Dr Wang I Sing Sandy v. The Medical Council of Hong Kong
Read the full judgment text of CACV 554/2020 on BabelCite. This Court of Appeal judgment was delivered on 25 November 2022.
1. This is the appeal of Dr Wang I Sing Sandy (“the Appellant”) from a decision given on 15 September 2020 (“the Decision”) by the Medical Council of Hong Kong (“the Council”) after a hearing by the Inquiry Panel, in which the Appellant was found guilty of the following charge:
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CACV 554/2020 [2022] HKCA 1772 IN THE HIGH COURT OF THE HONG KONG SPECIAL ADMINISTRATIVE REGION COURT OF APPEAL CIVIL APPEAL NO 554 OF 2020 (ON APPEAL FROM THE DECISION OF THE MEDICAL COUNCIL OF HONG KONG DATED 15 SEPTEMBER 2020) ________________________ BETWEEN
________________________ Before: Hon Yuen, G Lam & Chow JJA in Court Date of Hearing: 11 November 2022 Date of Judgment: 25 November 2022 ________________________ J U D G M E N T ________________________ Hon Yuen JA: 1.This is the appeal of Dr Wang I Sing Sandy (“the Appellant”) from a decision given on 15 September 2020 (“the Decision”) by the Medical Council of Hong Kong (“the Council”) after a hearing by the Inquiry Panel, in which the Appellant was found guilty of the following charge:
2.The Council ordered the Appellant’s name to be removed from the General Register for 6 months, the operation of the removal order to be suspended for 36 months. The Appellant has also appealed against this penalty. Background 3.NuMe Ltd (“NuMe”) was the Appellant’s “partnership company”1. It carried on business as an “aesthetic medical and surgical centre” in Hong Kong. 4.1.On 20 September 2014, NuMe held an event at its Causeway Bay branch to promote two items, one of which was “Restylane”, a dermal filler. Persons invited to the promotion event included one “Jo Wong”. 4.2.It is common ground that the Appellant was present at the time and was aware of the promotion event, and was photographed injecting a patient with the Products. The Blog Article 5.1.On 9 October 2014, the Article was posted by Jo Wong (“the blogger”). The Article comprised of text and photographs which the Council summarised as follows:
5.2.The Article introduced NuMe and Restylane in highly complimentary terms. It set out the effect of Restylane and claimed that it was used by 20 million people worldwide, including the blogger, who has been using it for the past 2 years to improve her facial contour, and her friends. It ended with the address and contact details of NuMe. 5.3.There were 22 photographs including 5 photographs of persons (not the Appellant) speaking through a microphone, and 6 photographs of the Appellant performing a procedure on a patient (not the blogger) with captions (translated) including:
5.4.As the Council found, one photograph showed the Appellant looking directly at the camera whilst holding a syringe5. Complaint 6.In 2018, a complaint was made to the Council against the Appellant. Letters from the Appellant’s solicitors 7.1.In reply to correspondence from the Council, the Appellant’s solicitors sent two letters which were referred to during the inquiry hearing. 7.2.The 1st letter dated 21 June 2019 said (among other things):
After the existence of the Article was made known to the Appellant, she demanded that NuMe write to Ms Wong to request her to delete all identifiable information of the Appellant. Two emails were sent, on 25 April 2018 and 5 June 2018 respectively6. 7.3.The 2nd letter dated 27 December 2019 said (among other things):
Inquiry 8.On 8 May 2020, a Notice of Inquiry was sent to the Appellant. 9.The Appellant did not attend the hearing of the inquiry and no witnesses were called on her behalf. She was represented by counsel Mr Charles Chan. The Undertaking 10.1.The Appellant’s lawyers provided the Council with a document in Chinese dated 1 April 2013 entitled “Undertaking” purportedly signed by a manager of NuMe. It stated (among other things) that while the Appellant is providing services to NuMe, it must comply with the Code of Professional Conduct (“the Code”) of the Council, including a term to the following effect7:
10.2.At the hearing,
The Decision 11.1.To summarize, the Council found:
11.2.In its decision on penalty, when considering the Appellant’s disciplinary record, the Council discussed in more detail a decision dated 13 January 2010 (“the 2010 Decision”), given by a differently-constituted panel, relating to impermissible practice promotion by the Appellant in 2008, which concerned the publication of her name, title, photographs and statements in an advertisement in a magazine, in which she endorsed a similar aesthetic medical product offered by a company by which she was then employed (§26). The Council in the present case found:
Appeal 12.On 14 October 2020, the Appellant lodged a notice of appeal. This was subsequently amended and re-amended. 13.1.On 19 September 2022, the Appellant issued a summons to further re-amend the notice of appeal (“the summons”). The court directed that the summons be heard on the day fixed for the appeal. 13.2.At the hearing, we indicated that we would consider the proposed further re-amendments de bene esse. Legal principles 14.Before discussing the grounds, it would be helpful to restate the applicable legal principles. 15.First, the Appellant accepted that the Council had correctly directed itself on the law on the burden and standard of proof, on the test for misconduct in a professional respect, on the Appellant’s right not to give evidence, and that no adverse inference should be drawn against her in exercising that right. 16.It is also not disputed that on appeal from a professional disciplinary tribunal, the court would correct a decision if there has been an error of law, but if the appeal is against a finding of fact, the approach10 should be the following11:
Discussion Proposed Ground A1 17.1.Mr Anthony Ismail, counsel for the Appellant, first submitted that there was an error of law because at §23 of the Decision, the Council found that the Appellant had fallen below expected standards
when the charge was
17.2.Mr Ismail argued that since the words italicized above had been omitted in §23, and s.26(3) of the Medical Practitioners (Registration and Disciplinary Procedure) Regulation Cap.161E states that “the panel must consider and determine whether the facts alleged in any charge before it have been proved to its satisfaction”, the Council had “convicted and sentenced the Appellant for an offence for which she had not been charged”12, and thus the Council had acted beyond its jurisdiction in finding the Appellant liable. 18.1.With respect, that argument must be rejected. The passages preceding §23 demonstrate that the Council was well aware of the components of the charge (which was set out in §2), as those passages repeatedly referred to the use or appearance of the Appellant’s name, title and/or photographs in the Article promoting the products. 18.2.Thus, in the section on Findings of the Inquiry Panel, §14 starts off with the following focal point:
18.3.Then, in §15, the Council referred to the Appellant’s acceptance of the publication of the Article on the internet on the date in question, and that her name, professional title and photographs appeared, with her being depicted in a white gown and a surgical mask, and providing treatment to a patient. 18.4.In §§18-20, the Council made the finding that the Appellant must have been aware of the photographs being taken of her when she was administering treatment inside the treatment room. In §§21-22, the Council also found the Appellant knew of the promotion event that day, and failed to take adequate steps to ensure that the photographs would not be used for promotion of the products. 18.5.If, as Mr Ismail submitted, the Council had not taken into account the components of the charge relating to the use or appearance of her name, title and/or photographs before convicting her, all those discussions and findings by the Council in the preceding paragraphs would have been irrelevant and superfluous. On the contrary, it is clear from the passages referred to above that the Council was well aware what were the facts alleged in the charge which it had to determine before conviction. The proposed Ground A1 is therefore unmeritorious, and no purpose would be served by allowing its inclusion in a further re-amendment of the Notice of Appeal. Proposed Ground A2 19.1.Second, it was submitted in the proposed Ground A2 that there was no evidence that the Appellant knew or ought to have known:
19.2.Mr Ismail submitted that it was necessary to prove that the Appellant ought to have known that the Product(s) would be promoted through the article published on that particular blog, even if not on that particular day, and that the Council’s findings in §21 that the Appellant knew that NuMe was holding a promotion event that day and that photographs were being taken of her treating a patient would at most entitle the Council to find that she knew of the promotion of the Products “generally”, but that would not be sufficient for conviction. 20.1.This submission that it must be proved that the Appellant ought to have known each of the 4 (or 5) factual allegations (depending on whether the date of publication was an independent factual allegation to be proved) was not advanced before the Panel13, but in any event, this proposed ground is also unmeritorious. 20.2.The relevant part of the Code (which the Council cited in the Decision) states:
20.3.In Dr Lee Yau Wing, where the charge was drafted in a similar way14 to the one in the present case, the Court of Appeal rejected the submission that actual knowledge of the publication of an advertisement was necessary for the doctor to be imposed with the duty to ensure that his professional title was not misquoted in the advertisement of a health education activity. It was open to the Council to form the objective view that the doctor ought to have anticipated some form of promotion15. Mr Ismail did not dispute the correctness of this authority. 20.4.Similarly, in the present case, the issue is whether there were circumstances from which the Appellant ought to have anticipated the possibility of some form of promotion using her name, title and/or photographs. The gravamen of the charge is that the Appellant had failed to take adequate steps to ensure that it/they would not be used in materials for the promotion of the Products. The specific article and the specific blog are just the medium of promotion and, with the actual date on which the article was posted, are simply particulars identifying the promotional materials in the present case. As long as it is found the Appellant ought to have anticipated the possibility of some form of promotion, there is no reason why it would be necessary to prove that she should have known the exact details of the promotional materials. 20.5.That is not to say that the method and time of publication are always irrelevant to the issue whether a doctor is guilty of misconduct by failing to prevent the use of say, photographs. For example, if the promotion of a product was live streamed before a doctor was reasonably aware that he was being filmed, there would be nothing he could reasonably have done to prevent such a publication. In contrast with a live stream, the longer the period before publication, the more time in which a doctor could make relevant inquiries and consequently take adequate steps to prevent his name, title and/or photographs from being used in connection with promotion of the products. 20.6.In any event, as to the Appellant’s submission that there was no evidence from which it could be inferred that she ought to have known that her name, title and/or photographs may be used in materials promoting the Products, it was open to the Council to rely on the following evidence of the circumstances which gave rise to the duty in §6.2 of the Code:
20.7.As the proposed Ground A2 is premised upon there being no evidence, it is not necessary to comment on the weight of the evidence listed above, which in any event is a matter for the fact-finding tribunal. 21.As the proposed Ground A2 is also unmeritorious, no purpose would be served by allowing its inclusion in a further re-amendment of the Notice of Appeal. Ground 1 22.This ground deals with the adequacy of the Undertaking as a means to prevent the use or appearance of the Appellant’s name, title and/or photographs in the Article. Apart from discussing the submission on the adequacy of the Undertaking16, the Council was also aware of Mr Chan’s submission on its connection with the 2010 Decision17. 23.1.The relevant part of the Undertaking has been set out in §10.1 above. It would be noted immediately that it was given only by NuMe, whereas the Article was published by the blogger. 23.2.There was no evidence that the Appellant had mistakenly thought that the blogger was a member of NuMe’s staff. 23.3.And yet, even though the Appellant
she took no steps to ascertain the identity of the person and the purpose behind that person’s
and to inform that person that her professional body did not permit photographs taken of her to be used in any materials promoting commercial products. 23.4.Had the Appellant done so, the blogger may have agreed to e.g. pixelate the photographs sufficiently to anonymize her image. But it is hypothetical now to surmise what would have happened, because the Appellant failed to take any such steps. 23.5.Nor was there evidence from the Appellant that she had delegated those steps to NuMe staff. In any event, appellate authorities have long established that even if a doctor had delegated such a task and it was the delegate who had failed to perform it, the responsibility for the failure, so far as the medical authorities are concerned, must lie with the doctor19. Mr Ismail did not dispute the correctness of those authorities. 23.6.In light of the undisputed facts in §§23.1-3 above, it was open to the Council to hold that the Appellant should have taken proactive steps to ensure that the photographs would not be used for promotional purposes20, and to find that it was inadequate21 to “rely solely on what she claimed to be the [Undertaking]. Nor could the [Appellant] safely assume that photographs taken of her whilst administering injections to a female patient would not be disclosed to third parties and let alone not to be used for promotional purposes”22. (Emphasis added). 24.1.As for Mr Ismail’s submission regarding the 2010 Decision, he first said from the Bar table that the Undertaking came into being as a result of the 2010 Decision. That statement is not acceptable, as there was no evidence as to how the Undertaking came about. Before the Council, the Appellant’s counsel Mr Chan had accepted that as he would not be calling the maker of the Undertaking, it would be up to the Council to place what, if any, weight on it23. 24.2.Mr Ismail then submitted that the Council should have found that the Undertaking was adequate as it was reasonable for the Appellant to follow the “advice” or “suggestion” of the Council in the 2010 case to procure a written undertaking from her employer. 25.1.As the Council noted, each case turns on its own facts. The crucial point is that in the 2010 case, the Appellant said it was her employer who had asked her to write an article, which the employer then used in an advertisement. Thus, at all times, it was a purely bilateral transaction, with no third party involvement. 25.2.Accordingly, the Council’s view24 in the 2010 Decision as to how the Appellant should have regulated her relationship with her employer cannot be pertinent to the issue in the present case whether she had taken adequate steps to prevent the use of her name, title and/or photographs in an article published by a third party (the blogger). As noted above, the blogger was not a staff member of NuMe, so the Undertaking would not apply. 26.This ground should therefore be rejected. Ground 2 27.Although Mr Ismail did not abandon this ground, he rightly did not attempt to develop it in written or oral submissions. 28.1.The ground comprises a number of matters, some of which did not advance the Appellant’s case, and some of which were not supported by evidence or was evidence which the Council was entitled to give little to no weight. 28.2.For example, the ground referred to the Appellant’s solicitors’ 1st letter alleging that for every activity involving a third party engaged by NuMe to promote its business, it would sign a contract with the third party containing a confidentiality clause. No such letter was produced before the Council. 28.3.Another example is the allegation in the Appellant’s solicitors’ 2nd letter that the Article was published by the blogger without NuMe’s knowledge or consent. No one from NuMe was called to verify that allegation. 28.4.Yet another example is the allegation that the Appellant took immediate steps to ensure the removal of the Article upon discovering it. The Appellant did not give evidence as to when and how she discovered the Article. 29.Accordingly, there is nothing in this ground, and it should be rejected. Ground 2A 30.It was submitted in this ground that an ordinary and reasonable person reading the Article would understand it to be merely an account of the blogger’s own experience and opinion, and not as a promotion or endorsement of the Products, or at most, only a promotion of NuMe. 31.This ground can be disposed of briefly. Having read the Article, it is clear that there was evidence on which it was open to the Council, as the fact-finding tribunal, to find that the Article did not merely recount the blogger’s personal experiences and private observations as an independent party. On the contrary, the Article was couched in language that would suggest to an ordinary reader that it was promoting Restylane (the efficacy and popularity of which were expressed in highly complimentary terms), informing him/her that treatment with this product was available at NuMe, which was recommended for the spaciousness of its premises and other features. Ground 3 32.This deals with the penalty. It is well-established case law that the court would only interfere if the penalty was outside the reasonable ambit of sanctions that the Council could impose, or in other words, plainly wrong25. 33.Mr Ismail relied on (1) the penalty in this case being heavier than that in the 2010 Decision and (2) the Appellant having obtained the Undertaking from NuMe. 34.The Council was clearly aware of both points and dealt with them in §§26 and 28 respectively. In my view, the high threshold required to merit this court’s interference with a penalty ordered by a professional tribunal has not been met. This ground should therefore also be rejected. Order 35.For the above reasons, the summons and this appeal should be dismissed and, as the parties have agreed that costs should follow the event, the Appellant should pay the Respondent’s costs of the summons and the appeal, to be taxed if not agreed. Hon G Lam JA: 36.I agree with the judgment of Yuen JA. Hon Chow JA: 37.I agree with the judgment of Yuen JA.
Mr Anthony Ismail, instructed by Howse Williams, for the appellant Ms Sanyi Shum, Senior Government Counsel, of the Department of Justice, for the respondent [1] As per the Appellant’s solicitors’ letter dated 21 June 2019. [2] As indicated in the Article, AB/25. [3] AB/23, 30. [4] AB/24, 30. [5] AB/29. [6] It was an agreed fact at the Inquiry that the Article was removed from the internet after April 2018 and is now no longer available. [7] No translation was provided to the Council or this court. [8] Transcript, p.61. [9] Transcript, p.69. [10] Applicable to the present case where no witnesses gave oral evidence. [11] Adopted from Dr Lee Yau Wing v The Medical Council of Hong Kong [2022] HKCA 801, §20. [12] Proposed Ground A1. [13] See Mr Chan’s submission on the 4 elements to be proved: Transcript, pp.64-5. [14] §2. [15] §§25-28. [16] Decision, §22. [17] Decision, §28. [18] See the Appellant’s solicitors’ 1st letter. [19] Wong Kai Fou v The Medical Council of Hong Kong [1967] HKLR 620, 643, and Keeson Shum v The Medical Council of Hong Kong CACV73/1980, 19 December 1980, p.4. [20] Decision, §21. [21] (Which is a matter of judgment). [22] Decision, §22. [23] Transcript, p.69. [24] This was obiter anyway, as the Council rejected her evidence that she did not know the purpose of the article was for an advertisement. [25] Dr Wong Cheuk Yi v The Medical Council of Hong Kong [2019] HKCA 1332, §§44-51. |