This issue of the Newsletter mainly reports on the work of the Chinese Medicine Practitioners Board (Practitioners Board) in the past four months, which includes matters relating to the Chinese Medicine Practitioners Licensing Examination, renewal of practising certificates and Continuing Education in Chinese Medicine (CME) for registered Chinese medicine practitioners (CMPs), findings of disciplinary inquiries, reminders for CMPs from the Practitioners Board, and other issues such as the mislabeling of herbal medicines by Chinese medicines traders.
In the hope of encouraging CMPs to read the Newsletter, the Practitioners Board has arranged for a quiz on the practice of Chinese medicine to be featured in every December issue, through which CMPs could earn CME points. Ever since the first CME Quiz was published in late 2011, the responses and support received from registered CMPs have been overwhelming. The CME Quiz for this year has been attached to this Newsletter, and the Practitioners Board is looking forward to the keen participation of all registered CMPs. Reading the Newsletter helps gain not only the latest information of the Chinese medical profession, but also CME points.
With regard to disciplinary inquiries, the Practitioners Board would like to remind all CMPs specifically not to dispense western drugs, not to sell or possess any goods to which forged trade mark is applied, but to take heed of the standards on prescribing medicines and the requirement of reporting court convictions to the Practitioners Board. This Newsletter contains statistics on the disciplinary cases in 2013. For details, please refer to the content.
The Practitioners Board in particular would also like to draw all CMPs’ attention to the following matters reported in this Newsletter: "Compliance with the Code of Professional Conduct for Registered CMPs in Hong Kong" has been set out as a condition for practice for registered CMPs on practising certificates; Radix Aconiti Lateralis (Bai Fu Pian) has been mislabeled as Rhizoma Typhonii (Bai Fu Zi) for sale, and a lack of knowledge on these two herbal medicines has resulted in poisoning cases.
To prevent Ebola Virus Disease (EVD), this Newsletter contains the "Infection Control Measures for EVD – Chinese Medicine Clinic" for reference of all CMPs. Related information has been mailed separately to various major CMP associations, three local universities and the Chinese Medicine Clinics of the Hospital Authority.
On behalf of the Practitioners Board, I wish all CMPs good health and happiness in the year to come.
Mr WONG Kit
Chairman of the Chinese Medicine Practitioners Board
The Clinical Examination of the 2014 CMPs Licensing Examination was conducted in August 2014. A total of 450 candidates attended the Clinical Examination, and 202 candidates (44.9%) passed the Clinical Examination.
The Written Examination and the Clinical Examination of the 2015 CMPs Licensing Examination will be conducted in June and August 2015 respectively. The application period for non-listed CMP persons started on 17 September and ended on 31 October 2014, whereas the deadline for submitting applications for listed CMPs and repeaters is 31 March 2015. The Practitioners Board has notified all qualified listed CMPs by mail the enrollment period for taking the examination.
As at December 2014, there were 6,892 registered CMPs, 63 CMPs with limited registration and 2,694 listed CMPs.
Pursuant to section 76 of the Chinese Medicine Ordinance (CMO), registered CMPs must hold 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 Practitioners Board before they can renew their practising certificates.
From August to November 2014, 1,534 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 Practitioners Board may order removal from the Register the name of those registered CMPs in accordance with section 56(1)(d) of the CMO.
Apart from the CMO, the Codes also stipulate that registered CMPs should be holders of valid practising certificate to practise Chinese medicine. The Practitioners Board will process violation cases seriously in accordance with the procedures stipulated under the CMO.
Currently, the Practitioners Board will issue a Certificate of Registration, enclosed with relevant documents such as the Notes for Registered CMPs (Notes) and the Code of Professional Conduct for Registered CMPs in Hong Kong (Code of Professional Conduct), to every registered CMP upon his/her registration. It is stipulated in the Notes first and foremost that "registered CMPs must comply with the Code of Professional Conduct promulgated by the Practitioners Board of the Chinese Medicine Council". Registered CMPs who violate the Code of Professional Conduct shall be deemed to be guilty of misconduct in a professional respect. According to this stipulation, compliance with the Code of Professional Conduct shall be considered by the Practitioners Board as a prerequisite for registered CMPs to practise Chinese medicine.
For the sake of clarity, the Practitioners Board has endorsed in the meeting held in August 2014 to have "Comply with the Code of Professional Conduct for Registered CMPs in force as published by the Practitioners Board" set out as a condition for practice for registered CMPs on practising certificates. The arrangement has taken effect immediately. Please be reminded that only when registered CMPs apply for issue and renewal of practising certificates after the arrangement has taken effect, will the Practitioners Board include such condition on the practising certificates issued or renewed.
The system of CME for registered CMPs has been implemented since February 2005. The Practitioners Board will conduct the fifth review of the CME system in early 2015. In accordance with the requirements of the system, all accredited CME Administrators and Programme Providers are required to submit their working reports for the period from 1 January 2012 to 31 December 2014 to the Practitioners Board by early 2015, for the latter to conduct the fifth review of the system.
To encourage the CMPs in reading the newsletter, 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 2014 is attached at Appendix 1 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 6 February 2015. 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 Practitioners Board held disciplinary inquiries from August 2014 to November 2014 on six registered CMPs and one listed CMPs who were convicted of an offence punishable with imprisonment and/or alleged breaching the Codes1. Five registered CMPs and one listed CMP were found guilty after the inquiries. The Practitioners Board removed the name of four registered CMPs for three to six months with a suspension of nine to 18 months, one of the registered CMPs was ordered to pursue Internal Medicine of Chinese Medicine course and get 200 credits within the suspension period; reprimanded one registered CMP and put the decision for one listed CMP on record for future reference.
Summing up the above cases, the Practitioners Board reminds all CMPs to take note of the following issues.
Chinese Medicine Practitioner Must Not Prescribe Western Medicine
The Practitioners Board would like to remind all CMPs again that a CMP should not prescribe any Chinese herbal medicines or proprietary Chinese medicines which contain Western medicine to his patient when practising Chinese medicine. The Practitioners Board is of the view that CMPs should have a thorough understanding of the regulations of practising Chinese medicine as stated in the Codes and understand the medicines which can be prescribed by CMPs under the CMO.
As CMPs prescribing herbal medicine which contains Western medicine to patient not only violates the laws and endangers public safety, it also has an adverse effect on the image of the Chinese medicine profession, the Practitioners Board would like to remind all CMPs to observe relevant regulations stated in the Codes at all time, i.e. CMP should adopt treatment methods on the basis of principles of the Traditional Chinese Medicine in prescribing Chinese herbal medicines or proprietary Chinese medicines and shall not use other professional treatment methods (e.g. medical practitioners). If any CMP is convicted for similar case, the Practitioners Board will process the case seriously in accordance with the disciplinary procedures stipulated under the CMO.
Be sure not to sell or possess any goods to which forged trade mark is applied
Separately, the Practitioners Board again calls on all CMPs to obtain medicines from licensed wholesalers of proprietary Chinese medicines (pCms) or Chinese herbal medicines with good reputation in a bid to provide patients with safe and effective medicines, instead of those with unclear ingredients or from unknown sources. If any CMP sells or possesses any goods to which forged trade mark is applied, the Practitioners Board will definitely handle the case strictly in accordance with the disciplinary procedures laid down in the Ordinance upon conviction by the court.
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 Practitioners Board immediately, specifying the case number, date of conviction, venue, offence and sentence. If the CMP concerned fails to do so, the Practitioners Board will take disciplinary actions in accordance with the Codes.
A recent disciplinary case shows that after the treatment of acupuncture, there is no removal of all needles for patients, making the patients endure unnecessary pain and almost causing serious medical incident. The Practitioners Board reminds all CMPs to provide treatment carefully, avoid a hazard to the patient and guilty of professional misconduct.
According to the provisions of section 2 of Part III of the Code, CMPs have a professional responsibility to patients. They should patiently explain to patients their medical conditions, methods of treatment and the precautions in taking drugs. They should diligently improve their professional knowledge and skills, so as to maintain high professional standards in providing medical service to patients. If the Practitioners Board considers that a CMP, in the course of conduct of his profession, has conducted himself in a way which has fallen short of the reasonable standards of conduct expected among his professional colleagues, the CMP may have committed the above-mentioned provisions of the Code.
Issue of Certificates
When CMPs issue sick leave certificates and medical receipts, they should be mindful not to issue professional documents which are untruthful or misleading. The Reference Guide on Issuance of Sick Leave Certificate by Registered CMPs also clearly stipulates that CMPs should never issue retrospective sick leave certificates. Apart from being subject to criminal liabilities, any CMP reported to have violated the above regulations is also guilty of misconduct in a professional respect.
Standards on Prescribing Medicines
It is stipulated in the Codes that a CMP shall issue prescriptions which conform with professional standards and shall not prescribe excessive or inappropriate medicines. If a CMP prescribes inappropriately with excessive dosages or excessive number of medicines without referring to any therapeutic principles, treatment methods, treatment priorities, or against the principle by which medicines are combined, the treatment of patients would be adversely affected.
In addition, the Practitioners Board reminds all listed CMPs that, according to section 109 of the CMO, only registered CMPs are permitted to prescribe Chinese herbal medicines specified in Schedule 1. For details of the provision and the Schedule, please visit this website (http://www.legislation.gov.hk/blis/eng/index.html).
Information in Prescriptions
The Practitioners Board notices that there are CMPs who fail to list out in their prescriptions all necessary information, such as the names and dosages of all Chinese herbal medicines involved; methods of preparation and administration; the number of times for re-dispensing; the name, address, contact telephone number and signature of CMP, as well as the issuing date of the prescription. The Practitioners Board would like to remind all CMPs again that the patients have the right to gain full knowledge of the Chinese herbal medicines prescribed to them. In the case of a medical incident, healthcare professionals can also initiate investigations and follow up on necessary treatments based on the information provided in the prescriptions to ensure the best medical benefit for the patient.
The Practitioners Board has received enquiries from CMPs recently regarding practice advertising on internet. The Practitioners Board would like to reiterate that according to the Codes, CMPs shall not carry out or participate in any practice advertising works or activities. Practice advertising refers to adoption of various promotion measures to enhance the popularity of CMPs so as to gain benefits from his business, including the promotion of a CMP, his work or his practice, by himself or others (including his employer). Inappropriate advertising measures include the provision of information to, and soliciting business from the public or his patients. Any information provided by a CMP to the public or his patients must be legitimate, honest, true, not exaggerated, and must not claim superiority over other CMPs, or disparage other CMPs. A CMP who has any kind of professional relationship with an organization, when participating in advertising activities or services of the organization, must exercise due diligence to ensure that the organizations do not advertise in contravention of the principles and rules applicable to CMPs as mentioned above.
1 The 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.
In 2013, a total of 169 disciplinary cases were received by the Practitioners Board, the details of the disciplinary figures are listed as follow:
The Practitioners Board held 14 inquiries in 2013 in accordance with section 91 and 98 of CMO, involving 13 CMPs. The outcomes of the inquiries are as follow:
Since 2012 to date, the Department of Health (DH) has discovered cases in which Chinese medicines traders mislabeled processed Radix Aconiti Lateralis as Rhizoma Typhonii for sale, and a lack of knowledge in these two herbal medicines has resulted in poisoning cases.
Processed Radix Aconiti Lateralis is a Schedule 2 Chinese herbal medicine mainly used for pain relief. It contains toxic aconitum alkaloids, which if used improperly, will result in symptoms such as numbness of the mouth and limbs, nausea, vomiting, peripheral weakness, and in extreme cases, breathing difficulties and cardiac arrhythmia that may endanger life. Rhizoma Typhonii is another type of Chinese herbal medicine. Unprocessed Rhizoma Typhonii is a Schedule 1 Chinese herbal medicine, while processed Rhizoma Typhonii is a Schedule 2 Chinese herbal medicine. Processed Rhizoma Typhonii is mainly used to relieve phlegm congestion and pain. If used improperly, it too could lead to adverse reactions, such as skin and mucous membrane irritation, central nervous system suppression, and even death in severe cases. These two herbal medicines should be distinguished in use.
Apart from that, Radix Aconiti Lateralis (Fu Zi) and Rhizoma Typhonii (Bai Fu Zi) are also different from each other. For details, please refer to the table below.
The 2014 Health Manpower Survey conducted by the DH has commenced. This survey aims 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. The questionnaire has been distributed to all CMPs together with the previous issues of Newsletter. It is known that some CMPs have not returned the completed questionnaire yet, enclosed please find the reminder and questionnaire to all CMPs from DH. Please return the duly completed questionnaire to the Health Manpower Unit of the DH as soon as possible. For further enquiry, please visit http://www.dh.gov.hk/tc_chi/statistics/statistics_hms/statistics_hms.htm or contact Health Manpower Unit at 2961 8566.
The World Health Organisation (WHO) declared on 8 August 2014 the outbreak of EVD in West Africa a Public Health Emergency of International Concern. On 20 August, the Government announced the "Preparedness and Response Plan for EVD" and activated the Alert Response Level under the response plan.
The Centre for Health Protection (CHP) of DH has drawn up the "Infection Control Measures for EVD - Chinese Medicine Clinic" for the prevention of EVD. For details, please refer to Appendix II (Chinese version only). CMPs can also visit the website below to obtain the latest information on the infection control measures (http://www.chp.gov.hk/files/pdf/ic_measures_for_evd_chinese_medicine_clinic.pdf).
As medical professionals, CMPs should remind the patients that if they have returned to Hong Kong from the affected areas, they should have their health condition closely monitored. Should any symptoms of EVD develop in 21 days after return, they should call 999 and inform the personnel of their situation, so that treatments at Accident and Emergency Department (A & E Dept) could be arranged. If CMPs suspect their patients of being infected with EVD, they should also call 999 immediately and inform the personnel of the situation, so that treatments at A & E Dept could be arranged for these patients.
The CHP of DH will monitor the latest situation of EVD closely and CMPs are advised to pay attention to the press releases and updated information issued by the CHP (http://www.chp.gov.hk/en/view_content/34199.html).
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
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