Offering and acceptance of illegal advantages
A doctor owes an obligation of fidelity to his patients and, at the same time, should demonstrate loyalty to the organisation he is working for. The offering and acceptance of illegal advantages in the course of clinical practice can compromise the doctor's professional judgement, erode patients' trust and impair the interest of his employer. It is thus of great importance that doctors should comply with the legal and the conduct requirements governing corruption.
Scenario 1 | Procurement of medicine
Dr A is a consultant of a private hospital. His assessment of the effectiveness of medicine will have a strong bearing on the final selection of the drug for use in his department which would also mean major business for the supplier. On one occasion, Dr A attended an annual ball hosted by a pharmaceutical company on behalf of the hospital and came to know its CEO, Andy. They then maintained close ties and Andy always treated Dr A by way of lunches and dinners to share the latest information and development of new drugs. Lately, Andy called Dr A for dinner in a private club where he disclosed that his company had successfully developed a new antibiotic and requested for Dr A's assistance in recommending the drug for use in his hospital. Andy even suggested to offer shares of his company to Dr A if he agreed to help. Should Dr A accede to Andy's offer?
In this case, Dr A might violate Section 9 of the Prevention of Bribery Ordinance (POBO) if he accepts an advantage from Andy (in the form of company shares) for recommending the new drug to his department without the permission from the hospital.
Doctors are expected to choose the drug that best serves the medical interests of their patients. Dr A is subject to disciplinary action of the Medical Council of Hong Kong (MCHK) for breaching the Code of Professional Conduct of MCHK (Oct 2022), which prohibits doctors from accepting any inducement from commercial firms within the pharmaceutical and allied industries as such acceptance may compromise, or may be regarded by others as likely to compromise the independent exercise of their professional judgement in matters pertaining to patients' well-being.
Generally speaking, entertainment, which refers to the provision of food or drink for consumption on the occasion when it is provided, and of any other entertainment connected with such provisions, is a form of social behaviour and does not constitute an advantage under the POBO. However, Dr A should not accept frequent or lavish entertainment from Andy as such acceptance of entertainment would impose an obligation on himself to do Andy a favour, bring himself or the hospital into disrepute or lead to conflict of interest.
Dr A should not accept Andy's offer and should report to appropriate authority if corruption is suspected.
Scenario 2 | Rebates from diagnostic laboratories
Shortly after starting his private practice, Dr C was approached by Carlye, the proprietor of a medical laboratory in the same building, who requested for the referral of all his patients to her. Carlye suggested that an arrangement could be made for a sum to be offered to Dr C by the laboratory for each patient referred. She emphasised that it was in no way unfair to the patients since in any case they had to do the tests somewhere and it would be more convenient for his patients to do so at her laboratory. She also said that a number of other doctors in his building had already made similar arrangement with her. Should Dr C accept Carlye's request? Would Dr C commit any offence if he does not refer any patients to Carlye eventually?
Dr C should not accept Carlye's request.
A principal and agent relationship exists between Dr C and his patients. As such, Dr C would breach Section 9 of the Prevention of Bribery Ordinance (POBO) by accepting payments from Carlye for referring his patients to her laboratory if Dr C does not have the permission of his patients.
Even if Dr C and Carlye have not executed the "referral scheme", they would still be liable to prosecution. Under the POBO, both parties can be found guilty of an offence as long as the agreement on solicitation and acceptance of advantages is reached, no matter Dr C has actually referred patients to Carlye or not.
A doctor may refer a patient to any hospital, nursing home, health centre or similar institution, for treatment by himself or other persons only if it is, and is seen to be, in the best interest of the patient. Even if Dr C has received permission from his patients to receive rebates from Carlye for the referral arrangement, he might still violate the Code of Professional Conduct of the Medical Council of Hong Kong (Oct 2022) which prohibits doctors from accepting from any person or organisation (including diagnostic laboratories) any financial or other inducement for referring patients as such acceptance may compromise, or may be regarded by others as likely to compromise, the independent exercise of their professional judgement.
Understand the law and the professional code of conduct
The best solution is to have full understanding of the Prevention of Bribery Ordinance and the conduct requirements on integrity stipulated in the Code of Professional Conduct of the Medical Council of Hong Kong (Oct 2022) to avoid accepting advantages that will lead to loss of objectivity and honesty in the course of clinical practice.
Follow the organisation policy
Whether doctors are employed by the government, the Hospital Authority (HA) or private medical institutions, they should always seek guidance from the organisations concerned in the matter of acceptance of advantages. Public servants should not accept advantages offered to them by virtue of their official position. Gifts offered/presented to public doctors in their official capacity should be dealt with in accordance with respective rules and regulations of the government and the HA. HA employees should not solicit or accept, directly or indirectly, any advantage or gift which would, or might reasonably be seen to, compromise their integrity or judgement or influence the discharge or non-discharge of their duties and responsibilities. As in the private sector, the recipients should clarify with their respective employers whether they can accept advantages from patients or business associates in the discharge of their official duties.
Avoid the "sweetener"
Many ICAC cases reflect that corruption always begins with a "sweetening up" process instead of a direct bribe at the outset. It usually starts with the offering of entertainment which appear not to be related to the recipient's official duties at the time of offer. Hence, the recipient would easily be trapped in an embarrassing or compromising situation when being asked to return a favour later on. Therefore, doctors should not accept entertainment from persons with whom they have official dealings if it is:
Corruption should be reported to the management of the organisations concerned and the ICAC as soon as possible. One may risk being suspected of conspiring to commit corruption if he, even without being involved in the scam, delays blowing the whistle or turns a blind eye to the crime.
Any party may lodge a complaint or make an enquiry with the ICAC through the various channels.