Flowers Blooming and full moon rising for twelve years
Striding forward on the professional path for Chinese medicine practitioners
The Establishment Day of the Hong Kong Special Administrative Region with the city symbol of a bauhinia signifying the return of sovereignty to our motherland for fourteen years falls in the same year when the Chinese Medicine Ordinance (Chapter 549, Laws of Hong Kong) and the Chinese Medicine Council of Hong Kong (the Council) celebrate their twelfth anniversary. Looking back on my humble participation in the work of the Chinese Medicine Practitioners Board (Practitioners Board) and committees under the Council for twelve years, I am very delighted to see the strong development of the Chinese medicine in Hong Kong. At present, the traditional Chinese medicine with a long history of heritage is still serving the people of Hong Kong and the health of mankind because of its inherent philosophy of truthfulness and natural sciences. In the past twelve years, Chinese medicine practitioners (CMPs) over the territory sharing the same thought targeted at the same goal for the promotion of the practice of traditional Chinese medicine and the contribution to the professional training of CMPs. The professional status of CMPs is more widely recognised in the community.
I learn with great excitement that my term of office as the Chairman of the Practitioners Board will expire on the day of the mid-autumn Moon Festival. It looks as if my efforts on the work of the Practitioners Board, including examination, registration, disciplinary and ethic affairs as well as programme accreditation are completely concluded at the end of my term.
As the Chairman of the Practitioners Board, I take this opportunity to extend my sincere appreciation to all CMPs, members of the Practitioners Board, administrators of continuing education in Chinese medicine (CME), CME programme providers, the three local universities offering undergraduate courses of Chinese medicine, Department of Health, Secretariat of the Council and various government departments which have rendered unfailing support and expressed concern to the regulatory work of the Practitioners Board. Besides, I would also like to give special vote of thanks to the staff of the Secretariat under the Department of Health assisting in the implementation of the regulatory measures on CMPs.
The treasure of the traditional Chinese medicine is passed on from one generation to another. SUN Simiao, a medical practitioner in Tang Dynasty, taught us that we have to be "knowledgeable in medicine and fully dedicated to it". At this moment, SUN's idea serves as an inspiring reminder that CMPs are encouraged to think positively and inherit to promote the traditional Chinese medicine whole-heartedly.
Last but not least, let us reinforce and complement each other. Fellow practitioners should keep up their hard work on the promotion of the traditional Chinese medicine.
Mr. Wong Ngar-kok James
Chairman of the Chinese Medicine Practitioners Board
At the end of July 2011, there were 6,242 registered CMPs, 69 CMPs with limited registration, and 2,763 listed CMPs.
The Paper 1 and Paper 2 of Part I Written Examination of the 2011 Chinese Medicine Practitioners Licensing Examination were conducted on 14 June and 16 June 2011 respectively. The Clinical Examination (Part II) was conducted from 2 to 12 August 2011. A total of 320 candidates sat for the Written Examination, of which, 7 candidates were absent from the examination and 204 candidates (63.8% of candidates) passed the examination.
The Practitioners Board will publish the Candidates' Handbook for the 2012 CMPs Licensing Examination and disseminate the details in due course. Please watch out for the announcements in the Newsletter of the Practitioners Board (the Newsletter) and the Council's homepage (www.cmchk.org.hk).
In accordance with section 76 of the Chinese Medicine Ordinance (the Ordinance), a registered CMP must apply for a valid practising certificate before he/she is allowed to practise Chinese medicine in Hong Kong. The usual validity period of a practising certificate is three years. Before a registered CMP is issued with the renewed practising certificate, he/she must fulfill the requirements of continuing education in Chinese medicine, as determined by the Practitioners Board. From April 2011 to July 2011, 15 registered CMPs renewed their practising certificates.
According to Appendix V of the Handbook on System of Continuing Education in Chinese Medicine for Registered Chinese Medicine Practitioners, registered CMPs would be awarded CME points from participating in courses/programmes of CME subjects held by the accredited Mainland institutions. Subsidiaries of these institutions which would like to have their courses/programes be accredited as CME courses/programes, should submit application for the approval of the Practitioners Board. Otherwise, registered CMPs who attend the non-accredited courses/programmes would not be awarded any CME points.
To facilitate registered CMPs who are taking Chinese medicine courses organized by Mainland tertiary institutions to acquire CME points, the Practitioners Board has recognized the CME courses (including full-time, part-time, correspondence, online, and clinical courses) or academic meetings, seminars, academic conferences, workshops and forums etc. organised by 28 Mainland Chinese tertiary institutions. They are not required to be assessed by the Registration Committee and are recognised as accredited CME courses. The Practitioners Board has also recognised with effect from 14 April 2011, similar courses/programmes organised by "Southern Medical University" and "Xiamen University" as accredited courses/programmes. The relevant list of accredited Mainland institutions has been updated accordingly. Registered CMPs, who study the courses/programmes held by "Southern University" on or after 10 June 2010 or the courses/programmes held by "Xiamen University" on or after 12 August 2010, can directly apply to CME Administrators for evaluation of CME points to be earned. Registered CMPs are encouraged to read the Annex of the Newsletter for the relevant arrangement and the updated list of accredited Mainland institutions.
Registered CMPs who have any enquiries on CME matters are encouraged to contact their CME Administrators. The Practitioners Board will disseminate information on the latest development and arrangement of the CME system through the Newsletter and the Council's homepage.
To encourage CMPs to read the Newsletter, the Practitioners Board has decided to introduce the CME Quiz for registered CMPs. Ten questions, based on the content of the first three issues of the Newsletter in a year, will be published in the December issue every year. Registered CMPs may send the completed answer sheet attached to the Newsletter to their "CME administrator" within the specified time of one month for the assessment and record of the CME points that they can be awarded.
Two CME points would be awarded for successful attempt of six or more questions. The ceiling of CME points through CME Quiz within each three-year cycle is 10% of the 60 CME points required in the same cycle, i.e. six points per cycle. The accumulated CME points through CME Quiz and other self-study activities s should not exceed 30 points per cycle.
The Practitioners Board would inform the "CME administrators" of the relevant arrangements of the CME Quiz.
The Practitioners Board held the disciplinary inquiries for three registered CMPs and two listed CMPs who were convicted of an offence punishable with imprisonment or breached the Codes of Conduct (the Codes) from April to July 2011. After the inquiries, the Practitioners Board ordered to remove the name of a registered CMP for 12 months, but suspended the applications for 36 months, and reprimanded two registered CMPs. The Practitioners Board also decided to remove the name of one listed CMP who had breached the Codes from the list of listed CMPs, and put the decision for one listed CMP on record for future reference after the inquiry.
Summing up the above cases, the Practitioners Board would like to remind all CMPs to take note of the issues below.
In the judgments of the three disciplinary inquiries, the Practitioners Board reaffirms that CMPs must familiarise themselves with laws of Hong Kong and the requirements of the Codes. Professional CMPs should entirely avoid using Western medicines to treat their patients, and they need to understand the differences between Chinese and Western medicines. According to section 5(2) of Part III of the Codes, CMPs should adopt treatment methods on the basis of principles of the traditional Chinese medicine in prescribing Chinese herbal medicines or proprietary Chinese medicines.
In addition, the Practitioners Board also stresses that CMPs should always act in the best interest of their patients. According to section 3(5) of Part III of the Codes, CMPs should choose the medicines or apparatus that best serve the medical interest of their patients according to their independent professional judgment, so as to maintain the professional integrity of CMPs. If the Practitioners Board considers that a CMP does not provide adequate treatment to patients according to their medical conditions or prescribe excessive or inappropriate medicines, the CMP concerned may have breached section 3(5). In this case, the Practitioners Board will consider whether the prescription issued by the CMP is well below the reasonable standard of conduct expected among his/her professional colleagues. If the Practitioners Board considers that the prescription is well below the professional standard of a CMP, the charge is established, and vice versa.
When making judgment in disciplinary inquiries, the Practitioners Board would take into consideration factors including the seriousness of the matter inquired into, the number and date(s) of the offence(s), the CMP's background, character, level of integrity and conduct, public's expectation and views of the Chinese medical profession as a result of the matter inquired into, the CMP's right to practise in his/her profession, etc.
The Practitioners Board reminds all CMPs again that, if a CMP has been convicted of an offence punishable with imprisonment (irrespective of whether a prison term is imposed or not), he/she must report to the Practitioners Board immediately. He/she should quote the case number, date of conviction, venue, offence and minute of adjudication to the Practitioners Board. If the CMP fails to report to the Practitioners Board after being convicted of an offence, the Practitioners Board will take disciplinary action according to the established procedures.
The Codes of Conduct have become effective from 1 January 2011. The sections regarding "Signs and Signboards at clinics" under Part III of the Codes, have become effective from 1 July 2011 after a grace period of six months. Please note that after the grace period, the Practitioners Board would take necessary disciplinary actions against CMPs who fail to comply with the revised requirements. The revised Codes were distributed to all CMPs at the end of December 2010, and were also uploaded to the website of the Council (http://www.cmchk.org.hk). All CMPs are reminded to read and conform to the revised Codes.
Section 119 of the Ordinance concerning the mandatory registration of proprietary Chinese medicines (pCm) has commenced on 3 December 2010, and those provisions related to the requirements of label and package insert as stipulated in section 143 and 144 of the Ordinance, section 26 and 28 of the Chinese Medicines Regulation (the Regulation) will commence on 1 December 2011. By then, no person shall sell, or have in his possession for the purpose of selling, any pCm without proper label and package insert as required. Any person who contravenes the sections shall be liable upon conviction to a Level 6 fine (i.e. $100,000) and imprisonment for two years.
As stipulated under section 158(6) of the Ordinance, exemptions are given to the pCm administered or supplied by a registered or listed CMP. Situations under which pCm are exempted from registration have been published in the previous issue of Newsletter.
Detailed requirements of section 143 and 144 are listed below. CMPs are reminded to note the label and package insert of the pCm purchased for the purposes of dispensing to their patients.
According to section 26 of the Regulation, label on the package of pCm sold in Hong Kong shall at least include the particulars in Chinese of the name of the product, the name(s) of the major active ingredient(s), the dosage and method of usage, the expiry date, the name of the territory in which the medicine is produced, the registration number as specified in the certificate of registration, the name of the holder of the certificate of registration as specified in the certificate, the packing specification, and the batch number.
Regarding the label of pCm to be exported, section 27 of the Regulation stipulates that the label on the outermost package of the pCm concerned shall include the name of the product, the registration number as specified in the certificate of registration, and the name of the holder of the certificate of registration as specified in the certificate of registration.
According to section 28 of the Regulation, package insert accompanied with the pCm sold in Hong Kong shall at least include the particulars in Chinese of the name of the product, the name(s) of the major active ingredients(s) and its quantity, the dosage and the method of usage, the functions or pharmacological action, the storage instructions, the packing specification, the name of the holder of the certificate of registration as specified in the certificate, the indications (if any), the contra-indications or toxic effects/side-effects (if any), and the precautions to be taken regarding its use (if any).
CMPs should be aware of the following case and use Chinese herbs with liver toxicity carefully.
The Department of Health received notification from the Hospital Authority of a suspected case of liver failure after consuming Chinese herbs in June 2011. The patient had consulted a CMP to treat her breast lump for about three months. During that period, some herbs which are known to cause liver toxicity including Fructus Toosendan (川楝子) and Rhizoma Dioscoreae Bulbiferae (黃藥子) had been prescribed repeatedly to the patient. The patient was subsequently admitted to the hospital for management of liver failure in April. After exclusion of viral hepatitis, autoimmune diseases and liver mass, the doctor in-charge diagnosed that the liver failure was herb-related. After receiving liver transplantation in May, the patient's condition is now stable.
According to Pharmacopoeia, Fructus Toosendan (川楝子) and Rhizoma Dioscoreae Bulbiferae (黃藥子) are two examples of those Chinese herbs which are known to cause liver toxicity. Other examples include unprocessed Radix Polygoni Multiflori (生何首烏), Fructus Xanthii (蒼耳子) and Radix Tripterygii Wilfordii (雷公藤). In view of their toxicity, CMPs should use these herbs cautiously, and should never prescribe the herbs at a dose that is higher than the usual dose or the dose that is recommended in the Pharmacopoeia of the People's Republic of China. These herbs should not be consumed continuously for long time. Moreover, CMPs should not prescribe these herbs to those patients with a history of hepatobiliary diseases. If liver toxic herbs have to be prescribed, CMPs should explain to their patients about the effects of the herbs to the liver and advise them to watch out for symptoms suggestive of deranged liver function (e.g. abdominal distension or jaundice). During each follow-up, CMPs should monitor patient's liver condition closely. If deranged liver function is suspected, the CMP should stop prescribing the herbs immediately and advise the patient to attend the hospital for further examination.
The Practitioners Board has lost contact with the following listed CMPs based on the information of their telephone numbers and addresses.
The Practitioners Board appeals to the following CMPs for contacting the Secretariat of the Council as soon as possible. If other CMPs have contact with them, please notify them of the above.
The Practitioners Board has sent registered letter to a Registered CMP, but the letter remains unclaimed after 4 months of issue. According to section 56(2) of the Ordinance, the Practitioners Board may order removal from the Register the names of such registered CMPs in such circumstances. In accordance with section 57 of the Ordinance, the Practitioners Board shall serve a notice to the CMP concerned stating its intention to remove her name from the Register under section 56(2) of the Ordinance and to invite her to give any written representations to the Practitioners Board.
The Practitioners Board appeals to the following CMP for contacting the Secretariat as soon as possible. If other CMPs have contact with the following CMP, please notify her of the above.
CMPs are required to use the name recorded in the list/register of CMPs when providing practicing information to the public, failing which, they may contravene the Codes and may be investigated by the police for suspected unlawful practice of Chinese medicine.
The Practitioners Board reminds all CMPs that CMPs who intend to use an alias should register with the Immigration Department and submit the "Certificate of Registered Particulars" issued by the Immigration Department to the Practitioners Board for acceptance, before using an alias in their practice.
CMPs who have completed the alias registration procedures can either use the name recorded in the list/register of CMPs and/or the alias in their practice. In case the alias registration procedures have not yet completed, the CMPs can only use the name recorded in the list/register of CMPs. Those CMPs who have been reminded by the Practitioners Board should complete the alias registration procedures in twelve weeks. If CMPs continue to use unregistered alias in their practice, the Practitioners Board will handle the cases in accordance with the disciplinary procedures.
The Health Manpower Survey conducted by Department of Health in 2008 had been accomplished in May 2009. The key findings are enclosed with the Newsletter.
Aimed at collecting information on the manpower and employment status of healthcare personnel practising in Hong Kong, which is essential for reference of health manpower planning, a new survey is conducted in 2011. Enclosed please find the letter and questionnaire from Department of Health to all CMPs. Please duly return the completed questionnaire to the department.
For further enquiries, please visit http://www.dh.gov.hk/tc_chi/statistics/ statistics_hms/statistics_hms.html or contact Health Manpower Unit at 2961 8566.
All CMPs are requested to notify the Secretariat as soon as possible if there are changes in their registered address, correspondence address, practising address, telephone number, fax number and other personal data which have been previously reported to the Practitioners Board. Enclosed please find the form for notification of change of personal data. It may also be obtained from the Secretariat if needed.
Should you have any opinions regarding the contents of the Newsletter of the Chinese Medicine Practitioners Board, please send them to the Secretariat by post, fax or email, indicating "Newsletter of the Chinese Medicine Practitioners Board". All published Newsletters of Chinese Medicine Practitioners Board have been uploaded to the Council's homepage (http://www.cmchk.org.hk). CMPs are cordially invited to visit the above website.
Chinese Medicine Council of Hong Kong
Room 2201, 22/F, Wu Chung House, 213 Queen's Road East,
Wanchai, Hong Kong
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