This issue of the Newsletter mainly reports on the work of the Chinese Medicine Practitioners Board (“CMPB”) in the past four months, which includes 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 and reminders for CMPs from the CMPB.
As regards CME, the CMPB has decided to strictly execute the requirements stipulated in the Handbook on System of Continuing Education in Chinese Medicine for Registered Chinese Medicine Practitioners to ensure the effectiveness of the CME system, i.e. from 1 July 2016 onwards, any registered CMP who fails to fulfill the CME requirements must submit a written explanation, together with the relevant proofs, to the CMPB. In addition, the list of CME programme providers accredited by the CMPB has been updated. Please refer to the main text for details.
As a reminder from the CMPB, registered CMPs are required to update the Chinese Medicine Council of Hong Kong (“CMCHK”) on their registered address/practising address. For those who practise at more than one location, their principal practising address should be provided as the registered address.
With regard to disciplinary inquiries, CMPs are specifically reminded to observe the requirements stipulated in the Chinese Medicine Ordinance (“CMO”) and the Codes1, namely the regulation of the prescription of proprietary Chinese medicines (“pCm”), their professional responsibilities and conduct, standards for prescribing medicines, appropriate referrals of patients, reports of offences committed to the CMPB and change of name or use of an alias in their practice.
Moreover, this issue also features the summaries of how to prepare herbal decoctions and handle moxa products. A letter issued by the Independent Commission Against Corruption to private organization operators concerning the Integrity and Corruption Prevention Guide on Managing Relationship with Public Servants is enclosed as well for CMPs’ information.
The Mid-Autumn Festival is coming, may I wish you all happy Mid –Autumn Festival, good health and happiness.
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.
Mr WONG Kit
Chairman of the Chinese Medicine Practitioners Board
Paper 1 and Paper 2 of Part I Written Examination of the 2016 Chinese Medicine Practitioners Licensing Examination were conducted on 14 June and 16 June respectively. The Clinical Examination (Part II) was conducted from 1 August to mid-August. A total of 437 candidates sat for the Written Examination, 12 candidates were absent from the examination and 348 candidates (79.6% of candidates) passed the examination.
The CMPB will publish the Candidates' Handbook for the 2017 CMPs Licensing Examination in September 2016 and disseminate the details of taking the 2017 examination. Please take notice of the announcements on the homepage of the CMCHK (http://www.cmchk.org.hk).
As at the end of July 2016, there were 7,046 registered CMPs, 51 CMPs with limited registration and 2,650 listed CMPs.
Pursuant to section 76 of the 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 April to July 2016, 228 registered CMPs had their practising certificates renewed. 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 s.76 of the CMO, the Codes 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.
Under section 76 of the CMO, a registered CMP must fulfill the CME requirements prescribed by the CMPB when he applies for renewal of his practising certificate.
As stipulated in paragraph 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 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 registered 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 existing arrangements for applications for renewal of practising certificates by registered CMPs who fail to fulfill the CME requirements for the first time. It is noted that while the number 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 to avoid abuse of 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.
In view of the above decision, paragraph 2.4 of the Handbook has been 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 I and the revised arrangements have taken effect from 1 July 2016. The CMPB has promulgated the revised arrangements to all CMP associations and registered CMPs by a letter on 29 February 2016.
The CMPB has agreed for "Tung Wah Group of Hospitals (CME-PP0032)" to become an accredited CME Programme Provider under the CME system with effect from 2 June 2016. There are currently a total of 28 CME Programme Providers accredited by the CMPB. CMPs may wish to note that the updated list of accredited CME Programme Providers and the contact details of "Tung Wah Group of Hospitals" are enclosed at Appendices II(i) & (ii) of this Newsletter and uploaded to the CMCHK website.
It is specified in the Application Form for Registration as Registered Chinese Medicine Practitioner and Practising Certificate that registered CMPs must provide their practising address as the registered address. For those who practise at more than one location, their principal practising address should be provided as the registered address.
In accordance with sections 52 and 53 of the CMO, registered address shall be recorded in the Register of Chinese Medicine Practitioners. The Registrar shall publish in the Gazette once every 12 months the names, registered addresses and qualifications of all registered CMPs listed in the said Register. Such information will also be uploaded onto the website of the CMCHK.
In addition, the CMPB shall arrange to publish in the Gazette from time to time the list of listed CMPs under section 90(6) of the CMO. Such information will also be uploaded onto the website of the CMCHK.
To ensure that members of the public may verify the qualifications of CMPs from the Gazette or the website of the CMCHK, both registered and listed CMPs are required to update the CMCHK on their practising address. CMPs who wish to change their personal particulars should complete the form, namely “Change of Personal Particulars of Chinese Medicine Practitioners”, enclosed at Appendix III, and send it to the Secretariat of the CMCHK by post (Address: 22/F, Wu Chung House, 213 Queen’s Road East, Wan Chai, Hong Kong) or by fax (Fax no.: 2121 1898).
The CMPB held disciplinary inquiries from April to July 2016 on six registered CMPs who were convicted of an offence punishable with imprisonment and/or alleged breaching the Codes. Five registered CMPs were found guilty after the inquiries. The CMPB warned and removed the name of one registered CMP for 2 years; removed the name of two registered CMPs for 1 to 2 months with a suspension of 18 months; reprimanded one registered CMP and warned another registered CMP.
Summing up the above cases, the CMPB reminds all CMPs to take note of the following issues.
Regulation of the prescription of pCm
It has come to the attention of the CMPB that some CMPs do not specify in their prescriptions all the ingredients and quantities of the Chinese herbal medicines contained in the pCm prescribed. CMPs are hereby reminded again that:
all the ingredients and quantities of the Chinese herbal medicines contained.
The above requirements serve to protect the right of the patients to gain full knowledge of all Chinese medicines prescribed. In case of medical incidents, healthcare workers can initiate prompt investigations and provide follow-up treatments by making reference to the prescriptions issued, thereby ensuring that the medical interests of the patients are best served.
According to the provisions of section 2 of Part III of the Codes, CMPs shall be professionally responsible to their patients. They should explain patiently 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 CMPB 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 Codes.
The CMPB reminds all CMPs to provide treatment carefully, avoid a hazard to the patient and committing any professional misconduct.
Professional Conduct of CMPs
Regarding a CMP convicted by the court of indecent assault in the course of treatment of a patient, the CMPB has, after due disciplinary inquiry, removed the name of the CMP concerned. The CMPB reminds all CMPs that, while the Codes do not require the presence of an assistant when a CMP is conducting a physical examination on his/her patient, to safeguard the interests of both the CMP and the patient, the CMP should arrange the presence of an assistant/a nursing staff as far as possible when he/she is to conduct a physical examination on a patient of the opposite sex. If the patient demands the examination to be conducted in the absence of other persons, the CMP should record such request in the patient’s medical record.
The CMPB reiterates that if a CMP commits similar offences, once convicted by the court, the CMPB shall handle the case strictly in accordance with the disciplinary procedures specified under the CMO.
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).
Appropriate Referral of Patients
According to section 2(5) of Part III of the Codes, CMPs should make medical referrals when necessary, and the registered medical professionals to whom a patient is referred should be able to provide the required treatment according to the diagnosis. The CMPB reminds all CMPs to make appropriate referral of patients when necessary and choose the medicines or apparatus that best serve the medical interest of patients according to his independent professional judgment.
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.
Change of Name of CMPs or Use of Alias in their Practice
CMPs must make sure that their name as recorded in the list/register of CMPs is used when they practise Chinese medicine, or otherwise they may contravene the Codes and even be investigated by the Police for suspected illegal practice of Chinese medicine.
The CMPB hereby reiterates that CMPs who wish to use an alias in their practice should apply to the Immigration Department (“ImmD”) for alias registration and submit the Certificate of Registered Particulars for the CMPB’s approval before using the alias. CMPs who have completed the alias registration may use their name as recorded in the list/register of CMPs and/or their alias in their practice. As for CMPs whose application for alias registration is still being processed by the ImmD, they may only use their name as recorded in the list/register of CMPs or list their alias alongside their name as recorded in the said list/register.
CMPs who have been notified by the CMPB of the requirement for alias registration but have not yet filed an application to the ImmD should complete the registration within 12 weeks from the date of notification. CMPs who continue to use their alias in their practice without completing the alias registration may be subject to disciplinary procedures.
On the other hand, for CMPs who have changed their name, please bring along the original of their deed poll and proof of identity to the Secretariat of the CMCHK for change of personal particulars as soon as practicable.
Decoction is the most common dose form in Chinese herbal medicines (“Chm”) and the containers and methods used in preparing the decoction will have a direct effect on the quality of Chm. Clinically, some patients would customarily self prepare decoction after Chm are dispensed. To achieve the desirable effects of Chm, CMPs should clearly state the decoction method on the prescriptions to ensure patients could adopt appropriate decoction method in preparing Chm.
Before starting the decoction, patients are advised to choose appropriate containers in preparing herbal decoction. In this connection, CMPs may advise patients to choose containers, e.g. ceramic containers, which are chemically stable in which heat can be transmitted evenly and well preserved, to prepare decoction of good quality. Besides, the containers for preparing herbal decoction should be washed thoroughly after each use. This is to prevent the residues from interfering with Chm to be decocted next, which may change the properties of herbal decoction. In general, the steps below could be followed in preparing herbal decoction:
In addition, CMPs should remind patients to follow special decoction requirements, such as decoct first, decoct later, decoct separately, dissolve, wrap decoct, re-decoct after dregs out, etc, for preparing some Chm, to avoid influencing the effects of Chm.
Moxibustion is a therapeutic procedure involving ignited moxa products such as moxa sticks or moxa cones, usually made of moxa floss, to apply heat to certain acupuncture points of the body surface for curing or preventing disease. Moxa products can be made of purely moxa floss as raw material or combined with other herbal medicines such as Ramulus Cinamomi, Radix Salviae Miltiorrhizae or Angelicae Dahuricae Radix. Moxibustion is a common Chinese medicine therapy and it involves certain risks. If the procedure is operated improperly, it can cause dizziness, infection or burns. Applying moxibustion to the abdomen or lumbar region of pregnant women may also lead to miscarriage. Therefore, moxibustion must be performed by a qualified Chinese medicine practitioner.
The Chinese Medicines Board (“CMB”) under the Council has deliberated the classification of moxa products and it is elaborated below for reference.
Moxa floss is the processed form of Artemisiae Argyi, which is a Schedule 2 Chinese herbal medicine;
Proprietary moxa product that is made of moxa floss or combined with other herbal medicines falls within the definition of proprietary Chinese medicine under the CMO. Such product must apply for registration with the Chinese Medicines Board in accordance with the CMO before it can be imported, possessed or sold in Hong Kong;
If the moxa product is made of purely moxa floss and it does not contain any claim on curative function, it is considered as the processed form of Folium Artemisiae Argyi, which is a Schedule 2 Chm; and
Any person who wishes to carry on a business in the retail or wholesale of Chm must first obtain a licence issued by the CMB.
To ensure local CMPs can continue performing moxibustion to their patients using moxa products containing multiple herbal medicine ingredients, the CMB has decided to implement the relevant measures in phases. Firstly, Chinese medicine traders and CMPs will be reminded of the above-mentioned classification to avoid violating the Ordinance. In general, the DH will issue advisory letter to Chinese medicine traders and CMPs concerned, provided that there is no public health risk. Education and publicity on the above issue will be provided. After 30 June 2018, the DH will initiate enforcement action against any of the above violations. The case will be referred to the Council for disciplinary action when necessary.
CMPs are reminded to take note of the above classifications and ensure the moxa products that are currently in use comply with the requirements. If required, CMPs may consider purchasing moxa products made of purely moxa floss and without any claim on curative function from licensed retailer or wholesaler of Chm; or compound the product at his practicing premises for the purpose of administering to a patient under his direct case in accordance with section 158(6)(a) of the CMO; or entrust a manufacturer of proprietary Chinese medicine to manufacture the product in accordance with section 37 of the Chinese Medicines Regulation, to replace moxa product made of multiple herbal medicine ingredients that is not registered. CMPs are also reminded to comply with the related requirements set out in the above-mentioned provisions to avoid violating the CMO.
To help maintain a high standard of integrity in interactions between business operators/private organizations and public servants, the Corruption Prevention Advisory Service of the ICAC has produced the “Integrity and Corruption Prevention Guide on Managing Relationship with Public Servants” (Appendix IV) for reference by operators of private organization and their employees.
For inquiries, please call the hotline of Corruption Prevention Advisory Service at 2526 6363.
Listed Chinese Medicine Practitioners
The CMPB has lost contact with the following listed CMPs based on the information of their telephone numbers and addresses.
The CMPB 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 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
Service Hours: Monday to Friday: 9:00 am to 5:30 pm
Closed on Saturdays, Sundays and Public Holidays