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Dr Wu Hin Ting, Peter Brendan v The Medical Council Of Hong Kong

Judgment Cited authorities 4 Cited in Precedent Map Related
Vincent
Judgment Date20 November 2003
Year2003
Judgement NumberCACV36/2003
Subject MatterCivil Appeal
CourtCourt of Appeal (Hong Kong)
CACV000036/2003 DR WU HIN TING, PETER BRENDAN v. THE MEDICAL COUNCIL OF HONG KONG

CACV000036/2003

CACV36/2003

IN THE HIGH COURT OF THE

HONG KONG SPECIAL ADMINISTRATIVE REGION

COURT OF APPEAL

CIVIL APPEAL NO. 36 OF 2003

(On Appeal from the Order of The Medical Council of
Hong Kong made on 15 January 2003 and dated 17 January 2003
and served on 23 January 2003)

_________________________

BETWEEN
DR WU HIN TING, PETER BRENDAN Appellant
AND
THE MEDICAL COUNCIL OF HONG KONG Respondent

_________________________

Coram: Hon Ma CJHC, Woo VP & Suffiad J in Court

Date of Hearing: 20 November 2003

Date of Decision: 20 November 2003

Date of Handing Down of Reasons for Decision: 12 February 2004

________________________

REASONS FOR DECISION

________________________

Hon Ma CJHC :

Introduction

1. On 15 January 2003, the Appellant (Dr Peter Brendan Wu Hin Ting) was found guilty in disciplinary proceedings by the Medical Council of Hong Kong ("the Medical Council") of the following charges:-

"He, being a registered medical practitioner, disregarded his professional responsibility to treat or care for his patient Madam Wong Shui King or otherwise neglected his professional duty in that in the period between August 1992 and November 1992 he prescribed the patient with medication that contained steroid and,

(a) he failed to inform and to explain to the patient the reason for such medication, its nature and side-effects; and
(b) he failed to keep proper medical record on all the patient's consultations with him and on the prescription of medication that contained steroid.

In relation to the facts alleged, he has been guilty of misconduct in a professional respect."

The charges having been found proved, the Medical Council ordered the Appellant's name to be removed from the General Register for 12 months and that its decision be published in the Hong Kong Government Gazette.

2. It is from that finding of guilt that the Appellant has appealed to this court by a Notice of Appeal dated 20 February 2003. The Notice of Appeal was amended on 17 October 2003 and there was an application to re-amend the day before the hearing of the appeal. I shall return to this application presently.

3. The disciplinary proceedings before the Medical Council arose from the treatment that was given by the Appellant to one Madam Wong Shui King ("Madam Wong") in 1992. She first saw the Appellant on 10 August 1992 complaining of weakness on her right side. In the Appellant's notes of this consultation, reference is made to an incident on 19 June 1992 when Madam Wong suffered weakness of her right leg, loin pain (again on the right side) and nausea. In her testimony to the Medical Council, Madam Wong told of her having been admitted to the Prince of Wales Hospital in late 1991 and over the course of 1992 up to June of that year. She had apparently fainted a number of times. She consulted the Appellant on the recommendation of a friend since the Appellant was a specialist neurophysician and neurosurgeon.

4. That Madam Wong first consulted the Appellant on 10 August 1992 was not in dispute in the disciplinary inquiry. Nor was it in dispute that she told the Appellant of her medical history, showing him an MRI scan. She told him of the lack of movement on the right side. She also mentioned the fact that the doctors at the Prince of Wales Hospital had told her she had a "scar" in the brain. She was examined by the Appellant.

5. What was, however, keenly contested (and this was really the critical issue before the Medical Council) was the medication that Madam Wong says she received from the Appellant. Specifically, according to her, she was prescribed some yellow pentagonal pills. She was told to take these pills three times a day, four each time. Her evidence was also that the Appellant at no stage identified the pills nor informed her of the reason for prescribing them. Nor did he warn her as to the possible side effects of the medication. This part of her evidence was of course crucial to the charge that the Appellant had failed to inform and explain to Madam Wong the reason for the medication, its nature and side effects. It was also relevant to the second charge that the Appellant failed to keep a proper medical record of the prescription of these pills. The Appellant's notes do not refer to the prescription of the yellow pills at all.

6. Madam Wong's evidence was also to the effect that she saw the Appellant fairly regularly, at first weekly, later bi-weekly. This part of her evidence was relevant to the other charge that the Appellant faced, namely, that he had failed to keep proper medical record of Madam Wong's consultations. Here, the Appellant's records only showed that Madam Wong consulted him on three occasions - on 10 August 1992, 19 November 1992 and 30 December 1992.

7. I have already referred to Madam Wong's evidence that initially the dosage of the yellow pills was three times a day, four pills each time. After about a month, according to her, the dosage was reduced by half. No explanation was given as to the reason for this. It appears at a later stage that the dosage may have reverted to the original one.

8. According to Madam Wong, her condition appeared to have improved after first seeing the Appellant. In her examination-in-chief, she said that when she first saw the Appellant she needed a walking stick and someone to accompany her. Later, she dispensed with the walking stick and needed no companion.

9. However, in November 1992, she complained to the Appellant of some pain to her right hip. This complaint was recorded in the Appellant's clinical notes of the consultation on 19 November 1992. X-rays were then taken and also on the 30 December 1992 when there was another consultation. As I have mentioned above, these two consultations (together with the one held on 10 August 1992) were the only ones recorded by the Appellant in his clinical notes.

10. Madam Wong's weight increased over the period from August to November 1992 by about 40 pounds. We have been provided with photographs that show quite dramatically the increase in weight.

11. It was Madam Wong's evidence that she saw the Appellant only up to about February or March 1993. She stopped seeing him because a friend remarked she was very fat and looked bloated. The friend suggested that she consult another doctor. It was not in dispute that in March 1993 she consulted Dr Edmund Woo Kin Wai, a well-known neurologist. She consulted Dr Woo for two reasons: she was too fat and her right hip was causing her considerable pain.

12. When Madam Wong saw Dr Woo, she related to him her medical history and also the fact that she had earlier consulted the Appellant. In his testimony, Dr Woo said he found it striking that she had Cushingnoid features. Characteristics of such features include obesity and a "lemon on a stick" appearance. She says she mentioned to Dr Woo the fact that she had been prescribed yellow pentagonal tablets and described them to him. This part of her evidence was consistent with what Dr Woo said in evidence and also with the evidence with a Madam Sin Yuet Ling (who had accompanied Madam Wong to see Dr Wu). After the reference to the yellow pills, Dr Woo then showed Madam Wong some yellow pentagonal pills that he kept in his surgery. Madam Wong confirmed these pills to be the same as those prescribed by the Appellant.

13. The yellow pentagonal pills were identified as being Dexamethasone, a drug containing steroids. It is this drug that forms the subject matter of the first charge. It was alleged against the Appellant that he had failed to inform or explain to Madam Wong the reason for prescribing Dexamethasone, its nature and side effects. The side effects of Dexamethasone are manifested in the Cushingnoid features earlier described. In Dr Woo's notes, he states, "[Madam Wong] used Dexamethasone - marked Cushingnoid features".

14. I should also mention that on 21 September 1992 and 16 November 1992, Madam Wong consulted a Dr Richard Kay of the Prince of Wales Hospital. Dr Kay's clinical notes record the fact that Madam Wong was seeing a neurosurgeon privately. The notes also revealed the medication that Madam Wong was taking. However, no mention was made of Dexamethasone or yellow pentagonal pills. I shall return to this aspect.

15. In April 1997, Madam Wong commenced personal injury proceedings against the Appellant. Although none of the papers in that action was placed before us (not even the judgment), we were told that Madam Wong was successful in her claim against the Appellant.

16. On 12 June 2001, the Appellant was charged with professional misconduct. I have already set out the charges in paragraph 1 above.

The proceedings before the Medical Council

17. The hearing before the Medical Council lasted 5 days but over a period of some 13 months:- 12 December 2001, 27 March 2002, 29 May 2002, 13 June 2002 and finally 15 January 2003. The disjointed nature of the hearing forms a ground of appeal.

18. At the hearing, the Appellant was represented by leading and junior counsel (Mr Adrian Huggins, SC and Mr K Y Thong). The Medical Council was assisted by a Legal Adviser (Ms Margaret Crabtree). A Legal Officer (Ms Phyllis Wong) presented the case (effectively as the prosecutor) to the Council.

19. The issues for the Medical Council to resolve can simply be stated:-

(1) Had Madam Wong been taking steroids, specifically Dexamethasone?
(2) Did the Appellant prescribe Dexamethasone to Madam Wong or could she have taken it from some other source?
(3) If the Appellant did prescribe Dexamethasone to Madam Wong, did he inform or explain to Madam Wong the reason for prescribing this drug, its nature and side
...

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