醫醫相衛埋禍根 醫患對立難紓解

<轉載自2018年5月11日 明報 社評>

六年多前九龍醫院「紗布封喉」醫療事故導致病人死亡，醫委會重罰涉事醫生除牌半年，死者家屬認為判決公平公正，部分前線醫生則認為裁決受民粹輿論影響，質疑懲罰過重不公。公立醫院人手不足，市民明白前線醫生疲於奔命，可是涉事醫生對錯誤有責任，亦不容否認。當事人若不服裁決，可以提出上訴，前線醫生團體應該保持冷靜，以病人福祉為重，避免意氣用事。醫委會偵查聆訊屢惹「醫醫相衛」質疑，削弱了裁決公信力，不管判罰輕重，都容易惹來非議，醫委會需要多就初步偵訊和判罰準則作出說明，透過深化醫委會改革，重建公信力。

本港不少專業界別都奉行自我規管，公眾希望專業人士會律己以嚴，維護公眾利益。然而過去十多年，市民對於醫生業界公正不阿處理醫療事故，卻產生了懷疑。醫委會對於部分投訴個案的處理，市民都覺得匪夷所思﹕2001年「手機醫生」事件，有醫生在手術途中接聽電話，醫委會的裁決是涉事醫生沒有專業失當(當時稱失德)；有名醫草率進行高風險手術，導致病人內臟灼傷死亡，惟醫委會僅輕判停牌半年緩刑兩年；有早夭嬰兒家屬不滿醫療失誤，向醫委會投訴，花了近十年時間才討回公道。凡此種種，均令「醫醫相衛」之說不脛而走。

醫委會處事未能服眾，屢惹輿論抨擊，其中一個深遠影響，是損害了醫委會裁決的公信力﹕處罰偏輕，公眾必然懷疑「醫醫相衛」；處罰偏重，則輪到業界質疑醫委會怯於輿論壓力，拿涉事醫生「祭旗」，導致本應一致的專業利益和公眾利益，處於對立面。「紗布封喉」裁決爭議折射的，正是這種緊張對立狀態。

醫生怨氣可理解 看待裁決須冷靜

事故中，73歲咽喉癌病人疑因氣管造口被紗布密封死亡，主診醫生黃卓義被指未有採取正確步驟，提醒醫護人員，防止病人永久氣管造口被當成臨時造口。醫委會裁定黃兩項專業失當，除牌半年，不設緩刑。部分前線醫生不滿裁決，認為是護士洗傷口出錯，沒理由要醫生為他人錯誤負責。有公院醫生認為，事發的九龍醫院，醫生每日需負責最少40張病牀，由伊利沙伯醫院抽調過來支援的涉事醫生，只是「捱義氣」，問題根源在於醫療制度，日後其他醫生鑑於人手壓力，為免百密一疏出錯，「唯一選擇就是拒絕相關工作」。有人甚至還揚言，裁決令公院醫生人人自危，恐會加劇離職潮，云云。

公院人手不足，醫生壓力沉重，市民並非不理解，當局亦必須正視問題，減輕公院醫生壓力，然而如果醫生真的大意犯錯，就得直面責任，不能總是以制度問題作為擋箭牌。「紗布封喉」事故，涉事醫生並非一時疏忽，而是8次巡房都沒有發現問題，不可能說對病人死亡毋須負責。護士管理局聆訊後，判處案中3名護士除牌1個月，懲罰較涉案醫生為輕，惹來醫生業界一些人質疑，惟醫生有責任糾正護士錯誤，不能簡單根據是誰「親手」犯錯，作為衡量懲罰輕重唯一標準。

有醫生提到，養和醫院有醫生誤診，最後病人死亡，早前醫務聆訊僅判停牌3個月緩刑2年，然而值得留意是，該名醫生聆訊期間有向病人家屬致歉。相比下，「紗布封喉」裁決判辭提到，涉事醫生未見悔意，沒有反省錯誤，直至結案時，辯方才承認其中一項指控。翻查案例，是否承認錯誤和有否悔意，是醫委會考慮緩刑的關鍵，涉案醫生若覺得裁決不公，可以提出上訴。今次裁決引爆部分前線醫生積存已久的怨氣，然而普羅市民希望醫生業界保持冷靜，緊守崗位，以病人利益為優先。公眾不希望見到醫生業界視輿論監督為存心找碴。

除了「紗布封喉」聆訊，最近還有另一宗備受矚目的醫委會聆訊，涉案兒科專科醫生陳以誠，被指未有妥善處理男嬰傷口，兩項專業失當指控成立，停牌半年不設緩刑。兩宗聆訊有一共同之處，是醫委會獲投訴後，初步偵訊委員會均拒絕受理，惟病人家屬堅持到底，甚至不惜提出司法覆核，最終促使醫委會立案跟進。事態令外界關注初偵會的角色。關於陳以誠案的司法覆核，高院判辭提到，時任初偵會主席蔡堅在篩查證據時越權，又對蔡堅認識陳以誠卻未有申報感到驚訝，要求醫委會改善。

輿論監督非為找碴 醫委會須深化改革

醫委會接獲投訴眾多，初偵會負責篩走毫無理據個案。初偵會拒絕受理一宗個案，需要正副主席與一名業外委員一致同意，然而是否篩走個案，始終是3個人說了算，外間難免關注初偵會處理是否恰如其分，會否還有更多類似陳以誠案和「紗布封喉」事件未有機會申冤。醫委會改革因業界阻力拖拉多年，今年初終獲立法會通過，醫委會表示將增加初偵會數目，盼望有更多具公信力的醫生參與。然而這次醫委會改革，始終未有改變醫生團體控制醫委會一半席位的格局，市民仍然關注「醫醫相衛」，醫委會有必要深化改革，提高公信力。

Antagonism between doctors and patients caused by "doctors shielding each other"

IN a medical incident in Kowloon Hospital 6 years ago, a patient died from his throat being covered by a gauze. The Medical Council has imposed a heavy punishment on the doctor concerned by banning him from practicing for 6 months. The family of the deceased think that the ruling is fair and just, but some front-line doctors think that the ruling was influenced by populist public opinion and questioned the penalty for being too heavy and unjust. Investigations and hearings conducted by the Medical Council have often been questioned, with scepticism about "doctors shielding each other" undermining the credibility of its rulings. As a result, whether a penalty is heavy or light, it attracts criticisms nonetheless. The Medical Council should explain more the criteria it uses in its preliminary investigations and for penalty assessment. It should also rebuild its credibility by deepening the reform of the council.

Many professional sectors in Hong Kong practice self-regulation. The public expect the professionals to protect the public interest by being strict with themselves. However, in the past 10-odd years, the public have begun to wonder whether the medical sector has been fair and impartial in handling medical incidents.

For the public, the ways the Medical Council handles medical incidents have failed to convince the public. The council is, therefore, constantly criticised by the public. One of the profound impacts of this situation is the undermining of the credibility of the ruling of the council. When a penalty is on the light side, the public suspect that it is because "doctors shield each other". When a penalty is on the heavy side, the doctors will question if the doctor concerned has been scapegoated by the council under the pressure of public opinion. As a result, while professional interest and public interest should be in accord, they are now in conflict.

The public understand that public hospitals suffer from a lack of human power and doctors are under a lot of pressure. The concerned authorities should confront these problems and reduce the pressure on doctors in public hospitals. However, if any doctor has really made a careless mistake, he must face up to his responsibility and should not keep defending himself by using systemic issues as an excuse.

Apart from the hearing on the case of the patient whose throat was covered by gauze, another case heard by the Medical Council has also attracted a lot of attention. A paediatrician Chan Yi-shing was accused of handling a baby boy's wound improperly. He was banned from practicing for six months without suspension after the Medical Council ruled that he was guilty of two counts of professional misconduct. The two cases have one thing in common. After complaints were filed to the Medical Council, they were dismissed by the council's Preliminary Investigation Committee (PIC). It was only after the families of the patients persisted and even applied for judicial review that the Medical Council was forced to open and follow up the cases. What happened has aroused public's concern about the role of the PIC.

The Medical Council receives a lot of complaints, and the PIC is tasked with screening out cases which are absolutely groundless. The dismissal of a case requires unanimity of opinion from the chairman, the deputy chairman and a lay member of the PIC. In spite of this, however, whether a case will be dismissed or not depends solely on 3 persons. It is inevitable that the public query whether the way the PIC tackles complaints is appropriate. The reform of the Medical Council has been delayed for many years due to resistance from the sector. It was finally approved by the Legislative Council early this year. The Medical Council said that it would increase the number of PICs and hoped that more doctors with credibility would join the committee. However, the forthcoming reform of the Medical Council will not change its overall structure wherein half of its members are controlled by physician groups. The public are still concerned about "doctors shielding each other". To increase its credibility, the Medical Council must deepen its reform.

醫醫相衛埋禍根 醫患對立難紓解

六年多前九龍醫院「紗布封喉」醫療事故導致病人死亡，醫委會重罰涉事醫生除牌半年，死者家屬認為判決公平公正，部分前線醫生則認為裁決受民粹輿論影響，質疑懲罰過重不公。醫委會偵查聆訊屢惹「醫醫相衛」質疑，削弱了裁決公信力，不管判罰輕重，都容易惹來非議，醫委會需要多就初步偵訊和判罰準則作出說明，透過深化醫委會改革，重建公信力。

本港不少專業界別都奉行自我規管，公眾希望專業人士會律己以嚴，維護公眾利益。然而過去十多年，市民對於醫生業界公正不阿處理醫療事故，卻產生了懷疑。

醫委會處事未能服眾，屢惹輿論抨擊，其中一個深遠影響，是損害了醫委會裁決的公信力﹕處罰偏輕，公眾必然懷疑「醫醫相衛」；處罰偏重，則輪到業界質疑醫委會怯於輿論壓力，拿涉事醫生「祭旗」，導致本應一致的專業利益和公眾利益，處於對立面。

公院人手不足，醫生壓力沉重，市民並非不理解，當局亦必須正視問題，減輕公院醫生壓力，然而如果醫生真的大意犯錯，就得直面責任，不能總是以制度問題作為擋箭牌。

除了「紗布封喉」聆訊，最近還有另一宗備受矚目的醫委會聆訊，涉案兒科專科醫生陳以誠，被指未有妥善處理男嬰傷口，兩項專業失當指控成立，停牌半年不設緩刑。兩宗聆訊有一共同之處，是醫委會獲投訴後，初步偵訊委員會均拒絕受理，惟病人家屬堅持到底，甚至不惜提出司法覆核，最終促使醫委會立案跟進。事態令外界關注初偵會的角色。

醫委會接獲投訴眾多，初偵會負責篩走毫無理據個案。初偵會拒絕受理一宗個案，需要正副主席與一名業外委員一致同意，然而是否篩走個案，始終是3個人說了算，外間難免關注初偵會處理是否恰如其分。醫委會改革因業界阻力拖拉多年，今年初終獲立法會通過，醫委會表示將增加初偵會數目，盼望有更多具公信力的醫生參與。然而這次醫委會改革，始終未有改變醫生團體控制醫委會一半席位的格局，市民仍然關注「醫醫相衛」，醫委會有必要深化改革，提高公信力。