This issue of the Newsletter mainly reports on the progress of work of the Chinese Medicine Practitioners Board ("CMPB") in the past four months, which includes the Chinese Medicine Practitioners Licensing Examination, matters related to renewal of practising certificates and Continuing Education in Chinese Medicine ("CME") for registered Chinese medicine practitioners ("CMPs") and findings of disciplinary inquiries. Some requirements under the Codes1 are also highlighted in this issue for the attention of CMPs.
In accordance with the Chinese Medicine Ordinance ("CMO"), 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. All registered CMPs are hereby reminded to take note of the validity of their practising certificate and submit a renewal application to the CMPB according to the schedule.
The CMPB had received reports that individual registered CMPs still practised Chinese medicine even after their practising certificates had expired. With a view to safeguarding public interests, the CMPB has held discussions on the publication of the expiry dates of the practising certificates for registered CMPs, and subsequently decided to include the expiry dates in the list of registered CMPs on the Chinese Medicine Council of Hong Kong (CMCHK)'s website with effect from 1 November 2018. Further details can be found on the following pages.
With regard to disciplinary inquiries, CMPs are specifically reminded not to dispense western medicines, they should observe the requirements stipulated in the CMO and the Codes, namely their professional responsibilities, standards on prescribing medicines, practice advertising, professional conduct of CMPs, and reporting court convictions to the CMPB etc.
On 15 May 2018, the CMCHK endorsed the establishment of a Health Committee for Listed CMPs under the CMPB. The primary function of the Committee is to handle cases specifically related to medical grounds, evaluate if the listed CMPs with medical problems are fit to continue practising Chinese medicine, and make recommendations to the Disciplinary Committee and CMPB in this regard. Further details can be found on the following pages.
Legislative amendments were made to the Protection of Endangered Species of Animals and Plants Ordinance ("the Ordinance"). Under the corresponding amendments, "Manis pentadactyla 中華穿山甲" is scheduled in Appendix I of the Ordinance. The new controls will become effective on 1 November 2018. CMPs are reminded to pay attention to this issue.
On behalf of the CMPB, may I wish all CMPs all the best and good health.
Ms WONG Yu-yeuk
Chairman of the Chinese Medicine Practitioners Board
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.
Paper 1 and Paper 2 of Part I Written Examination of the 2018 Chinese Medicine Practitioners Licensing Examination were conducted on 5 June and 7 June respectively. The Clinical Examination (Part II) was conducted from 1 August to mid-August. A total of 567 candidates sat for the Written Examination (including Paper 1 and Paper 2) and 443 candidates (78.1 % of candidates) passed the Written Examination.
The CMPB will publish the Candidates' Handbook for the 2019 CMPs Licensing Examination and disseminate in September 2018 the details of taking the 2019 CMPs Licensing Examination. Please take notice of the announcements on the CMCHK homepage (http://www.cmchk.org.hk).
As at 15 July 2018, there were 7,126 registered CMPs, 39 CMPs with limited registration and 2,614 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 16 March to 15 July 2018, 1,261 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.
Under the CMO, registered CMPs shall hold a valid practising certificate to practise Chinese medicine in Hong Kong. Registered CMPs shall also display their practising certificates at a conspicuous place in their clinics in accordance with the "Code of Professional Conduct for Registered Chinese Medicine Practitioners in Hong Kong". If registered CMPs practise Chinese medicine without valid practising certificates for a period exceeding six months, the CMPB may order removal from the Register the name of those registered CMPs under the Ordinance. Apart from the list of registered CMPs published in the Gazette by the Registrar every November, the public can also refer to the list of registered CMPs on the website of the CMCHK for the latest information at the time being. However, the lists of registered CMPs in the Gazette and on the CMCHK's website do not set out the expiry dates of the practising certificates for registered CMPs presently, and the public therefore cannot check whether the registered CMPs whom they are consulting are holders of a valid practising certificate from these sources.
The CMPB had received reports that individual registered CMPs still practised Chinese medicine even after their practising certificates had expired. With a view to safeguarding public interests, the CMPB has held discussions on the publication of the expiry dates of the practising certificates for registered CMPs, and subsequently decided to include the aforementioned expiry dates in the list of registered CMPs on the CMCHK's website with effect from 1 November 2018.
As it takes time to process applications for the renewal of practising certificates, the CMPB hereby appeals to all registered CMPs to follow the written reminders issued by the CMCHK and submit their renewal applications at least six weeks before the expiry of their practising certificates to ensure timely update of the relevant expiry dates on the CMCHK's website.
In view of an earlier case that a patient was admitted to hospital and died due to pulmonary embolism induced by a blood clot which formed within a deep vein in the lower limb and broke loose during a Chinese acupuncture and acupressure treatment, the CMPB hereby introduces the clinical characteristics of deep vein thrombosis in the lower limbs to all CMPs so as to raise their awareness of this disease. Moreover, the CMPB reminds all CMPs that according to section 2(5) of Part 3 of the Codes, CMPs shall 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. If CMPs are not clinically equipped with adequate skills or medical facilities to provide their patients with appropriate diagnosis or treatment during their consultations, they should make medical referrals in accordance with the above regulation.
According to the sixth edition of Chinese Surgery ("《中醫外科學》") (first edition in 1997), the planned teaching material on Chinese medicine for general higher education chiefly edited by Lu Deming, "thigh swelling (股腫)" in Chinese surgery is first described as being equivalent to "deep vein thrombosis in the lower limbs" in western medicine, and its clinical spectrums are swelling, pain, rise in local skin temperature and distention of superficial veins of the diseased limbs, etc. while patients are mostly bedridden, postnatal, having undergone abdominal surgery and with trauma history, etc.
"Thigh swelling" may give rise to a lot of complications. Among them, the most serious one is pulmonary embolism, which is clinically one of the common causes of sudden death. In case patients are found to have sudden symptoms such as shortness of breath, chest tightness, a drop in blood pressure, loss of consciousness, etc., they should be sent to hospital immediately for acute and emergency treatment.
The CMPB held disciplinary inquiries from 16 March to 15 July 2018 on seven registered CMPs and two listed CMPs who were convicted of an offence punishable with imprisonment and/or alleged breaching the Codes. Six registered CMPs and two listed CMPs were found guilty after inquiries. Upon inquiry, the CMPB removed the name of one registered CMP for 48 months and reprimanded the CMP; removed the name of one registered CMP for 30 months; warned and removed the name of one registered CMP for 6 months but with a suspension of 24 months; removed the name of one registered CMP for 3 months with a suspension of 24 months; and reprimanded two registered CMPs. In addition, the CMPB put the decision for two listed CMPs on record for future reference.
Summing up the above cases, the CMPB reminds all CMPs to take note of the following issues.
Chinese Medicine Practitioners Must Not Prescribe Western Medicines
Illegal sale or possession of Part 1 poisons are criminal offences under the Pharmacy and Poisons Ordinance (Cap. 138), and offenders are liable on conviction to a maximum fine of $100,000 and to imprisonment for up to 2 years on each count. Moreover, illegal sale and possession of antibiotics are prohibited under the Antibiotics Ordinance (Cap. 137), and offenders are liable for conviction to a maximum fine of $30,000 and to imprisonment for up to 1 year on each count.
Under the Codes, CMPs are required to prescribe Chinese herbal medicines ("Chm") or proprietary Chinese medicines ("pCm") to patients on the basis of principles of the Traditional Chinese Medicine. The CMPB considers that CMPs must know clearly the ingredients of the medicines prescribed to patients, be conversant with the professional requirements stipulated in the Codes, and have a thorough understanding of the medicines allowed to be prescribed by them under local laws. In this connection, CMPs are required to deal with reputable licensed Chinese medicine traders and prescribe medicinal products which are safe and effective for treating patients. They must not purchase Chm or pCm with unknown ingredients or from doubtful sources whilst they should keep the receipts in order to trace the sources of the Chm and pCm. All CMPs are also specifically reminded that in accordance with section 158(6)(a) of the CMO, the requirements for pCm to be registered and a person who manufactures pCm to apply for a manufacturer licence in pCm may be exempted for pCm compounded by or under the supervision of a CMP at the premises where he practises if, and only if, such pCm is being used for the purpose of administering or supplying to a patient under his direct care. Yet, CMPs are still rested with the professional responsibility to ensure the safety, quality and efficacy of the pCm compounded.
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 restate that all CMPs should 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 Chm or pCm and shall not use any western medicines. If any CMP is convicted for prescribing medicines adulterated with western drug ingredients, the CMPB will process the case seriously in accordance with the disciplinary procedures stipulated under the CMO.
As in a recent disciplinary case, a CMP warmed up treatment cups above a patient's body during a cupping treatment, while the patient raised his head all of a sudden for some reason and thus got scalded by the red-hot object, resulting in a second-degree burn on his skin eventually. All CMPs are therefore reminded to be cautious when providing diagnosis and treatment to their patients so as not to pose any harm to them and commit a professional misconduct.
According to the provisions of section 2 of Part 3 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 contravened the above-mentioned provisions of the Codes.
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, against the principle by which medicines are combined or compatibility of Chinese medicine principle, the treatment of patients would be adversely affected.
Furthermore, all CMPs must make safety their first priority in prescribing medicines especially when toxic Chinese herbal medicines are prescribed. They should draw reference to the recommended drug dosages stated in the Pharmacopoeia of the People's Republic of China, and closely monitor for any adverse reactions of patients. CMPs should also give medical instructions in clear written form to ensure that their patients can understand and follow their instructions in preparing and consuming the Chinese medicines. CMPs should also inform their patients of the known possible side effects of the prescriptions, and ask them to seek medical advice promptly if they experience any illness after taking the prescribed medicines.
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/eng/index.htm). If any listed CMP is found for prescribing Chinese herbal medicines specified in Schedule 1, the CMPB will process the case seriously.
The CMPB 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 the 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.
Professional Conduct of CMPs
Regarding a CMP convicted by the court of indecent assault in the course of treatment of a patient, 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 a chaperone 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.
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.
To have a consistent approach in handling health cases of all CMPs, CMCHK endorsed the establishment of the "Health Committee for Listed Chinese Medicine Practitioners" under the CMPB on 15 May 2018 to handle cases specifically related to medical grounds, evaluate if the listed CMPs with medical problems are fit to continue practising Chinese medicine, and make recommendations to the Disciplinary Committee and CMPB in this regard. Health cases of listed CMPs would be handled by the Disciplinary Committee following the disciplinary procedures for handling violation of professional conduct by listed CMPs. The Committee shall consist of 11 members, including a chairman who should be a member of the CMPB, 4 CMPs, 4 registered medical practitioners and 2 lay persons. In addition, there will also be a Legal Adviser in the Committee. The member list is the same as the existing Health Committee. You may refer to the CMCHK homepage (http://www.cmchk.org.hk) for details.
As informed by the Agriculture, Fisheries and Conservation Department (AFCD), legislative amendments were made to the Protection of Endangered Species of Animals and Plants Ordinance ("the Ordinance"). Under the corresponding amendments, "Manis pentadactyla 中華穿山甲" is scheduled in Appendix I of the Ordinance. The new controls will become effective on 1 November 2018. When the above new controls take effect, all newly scheduled species will be subject to licensing control. According to the Ordinance, unless exempted or otherwise specified, the import, introduction from the sea, export, re-export or possession of endangered species, whether alive, dead, its parts or derivatives, requires a licence issued in advance by AFCD. You may refer to the following link for the circular letter issued by AFCD for above mentioned legislative amendments: http://www.afcd.gov.hk/tc_chi/conservation/con_end/files/ES03_18c.pdf
According to the Chinese Pharmacopoeia (2015 Edition)，pangolin 穿山甲 is the scale of Manis pentadactyla Linnaeus 鯪鯉科動物穿山甲.
If you have any enquiries regarding the above, please email to firstname.lastname@example.org or contact AFCD (Tel: 2150 6969).
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 CMPB. 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 of the CMCHK 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
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