Replies to LegCo questions

LCQ6: Patients' medical records

     Following is a question by the Hon Emily Lau and a written reply by the Secretary for Health, Welfare and Food, Dr Yeoh Eng-kiong, in the Legislative Council today (May 5):

 

Question:

 

     It has been reported that the Hong Kong Patients' Rights Association has recently received four complaints from the family members of patients of public hospitals who suspect that health care personnel have tampered with their relatives' medical records in an attempt to cover up evidence which may work to the disadvantage of such personnel.  Such act may constitute an offence of making a false instrument.  In this connection, will the Executive Authorities inform this Council whether:

 

(a)  they know:

 

(i)  the details of such complaints;

 

(ii)  the number of complaints of this kind received by the Hospital Authority (HA) and its hospitals in the past three months; and

 

(iii)  whether HA will amend the Manual of Good Practices in Medical Records Management to prevent the tampering of patients' medical records; if amendments will be made, of the details; if not, the reasons for that; and

 

(b)  the Police have commenced investigations into the allegations in the complaints; if not, of the reasons for that?

 

Reply:

 

(a)  (i)  The details of the four cases are as follows:

 

Case in Haven of Hope Hospital

 

     The case concerned a male elderly patient who passed away in the Haven of Hope Hospital in February 2004.  In the course of an investigation which was initiated in response to allegations of misconduct on the part of the hospital's nursing staff, the hospital management discovered that one page of the patient's nursing progress record had been replaced by a page of non-contemporaneous record.  Although the result of the hospital's preliminary investigation suggested that the intention of the nursing staff concerned was to make a supplement to the patient's record so as to give a more accurate account of the events, the Hospital Authority (HA) considers that the staff's action was inappropriate and amounted to a serious procedural error.  In view of the potential seriousness of the staff's act, the HA has already reported the matter to the Coroner's Court and the Nursing Council. The hospital is also in the process of initiating internal disciplinary action against the staff concerned in accordance with HA policies.

 

Case in Prince of Wales Hospital

 

     The second case concerned a female patient who was admitted to the Prince of Wales Hospital for a repair of fracture in the femur.  On October 1, 1999, the patient choked after eating in a hospital ward and required emergency medical assistance.  An Orthopaedic & Traumatology (O&T) doctor in the ward was alerted of the incident and rushed over to the patient.  The O&T doctor initiated cardiac-pulmonary procedures in an attempt to resuscitate the patient.  A resuscitation team arrived at the ward shortly after and took over from the O&T doctor in resuscitating the patient.  The patient passed away five days later.  The patient's family alleged that the patient's medical record had been altered to shorten the response time of doctors in rendering emergency medical assistance to the patient.  The hospital investigated the allegations and concluded that the patient's record was a truthful account of events. The hospital found that the documentation in the patient's record was made immediately after the relevant events occurred and that the patient's record had not been tampered with.

 

First case in Queen Elizabeth Hospital

 

     A female patient suffered internal bleeding, which was a known complication, after undergoing percutaneous nephrolithotripsy in Queen Elizabeth Hospital on November 7, 2002.  Despite medical treatment, the patient passed away on November 27, 2002.  The patient's medical record showed that explanations on the risks and complications of the operation had been given to the patient and her relatives prior to the operation.  However, the patient's family alleged that the patient's doctors did not inform the patient and her family of the risks of the operation and failed to provide the patient with alternative treatment options.  The hospital investigated the allegations and found that the patient's medical record was a truthful account of the relevant events.

 

Second case in Queen Elizabeth Hospital

 

     A male patient attended the Accident and Emergency (A&E) Department of Queen Elizabeth Hospital in the early hours of February 15, 2004 for shortness of breath.  The patient was admitted into the hospital for further treatment.  Since the medical admission wards were full at the time, the patient was temporarily admitted to a ward in the Department of Surgery, in accordance with the hospital's prevailing admission policy.  In the surgical ward, the patient was treated by doctors from the medical specialty.  Later that day, the case doctor transferred him to a medical ward for further treatment.  The patient passed away in the afternoon of February 15.  In arranging for the transfer of the patient from the surgical ward to the medical ward, the case doctor, who was not familiar with the appropriate transfer procedures, advised the admission office to simply put in the record that the patient was admitted directly from the A&E Department to the medical ward.  The hospital management was alerted of the incident and its investigation found that while the patient was given proper treatment and care, the recording of admission and transfer procedures was improperly done.  The Chief of Service of the Medical Department interviewed and advised the doctor concerned of the need for strict adherence to recording admission and transfer procedures.

 

(ii)  During the 3-month period from January 27 to April 26, 2004, the HA and its hospitals received five complaints of a similar nature, inclusive of the four cases set out in part (a)(i) above.  The fifth complaint was received by Fung Yiu King Hospital.  The hospital's investigation concluded that the case involved the choice of terminology in the Chinese translation of a record of conversation between the doctor on duty and a member of the patient's family.  The allegation that the patient's medical record had been altered was not substantiated.

 

(iii)  The HA Manual of Good Practices in Medical Records Management has already set out clear instructions on the proper keeping of patients' medical records.  The HA has not identified a need to amend the Manual at this stage, but would remind the staff of the instructions from time to time.

 

(b)  The Police has commenced investigation into the cause of death in the first three cases set out in part (a)(i) above.  However, no report, complaint or enquiry had been made to the Police in respect of the fourth case. 

 

Ends/Wednesday, May 5, 2004

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