This issue of the Newsletter mainly reports on the work of the Chinese Medicine Practitioners Board ("CMPB") in the past four months, which includes preparation for the 2016 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 and reminders for CMPs from the CMPB.
As regards CME, the CMPB has recently reviewed the Handbook on System of Continuing Education in Chinese Medicine for Registered Chinese Medicine Practitioners ("the Handbook") to ensure the effectiveness of the CME system. It is decided that the requirements stipulated in the Handbook should be strictly executed i.e. any registered CMP who fails to fulfill the CME requirements must submit a written explanation, together with the relevant proofs, to the CMPB. Please refer to the main text for details.
With regard to disciplinary inquiries, CMPs are specifically reminded to avoid dispensing Western drugs and to observe the requirements such as proper keeping of patients' medical records, paying attention to standards on prescribing medicines and information in the prescriptions, reporting of offences committed to the CMPB and upholding their professional responsibility in dispensing Chinese medicines so that they would not violate the laws inadvertently or perform acts which might constitute professional misconduct.
In addition, CMPs are also requested to take note of the updated application documents and guidance notes for holders in respect of a certificate for clinical trial and medicinal test of proprietary Chinese medicine ("pCm"), measures for preventing and controlling influenza recommended by the Department of Health ("DH"), news relating to the Elderly Health Care Voucher Scheme as well as the findings of the 2014 Health Manpower Survey on CMPs covered in this issue.
Last but not least, the answers of the 2015 CME Quiz for awarding CME points through reading the Newsletter are attached to this issue for CMPs' reference.
May I wish you all good health and happiness.
Mr WONG Kit
Chairman of the Chinese Medicine Practitioners Board
The application for sitting the 2016 CMPs Licensing Examination for non-listed CMP persons was closed in late October 2015 and that for listed CMPs and repeaters was closed on 31 March 2016.
The Paper 1 and Paper 2 of the Written Examination of the 2016 CMPs Licensing Examination will be conducted on 14 June and 16 June 2016 respectively. In the event of bad weather, the examination on 14 June and 16 June 2016 will be postponed to 20 June and 22 June 2016 respectively. The clinical examination is scheduled to be held between 1 August and mid-August 2016.
Candidates should receive the admission form and the Guidelines for Candidates one week prior to the examination. They may contact the Secretariat of the Chinese Medicine Council of Hong Kong ("CMCHK") at 2121 1888 if they do not receive the above-mentioned documents in time.
As at the end of March 2016, there were 7,062 registered CMPs, 52 CMPs with limited registration and 2,656 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 CMPB before they can renew their practising certificates.
From December 2015 to March 2016, 186 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 valid practising certificates for a period exceeding six months since the expiry of their practising certificates, the CMPB 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 Codes1 also stipulate that registered CMPs should be holders of valid practising certificate to practise Chinese medicine. The CMPB will process violation cases seriously in accordance with the procedures stipulated under the CMO.
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.
Under section 76 of CMO, a registered CMP applying for renewal of his practising certificate must fulfill the CME requirements prescribed by the CMPB.
As stipulated in paragraph 2.4 of 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 CMPB before the end of the CME cycle to explain the reasons for the failure. The CMPB may issue a warning to such registered CMP who should then, within the new CME cycle, acquire the CME points required for that 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, the practising certificate of the CMP will not be renewed until all unearned CME points have been made up.
Since the CME system for registered CMPs has been implemented for more than a decade, the CMPB has recently conducted a review on the above arrangements and the renewal of practising certificate of registered CMPs at present. It is noted that while the number of cases of registered CMPs failing to fulfill the CME requirements has dropped significantly as compared with several years ago, the reasons provided by some of them are not sound. To ensure the effectiveness of the CME system and prevent registered CMPs from abusing the system, the CMPB has decided to strictly execute the requirements stipulated in paragraph 2.4 of the Handbook that any registered CMP who fails to fulfill the CME requirements must submit a written report, together with the relevant proofs, to the CMPB to explain the reasons for the failure. "The relevant proofs" refer to the certifications of CME points which are issued by the CME Administrator as a proof of the actual CME points acquired by the registered CMP who fails to fulfill the CME requirements within the CME cycle for the CMPB's consideration.
In addition, the registered CMP who fails to fulfill the CME requirements should also submit the following objective proofs to the CMPB, as appropriate, to explain the reasons for his failure:
Medical proofs: Any registered CMP who fails to fulfill the CME requirements due to illness should submit medical proofs issued by a registered medical practitioner, CMP or dentist to the CMPB for consideration. Such proofs should show to the satisfaction of the CMPB that the illness has indeed prevented the CMP from receiving CME in the previous CME cycle but will not render him incapable of taking any further CME persistently or directly affect his ability to practise; or
Other proofs: Any registered CMP who fails to fulfill the CME requirements due to reasons other than illness should submit objective proofs to the satisfaction of the CMPB that the circumstances have indeed rendered him incapable of receiving CME in the previous CME cycle but will be improved in the subsequent CME cycle.
Please note that in view of the above decision, paragraph 2.4 of the Handbook will be revised to specify that where a registered CMP fails to fulfill the CME requirements even for the first time, the CMPB has the right to refuse his application for renewal of practising certificate if he fails to provide sound reasons or relevant proofs. The revised paragraph 2.4 of the Handbook is enclosed at Appendix 1 and will take effect from 1 July 2016.
To encourage CMPs in reading the Newsletter, the CMPB endorsed in 2011 the introduction of the CME Quiz. Ten questions, based on the content of the three issues of the Newsletter of the year, will be published in the December issue every year. Two CME points would be awarded if successful attempt of six or more questions.
The correct answers of the 2015 CME Quiz are attached to this issue of Newsletter at Appendix 2 for CMPs' reference. The 2016 CME Quiz will be published in the December issue of the Newsletter this year.
The CMPB held disciplinary inquiries from December 2015 to March 2016 on seven registered CMPs and one listed CMP who were convicted of an offence punishable with imprisonment and/or alleged breaching the Codes. The seven registered CMPs and one listed CMP were found guilty after the inquiries. The CMPB reprimanded and removed the name of two registered CMPs for 24 to 30 months; removed the name of two registered CMPs for 12 months; removed the name of two registered CMPs for 3 months with a suspension of 18 to 24 months; warned another registered CMP and removed the name of one listed CMP.
Summing up the above cases, the CMPB reminds all CMPs to take note of the following issues.
Chinese Medicine Practitioner Must Not Prescribe Western Medicine
The CMPB 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 CMPB 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 CMPB 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 CMPB will process the case in accordance with the disciplinary procedures stipulated under the CMO.
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 responsibility of CMPs. In case a patient has concern on the medical treatment given by individual CMP or suffers from medical incident whereas the CMP concerned is not available to provide details of the patient, the medical record and history of the patient shall be important references for the officers responsible for investigating the incident, other medical professionals or first-aiders to take measures accordingly. The Codes require that a CMP should be able to provide information including his diagnosis of the patient, medicines prescribed and treatment methods. The CMPB reminds all CMPs again the importance of complying with the above regulations on proper keeping of medical records. If there is any violation, the CMPB will process the case seriously in accordance with the disciplinary procedures.
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 CMPB 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 CMPB 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 CMPB would like to remind all CMPs again that 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 follow up on necessary treatments or initiate investigations based on the information provided in the prescriptions to ensure the best medical benefit for the patient.
Reporting Court Convictions to the CMPB
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 CMPB within 28 days, specifying the case number, date of conviction, venue, offence and sentence. If the CMP concerned fails to do so, the CMPB will take disciplinary actions in accordance with the Codes.
Professional Responsibility in Prescribing Chinese Medicines
There was a recent disciplinary case where a CMP disregarded his professional responsibility to a patient with the quantity of Chinese herbal medicines he dispensed to the patient inconsistent with the prescription, or he did not supervise the process of dispensing the Chinese herbal medicines to the patient.
Under section 158 of the CMO, a CMP who dispenses Chinese herbal medicines to a patient under his direct care on a prescription given by him and at the premises where he practises may be exempted from obtaining a retailer licence in Chinese herbal medicines from the Chinese Medicines Board ("CMB") under the CMCHK.
Professionally, a CMP is held responsible for the Chinese medicines dispensed by him directly or by Chinese medicine dispensers and other staff under his supervision to patients under his care.
Any act committed by a CMP during his practice which falls short of the standards expected among members of the profession may constitute professional misconduct. The CMPB and its Disciplinary Committee of Chinese Medicine Practitioners will handle such cases in a serious manner.
Under section 129 of the CMO, the CMB may, upon application, issue a certificate for clinical trial and medicinal test ("Certificate") for the purpose of facilitating the conduct of a clinical trial or medicinal test of any pCm. Upon submission of the documents, information, samples and other materials required by the CMB and payment of the prescribed fee, the CMB may issue to the applicant a Certificate subject to such conditions as it thinks fit.
In 2013, the CMB has updated the "Good Clinical Practice for Proprietary Chinese Medicines" ("GCP") which serves as the guiding principles for clinical trials of pCms to provide assurance that the trial process is standardized; the results are reliable; and that the rights and safety of trial subjects are protected.
For more effective management of clinical trials of pCms and promoting the development of scientific research on pCms, the CMB has updated the guidance notes, form and checklist for application of a Certificate as well as the guidance notes for holders of the Certificate in September 2015 to help the Certificate applicants and holders understand the requirements on application for and holding of the Certificate.
Pursuant to the updated "Guidance Notes on the Application for Certificate for Clinical Trial and Medicinal Test", where the Certificate applicant is a sponsor-investigator2 (non-commercial sector) and declares on the application form that findings of the clinical trial will not be used in an application for pCm registration or a variation of any registered particulars of a registered pCm (e.g. indications and patient population), the CMB may, based on the risk level of the investigational product, consider granting an exemption for submission of certain application documents. The risk level of the investigational product is determined by comparing the potential risks of the investigational product with risks of standard medical care, for instance, whether the indication, method of administration and dosage of the investigational pCm match with any registered pCm or are supported by any published evidence and/or guidelines.
The newly added Part B of the "Guidance Notes for Holders of the Certificate for Clinical Trial and Medicinal Test" describes the handling method when a Certificate holder, after the issuance of a Certificate, intends to vary any information or documents submitted during the application for that Certificate.
For details, the above documents can be viewed and downloaded from the website of the CMCHK (http://www.cmchk.org.hk/pcm/eng/#main_down02.htm).
2 According to GCP, "Sponsor-Investigator" refers to an individual who both initiates and conducts, alone or with others, a clinical trial, and under whose immediate direction the investigational product is administered to, dispensed to, or used by a subject.
In Hong Kong, seasonal influenza is usually more common in periods from January to March and from July to August. DH urges all CMPs to remind their patients to avoid going to crowded or poorly ventilated public places when influenza is prevalent; high-risk individuals, such as the elderly and young children, may consider putting on surgical masks when staying in such places.
Besides, the DH also recommends that CMPs should remind members of the public to take the following measures to prevent influenza and respiratory tract infections:
For the latest information on influenza activity, please visit the website of the Centre for Health Protection (CHP) under the DH (http://www.chp.gov.hk/en/view_content/14843.html) or refer to the Flu Express published weekly by the CHP (http://www.chp.gov.hk/en/guideline1_year/29/134/441/304.html).
The Elderly Health Care Voucher Scheme ("HCVS") was initially launched in January 2009. According to the DH's record, over 1 800 registered CMPs have enrolled in the HCVS and around 79% of the eligible elderly population have used their vouchers as at December 2015. Registered CMPs are hereby cordially invited to enrol in the HCVS to allow eligible elders to select Chinese medicine services in their community which can best cater for their needs. A copy of the leaflet about the HCVS is enclosed at Appendix 3 to this issue for CMPs' reference. Procedures for enrolling in the scheme and using vouchers are simple and easy. For details, please visit HCVS's website (http://www.hcv.gov.hk) or contact Health Care Voucher Unit of the DH (Tel. No.: 3582 4102).
The 2014 Health Manpower Survey conducted by the DH was completed in May 2015. A summary of the findings of the survey is attached at Appendix 4 to this issue of the Newsletter for information. For further enquiry, please visit http://www.dh.gov.hk/english/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 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
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Fax Number: (852) 2121 1898
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