Further to the medical negligent case just shared, there are a series of further events that lead to my contemplation of Medical Law in Hong Kong. I am going to share it to you one by one. I am not going to disclose the name of the patient because of patient confidentiality. Please treat it like a case report for your own interest.
In 2004, when I was a Family Medicine trainee rotated to the Accident & Emergency Department (AED) of the Queen Elizabeth Hospital (QEH). One day, an old gentleman attended by me because he had a fever and upper respiratory tract symptoms. Of course, he was a normal walk-in patient wearing his own clothes except that he was on a wheelchair. I obtained his history and had some preliminary investigations on him. The initial investigations showed that he had only mildly elevated white cell counts and Chest X-ray showed mild lung haziness only. He was treated as chest infection and a follow-up appointment was arranged at the AED subsequently. All the clinical signs were stable at that time. He was also advised to attend if necessary in case of any deterioration. He was not accompanied by any staff or relatives. He defaulted the follow-up subsequently.
A few months later, the Chief of Service of the AED suddenly summoned me and explained to me that there was a complaint by the relatives and it was related to this case. The relatives made the complaint because this old gentleman died eventually because of complications of endocarditis subsequent to the valvular replacement. He was a transfer case from the United Christian Hospital (UCH) by ambulance. He had his valvular replacement previously done at the QEH and later admitted to the UCH due to fever. After a series of investigations, he was diagnosed with endocarditis and treated with intravenous antibiotics. He was transferred to the QEH for further care because his surgery was done there. The relatives made the complaint to the Hong Kong Medical Council and I had to contact the medical indemnity organization and sought help from the lawyer. I discovered that there were several pitfalls in making the transfer. The pitfalls were as follows:
1. the Medical Officer of the UCH only contacted the doctors of QEH Medical Department but did not inform the AED staff about the trasnfer but they transferred the patient through AED,
2. the patient was clinically stable but the transfer was made through the ambulance instead of the non-emergency transfer services,
3. there was no transfer note whatsoever,
4. there was no prior notification to the AED of QEH,
5. the patient was not accompanied by any relatives or hospital staff (whether it was from QEH or UCH) and, very strangely, the AED staff of QEH did not inform me it was a transfer case,
6. he was in his own clothes instead of his hospital dress,
7. there was no documentation in the Clinical Management System of the Hospital Authority network (except a note in a newly developed inter-hospital network that was only on an experimental stage and I did not know about the existence of this network at that time),
8. he was a poor historian because of his age (I was quite meticulous in my history taking and I specifically asked him for his past health but he said he was in good health previously).
I was so worried at that time because it was the first time I received a formal complaint from the Preliminary Investigation Committee (PIC) of the Hong Kong Medical Council. I had to defend for myself and all of the above pitfalls were found out by myself. The PIC eventually dismissed my case just before Christmas of next year.
I remember this case very clearly because this was exactly the year when there was a rumour that my father-in-law will be the next Secretary of Food and Health Bureau.