This issue of Newsletter mainly reports the work of the Chinese Medicine Practitioners Board (PB) in the past four months, including the conduct of the Chinese Medicine Practitioners (CMPs) Licensing Examination, renewal of practising certificates of registered CMPs, the review of the system of Continuing Education in Chinese Medicine for registered CMPs (CME), announcement of results of the disciplinary inquiries conducted by the PB, and the points to note for CMPs entrusting local manufacturers to manufacture proprietary Chinese medicines (pCm).
Taking into consideration the appeal of the Chinese medicine sector and the difficulties the elderly registered CMPs encounter in pursuing continuing education, the PB has endorsed the reduction of required CME points in each CME cycle for registered CMPs aged 75 or above. For the detailed arrangement and effective date, please refer to the content of this Newsletter.
Regarding the disciplinary inquiries, the PB reminds all CMPs to comply with the Chinese Medicine Ordinance (CMO), Codes of Conduct 1(Codes) and other laws at their practices, especially in the aspects of professional responsibility and ethics, issuance of prescriptions, maintenance of personal medical records for patients, report of conviction of offense and provision of medical documents to patients. CMPs are reminded again not to dispense medicines adulterated with western medicines in order to observe the Codes and CMO, as well as to prevent from posing adverse impact to the profession.
To encourage the CMPs in reading the Newsletter, the PB endorsed in 2011 the introduction of the CME Quiz. The first CME Quiz was published in end 2011 and the response of the registered CMPs was encouraging. The CME Quiz of 2012 is attached to the Newsletter. The PB encourages keen participation in this year’s quiz, as CMPs can acquire both the latest knowledge of the profession and CME points through reading the Newsletter.
CMPs may also obtain information regarding the Chinese Medicine Practitioners Sub-directory of the Primary Care Directory of the Department of Health (DH) from this Newsletter.
I wish you good health and happiness in the coming year.
Mr WONG Kit
Chairman of the Chinese Medicine Practitioners Board
1 Codes of Practice refers to the "Code of Professional Conduct for Registered Chinese Medicine Practitioners in Hong Kong" and the "Code of Conduct for Listed Chinese Medicine Practitioners"
The Clinical Examination of the 2012 CMPs Licensing Examination was conducted in August 2012. A total of 429 candidates attended the Clinical Examination, and 199 candidates (46.4%) passed the Clinical Examination.
The Written Examination and the Clinical Examination of the 2013 CMPs Licensing Examination will be conducted in June and August 2013 respectively. The application period for non-listed CMP persons started on 17 September 2012 and ended on 31 October 2012, whereas the deadline for submitting applications for listed CMPs and repeaters is 29 March 2013. The PB has notified all qualified listed CMPs by mail the enrollment period for taking the examination.
In early December 2012, there were 6,564 registered CMPs, 73 CMPs with limited registration and 2,734 listed CMPs.
In accordance with section 76 of the CMO, a registered CMP must apply for a valid practising certificate before he/she is allowed to practise Chinese medicine in Hong Kong. The usual valid period of a practising certificate is three years. Before a registered CMP is issued with the renewed practising certificate, he/she must fulfill the CME requirements determined by the PB. From July to early December 2012, 1,120 registered CMPs renewed their practising certificates. All registered CMPs must report promptly to their CME Administrators their new CME cycles, required CME points, and the valid period of their practising certificates.
It is also stipulated in the CMO that if a registered CMP practises Chinese medicine without obtaining a valid practising certificate over a period exceeding six months since the expiry of his/her practising certificate, the PB may act in accordance with section 56(1)(d) of the CMO, to order the removal from the Register the name of that registered CMP.
CME was implemented on 28 February 2005. Three reviews of the CME were conducted at the end of 2005 and 2006 and early 2009 respectively. The report period for the fourth review was from 1 January 2009 to 31 December 2011 (36 months in total). The PB has completed the fourth review and results of the review are enclosed in Appendix 1.
The amendments, which will take effect from 1 January 2013, have been made to the Handbook on System of Continuing Education in Chinese Medicine for Registered Chinese Medicine Practitioners (the Handbook) after the fourth review. The revised edition of Handbook has been sent out to all registered CMPs in December 2012. To facilitate clear knowledge of registered CMPs on the amendments, all amendments in the revised edition are highlighted in red. The amendments are summarised in Appendix 2.
Taking into consideration of the appeal of the Chinese medicine sector and the difficulties encountered by the elderly registered CMPs in pursuing continuing education, the PB has endorsed that the reduction of the requirement of CME points for registered CMPs aged 75 or above in each CME cycle from 60 to 30. This arrangement is only applicable to the CME cycles of a registered CMP commenced after he/ she has reached the age of 75. If a registered CMPs fails to acquire the required CME points in his/her previous cycle, he/she are required to make up the unearned points so as to have his/her practising certificate renewed, even if he/she has reached the age of 75 at his/her new CME cycle. This arrangement has taken effect on 29 November 2012, the 10th anniversary of registration of the first batch2 of registered CMPs.
2 The list of the first batch of registered CMPs was announced by the Chinese Medicine Council of Hong Kong on 29 November 2002.
To encourage the CMPs in reading the newsletter, the PB endorsed in 2011 the introduction of the CME Quiz. Ten questions, based on the content of the three issues of Newsletter of the year, will be published in the December issue every year. Two CME points would be awarded for successful attempt of six or more questions. The ceiling of CME points obtained 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 obtained through CME Quiz and other self-study activities should not exceed 30 points per cycle.
The CME Quiz of 2012 is attached at Appendix 3 of this issue of Newsletter. Registered CMPs may send the completed answer sheet to their respective CME Administrators by fax or by mail on or before 4 February 2013. The CME Administrators will assess and record the CME points awarded for the registered CMPs. No CME points would be awarded for any late submission.
The Secretariat of the Chinese Medicine Council of Hong Kong (CMCHK) will not relay the answer sheets to the CME administrators for any CMPs. To avoid delay, CMPs are reminded to submit the completed answer sheets directly to their CME Administrators.
CMPs are welcome to read the previous issues of the Newsletters in the CMCHK homepage (http://www.cmchk.org.hk).
The PB would like to draw the attention of all CMPs with limited registration to the following case. CMPs with limited registration are reminded that they should apply for renewal of limited registration before expiry of the current registration.
In a recent application for renewal of limited registration, the PB noted that the application was submitted by the employing institution after the expiry of the applicant’s current registration and the applicant continued to practise Chinese medicine after expiry of his current registration. The PB referred the case to the Police. After investigation, the Police issued the applicant a warning letter, stating that any person who practise Chinese medicine (including clinical teaching) should hold a valid limited registration or he/ she commit an offence and is liable to a fine at level six (currently HKD 100,000) and to imprisonment for three years. Meanwhile, an advisory letter was issued by the Police to the employing institution of the applicant reminding it to be conscious of the valid period of the limited registration so as to avoid recurrence of similar incidents.
The PB held disciplinary inquiries from August to November 2012 for four registered CMPs and two listed CMPs who were alleged breaching the Codes and/or convicted of an offence punishable with imprisonment. After the inquiries, the PB ordered to remove the name of one registered CMP for six months and warn the CMP; to remove the name of another registered CMP for 12 months, but suspend the application for 24 months and also warn the CMP; to remove the name of another registered CMP for six months, but suspend the application for 24 months; to remove the name of another registered CMP for six months, but suspend the application for 18 months; and to remove the names of two listed CMPs.
Summing up the above cases, the PB reminds all CMPs to take note of the following issues.
Chinese Medicine Practitioner Should NOT Use Western Medicines
It is stipulated in section 5(2) in Part 3 of the Codes (http://www.cmchk.org.hk) that a CMP should adopt treatment methods on the basis of principles of the traditional Chinese medicine in prescribing Chinese herbal medicines or pCm, and in using traditional therapeutic apparatuses or other innovative therapeutic apparatuses developed with the incorporation of Chinese medicine theory; and shall not use other professional treatment methods as regulated by the laws concerning those other medical and healthcare professions.
Recently, the numbers of news reports and of disciplinary cases regarding the prescription of herbal cream containing western medicines to patients by CMPs have been increasing. The PB would like to remind all CMPs that a CMP should not prescribe any Chinese herbal medicines or pCm containing western medicines to his/ her patients. The PB is of the view that CMPs should have a thorough understanding of the regulations of practising Chinese medicine and of prescribing medicines stated in the Codes and CMO.
In addition, in order to provide safe and effective medicines to patients, CMPs should purchase medicines from licensed wholesaler of pCm or Chinese herbal medicines with good reputation. No medicines of unclear or unreliable sources should be purchased.
As the prescription of western medicines-adulterated herbal cream to patients poses an adverse effect on the image of the Chinese medicine profession, the PB would like to remind all CMPs to observe relevant regulations stated in the Codes at all times, i.e. a CMP should adopt treatment methods on the basis of principles of the traditional Chinese medicine in prescribing Chinese herbal medicines or pCm and shall not use other professional treatment methods (e.g. medical practitioners). If any CMP is convicted of similar offenses by court, the PB will process the case with a particularly serious view in accordance with the procedures stipulated in the CMO.
According to section 2 of part 3 of the Codes, a CMP should be professionally responsible to his/ her patients, explain patiently to patients their medical conditions, methods of treatment and the precautions in taking drugs, and diligently improve his/ her professional knowledge and skills so as to maintain high professional standards in providing medical service to patients. If the PB considers that a CMP has not provided adequate treatment to his/ her patients according to their medical conditions or the prescription issued is well below the professional standard of CMP, the CMP concerned may have breached the above-mentioned Codes.
The PB also noticed that there were CMPs failing to issue prescriptions to their patients, or issuing unclear prescriptions to their patients. The PB reminds all CMPs that patients have the rights to know clearly the details of the prescribed Chinese medicines. In case of any medical incident, medical professionals to whom the patient is referred can make use of the prescription to take immediate follow up actions so as to ensure the well-being of the patient as far as possible. The Codes also state that the contents of the issued prescriptions by a CMP should be clear and easily legible. In addition, the prescriptions must include the names and dosages of all Chinese medicines prescribed; method of use of the medicines; and if applicable, number of times for re-dispensing and remarks, as well as the name, address, contact telephone number and signature of the CMP and the issue date of the prescription.
Proper Keeping of Medical Records
It is stipulated in the Codes that a CMP should maintain personal medical records for his/her patients. Personal medical records should include the patients’ names, gender, consultation dates, contact details, symptoms, diagnosis and treatments applied. Proper maintenance of the medical records of patients is an important professional responsibility of CMPs. In case a patient has any concern on the medical treatment given by the CMP or suffers from a medical incident, whereas the CMP concerned is not available to provide details of the patient, the medical record and history of the patient are important references for the medical professionals or first-aiders that the patient is referred to. In view of that, a CMP, as one of the medical professionals, should be able to provide the above mentioned information. The PB stresses to all CMPs again the importance of complying with the regulations about keeping of medical records for patients stated in the Codes.
Providing Medical Documents to Patients
When exercising the functions related to the discipline of CMPs as stipulated in the CMO, if the PB or Disciplinary Committee of Chinese Medicine Practitioners (DC) under the PB receives a complaint/ piece of information alleging any misconduct of a CMP, DC will consider and decide, in accordance with the CMO, whether the complaint/ information is frivolous or groundless. If further investigation is considered necessary, DC may request further information and written explanation from the CMP concerned. DC does not obtain medical documents from the CMP concerned on behalf of the complainant/ patient, nor take the initiative in passing the medical documents obtained to the complainant/ patient.
All CMPs are reminded that, according to the Personal Data (Privacy) Ordinance (Cap. 486), patients have the rights of access to his/her own medical documents which include medical records. The CMPs have the obligation to provide the required record upon the patient’s requests unless the circumstances satisfy section 20 of the Ordinance, in which case the CMPs shall refuse to comply with the data access request. It is upon the CMP’s decision on whether to charge the fee of providing copies of the medical documents to his/ her patients.
Reporting Court Convictions to the Practitioners Board
According to the Codes, if a CMP has been convicted of an offence punishable with imprisonment in Hong Kong or elsewhere (irrespective of whether a prison term is imposed or not), he/she must report to the PB immediately. He/she should quote the case number, date of conviction, venue, offence and minute of adjudication to the PB. If the CMP fails to do so, the PB will take disciplinary action according to the established procedures.
Professional Conduct of Chinese Medicine Practitioners
There have been CMPs being convicted by the court of indecent assault recently. Although the Codes do not require the presence of an assistant when a CMP is conducting physical examination on his/ her patient, whose gentle is opposite to the CMP’s, the CMP should arrange the presence of an assistant of same gender of the patient as best as possible, in order to safeguard the interests of both the CMP and the patient. If the patient demands the examination to be conducted in the absence of an assistant, the CMP should record such request in the patient’s medical record.
The findings of adverse reaction events related to Chinese medicines investigated by the DH during the period from October to November 2012 are summarised below for by the CMPs’ reference.
Regarding a confirmed case of aconitum alkaloid poisoning, the involved CMP prescribed processed Radix Aconiti Kusnezoffii and processed Radix Aconiti of 9g each at the same time to his patient. The dosage was over the recommended limit (1.5-3.0g) of the Pharmacopoeia of the People’s Republic of China (2010) and that caused symptoms of aconitum alkaloid intoxication after consumption of the medicines by the patient.
Processed Radix Aconiti Kusnezoffii and processed Radix Aconiti are toxic Chinese herbs containing aconitum alkaloids and indicated for pain relief. Prolonged decoction to reduce their toxicity is required before they can be safely consumed orally. Their overdose can cause perioral and limb numbness, dizziness, nausea, diarrhea, weak pulses and shortness of breath. In severe cases, it may be fatal.
Unclear Medical Instruction
For an adverse event related to the consumption of Chinese medicines, Scorpio, the involved CMP only verbally instructed the patient to self-measure the amount of medicines powder from a “separated other pack” of Chinese medicines (including 3g Scorpion powder) for oral consumption. This kind of practice, without giving clear medical instruction to patient in written form and solely rely on patient’s own measurement of medicines amount, would put the patient’s life at risk as the CMP is not practising all safety precautions to ensure what the amount of the Chinese medicines to be taken by the patient is according to medical instruction.
Scorpio is a Chinese medicine containing neurological toxic peptide and is indicated for pain relief of muscle and nerve. The prescription should be advised to start from low dosage. Prolonged decoction to reduce its toxicity is recommended before it can be consumed orally. On the other hand, the dosage of blended powder should be closely monitored. Its overdose can cause muscular spasm and limb numbness, respiratory suppression which could be fatal in severe cases. Scorpio is contraindicated in pregnancy.
Mislabelled Chinese Herbal Medicines
Processed Radix Aconiti Lateralis and Giant Typhonium Rhizome
During the investigation of a confirmed case of aconitum alkaloid poisoning, the involved CMP and Chinese medicines wholesaler had wrongly labelled on the packaging the Chinese herbal medicines processed Radix Aconiti Lateralis (Bai Fu Pian) as Giant Typhonium Rhizome which corresponds to another Chinese herbal medicines, Rhizoma Typhonii in processed form.
Processed Radix Aconiti Lateralis is a Schedule 2 Chinese herbal medicines used for pain relief. It contains toxic aconitum alkaloids. If used improperly, aconitum alkaloids can cause discomfort like numbness of the mouth and limbs, nausea, vomiting and peripheral weakness, and can even lead to life-threatening breathing difficulties and cardiac arrhythmia. On the other hand, processed Rhizoma Typhonii is a Schedule 2 Chinese herbal medicines. It has two herbal sources, processed Radix Aconiti Corean and Rhizoma Typhonii in which processed Rhizoma Typhonii does not contain aconitum alkaloids. It is used for relieving phlegm congestion and pain. The possible side effects include aconitum alkaloid poisoning-like symptoms, skin and mucous membrane irritation and central nervous system suppression. In extreme cases, it may also be lethal if used improperly.
Prevention and Advice
All CMPs are reminded to follow the names in Schedules 1 and 2 of the CMO for prescription and labelling of Chinese medicines as well as to comply with the relevant Codes and practising guidelines.
All CMPs should draw reference to the recommended drug dosage by the Pharmacopoeia of the People’s Republic of China, and closely monitor for adverse reactions of patient especially when prescribing toxic Chinese herbs. When prescribing two types or above of similar toxic herbs, CMPs are reminded to be more vigilant to avoid intoxication (e.g. prescribing processed Radix Aconiti Kusnezoffii and processed Radix Aconiti at the same time). Extra precaution has to be paid when prescribing medicines to the elderly, children and vulnerable persons.
CMPs should give medical instructions clearly in written form so as to make sure the patients could understand and follow their instructions in the preparation and consumption of Chinese herbs. CMPs should remind the patients the possible side effects of medicines in advance, and should also remind them that medical advice should be sought as soon as possible if there is any discomfort after taking herbal medicines.
CMPs entrust local manufacturer of pCm to manufacture pCm must meet the requirements of section 37 of the Chinese Medicines Regulation (the Regulation) (Cap. 549F). Section 37 reads as follows:
Sections 119 (provision on mandatory registration of pCm) and 144 (provision on requirements for package inserts of pCm) of the CMO shall not apply in respect of a pCm if-
the medicine is manufactured-
in the premises in respect of which a manufacturer licence is in force; and
by or under the supervision of a responsible person in accordance with a prescription given by a registered or listed CMP;
the medicine is-
for internal application or both internal and external application, and the medicine is to be administered or supplied to the patient to whom the prescription is given and who is under the direct care of the CMP; or 並獲開給該處方的病人的；或
for external application only, and the medicine is to be administered or supplied to a patient or patients under the direct care of the CMP; and
the Chinese Medicines Board has received from the manufacturer, at least one working day before the day on which the manufacturing process of the medicine begins, a written notification including the particulars set out in subsection (2) and being accompanied by an undertaking referred to in subsection (3).
A notification referred to in subsection (1)(c) shall include-
the quantity of the medicine to be manufactured;
the names and quantities of each ingredient listed in the prescription;
its dose form;
the name and address of the registered or listed Chinese medicines practitioner; and
the date on which the CMP entrusts the manufacturer to manufacture the pCm.
A notification referred to in subsection (1)(c) shall be accompanied by a written undertaking given by the registered or listed CMP to the manufacturer, stating that the medicine will only be administered or supplied to-
(in the case where the medicine is for internal application or both internal and external application) the patient to whom the prescription is given and who is under his direct care; or
(in the case where the medicine is for external application only) a patient or patients under his direct care.
CMP are reminded that according to the above provision, the involved pCm must be manufactured by or under the supervision of a responsible person of the entrusted licensed manufacturer in accordance with a prescription (See Appendix 4) given by a registered or listed CMP. If the pCm involved fulfills part (1)(b)(i) above, the medicines is to be administered or supplied to an identifiable patient to whom the prescription is given and who is under the direct care of the CMP. The manufacturer must manufacture pCm according to the prescription given by the CMP to that identifiable patient. In addition, if the pCm involved fulfills part (1)(b)(ii) above, the medicines can be administered or supplied to a patient or patients under the direct care of the CMP.
Manufacturer entrusted shall possess appropriate techniques and knowledge in manufacturing concept, method and quality control, etc. of manufacturing pCm, and have been authorised to handle the dose form and process so entrusted, in order to ensure that the pCm manufactured meet the requirements in safety, quality and efficacy, as well as that of laws. The label of pCm so manufactured must also fulfill requirements stipulated under section 143 of the CMO, and sections 25 and 26 of the Regulation. Details of the provisions under the CMO and Regulation can be found in the following webpage: http://www.legislation.gov.hk/eng/home.htm.
Please also be reminded that the entrusted manufacturer must comply with the requirement in submitting relevant documents to the Chinese Medicines Board under the CMCHK at least one working day before the day on which each manufacturing process of entrusted pCm begins, and retain relevant documents and records properly. CMP may deliberate with individual manufacturer on manufacturing method and requirements of pCm, if he/ she wishes to do so.
From September to early December, the World Health Organization (WHO) reported six cases on human cases of Severe Respiratory Disease associated with Novel Coronavirus. The Centre for Health Protection (CHP) of the DH issued to all CMPs the reporting criteria and the advice on prevention of Severe Respiratory Disease Associated with Novel Coronavirus. The Chinese Medicine Division (CMD) of the DH has also issued the relevant infection control measures of Chinese medicine clinics to the Chinese medicine organisations. The mentioned letters and documents are available on the CMCHK homepage (http://www.cmchk.org.hk).
DH will stay vigilant on monitoring the latest development of this novel infectious disease while the CMPs are advised to stay alert for the latest press releases and announcements published by the DH.
The DH launched the Chinese Medicine Practitioners Sub-directory of the Primary Care Directory (the Directory) (http://www.pcdirectory.gov.hk) on 25 October 2012. The public can now access the Directory website to find family doctors, dentists or CMPs that are suitable for them. For CMPs who are not yet enrolled in the Directory, they are most welcome to enrol on-line by accessing the enrolment platform of the Directory or to submit the application form which is attached to the invitation letter issued by the DH on 18 April 2012.
Remain Listed in the Directory –Pursuing Continuing Education in Chinese Medicine
Enrolled CMPs must demonstrate that they are pursuing continuing education in Chinese medicine in order to remain listed in the Directory. To facilitate CMPs with limited registration and listed CMPs enrolled to pursue continuing education, the Primary Care Office of the DH has invited Chinese medicine organisations and academic institutions to manage and record continuing education activities and to provide education programmes for the enrolled CMPs. Enrolled CMPs are encouraged to approach individual Chinese medicine organisations and academic institutes for detailed arrangement.
The WHO convened on 27 Nov 2012 a four-day meeting in Hong Kong to further discuss and develop the next WHO traditional medicine global strategy.
The meeting, which aims to get an update on participating countries' progress in the development of traditional medicine and seek expert views on devising the next global strategy to meet new challenges, is supported by the CMD of the DH.
Registered Chinese Medicine Practitioners
The PB has lost contact with the following registered CMPs based on the information of their telephone numbers and addresses.
The PB appeals to the following CMPs for contacting the Secretariat of the CMCHK (Tel. No.: 2121 1888, Fax No.: 2121 1898) as soon as possible. If other CMPs have contact with them, please notify them of the above.
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 PB. The form of Change of Personal Particulars of CMPs can be obtained from the Secretariat or downloaded from the CMCHK homepage (http://www.cmchk.org.hk).
Should you have any opinions regarding the content of the Newsletter, please send them to the Secretariat by post, fax or email, indicating "Newsletter of the Chinese Medicine Practitioners Board". All published Newsletters have been uploaded to the CMCHK 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
Enquiry telephone: (852) 2121 1888
24-hour enquiry system: (852) 2574 9999
Fax Number: (852) 2121 1898
E-mail Address: firstname.lastname@example.org
Service Hours: Monday to Friday: 9:00 am to 5:30 pm
Closed on Saturdays, Sundays and Public Holidays