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LCQ10: Code of Practice for Private Hospitals, Nursing Homes and Maternity Homes

     Following is a question by the Dr Hon Leung Ka-lau and a written reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (October 19):


     According to the Code of Practice for Private Hospitals, Nursing Homes and Maternity Homes (Code of Practice) issued by the Department of Health (DH), private hospitals must establish a vetting and monitoring mechanism for doctors with practising privilege, which includes checking the indemnification/medico-legal protection taken out by such doctors to ensure that reasonable compensation will be available to patients in cases of medical incidents. All along, private doctors may choose freely either to take out insurance plans with no indemnity ceiling provided by the Medical Protection Society (MPS) whose headquarter is in the United Kingdom, or take out professional liability insurance (insurance) provided by authorised insurance companies, which has an indemnity limit of $7.5 million or more, and the highest compensation limit may reach as high as $75 million, so as to enable the doctors to make compensation to patients in accordance with court rulings. Recently, the Hong Kong Private Hospitals Association (HKPHA), which has a total of 12 member hospitals, uses DH's Code of Practice as the basis to strictly require doctors to take out insurance policies which contain terms specifying that there is no indemnity ceiling and which are issued on an "occurrence basis" before they may refer patients to the hospitals. In this connection, will the Government inform this Council:

(a) whether DH has introduced guidelines on the indemnity limit and arrangements in respect of the relevant protection when formulating the Code of Practice; if so, of the details;

(b) given that the Hong Kong Doctors Union has pointed out (by quoting from its insurance consultant) that as the highest compensation amount awarded by the consultant in a single case over the past 12 years amongst all its insurance plans was less than $500,000, the insurance policies currently taken out by many private general practitioners, which have an indemnity limit of no less than $7.5 million, are considered to be sufficient, and it has further pointed out that HKPHA's latest insurance requirements are so stringent that MPS may probably be the sole supplier of such protection plans, and monopolisation will occur eventually, whether HKPHA's latest insurance requirements are consistent with DH's original intention of formulating the Code of Practice;

(c) given that there is information that MPS is neither an insurance company, nor is it registered in Hong Kong, of the laws of Hong Kong which govern MPS at present; whether the authorities have assessed if the affected doctors, patients and families will be protected by the existing laws when MPS closes down and fails to honor its undertakings for protection or fails to perform its duties; if they have, of the details; if not, the reasons for that; and

(d) given that the aforesaid requirements of HKPHA will, to a certain extent, affect private doctors and patients when choosing medical facilities, whether DH has plans to clarify the requirements of the Code of Practice on insurance arrangements and specifics (especially in respect of the amount and forms of indemnity); if so, of the details; if not, the reasons for that?  



     In accordance with the Hospitals, Nursing Homes and Maternity Homes Registration Ordinance (Cap. 165), the Department of Health (DH) registers private hospitals subject to their conditions relating to accommodation, staffing and equipment.  The Code of Practice for Private Hospitals, Nursing Homes and Maternity Homes (COP) issued by DH also sets out the standards of good practice for private hospitals to adopt, with an aim to provide quality healthcare services to patients.

     Section 4.4.1 of the COP requires private hospitals to have in place a mechanism to check the indemnification/medico-legal protection of practitioners with admission or practicing privilege. The COP does not specify any indemnity limit or arrangements in respect of the relevant protection, neither does it designate any organisation to provide indemnification/medico-legal protection for doctors practising in private hospitals.

     As we understand it, the Medical Protection Society (MPS), the world's leading mutual medical protection society established in 1892, operates in over 40 countries by subscription and provides protection to around 270,000 members in the world. According to the information provided by Hong Kong Medical Association (HKMA), at present, around 8,800 medical practitioners (about 70% of registered medical practitioners in Hong Kong) participate in the Professional Indemnity Insurance (PII) scheme managed by the MPS through HKMA. In case of a negligence claim, members of the MPS will be provided with indemnity against legal costs and damages awarded on a discretionary basis according to the track record of the members. For medical practitioners employed by the Government, their liability for damages arising from the actions in the performance of their duties is covered by the Government. For medical practitioners working in the Hospital Authority, a master policy is in place to cover liabilities arising from their medical practice in the course of their employment. In Hong Kong, our law recognises that the victims of personal injuries, including medical negligence, are entitled to be awarded by courts full compensation for loss attributable to the fault of the tortfeasor.

     The PII scheme for medical practitioners seeks to protect them from legal problems arising from their professional practice and the service recipients against malpractice and negligence. The medical profession has a responsibility to bear the cost incurred by the risks associated with their practice. Under the principle of professional autonomy, the Administration respects the arrangements made by the medical profession regarding the taking out of PII and does not intend to intervene with the details of the PII such as the limit and forms of indemnity. Private hospitals and doctors should choose the appropriate indemnification/medico-legal protection, taking into account the level of risks associated with their relevant professional practices.

Ends/Wednesday, October 19, 2011
Issued at HKT 12:45


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