Published on: 13 August 2014 by Michael Lamb
In recent weeks Hong Kong has been abuzz with the news of a concerning trend increasingly seen at the city’s hospitals. According to recent articles in leading news outlets, Hong Kong’s surgeons are leaving more foreign objects inside surgical patients. This, in turn, has prompted accusations of wide-spread problems within the city’s medical misconduct procedures leading to a wider debate on the quality of Hong Kong’s surgical healthcare offerings.
Seven patients who had surgical procedures performed during the first quarter of 2014 had foreign objects left in their bodies by operating room teams. From drainage tubes left in a patient’s abdomen to a drill bit which was snapped off inside another patient’s hip, there have been more foreign bodies left inside surgical patients so far in 2014 than any other year since 2010.
The average number of foreign objects left inside patients following a surgery is roughly 3.6 per quarter – but the upward trend being seen since the start of the year is concerning for many individuals in the healthcare sector. However, it is not just instances of foreign objects left after surgery which is concerning healthcare sector analysts; serious medical blunders, including instances of misread medical reports, are on the rise – leading to calls for more stringent reporting procedures for the city’s public healthcare services.
Hong Kong’s Medical Council, the watchdog for the Hospital Authority’s complaint system, has stated that there are severe concerns “that many cases of gross negligence, misconduct or incompetence may have been swept under the carpet by the authority. Serious cases are expected to be referred to the council, which regulates medical professionals' conduct.”
According to recent figures, only 4 cases of misconduct have been referred to the watchdog – despite increasing numbers of incidents ranging from foreign surgical objects, patients receiving the wrong treatments, medication errors, and human error resulting in death. For example, it was revealed this week that a United Christian Hospital Pathologist misread the health reports of 118 patients, leading to 17 individuals receiving the wrong treatment for their condition.
Whilst Hong Kong has an excellent global reputation for the quality of its public healthcare offerings, it is no great shock to state that the medical profession is highly exposed to risk. With the sheer volume of patients being treated each day instances of medical malpractice will occur. While there are concerns over the ability of the Hospital Authority to manage the complaint and mediation systems resulting from doctor error within the public healthcare network, the discussion over the increasing trend has largely ignored the end impact on doctors themselves.
Medical Malpractice insurance is designed to provide indemnity coverage for medical practitioners in the event of a serious medical error or incident – such as a misdiagnosis of a patient’s condition, or a surgical error resulting in a patient’s death. While the policy won’t cover the cost of removal associated with extracting a foreign object left in a patient’s body following surgery, it will protect the medical practitioner against any costs of a civil suit or loss of earnings following instances of libel and slander on the doctor’s practice.
However, despite the availability of professional indemnity insurance designed for the medical field, and the ability of a number of local insurance providers to offer comprehensive medical malpractice insurance coverage, a concerning trend has been noted in the decreasing number of insurers who are offering this type of protection to new clients.
Whilst this could be, in part, due to the increasing trend of local malpractice incidents, it also reflects a larger global drift on the part of insurers to lessen their exposure to costly medical risks. In Hong Kong, unlike the EU or other parts of Asia, this is highly concerning due to the fact that the city is home to the second highest average private medical costs in the world (just after the USA but tied with Israel). Consequently, private medical practitioners are potentially liable for extremely high suits in the event of a claim – and the increasing number of annual claims, as evidenced by the spate of recent reports, means that there is a higher risk element for any individual practitioner than there may have been 5 years ago.
This means that, not only is there a greater degree of risk in the Hong Kong healthcare sector than there was 5 years ago (both to the patient and the doctor), but that more of this risk is being borne by medical professionals as insurance providers increase the annual malpractice insurance premiums while reducing the overall levels of effective cover due to the risk trends being experienced throughout the industry as a whole.
With wide scale calls for a comprehensive overhaul in the city’s healthcare system, and the ongoing public healthcare reforms which have been ongoing in the halls of government since 2008. However, before any reform can be implemented effectively, a re-assessment of the adequacy of Hong Kong’s ability to implement sanctions of healthcare professionals needs to be put into force.
Providing a structure for a central complaints system, rather than the currently chaotic two-tiered system put in place by the Hospital Authority, would enable greater transparency into the malpractice issues being faced by the public healthcare system. This would also enable insurance providers offering medical professional indemnity products to access more insightful data as to the malpractice trends being experienced in Hong Kong’s healthcare system, which in turn would lead to a more sensible risk appetite for malpractice insurance products offered to the city’s doctors.
Enabling a wider range of malpractice coverage, as well as providing for more care options, would spread the risk pool wider making the proposition of covering medical professional indemnity risks much more attractive for Hong Kong Insurers. However, as it currently stands, there is simply too much confusion, and too many misunderstood factors within Hong Kong’s medical malpractice landscape for either consumers, or insurers, to have much confidence in the local healthcare system.