Coroner criticised over conduct of SARS inquest
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《英国医生杂志》
The inquest of the Hong Kong Coroner抯 Court into six healthcare professionals who died while caring for patients during last year抯 outbreak of severe acute respiratory syndrome (SARS) has returned a verdict of natural causes.
The court heard testimony from 43 witnesses, including family members of the deceased, doctors, nurses, medical experts, and hospital executives. Witnesses told the court that they thought the health workers had inadequate protective equipment. But the coroner, Michael Chan Pik-kiu, told the jury that it had to return a verdict of natural causes if it believed that SARS was the cause of death.
Witnesses explained that although Tuen Mun Hospital had no shortage of supplies medical workers were given one mask per 10 hour shift, had to turn gowns inside out and hang them up when they went on breaks, and had to clean goggles with disinfectant scrub and reuse them.
Doctors at the hospital bought their own P100 masks, which filter out almost 100% of contaminants, instead of using the hospital issue N95 masks, which filter out 95% of contaminants. P100 masks can also be better adjusted for a snug fit.
Nurse Lau Wing-kai, 38, was wearing an N95 mask that slipped off slightly while he was inserting a respiratory tube into a patient. He was admitted the next day with high fever and died within a month. His co-worker Dr Joanna Tse Yuen-man, 35, also contracted SARS from the same patient.
At the United Christian Hospital a technical services assistant, Tang Heung-may, 36, and a healthcare assistant, Lau Kam-yung, 47, were responsible for feeding and toileting patients with SARS. Both had complained to their husbands that the hospital had not provided them with enough masks, the court heard.
The inquest also looked into the cause of death of Wong Kang-tai, 53, a ward attendant at Shatin Hospital and one of the first healthcare workers to contract SARS, and Kate Cheng Ha-yan, 30, a doctor at Tai Po Hospital. The court heard that Dr Cheng was told by a hospital executive not to wear the P100 mask she had bought herself and to use the hospital issue masks instead.
Barrister Adrian Huggins, representing the Hospital Authority, the employer of the deceased healthcare workers, asked the coroner not to make any recommendations on the basis of the cause of death. He also successfully petitioned the coroner to have parts of the expert testimony relating to the authority抯 infection control guidelines and hospital practices deleted from the documents given to the jury.
The verdict was very disappointing and deviated from normal practice, said Dr Kwok Ka-ki, the medical profession抯 representative in Hong Kong抯 legislative council.
"The Hospital Authority barrister requested the coroner not to give a view. The coroner followed , and why he did this puzzles me. I am not very impressed. The coroner set a very bad example by giving a verdict without giving any explanation.
"He should let the public know why . I don抰 know if he was under pressure from the Hospital Authority or the government, but in this case the coroner抯 response was very political."
A spokesperson for the judiciary responded: "The coroner is completely independent in deciding whether to make any recommendations in any case."
However, Neville Sarony, a barrister and expert in medical malpractice lawsuits, criticised the coroner抯 actions. "The decision to exclude certain evidence was short on transparency, and one can抰 escape the feeling that perhaps the coroner had his own agenda. It is customary for the coroner to identify faults and make recommendations to ensure loopholes are closed," he said.
"He obviously didn抰 want to do that so he took an unusual step which had the effect of preventing the jurors from expressing their opinion. I think he did everybody a disservice. It is much better to bring things out and examine them, otherwise it gives the perception that there is a cover up."(Hong Kong Jane Parry)
The court heard testimony from 43 witnesses, including family members of the deceased, doctors, nurses, medical experts, and hospital executives. Witnesses told the court that they thought the health workers had inadequate protective equipment. But the coroner, Michael Chan Pik-kiu, told the jury that it had to return a verdict of natural causes if it believed that SARS was the cause of death.
Witnesses explained that although Tuen Mun Hospital had no shortage of supplies medical workers were given one mask per 10 hour shift, had to turn gowns inside out and hang them up when they went on breaks, and had to clean goggles with disinfectant scrub and reuse them.
Doctors at the hospital bought their own P100 masks, which filter out almost 100% of contaminants, instead of using the hospital issue N95 masks, which filter out 95% of contaminants. P100 masks can also be better adjusted for a snug fit.
Nurse Lau Wing-kai, 38, was wearing an N95 mask that slipped off slightly while he was inserting a respiratory tube into a patient. He was admitted the next day with high fever and died within a month. His co-worker Dr Joanna Tse Yuen-man, 35, also contracted SARS from the same patient.
At the United Christian Hospital a technical services assistant, Tang Heung-may, 36, and a healthcare assistant, Lau Kam-yung, 47, were responsible for feeding and toileting patients with SARS. Both had complained to their husbands that the hospital had not provided them with enough masks, the court heard.
The inquest also looked into the cause of death of Wong Kang-tai, 53, a ward attendant at Shatin Hospital and one of the first healthcare workers to contract SARS, and Kate Cheng Ha-yan, 30, a doctor at Tai Po Hospital. The court heard that Dr Cheng was told by a hospital executive not to wear the P100 mask she had bought herself and to use the hospital issue masks instead.
Barrister Adrian Huggins, representing the Hospital Authority, the employer of the deceased healthcare workers, asked the coroner not to make any recommendations on the basis of the cause of death. He also successfully petitioned the coroner to have parts of the expert testimony relating to the authority抯 infection control guidelines and hospital practices deleted from the documents given to the jury.
The verdict was very disappointing and deviated from normal practice, said Dr Kwok Ka-ki, the medical profession抯 representative in Hong Kong抯 legislative council.
"The Hospital Authority barrister requested the coroner not to give a view. The coroner followed , and why he did this puzzles me. I am not very impressed. The coroner set a very bad example by giving a verdict without giving any explanation.
"He should let the public know why . I don抰 know if he was under pressure from the Hospital Authority or the government, but in this case the coroner抯 response was very political."
A spokesperson for the judiciary responded: "The coroner is completely independent in deciding whether to make any recommendations in any case."
However, Neville Sarony, a barrister and expert in medical malpractice lawsuits, criticised the coroner抯 actions. "The decision to exclude certain evidence was short on transparency, and one can抰 escape the feeling that perhaps the coroner had his own agenda. It is customary for the coroner to identify faults and make recommendations to ensure loopholes are closed," he said.
"He obviously didn抰 want to do that so he took an unusual step which had the effect of preventing the jurors from expressing their opinion. I think he did everybody a disservice. It is much better to bring things out and examine them, otherwise it gives the perception that there is a cover up."(Hong Kong Jane Parry)