This issue of Newsletter mainly reports the work of the Chinese Medicine Practitioners Board (PB) in the past four months, including preparation for the 2013 Chinese Medicine Practitioners Licensing Examination, renewal of practising certificates of registered Chinese medicine practitioners (CMPs), arrangements for Continuing Education in Chinese Medicine (CME) for registered CMPs, and summary of the disciplinary inquiries conducted by the PB. In addition, CMPs are reminded to take note of matters concerning revision of regulation on use of "Calculus Bovis" and its substitutes in proprietary Chinese medicines (pCm) by the Chinese Medicines Board under the Chinese Medicine Council of Hong Kong (CMCHK).
Regarding CME, to ensure that registered CMPs can continuously improve their professional knowledge and skills through CME, the PB reminds all registered CMPs to comply with regulation on continuing education prescribed by the PB for renewal of practising certificates. CMPs are reminded that from 1 July 2013 onwards, the PB will, except for very special circumstances, reject application for renewal of practising certificate from registered CMPs if they fail to acquire the required CME points until they make up the unearned points. Please refer to the content of this Newsletter for details.
Regarding the disciplinary inquiries, the PB reminds all CMPs to observe the regulations on application for practising certificate and reporting conviction of offence stipulated in the Chinese Medicine Ordinance (CMO) and Codes of Conduct (Codes)1 during practice. In addition, the PB appeals to all CMPs to take note of the matters concerning issuance of receipts of consultation fees to avoid violation of laws or professional conduct as a result of negligence.
In addition, the PB reminds CMPs to note the arrangements on notification of unsubstantiated cases ruled by the Disciplinary Committee of Chinese Medicine Practitioners (DC) in this issue of Newsletter.
Last but not least, the answers of the 2012 CME Quiz for awarding CME points through reading the Newsletter are attached to this issue for CMPs' reference.
I wish you good health and happiness.
Mr WONG Kit
Chairman of the Chinese Medicine Practitioners Board
1 Codes refer 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 application for sitting the 2013 Chinese Medicine Practitioners Licensing Examination for non-listed CMPs was closed in late October 2012 and that for listed CMPs and repeaters was closed on 29 March 2013.
The Paper 1 and Paper 2 of the Written Examination of the 2013 Chinese Medicine Practitioners Licensing Examination will be conducted on 11 June and 13 June 2013 respectively. In the event of bad weather, the examination will be postponed to 15 June 2013. The clinical examination is scheduled to be held between 1 August and mid-August 2013.
Candidates should receive the admission form and the Guidelines for Candidates one week prior to the examination. They may contact the Secretariat of the CMCHK at 2121 1888 if they do not receive the above-mentioned documents on time.
Pursuant to section 76 of the CMO, registered CMPs must apply for valid practising certificates before they are allowed to practise Chinese medicine in Hong Kong. The usual validity period of a practising certificate is three years. Registered CMPs should fulfill the CME requirements prescribed by the PB before they can renew their practising certificates. From December 2012 to late March 2013, 153 registered CMPs renewed their practising certificates. All registered CMPs who have their practising certificates renewed should report promptly to their CME Administrators their new CME cycles, required CME points, and the validity period of their practising certificates.
The CMO also stipulates that if registered CMPs practise Chinese medicine without obtaining valid practising certificates for a period exceeding six months since the expiry of their practising certificates, the PB may order the removal from the Register the name of those registered CMPs in accordance with section 56(1)(d) of the CMO.
Rejecting the Application for Renewal of Practising Certificates of registered CMPs who Fail Again in Acquiring the Required CME Points
In a recent review of the renewal of practising certificates of registered CMPs, the PB noticed that since the CME system was implemented in February 2005, most of the registered CMPs have complied with the CME requirements determined by the PB under section 82 of the CMO when applying for renewal of practising certificate by submitting a copy of the certificate of fulfillment of CME requirements issued by their CME Administrators, but there are still some registered CMPs failing to acquire the required CME points.
Currently, as stipulated in section 2.4 of the Handbook on System of Continuing Education in Chinese Medicine for Registered Chinese Medicine Practitioners (the Handbook), any registered CMP who fails to acquire the required CME points within the specified CME cycle should submit a written report, together with the relevant proofs, to the PB before the end of the CME cycle to give the reasons for the failure. The PB will issue a warning to such registered CMPs who should then, within the new CME cycle, acquire the CME points required for the new CME cycle as well as making up the unearned points for the previous cycle. If the total CME points required for the two cycles still cannot be acquired at the end of the new CME cycle, their practising certificates will not be renewed until they make up all unearned CME points.
The PB agrees with the statutory requirement that registered CMPs should, through continuing education, improve their professional knowledge and skills, keep abreast of the latest development of their profession and areas of practice, ensure their professional standard is up to date, and maintain their professional qualification. As such, the PB has revised the existing arrangement that from 1 July 2013 onwards, if registered CMPs fail again to acquire the required CME points (i.e. they have been warned for their former failure), the PB will, except for very special circumstances, reject their application for renewal of practicing certificate until they make up the unearned points in the CME cycle. The PB has informed the CMP associations and all registered CMPs of the revised arrangement in February 2013.
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 correct answers of the 2012 CME Quiz are attached to this issue of Newsletter at Appendix I for CMPs' reference. The 2013 CME Quiz will be published in the December issue of the Newsletter this year.
According to the CMO, if the DC under the PB receives complaints against CMPs, it shall handle the complaint in accordance with the procedures stipulated in the Chinese Medicine Practitioners (Discipline) Regulation. For cases with prima facie evidence showing that the CMPs have committed misconduct which the PB may hold inquiries on, the DC will decide whether to refer them to the PB for disciplinary inquiries. For minor cases or those with insufficient evidence, the DC will conclude the cases after deliberation and investigation. All complainants will be informed of the results of their cases after investigation by the DC.
At present, on top of those minor cases concluded by DC through "reminder" or "commitment" mechanisms2, cases with insufficient evidence which are concluded by the DC can be divided into three categories as follows:
The DC considers-
the complaint to be frivolous or groundless;
there is insufficient evidence showing that the CMPs have committed misconduct after collecting further information from the CMPs concerned; or
there is insufficient evidence showing that the CMPs concerned have committed misconduct after issuing charge(s) against them and requests for representation and sequent considering the representation.
In the past, the DC would only inform the CMPs involved in type (iii) cases the investigation result of their cases. CMPs involving in types (i) and (ii) would not be informed after their cases were concluded.
In compliance with the Chinese Medicine Practitioners (Discipline) Regulation, the PB endorsed that with effect from January 2013, the DC, after concluding disciplinary cases, should notify in writing not only the CMPs involved in type (iii) cases but also those involved in types (i) and (ii) cases that their cases have been concluded.
For the cases supported by prima facie evidence and will be further processed, DC will handle them according to the procedures stipulated in the Chinese Medicine Practitioners (Discipline) Regulation. The CMPs concerned is subject to receiving "reminders", "committee letters" or being notified to attend disciplinary inquiries conducted by the PB.
By adopting the arrangements above, the PB appeals to the CMPs to be aware of the expectations of the public and society on Chinese medicine professions with a view to promoting the profession status of CMPs.
2 The PB established the "commitment" mechanism in June 2002 to handle minor misconducts of CMPs. Under the "commitment" mechanism, the DC shall inform the CMPs concerned that they may have violated the Codes. If the CMP can submit sufficient and reasonable explanation and statement of ceasing to commit the misconducts, the DC may conclude the case after receiving a written commitment of strictly observance of the Codes. In November 2007, the PB established the "reminder" mechanism to process the cases of minor misconducts of CMPs. Under this mechanism, the DC shall issue a reminder to the CMPs concerned, listing their alleged misconducts, and then conclude the case without requesting a formal response from the CMP concerned. The PB reviewed both mechanisms in February 2010 and endorsed the continual adoption of both the "commitment" and "reminder" mechanisms to handle disciplinary cases.
The PB held disciplinary inquiries from December 2012 to March 2013 on four registered CMPs and one listed CMP who were convicted of an offence punishable with imprisonment and/or alleged breaching the Codes of Conduct. Three registered CMPs and one listed CMP were found guilty after inquiries. The PB reprimanded and warned two registered CMPs; reprimanded another registered CMP and ordered to remove the name of the listed CMP.
Summing up the above cases, the PB reminds all CMPs to take note of the following issues.
Practising Certificate of Registered Chinese Medicine Practitioners
According to Section 76 of the CMO, registered CMPs shall not practise Chinese medicine unless they are the holders of valid practising certificate. In addition, according to the Codes, registered CMPs must display their practising certificates at a conspicuous place in the clinic.
Reporting Court Convictions to the Practitioners Board
According to the Codes, if CMPs have been convicted of an offence punishable with imprisonment in Hong Kong or elsewhere (irrespective of whether a prison term is imposed or not), they must report to the PB immediately. They should quote the case number, date of conviction, venue, offence and minute of adjudication to the PB. If the CMPs fail to do so, the PB will take disciplinary action according to the established procedures.
Issuance of Receipts of Consultation Fees by Chinese Medicine Practitioners
The Medical Insurance Association of the Hong Kong Federation of Insurers appeals to registered CMPs not to split receipts of consultation fees, so as to avoid contravening any criminal offences by aiding an insured member to get premium of consultation fees by cheating or fraud.
CMPs are recommended not to indicate the charged amount on the prescriptions when issuing both the receipts of consultation fees and prescriptions. This is to prevent an insured member from submitting separately a prescription and receipt, both of which is issued for the same service, to different insurance companies, for making a dual claim and gaining extra profit.
Such action violates the principles of indemnity in medical insurance, i.e. an insurance policy indemnifies an insured member only to the extent of the amount the insured member has paid for each consultation.
Other than possible criminal liabilities, CMPs would also commit professional misconduct if they are charged of aiding an insured member to get premium of consultation fees by cheating or fraud.
CMPs are requested to take note of the following issues concerning regulation of the Chinese Medicines Board under the CMCHK on the use of "Calculus Bovis" and its substitutes in proprietary Chinese medicines (pCm).
As a traditional precious Chinese medicinal material, "Calculus Bovis" has the functions of clearing the heart and eliminating the phlegm, inducing resuscitation, cooling the liver for calming endogenous wind and relieving toxicity and is used for pyrexia and coma, apoplexy and phlegmatic coma, panic epileptic convulsion, sore throat, oral sore and carbuncle and sore. Given the scarcity of natural "Calculus Bovis", the State Food and Drug Administration (SFDA) successively ratified three substitutes for "Calculus Bovis" ("Cultural Calculus Bovis"3, "Calculus Bovis Sativus"4, and "Calculus Bovis Artifactus"5).
Recently, SFDA promulgated the Notice for Strengthening the Control of Proprietary Chinese Medicines Containing Herbal Medicines such as "Calculus Bovis" (Notice)6 to enhance the management of "Calculus Bovis" and its substitutes. The Notice specifies that for the variety of proprietary Chinese medicine used for acute clinical conditions and in other dose forms or specifications, "Calculus Bovis" in the prescription can be replaced by "Cultural Calculus Bovis" or "Calculus Bovis Sativus" on equal amount but shall not be replaced by "Calculus Bovis Artifactus".
At present, there are many pCm products containing "Calculus Bovis" and its substitutes in Hong Kong. With an increasing scarcity of natural "Calculus Bovis", it is expected that more pCm containing "Calculus Bovis" will use the substitutes of "Calculus Bovis" in place of "Calculus Bovis". In order to make more effective use of the substitutes of "Calculus Bovis", the Chinese Medicines Board, with reference to the Notice, formulated the Handling Methods for Proprietary Chinese Medicines Containing "Calculus Bovis" and Its Substitutes (the Handling Methods) to regulate the use of "Calculus Bovis" and its substitutes in pCm to ensure their efficacy.
Pursuant to the Handling Methods, where pCm containing "Calculus Bovis" and its substitutes use the substitutes of "Calculus Bovis" in place of "Calculus Bovis", the said pCm must use "Cultural Calculus Bovis" or "Calculus Bovis Sativus" but shall not use "Calculus Bovis Artifactus" in the following circumstances:
The prescription is based on the National Drug Standards; the pCm is the variety used for acute clinical conditions or in other dose forms or specifications as specified in the Notice;
the prescription is not based on the National Drug Standards, but the product name contains descriptions of indications similar to those of acute clinical conditions (e.g. infantile convulsions); or
the prescription is not based on the National Drug Standards, but the scope of indications is similar to the indications of the varieties of medicines used for acute clinical conditions (e.g. infantile convulsions).
If CMPs need to prescribe pCm containing "Calculus Bovis" and its substitutes while treating their patients, they should take note of the above regulation to make proper choices. The PB has notified all CMPs individually of the above information by mail.
3 "Cultural Calculus Bovis" is the dried gallbladder stone cultivated in the living cattle's gall bladder.
4 "Calculus Bovis Sativus" is made of fresh cattle bile which integrates deoxycholic acid, cholic acid and compound calcium bilirubinate.
5 "Calculus Bovis Artifactus" is made by processing cattle gall powder, cholic acid, hyodeoxycholic acid, taurine, bilirubin, cholesterol and microelements.
6 Notice for Strengthening the Control of Proprietary Chinese Medicines Containing Herbal Medicines such as Calculus Bovis (Guo Shi Yao Jian Zhu  No. 355), please refer to http://www.sfda.gov.cn/WS01/CL0844/76608.html for details.
CMPs' attention are drawn to the following information about Hong Kong Chinese Materia Medica Standards (HKCMMS) (Volume 5) issued by the Department of Health (DH).
HKCMMS Volume 5 and its CD were published in December 2012. Covering standards for a total of 42 Chinese herbal medicines, it was printed and published in April 2013.
Launched in 2002, the HKCMMS aims to provide reference standards for commonly used Chinese materia medica (CMM) in Hong Kong and hence improve the safe use of CMMs. Five volumes of HKCMMS covering standards for a total of 140 CMMs have been published. The HKCMMS has been widely recognised in Mainland China and abroad, which not only guarantees the safety and quality of the CMMs but also promotes the research and development of Chinese medicines. For information about the HKCMMS, please visit the website of the Chinese Medicine Division of the DH (http://www.cmd.gov.hk).
To implement the policy of developing Chinese medicines committed in the Chief Executive's Manifesto, the Government established the Chinese Medicine Development Committee (CMDC) in February 2013, to give recommendations to the Government concerning the direction and long-term strategy of the future development of Chinese medicine in Hong Kong. The terms of reference of the CMDC are to:
examine the current landscape and the needs of the Chinese medicine sector in the areas of personnel training and professional development, Chinese medical services, scientific research and development of the Chinese medicines industry, etc;
explore the future development directions and goals of the above areas;
set priorities for the development goals of the above areas;
recommend feasible strategies and measures for projects for priority development; and
monitor the implementation of relevant measures.
Chaired by the Secretary for Food and Health, CMDC comprises 16 non-official members from among the CMPs, the Chinese medicines trade, academia, the research and healthcare sectors and lay persons; as well as four ex-officio members. CMDC held its first meeting in March 2013 and discussed a number of key areas in the development of Chinese medicine in Hong Kong, including personnel training and professional development, Chinese medical services, scientific research and development of the Chinese medicines industry. CMDC has also resolved to set up two standing sub-committees, namely the Chinese Medicine Practice Sub-committee and Chinese Medicines Industry Sub-committee, which will conduct studies and give advice and recommendations to CMDC on the development of CMPs and the Chinese medicines industry respectively.
CMPs are invited to pay attention to following messages about World Health Day 2013.
World Health Day is celebrated on 7 April to mark the anniversary of the founding of World Health Organisation (WHO) in 1948. The theme for World Health Day 2013 is "Hypertension - the preventable and treatable silent killer". To echo the theme of World Health Day 2013, the DH launched a territory-wide publicity and public education campaign on hypertension in April, with the slogan "Is your blood pressure normal? - High blood pressure kills but it's preventable and treatable" to enhance public concern for hypertension. The DH wrote to all CMPs in respect of the activity details on 20 March 2013.
CMPs are encouraged to promote healthy lifestyle to their patients in the view of preventing hypertension effectively. For more information about hypertension, please visit the website of the Centre for Health Protection (CHP) of DH (http://www.chp.gov.hk/en/view_content/28258.html).
After the WHO reported two confirmed cases of human infection with novel coronavirus in September 2012, severe respiratory disease associated with novel coronavirus was included as one of the statutorily notifiable diseases under the Prevention and Control of Disease Ordinance (Cap. 599) by the Hong Kong Government. In addition, CHP received notification from the National Health and Family Planning Commission in March 2013 concerning confirmed human cases of avian influenza A (H7N9) virus. H7 is a statutorily notifiable disease in Hong Kong.
In respect of the above two statutorily notifiable diseases, the DH maintains close liaison with the WHO and the relevant health authorities to obtain information for formulating appropriate control and preventive measures.
The DH wrote to all CMPs on 27 September 2012 and 5 April 2013 respectively to advise them on implementation of infection control measures in Chinese medicine clinics, and appeal to CMPs to remind their patients of taking appropriate measures to prevent the severe respiratory disease associated with novel coronavirus and the human infection with avian influenza A (H7N9) virus and to refer promptly any suspected cases to public hospitals for further treatment. The updated reporting criteria for the above two infectious diseases are at Appendix 2.
For further information on human infection with avian influenza A (H7N9) virus and severe respiratory disease associated with novel coronavirus, please visit avian influenza website (http://www.chp.gov.hk/en/view_content/24244.html) and severe respiratory disease associated with novel coronavirus website (http://www.chp.gov.hk/en/view_content/26511.html) of CHP.
If CMPs would like to receive public health-related and other information in a more effective means by email, please return the completed reply slip at Appendix 3 to CMCHK Secretariat by fax or e-mail.
Launched in January 2009, in which 1,130 registered CMPs have participated, the Elderly Health Care Voucher Scheme (HCVS) invites registered CMPs to join HCVS. Through active participation by registered CMPs, the elderly can choose Chinese medicine services tailor-made to meet their needs in their own communities. Attached to Newsletter is a leaflet of HCVS for CMPs' perusal. Registered CMPs are invited to visit the HCVS website (http://www.hcv.gov.hk) for details about the scheme. English leaflets are also available in this website.
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 are 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
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