasise that additional medical experts on the Council will be necessary. They say this is because the complaint mechanism requires medical knowledge as well as professional advice.
Dr Choi resigned from the post of PIC Chairman on 16 May in order to object to the government’s proposal of adding only appointed lay members to the Council.
He indicated the complexity of each case by allowing Harbour Times to take a photo of a stack of case files (pictured above) stored in his oldest clinic. Dr Choi said, “Each file contains one case, and the thickness of each file represents the complexity of the case.”
HKPDA even lists out the current ‘nine bottlenecks’ of the whole investigation and inquiry process, such as bureaucracy, a lack of enough medical members to form a quorum, and a lack of meeting venues. This can cause serious delays. For instance, Hong Kong singer Peter Cheung (張祟德) and his wife, former actress Eugina Lau (劉美娟), spent nine years waiting for justice for their newborn baby, who died shortly after his birth in 2005.
Hong Kong Patients’ Rights Association, the patients’ rights branch of Society for Community Organization, criticises the duration of the investigation and the length of the Council’s inquiry proceedings.
“I agree with any idea that can empower patients.” – Dr Louis Shih, former Chair of HKMA.
Patients join the party
The only point of consensus among all parties is that patients should have a voice.
According to the government, three of the four new appointees would be from patients’ rights groups, and the remaining one would be from the Consumer Council. It claims that adding the four new lay members would enhance the public accountability, transparency and credibility of the Council and help bring in fresh views and offer wider perspectives’.
Doctors are happy to have patients’ voices on the Council but not if it means that doctors could become a minority on the Council.
Some doctors, such as Dr Shih, fully support more patient participation. “The more sources of information for patients, the better for them. I agree with any idea that can empower patients,” Dr Shih says.
Policing the doctors
Patient organisations, such as the Hong Kong Alliance of Patients’ Organizations, Society for Community Organization and Hong Kong Patients’ Voices (HKPV), applaud the proposed enlargement of patient representation in the Council. Once three extra seats are allocated to patients’ representatives, the three organisations agree the new members can act to check the power of medical practitioners.
“Three out of four extra lay member seats will be allocated to patients’ groups in the government’s proposal, so I think patients’ representatives can act as the kingmakers in to balance the power between government and medical practitioners,” Alex Lam (林志釉), the Chairman of HKPV, tells Harbour Times.
According to its opinion letter submitted to LegCo, HKPV even proposes that the government should consider appointing six patients’ representatives out of the CE-appointed member quota.
However, Dr Choi questions the independence of some patients’ groups without mentioning their names. “Particular groups have close connections with the Hospital Authority, and, in most cases the same positions can be found.” argues Dr Choi.
Zubin’s co-founder: Patients are the future
Shalini Mahtani, co-founder and Chairman of Zubin Mahtani Gidumal Foundation, on 18th May launched an independent web platform HospitalAdvisor in Hong Kong. She emphasises the importance of allowing patients a real voice (see story on the new platform here).
“One thing that is very clear is patient-centred care…that means we don’t make the decisions without the patients,“ Ms. Mahtani explains. “That means too, every hospital, board, every decision-making body about healthcare at government, at NGO level…I don’t think in today’s world you can exist without the patient’s voice. It is even not according to me…just look at what KPMG and McKinsey’s report say: The biggest and most important component of the future of healthcare is including patient’s voice,” Ms Mahtani says.
In 2009, Ms Mahtani’s three-year-old son, Zubin, died after a swiftly fatal case of pneumococcal meningitis. Citing her lack of medical and healthcare background, she refuses to comment on the recent Council reform proposal, but did say that the “MCHK knows they need to change.”
No effect on locally trained doctors’ rights
The third aim of the Bill proposes to facilitate the admission of non-locally trained doctors, in particular specialists, to practise in Hong Kong by extending the registration and renewal term of limited registered medical practitioners on the Council from a maximum of one year to three years.
Concerns have been raised that if the government’s proposal is passed, more non-doctor appointees would open the profession to more government interference leading to, for example, a relaxation of standards that restrict mainland doctors from coming to Hong Kong.
Dr Leung, however, does not agree and says the matter is unrelated to locally trained doctors’ rights.
“Even if non-locally trained doctors receive extended registration in Hong Kong, they cannot practise if they cannot receive employment contracts from medical institutions,” Dr Leung explains. “Instead of non-locally trained doctors, the overseas medical professors working in HKU and CUHK would benefit as the administrative procedures of their employment are going to be reduced.”