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 in a timely manner.
With regard to disciplinary inquiries, CMPs are specifically reminded not to dispense western medicines. They should also observe the requirements stipulated in the CMO and the Codes, points to note on keeping, preparing and handling Chinese medicines in the Chinese medicine clinics, issuance of sick leave certificates, professional responsibility, handling of patients' personal data by CMPs, proper keeping of medical records, issuance of prescriptions, and reporting court convictions to the CMPB etc.
Information about setting limits of sulphur dioxide residues in Chinese herbal medicines ("Chm") in Hong Kong and related implementation information are also provided in this issue. Further details can be found in the following pages.
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
1The 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 2019 CMPs Licensing Examination were conducted on 4 June and 6 June respectively. The Clinical Examination (Part II) was conducted from 1 August to mid-August. A total of 636 candidates sat for the Written Examination (including Paper 1 and Paper 2) and 531 candidates (83.5% of candidates) passed the Written Examination.
The CMPB will publish the Candidates' Handbook for the 2020 CMPs Licensing Examination and disseminate in September 2019 the details of taking the 2020 CMPs Licensing Examination. Please take notice of the announcements on the Chinese Medicine Council of Hong Kong ("CMCHK") homepage (http://www.cmchk.org.hk).
As at 15 July 2019, there were 7,404 registered CMPs, 35 CMPs with limited registration and 2,599 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.
The CMPB will issue letters to notify the registered CMPs concerned of the arrangements for the renewal of their practising certificates about three months in advance of the expiry dates. To ensure timely processing of renewal application and update of the expiry date of the practising certificate on the CMCHK homepage, the CMPB hereby appeals to all registered CMPs to follow the advice in the notification letter and submit the application along with the prescribed fee at least six weeks before the expiry of the practicing certificate.
From 16 March to 15 July 2019, 242 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 CMPB hereby reminds that:
if a registered CMP has decided not to renew his current practising certificate, he must stop practising Chinese medicine upon expiry of the certificate. Otherwise, he will contravene section 76(1) of the CMO.
in accordance with section 56(1)(d) of the 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.
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 CMPs and the Registrar shall publish in the Gazette from time to time the names, registered addresses and qualifications of all registered CMPs listed in the said Register. Such information will also be published in the website of the CMCHK.
In accordance with section 56(2) of the CMO, if registered CMPs fail to acknowledge within four months after the date of despatch the receipt of a registered letter addressed by the CMPB to them at their addresses recorded in the Register, then the CMPB may consider ordering the removal of their names from the Register.
For listed CMPs, the CMPB shall 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 published in the website of the CMCHK.
To ensure that members of the public can 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 addresses. CMPs who wish to change their personal particulars should complete the form, namely "Change of Personal Particulars of Chinese Medicine Practitioners", enclosed at the Appendix, and send it to the Secretariat of the CMCHK (Address: Room 2201, 22/F, Wu Chung House, 213 Queen's Road East, Wan Chai, Hong Kong / Fax no.: 2121 1898 / E-mail: firstname.lastname@example.org).
The CMPB held disciplinary inquiries from 16 March 2019 to 15 July 2019 on four registered CMPs and one listed CMP who were convicted of offences punishable with imprisonment and/or alleged breaching the Codes. The registered CMPs and listed CMP were found guilty after inquiries. Upon inquiry, the CMPB warned and removed the name of one registered CMP for 3 months; reprimanded and removed the name of one registered CMP for 6 months but with a suspension of 24 months; and removed the name of two registered CMPs for 3 months but with a suspension of 24 months and reprimanded one of the registered CMP. In addition, the CMPB put the decision for one listed CMP 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 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.
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.
Points to Note on Keeping, Preparing and Handling Chinese Medicines in the Chinese Medicine Clinics
To facilitate the provision of treatment to patients, the enacted CMO provides the following exemptions to CMPs for licensing application and the registration of pCm -
According to sections 158(2) and (4), a CMP shall be exempted from applying to the Chinese Medicines Board ("CMB") for a retailer license in Chm if the Chm in question are dispensed to a patient under his direct care and on a prescription given by him and at the premises where he practices; and
According to section 158(6)(a), a CMP shall be exempted from applying to the CMB for a manufacturer license in pCm if a pCm is compounded by or under the supervision of the CMP for a patient under his direct care at the premises where he practices. Moreover, the pCm in question shall be exempted from registration.
All CMPs are reminded to strictly observe the statutory requirements and to fulfill their professional responsibility towards patients to, among other things, ensure the safety and quality standards of the Chm prescribed. Proper management should be in place for processing herbal medicines, preparing proprietary Chinese medicines and dispensing Chm, with records maintained of all concerned staff and relevant procedures.
To promote the standards of practice of the Chinese medicines trade, the CMB under the CMCHK has prepared relevant trade guidelines2 to regulate all the aspects involved in operating the Chm and pCm business. The CMB advises CMPs to refer to the "Practising Guidelines for Retailers of Chinese Herbal Medicines" and "Practising Guidelines for Manufacturers of Proprietary Chinese Medicines" for compliance in their relevant business.
2The relevant guidelines have been uploaded to the website of the CMCHK (www.cmchk.org.hk).
Issuance of sick leave certificates
Registered CMPs are medical professionals with legal status. Sick leave certificates issued by registered CMPs are legally recognised under the Employment Ordinance, which was amended in the end of 2006. The CMPB has compiled "Reference Guide on the Issuance of Sick Leave Certificates by Registered CMPs" (the Guide), which includes diseases commonly encountered by CMPs in Hong Kong and the respective recommended number of days of sick leave, and acts as a general reference for registered CMPs on the issuance of sick leave to be fallen into reasonable standards of conduct expected among their professional colleagues. CMPs should issue appropriate sick leave certificates on the basis of their personal professional judgment and the particular circumstances of individual patients. If any discrepancy between an issued sick leave certificate and the Guide that leads to a complaint against a registered CMP, the registered CMP concerned has the responsibility to explain how he/she has exercised professional judgment in issuing the respective sick leave certificate and the relevant circumstances.
The CMPB reminds all CMPs not to issue professional documents or certificates which are untruthful or misleading when issuing sick leave certificates and receipts of consultation fees; otherwise, the CMPB shall handle the case strictly in accordance with the disciplinary procedures specified under the CMO.
As revealed in a recent disciplinary case, a CMP conducted acupuncture treatment with heated needles without proper procedures, causing blisters on the patient's leg. Consequently, the CMP failed to fulfill his professional responsibilities to the patient. The CMPB urges all CMPs to stay vigilant and exercise special care when treating patients to avoid harm to patients or serious medical incidents.
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 contravened the above-mentioned provisions of the Codes.
Handling of patients' personal data by CMPs
The CMPB hereby reminds all CMPs that they shall comply with the Personal Data (Privacy) Ordinance ("PDPO") (Cap. 486) in the collection, holding, use, storage and erasure of their patients' personal data.
The personal data of patients collected by CMPs must be related to the diagnosis and treatment of the patients, and the extent or scope of data so collected should not be excessive to actual needs. CMPs shall collect patients' personal data by legal and fair means, and inform the patients of the purpose of collecting the data and its use. When CMPs collect or process patients' personal data in an open area (e.g. during medical consultations), they shall exercise great caution and take practicable steps to protect the data in order to avoid necessary disclosure to other patients or visitors.
If the CMPB considers that a CMP has not complied with the PDPO in processing his patient's personal data and his standard in this aspect is far below that of professional CMPs in general, it may take disciplinary actions against him.
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 practising rule 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.
Issuance of Prescriptions
The CMPB also noticed that there were CMPs failing to issue prescriptions to their patients and would like to remind all CMPs that patient has the rights to know clearly the details of the Chm being prescribed. In case of any medical incident, medical professionals whom the patient is referred to can make use of the prescription to take immediate follow up actions so as to maintain the benefits of the patient. The Codes also state that the contents written on the prescription issued by CMP must be clear and easily legible. In addition, prescription must include the names of all Chm; their dosages; number of times for re-dispensing; preparation and administration method for the medicines; name, address, contact telephone number and signature of the CMP and the issue date of the prescription.
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.
Sulphur fumigation is a traditional method of processing herbal medicines, where the medicines are fumigated by sulphur dioxide(SO2) gas produced by burning sulphur. Its application can help with better storage of the medicines by insect killing, prevention of the growth of mould, bleaching, preservation and anti-oxidation. Since sulphur dioxide is soluble in water, the amount of residues in the herbal medicines can be markedly lowered by proper washing, soaking and decoction. Moreover, consumed sulphur dioxide will be broken down to sulphate and excreted via urine. Therefore, a small amount of intake through normal consumption will not be harmful to health.
However, abuse or overuse of sulphur fumigation can compromise the quality of herbal medicines. In general, fumigated herbal medicines carry a pungent smell and brighter colour. Those with exceptionally sour pungent smell or bright colour may be over-fumigated. Excessive sulphur dioxide residues may be detrimental to health, in particular for people allergic to sulphur dioxide. They may develop symptoms like shortness of breath, headache or nausea. Prolonged exposure to excessive sulphur dioxide can also trigger respiratory system disorders.
Advice for Chinese Medicine Practitioners
Purchase herbal medicines from licensed Chinese medicine retailers as a way to guarantee that the herbal medicines come from reputable suppliers, thus minimising the risk of acquiring inappropriately processed herbal medicines.
Store herbal medicines properly according to their quality and medicinal properties. Processed herbal medicines that are accepted upon inspection should be stored away immediately with proper registration for dispensing on a first-in, first-out basis.
Reminders to patients:
Figure 1: Decoction pieces of Radix Angelicae Sinensis not fumigated by sulphur
Figure 2: Decoction pieces of Radix Angelicae Sinensis over-fumigated by sulphur
Setting limits of sulphur dioxide residues in Chm in Hong Kong
To further safeguard public health, the CMB endorsed on 9 May 2019 the proposal to set limits of sulphur dioxide residues in 31 types of potent/toxic Chm and 574 types of commonly used Chm (605 in total) together with their decoction pieces listed in Schedule 1 and Schedule 2 to the CMO respectively. For details of the limit set in this respect and the action plan, please refer to the information posted on the website of the CMCHK (http://www.cmchk.org.hk/pcm/pdf/CMT20190522.pdf).
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
Telephone number: (852) 2121 1888
Fax Number: (852) 2121 1898
E-mail Address: email@example.com
Service Hours: Monday to Friday: 9:00 am to 5:30 pm
Closed on Saturdays, Sundays and Public Holidays