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COVER STORY 封面專題 |
The authors discuss the legal position of people affected by the SARS outbreak
Introduction
Worldwide, Severe Acute Respiratory Syndrome (SARS) has claimed some 800 lives and infected around 9,000 persons. For Hong Kong, it is likely the most significant medical disaster in its modern history. The consequences of the SARS crisis are serious and far reaching. The families of those who have died have been badly affected. Those who have recovered may suffer long-term side effects. Many patients, health workers and their families are in danger of developing post-traumatic stress disorders (PTSD) and other psychiatric illnesses. The SARS tragedy also affected many businesses in Hong Kong. The Government has already announced that Hong Kong’s growth rate is set to fall from 3% to 1.5%. Airlines, hotels, travel agents, cinema operators, restaurants, retailers and others have suffered considerable financial losses. Some are on the verge of going out of business.
It is thus likely that, over the coming months, persons in Hong Kong affected by the outbreak of SARS will be considering their respective legal positions and what, if any, options they may have to take legal action – or to defend themselves in any legal action. Such persons include: SARS patients; families of persons affected or killed by SARS; medical and other staff in hospitals and in the medical profession generally; public health managers and a range of Government officials and civil servants.
This article considers a number of possible private law consequences of the onset of SARS in Hong Kong. We are particularly interested in how these issues might be addressed within Hong Kong in accordance with relevant tort law and related regimes applying in the HKSAR.
SARS also raises some very important public law issues including the rights of a Government to manage dangerous communicable diseases through quarantine and enforced treatment regimes. We do not deal with these here, although a number of these concerns were recently discussed in: M Davis and C Kumar, ‘The Scars of SARS – Balancing Human Rights and Public Health Concerns’, Hong Kong Lawyer (May 2003).
This article focuses on: certain general principles of liability; the potential general law liability of public health administrative authorities; the potential liability of hospitals (public and private); and the potential liability of medical and related staff. The discussion is mainly concerned with liability in tort, but liability in contract (for employees, for example) is also mentioned. The SARS crisis has raised a range of unusual issues. Some of the views expressed are, for this reason, preliminary.
In view of space limitations we do not discuss: occupier’s liability issues; liability for causing psychiatric illness; pure economic loss arising from the SARS crisis (by, for example, airlines, hotels, travel agents and retailers); and any possible liability arising out of breach of statutory duties (rather than general law duties) owed by the central public health administration in Hong Kong, including the Hospital Authority and the Department of Health. Finally, we do not consider any possible liability in Hong Kong of the World Health Organisation (WHO) with respect to the handling of the SARS crisis.
Briefly, potential plaintiffs who suffered no physical harm but who suffered what is known as ‘pure economic loss’ face the highest level of difficulty in launching any sort of SARS-based legal action. Thus, airlines, hotels, travel agents, restaurants, retailers and so on, who saw their businesses very badly hit, are not well placed to argue a case in negligence in relation to the SARS outbreak. The general law applying to pure economic losses cases in Hong Kong is not ‘plaintiff-friendly’.
SARS arrived in Hong Kong in late February 2003 from Guangdong Province, Mainland China. SARS (also known as Atypical Pneumonia) has since resulted in close to 2000 people being hospitalised in Hong Kong and nearly 300 deaths. On the Mainland the figures are worse.
SARS, unlike most strains of Influenza, has an intrinsic capacity to kill. It is also an entirely new disease for humans so no one enjoyed natural immunity once it began spreading. This fact, combined with mass air travel resulted in serious SARS outbreaks occurring in several East Asian jurisdictions and Canada almost simultaneously.
In tort law we are used to dealing with a single discreet occurrence or instance of negligence within a given time frame. Imagine if we were able to study six drivers (all driving similar vehicles) in six different jurisdictions all of whom were confronted with a similar, sudden hazard whilst travelling on similar quality roads with much the same visibility applying – and all within much the same time frame. In such a situation, assuming that some drivers handled the challenge better than others, we would expect that the comparative facts might have some impact on the assessment of any negligence alleged. This is the sort of comparative opportunity offered by the unfolding of the SARS crisis worldwide. It is conceivable, therefore, that, if or when SARS litigation proceeds, plaintiffs may make certain comparative points to strengthen their cases. Based on the comparative information currently available on the way the SARS crisis has been managed, the HKSAR appears to rank very well in terms of the performance of its frontline medical and related staff. With respect to the central management of the crisis, however, the public health authorities and the Hong Kong Government do not score particularly well compared to other developed (and even some lessdeveloped) jurisdictions.
We begin this article by setting out a chronology of the unfolding of the SARS crisis. The timeliness of decision-making is an important issue to consider when examining the possibility of any legal action arising from the SARS crisis. This register of events predominantly addresses the Hong Kong situation but references are made to relevant occurrences in other jurisdictions. Next, we make some brief comparative observations and then we consider potential liability issues.
Extensive sources (all publicly available) underpin the chronology, the comparative survey and the legal discussion following. The sources include case law, secondary legal commentaries, public reports and numerous newspaper and journal reports. Full documentation of the relevant sources is available from the authors (in particular, DK Srivastava and AD Tennekone, The Law of Tort in Hong Kong, Butterworths Asia, 1995).
A Chronology of the SARS Crisis
This chronology is not comprehensive. It documents a selection of significant events relevant to the discussion that follows. The incidents of most relevance to this article had taken place by early May 2003. The chronology thus concludes at this point.
October-November 2002
The WHO receives reports that there may have been a mass slaughter of poultry in Fujian Province in China. This arouses concerns that the socalled ‘bird flu’ may have jumped from chicken to man once again. There were also reports of a new, virulent flu-like illness in three cities in southern Guangdong Province, including Heyuan.
December, 2002-January, 2003
Huang Xingchu, a chef in Heyuan County in Guangdong who specializes in preparing exotic (non-farm) animals for human consumption, is admitted to Heyuan Municipal People’s Hospital with a respiratory illness. The illness cannot be diagnosed. Huang is subsequently admitted to hospital in Guangzhou. In January 2003 it is reported that Huang infects Professor Liu Jianlun, an expert in respiratory illnesses, with the same disease (which later comes to be known as SARS). Huang recovers. Subsequent research suggests that the SARS virus may have originated in wild cat-like animals. These animals are a regular item on the menus of restaurants in southern Guangdong that specialise in serving meat from exotic or wild species. On 12 December 2002, in response to a question about a new bird flu arising in Guangdong, a representative of Hong Kong's Health, Welfare and Food Bureau says that ‘the Hong Kong Government is in close liaison with Mainland authorities’. On 3 January 2003, the Yang Cheng Evening News reports the disease outbreak in Heyuan. On 17 January 2003, the New Express Daily in Guangzhou reports an outbreak in Zhongshan.
February 10-15, 2003
On 10 February 2003, Guangdong authorities make a public announcement about the new disease which is reported around the World including through the WHO. On 11 February 2003, a taskforce to watch for any outbreak of ‘community acquired pneumonia’ is established in Hong Kong. Professor Liu begins to show symptoms of the disease on 15 February 2003.
February 20, 2003
Professor Liu travels by bus to the HKSAR and books into the Metropole Hotel in Ho Man Tin. He plans to attend a family wedding in Hong Kong. While staying at the Metropole, Professor Liu infects at least seven other persons with SARS. One victim is later admitted to the Prince of Wales Hospital (PWH) in Shatin. Another is admitted to St Paul’s Hospital in Causeway Bay. The remaining persons take SARS to Canada, Singapore and Vietnam.
February 22, 2003
Professor Liu (Patient Zero) is admitted to Kwong Wah Hospital in Mong Kok. He is much too ill to attend the family wedding. Professor Liu warns staff at Kwong Wah hospital of the virulence of the disease afflicting him when he is admitted. The hospital takes significant precautions because of this warning.
February 22, 2003
Kwong Wah Hospital reports the very serious case involving Professor Liu to the Department of Health and the Hospital Authority. The Department of Health investigates the case on the same day but does not issue a public alert until two weeks later.
March 4, 2003
Professor Liu dies in Kwong Wah Hospital.
March 5-7, 2003
A local Hong Kong man (Patient One) who visited the Metropole Hotel on 21 and 22 February, whilst Professor Liu was staying there, is admitted to the PWH. On 7 March, the Hong Kong taskforce on ‘community acquired pneumonia’ advises the HKSAR Government that it is dealing with an unusual virus.
March 8-11, 2003
On 8 March, a PWH medical staff member comes down with the disease. On 11 March two more members of the PWH medical staff fall ill with SARS. On the same day the PWH issues a general warning to its staff to be careful but does not distribute special masks or take other special measures. Also, on the same day, the Department of Health makes its first statement about the virus – two weeks after considering the initial report of this dangerous disease from the Kwong Wah Hospital. In addition, on 12 March, Professor Chung Sheung Chee, Dean of the Faculty of Medicine at the University of Hong Kong, advises the Public Health Administration in Hong Kong that the PWH should be closed. His advice is not followed.
March 12-13, 2003
The WHO uses the term ‘severe acute respiratory syndrome’ (coined by WHO specialist Dr Carlo Urbani who treated the first SARS patient in Vietnam) and announces that Hong Kong has an outbreak of SARS. On 12 March the HKSAR Secretary for Health, Welfare and Food, Dr Yeoh Eng Kiong, denies there is such an outbreak.
March 14-27, 2003
On 14 March, the PWH distributes masks to its staff. On the same day, a man who normally resides in Shenzhen but is under treatment for chronic renal illness at the PWH develops symptoms of SARS (Patient Two). He pays a visit on 14 March to his brother who resides in Block E, Amoy Gardens, Ngau Tau Kok. On 15 March, Patient Two is admitted to the PWH as a suspected SARS patient. He is treated for influenza, however, and is discharged on 19 March. He visits his brother once more at Amoy Gardens on 19 March. Patient Two is admitted a second time to the PWH very shortly afterwards. On 21 March, William Ho Shiu Wei, the Chief Executive of the Hospital Authority, warns the HKSAR Administration that SARS had spread into the community. He advises the authorities to take swift action to prevent further infections. Patient Two is finally diagnosed with SARS at the PWH on 22 March. By this time, more than 100 medical and non-medical staff at the PWH are affected by SARS. Two weeks after the outbreak, the PWH bans visitors to wards. On 26 March, the outbreak at Amoy Gardens begins. Within three weeks over 300 people have been infected by SARS in Amoy Gardens. On 27 March, the University of Hong Kong announces SARS is caused by a coronavirus.
April-May, 2003
A fake news report on the impact of SARS causes mild panic in the HKSAR on 1 April. The next day the WHO advises travellers to stay away from Hong Kong. Schools and Universities are shut down for a minimum of two weeks. Thirty residents of Lower Ngau Tau Kok public housing estate (close to Amoy Gardens) are diagnosed with SARS. Counter-productive SARS-related competition between the Medical Faculties at the University of Hong Kong and the Chinese University of Hong Kong is reported. It is revealed that the Baptist Hospital (a private hospital) concealed information concerning a SARS outbreak in the hospital – which began on 27 April – until 6 May.
A Comparative Stocktaking
SARS in Hong Kong
Precise comparative figures on the infection rates of medical and other staff and patients at different hospitals in Hong Kong are not readily available. That said, it does seem clear that the infection rate at the PWH has been very high (more than 150 staff, family members, patients and visitors) whilst the Kwong Wah Hospital, where Patient Zero was admitted, has escaped any serious SARS outbreak. Moreover, the PWH is closely connected with the most serious residential area outbreaks at Ngau Tau Kok where several hundred infections were recorded within a few weeks.
SARS Offshore
The most serious SARS outbreaks, apart from Hong Kong, have occurred in: Mainland China, Taiwan, Canada, Singapore and Vietnam. There is not space in this article to review the detail of outbreaks in these other key jurisdictions but some brief points can usefully be made.
Mainland China
Until 20 April 2003, the approach to SARS in Mainland China was a mixture of inexcusable cover-up and denial. The outcome was a far worse spread of SARS, especially in Beijing, than should ever have occurred. The dropping of this shameful policy was signalled by the sacking of certain senior officials, invitations to the WHO to investigate the position in China and the launching of an all-out ‘War on SARS’. It seems hospitals in Beijing, especially, have aggravated the outbreak due to seriously deficient isolation procedures.
Taiwan
Initially, the outbreak of SARS in Taiwan seemed to be reasonably under control compared to other hard hit jurisdictions. Despite this, the island had, by late May, become the worst hit SARS zone after Mainland China and Hong Kong. Poor coordination in public health management, some bickering amongst officials and non-reporting of cases by some hospitals all seem to have contributed to the amplification of the crisis in Taiwan.
Canada
The worst affected city in Canada has been Toronto, Ontario. What is rather interesting is the way Vancouver, British Columbia dealt with the SARS threat when compared to Toronto (and, indeed, when compared to Hong Kong).
Although Vancouver and Toronto encountered their first SARS patients at almost the same time (with each city initially unaware of what was happening in the other), Vancouver confined its SARS outbreak most effectively by taking immediate action when the first SARS patient was admitted on 13 March 2003. This patient was immediately isolated and maximum staff protective measures were taken. On 20 February 2003, well before the first patient emerged, the Centre for Disease Control in British Columbia essentially issued a ‘red alert’ to the entire health system of British Columbia to be on the look out for any unusual influenza-type illness. This decision was taken based on the information supplied by the WHO (and Guangdong Province) up until that time, which information was available worldwide, including in Hong Kong. In British Columbia there have only been a handful of SARS cases, no healthcare worker infections and no secondary infections.
On 7 March 2003, the very first Canadian SARS patient was admitted to the Scarborough Grace Hospital in Toronto. It is believed that the infection of this patient (and the first Vancouver patient) can be traced directly back to the Metropole Hotel in Hong Kong. Unlike the case in British Columbia, no special warning had been sent out to the health care system in Ontario. No special precautions were taken with the patient. By late June 2003, Toronto had recorded over 350 SARS infections and more than 30 deaths. Like Hong Kong, Toronto saw the virus spread principally through the hospital system.
Singapore
Singapore’s SARS crisis can be traced back to three tourists who returned to the ‘Lion City’ after staying in the Metropole Hotel in Hong Kong in late February 2003. They were all admitted to hospital in Singapore between 1 March and 3 March 2003 (prior to Patient One being admitted to the PWH in Hong Kong on 5 March).
By late June 2003 Singapore had just over 200 recorded SARS infections. By this time, Hong Kong had just over 1700 infections. That is, Hong Kong had more than 8 times the infection rate of Singapore. At the end of March 2003, the comparable figures were 90 infections in Singapore and some 500 infections in Hong Kong or around 5.5 times the rate of infection in Hong Kong. A week earlier the comparative infection rates were approximately 165 in Hong Kong and 50 in Singapore or around 3.3 times the infection rate in Hong Kong.
The timing of the onset of SARS in Singapore was almost identical with the timing of its onset in Hong Kong. All the relevant ‘index patients’ almost certainly caught the disease at or about the same time from Professor Liu at the Metropole Hotel in Hong Kong.
The rapidly rising infection rate in Hong Kong compared to Singapore is likely due to a range of factors. One of these is very probably the swifter and more effective moves in Singapore to institute significant control measures to slow the spread of the disease. Quarantining, for example, was announced in Singapore on 24 March 2003. In Hong Kong it was announced on 10 April 2003.
The WHO subsequently described Singapore’s handling of the SARS outbreak as ‘exemplary’.
Vietnam
A Chinese-American businessman who had also stayed at the Metropole Hotel in Hong Kong in late February 2003 flew to Hanoi and was admitted to hospital there with SARS-like symptoms (Patient Five). A SARS epidemic – once again mainly hospital-based – began in Vietnam. Infections spread, but despite Vietnam being one of the poorest countries in East Asia, SARS was brought under control more swiftly than in any other declared, SARS affected area. On 28 April 2003, the WHO declared Vietnam to be SARS free. Total infections ran to 63 and total deaths 5, by late June 2003.
A significant factor in the comparatively successful management of the disease in Vietnam appears to have been the established presence of a number of WHO specialists in the country including Dr Carlo Urbani. Expert advice was at hand on how best to manage the new disease and it appears to have been followed.
Summary
The short comparative review above suggests the following. First, timely initial preventative measures appear to have spared Vancouver from what could have been a serious SARS outbreak. It follows from this (and less positive examples) that it is vital that hospitals treating any patients with SARS-like symptoms take the strictest possible protective and isolation measures from the outset. Third, once SARS is abroad, comparatively rapid containment is possible where public health authorities have a clear action plan to follow and implement it quickly and firmly. Fourth, proactive, focussed, respected leadership and strong teamwork will assist significantly in achieving optimal outcomes.
On the other hand, a heavy price is likely to be paid when the decision making delays common in ‘normal’ times are tolerated. Similarly, lack of clear, consistent and above all timely overall direction in the management of public health presents SARS with a prime opportunity to flourish. Without question, most damaging of all is any suppression of SARS related information whether by Government, hospitals or anyone else.
The SARS Crisis and Private Law Liability
General Principles of Liability in Negligence
The law of negligence pervades all forms of human activity and has assumed increasing importance in regulating actions that affect others, endanger lives or interfere with safety. Treatment of diseases, especially through the use of new drugs and medicines, has created new opportunities for ‘mischief’ and new situations for liability. Arguably, some hospitals did not show adequate care in treating SARS patients. There are also accusations that one hospital did not disclose to other patients that it was treating SARS patients. It has been alleged that that hospital’s executives suspected that several patients had SARS, but did not inform the Department of Health or other patients who stayed in the same ward.
The modern law of tort was enunciated in the landmark case of Donoghue v Stevenson [1932] AC 562. In that case, Lord Atkin said that one must take reasonable care to avoid acts or omissions, which one can reasonably foresee would be likely to result in injury to those who are so closely and directly affected by such actions that one ought reasonably to bear this in mind. However, there is no liability, as Judge Cardozo said, ‘in an indeterminate amount for an indeterminate time to an indeterminate class’ (Ultramares Corp v Touche (1931) 174 NE 441). The purpose of such a limitation is to avoid the proliferation of plaintiffs for policy reasons. In order to succeed in a case concerning medical negligence (as in other cases), the plaintiff must establish a duty of care, breach of that duty and foreseeable injury or damage arising out of such breach. However, the mere satisfaction of these elements does not automatically result in success for a plaintiff.
Lord Atkin’s dictum in Donoghue’s case laid down what is known as the ‘neighbour principle’, which is now encapsulated in three elements: foreseeability of harm; proximity; and fairness, justice and reasonableness. Foreseeability implies that the plaintiff must prove that he belongs to a class, which is likely to be affected by a negligent act or omission of the defendant. This will not be difficult to establish where negligent treatment by a doctor treating a patient causes injury or damage to the latter. In addition to foreseeability, the plaintiff is required to establish proximity. This is sufficiently established by the very existence of a doctor-patient relationship. Chung K Leung and Chung Kwok Keung Administrators of the estate of Lau Siu Chun deceased v Attorney General of Hong Kong & another [1991] HKLR 338, raised the question of liability of the Government for the death of a patient in a hospital, which was financially aided by the Government. At issue was whether the Government was liable. The court held that there was no proximity of relationship between the Government and the patient as it had no control over the hiring and firing of hospital staff; the deceased's close relationship was only with the hospital which owed a common law duty of care to her.
Liability of Actors within Hong Kong’s Public Health Management System
The SARS crisis raises the issue of the liability of the Government (and its departments and officers) in SARS related cases. The Government of the HKSAR was spearheading the treatment and rehabilitation measures arising out of the SARS crisis, even though the hospitals were providing the actual treatment. Any non-observance of duty by the Government (or its department or officers) by failing to ensure the taking of sufficient precautions within hospitals to control the spread of SARS may amount to negligence. If negligence were established, it would not be unfair, unjust or unreasonable to impose liability on the Government.
However, liability in negligence can be denied on grounds of policy. The courts have refused to impose liability under certain circumstances on the police, the Hong Kong Futures Exchange, and among others, the Director of Legal Aid and the Commissioner of Deposit-taking Companies. In each of these cases, public policy considerations were held to prevent any liability being imposed upon government, semigovernment or public authorities.
It may be possible to differentiate cases arising out of the SARS crisis and thus to argue that the Government (through its departments and officers) could be liable for compensatory damages to certain SARS victims. Public health is a major issue for every government. There is a significant risk of death and prolonged suffering if a government gets public health policy seriously wrong. Moreover, in the case of SARS, there is the unique circumstance, noted earlier, of simultaneous outbreaks in multiple, comparative jurisdictions. This leaves open the argument that the authorities in Hong Kong demonstrated some level of (directly) comparable negligence. This, combined with the argument that the Government (through its officials and departments) may have failed to take all reasonable necessary precautions for the protection of the SARS victims could suffice to impose liability in certain cases.
Liability of Hospitals and Medical and Other Staff in Hospitals
The hospital-patient relationship creates a duty of due care on the part of a hospital or a hospital administration. Doctors and surgeons are not expected to perform miracles or guarantee a cure. The standard of care demanded of hospitals and medical and other staff is a reasonable professional standard. There will be breach of this duty if the hospital (or its staff): (i) omit to do something which a reasonable hospital administration (or its staff), guided by considerations which ordinarily regulate the conduct of hospital and patient, would do, or; (ii) do something which a prudent and reasonable hospital administration (or its staff) would not do (see Blyth v Birmingham Waterworks Co (1856) 11 Exch 781, 784).
A doctor does not need the courage of Achilles or the wisdom of Ulysses or the strength of Hercules nor the prophetic vision of a clairvoyant (Winfield & Jolowicz on Tort (13th Ed, 1990), pp 46-47). He or she is not required to be a perfect doctor but is required to exhibit the degree of skill and competence usually associated with the efficient discharge of their medical work. If he or she professes to be, for example, a surgeon or a physician, then the law requires that person to show such skill as any ordinary member of his or her profession or calling would display. Further, medical staff by the very nature of their work must have sufficient leeway to use their discretion as to what method to apply and what treatment to prescribe. In the case of SARS, factors such as a high infection rate and uncertainty over transmission modes should be taken into account in determining liability. A doctor or surgeon cannot normally be found liable for choosing one method over the other. They cannot even be liable for not following a practice that commands universal acceptance. What a doctor or surgeon has to prove when confronted with legal action is that he or she acted to the best of his or her knowledge or ability and that any reasonable doctor or surgeon could have given similar treatment to the patient.
Nor can a doctor or surgeon be liable for a mere error of judgment. The court also takes into account whether a doctor was acting in an emergency or in a normal situation. The standard is an objective one. It is the standard of a hypothetical reasonable doctor or surgeon. A doctor or surgeon cannot be described as negligent because, in the initial stages of the SARS outbreak, they were looking for an influenza virus rather than coronavirus (later found to cause SARS).
Precautions that may have been sufficient to care for patients a decade ago may be regarded as obsolete today. Although we cannot anticipate what calamity might happen with an unknown infectious disease, given the prevalence of infectious diseases around the world (and the known capacity of viruses to mutate) a hospital and its medical staff should always take extra precautions where there is a suspicion of any serious infectious disease. Health services representative Michael Mak Kwok Fung said that it was unacceptable to just use plastic curtains to segregate SARS patients.
A hospital administration and medical or other staff members would have discharged their duty where they have taken reasonable precautions, such as those taken by other hospitals or medical staff in a similar situation. However, if the common practice were known to be fraught with inherent failure, adopting that practice would not be a reasonable thing to do. The Director of Health, Margaret Chan Fung Fu Chun, publicly admonished a hospital for its slow response to its own SARS outbreak which led to several people being infected.
‘The standard of reasonable care is measured by what is ordinarily to be done rather than what is ordinarily done’ (Fleming, The Law of Tort (8th ed 1992) 120; see also, Edward Wong Finance Co Ltd v Johnson Stokes & Masters [1984] 1 AC 296). Once it became known that certain precautions were necessary to prevent the spread of SARS, failure to take such precautions on the part of a hospital could expose it to liability. For example, it is now more clear than ever that hospitals must ensure ventilation facilities are in good condition, air filters are cleaned on a regular basis, windows in airconditioned rooms are periodically opened to ensure good ventilation, common-use equipment is regularly cleaned, and isolation procedures for patients are followed. Moreover, doctors need to be ready to change their common treatment for SARS patients and, for example, prescribe anti-HIV drugs in combination with Ribavirin if this combination is considered to be more effective than the Ribavirin and steroids combination.
In might be helpful to consider a particular, documented case. A lawyer by the name of Frankie Chu Hei Tak caught SARS on a Hong Kong to Beijing flight on 15 March 2003, after which he was admitted to Tseung Kwan O Hospital. His widow claims her husband was displaying all the symptoms of SARS but was only given anti-viral, steroid combination treatment belatedly. Her husband did not receive the drugs Ribavirin and Methylpredisolone until his sixth day in the hospital. The hospital, however, said ‘Mr Chu was initially treated as a suspected SARS case and treated with antibiotics as was the practice at that time’. ‘When his condition did not improve he was given the combination of steroid therapy.’ One question that this case raises is whether a reasonable doctor would have started the SARS antiviral- steroid treatment immediately after the admission of the lawyer to hospital or at least commenced it some days earlier, given that the antibiotic treatment had not been effective in improving his condition.
Causation
Another legal difficulty facing any SARS victim seeking compensation is that the victim has to establish that, but for the negligence of the defendant, the plaintiff’s injury or damage would not have occurred. For example, where a SARS patient would have died anyway, whether the right medical treatment was given or not, his or her death could not be blamed on a doctor or a hospital. Further, even if it is established that a defendant caused a SARS victim’s death or suffering, he or she could only recover such damages as are foreseeable. If a reasonable doctor could not foresee death or serious health risks because SARS was an unpredictable and indecipherable new kind of virus, it may be difficult to hold certain defendants liable for death or serious health consequences suffered by a would-be plaintiff.
Doctor Wing Yun Kwok of the psychiatry department of Chinese University and Dr Lee Mei Ying of the University of Hong Kong warn that SARS patients and their family are in danger of developing PTSD. However, it is questionable whether a court would award damages for subsequent medical problems of a SARS patient after his or her initial treatment had resulted in a prima facie recovery.
Vicarious Liability of the Hospital Authority and Hospitals
Under the principle of vicarious liability, the Hospital Authority managing public hospitals is liable for any injury or damage caused by their hospital employees in the course of their employment (see, sch 1-2 of the Hospital Authority Ordinance (Cap 113)). Hospitals (both public and private) are also vicariously liable for injury or damage caused to their patients by their employees. In this respect there is no difference between a Health Authority hospital and a private hospital. The underlying basis of this liability is summed up in the maxim: qui facit per alium facit per se (one who does a thing through another, does it himself). Hospitals as employers have vicarious liability towards any patient for negligent or intentional wrongdoing by their staff.
The liability of hospitals is strict in that they are liable without any fault on their part, and even if they have no control over the employees' mode of performance of his or her work. Hospitals are thus liable for the negligence of medical officers, nurses, radiographers, consultants, and anaesthetists, for example. The liability of the Hospital Authority – and hospitals – may also extend to part-time staff. However, the Hospital Authority and hospitals are not liable for the wrongs of a visiting physician or visiting surgeon or consultant chosen and employed by the patient (Ellis v Wallsend District Hospital [1990] 2 Med LR 103). Even here, however, if some of the services (for example, nursing services) are provided by the hospital staff and the provider is negligent, the hospital is still liable.
A hospital’s duty of care to its patients not only raises issues of vicarious liability, but more importantly, it is treated as an instance of primary duty. It is considered to be a non-delegable duty. A hospital cannot avoid liability by demonstrating that it has delegated the task to someone else. Thus, it is immaterial whether a medical staff member is under a contract of service (employee) or under a contract for services (independent contractor). In each case, the hospital is primarily and directly liable. Support for this view can be found in the following the statement by Brown-Wilkinson VC in Wilsher v Essex Area Health Authority [1987] 2 WLR 425:
A health authority which so conducts its hospital that it fails to provide doctors of sufficient skill or experience to give the treatment offered at the hospital may be directly liable to the patient.
In Cassidy v Ministry of Health [1951] 1 All ER 574) Lord Denning said that whenever hospital authorities
accept a patient for treatment, they must use reasonable care and skill to cure him of his ailment. The hospital authorities, cannot, of course, do it by themselves. They have no ears to listen through the stethoscope, and no hands to hold the knife. They must do it by the staff they employ, and, if the staff are negligent in giving treatment, they are just as liable for their negligence as is anyone else who employs others to do his duties for him.
Any breach of the duty of care owed by a hospital employee towards a SARS patient would, thus, make the hospital liable. It would be immaterial whether the wrong was committed intentionally or negligently. The existing law relating to employer's liability is sufficient to respond to the issues relating to liability arising out of the SARS crisis. The broader purpose of an employer’s liability under tort law is to ensure accountability of the employer. ‘He who reaps the benefits of another’s work must bear the burden arising from such work, ubi emolumentum ibi onus.’
Legal Duty of Hospitals to Employees
As a result of exposure to SARS patients, several medical staff died and several hundred health workers have been infected by the virus. A hospital has a special (contractual) relationship with its employees. It has an affirmative duty to take adequate measures to ensure the safety and well being of its staff and to demonstrate a reasonable degree of care for their safety.
Where an employment situation is more dangerous than usual, a greater degree of care must be taken. If the employer cannot eliminate risk of danger, it is required to take reasonable precautions to reduce the risk as far as possible (Wong Wai Ming v Hospital Authority [2001] 3 HKLRD, 209 at 212 (per Keith JA)). There is a common law duty to provide a safe place of work and to maintain it in a state of reasonable safety. Under the Occupational Safety and Health Ordinance (Cap 509) employers are also required to ensure the safety and health of their employees. If, for some reason, a hospital becomes an unsafe or unhealthy place (for example, where the safety and well-being of the staff is in danger because of the possibility of contracting SARS) this duty requires that the hospital take adequate steps to protect its staff. This may necessitate closing down the hospital or making the workplace truly safe for employees. The duty to make the workplace safe in situations such as those applying during a SARS outbreak may also require a hospital to allow non-essential staff to work from home. In extreme cases, extreme precautions are needed. In the case of a SARS-like outbreak, hospitals admitting SARS patients may well need to adopt radical measures to protect its employees as well as all patients and all visitors.
There is a further duty to employees to give timely information about the deadly effects of disease – and especially any new disease such as SARS. This duty extends to advising staff on the precautions to be immediately adopted to avoid contracting any such disease in the workplace. The hospital cannot escape liability where the place of work is or has become inherently dangerous and causes injury to the employees. In some cases the employer must issue warnings and employees must be told that failure to heed the any warning could prove fatal for them and spread the disease from one to another. An employer cannot argue that it has satisfied its obligations under this duty by appointing competent staff to handle the situation because the liability is personal and its delegation does not exonerate the employer (Mok Kwai v Yin USA Fir Processing Ltd & Anor [1994] 1 HKC 485).
Next, as an employer, a hospital is under a duty to provide its employees with proper plant, appliances and equipment and to maintain these in good condition. Plant and appliances would include adequate protective clothing and equipment such as appropriate breathing equipment, face masks, gloves, surgical gowns and the like. Thus, for a hospital taking in SARS patients, it would be essential to provide all appropriate equipment. This duty is non-delegable but not strict and can be discharged by showing that the hospital took reasonable steps to secure the safety of employees. According to a survey, more than 80% of frontline medics complained about a lack of protective gear – especially during infection peaks in March and April. A friend of a medical worker who died said the medical worker tried her best to protect herself by wearing gowns and masks, but she had to re-use her disposable paper gowns, as she was told to do so. Even when proper protective clothing is supplied, it is not enough to supply appropriate clothing without taking steps to ensure that employees wear such clothing while at work. However a hospital is not liable for the negligence of its employees if the employees do not conform to clear warnings to use protective clothing.
Next, a hospital is under a duty to provide a safe system of work. A system may be adequate when introduced but may require modification and improvement to meet new and difficult situations. If the system is not improved within a reasonable time and is deficient to meet such new situations this could enhance the likelihood of a hospital being held liable. Again a hospital’s duty here is a common law, nondelegable duty. The employer cannot avoid liability even though the injury or damage was caused by an employee to whom the task was delegated (Speed v Thomas Swift & Co [1943] KB, 557). Whether the system of work is safe or not depends upon the circumstances of the particular case. It has been held, for example, that a psychiatric centre which treats patients of known instability must take adequate precautions, such as putting a screen barrier between the staff at the reception desk and visitors and incoming patients, or by providing an emergency button, so as to protect staff from being attacked and injured by a patient (Wong Wai Ming v Hospital Authority [2001] 3 HKLRD, 209 at 217. The law will not demand that the system be perfect or foolproof (Thomas v General Motors- Holders (1988) 49 SASR 11). If the hospital can establish that the system was not dangerous or that other hospitals in the same situation would have found it reasonable to follow the same or similar system, no liability would be imposed on a hospital (Ho Mui v Gammon( HK) Ltd & Anor [1975] HKLR 195).
Finally, there is a duty on the hospital to make sure that no doctor, nurse or health worker who is known to be infected is allowed to work. A hospital may be liable for any breach of its (non-delegable) duty if it fails to provide fit and healthy staff – where such staff may infect other employees (or patients or visitors) with SARS.
Civil Procedure Issues
Unlike some other common law jurisdictions, Hong Kong does not have any provisions in its Civil Procedure rules allowing for what are commonly called ‘class actions’. Such provisions allow for a ‘class’ of (otherwise unrelated) plaintiffs to sue in a single action (under a single writ, usually) where these plaintiffs have suffered physical harm or damage arising out of the same set of circumstances allegedly brought about by a particular defendant or defendants. Key benefits of class actions include: more efficient use of court time, increased access to justice for certain plaintiffs, and lessening of legal costs.
Several potential ‘classes’ suggest themselves in the wake of the SARS crisis including, perhaps most notably, the SARS affected residents of Amoy Gardens in Ngau Tau Kok and especially those residents of Block E at Amoy Gardens.
Hong Kong does have provisions which allow ‘joinder of parties’ ( Rules of the Supreme Court, Order 15, Rule 4) and ‘representative proceedings’ (Rules of the Supreme Court Order 15, Rule 12). Each provision is governed by complex case law. Both are comparatively difficult to use for a variety of reasons. It is conceivable, however, that the SARS crisis could have produced a group (or groups) of plaintiffs who could persuade the court to allow the use of one of these provisions. If any successful move in this direction were made, the court may allow a single case (writ) from the group to proceed as a ‘test case’.
In the mean time, the other writs issued would, by agreement, not proceed. On resolution of the test case, the other plaintiffs would most likely either settle or withdraw their actions, depending on the test case outcome. Whether the plaintiff(s) would be exposed to a crippling costs award in the event of losing a test case is clearly an issue. A court agreeing to a procedure such as this likely would address this issue at the outset. Given the public interest element in any such litigation and the fact that, ultimately the Government would be a key defendant, it may be that the defendant(s) would agree not to seek costs.
Conclusion
The handling of the SARS crisis in Hong Kong by both front line medical and related staff has, overall, been excellent. Indeed, the crisis has evidenced remarkable professionalism and heroism amongst medical personnel. The general population has, by and large, demonstrated resilience and commendable collective intelligence in coping with the crisis.
When we consider how the SARS crisis has been managed at a more central public health management level, Hong Kong does not score so well. This is especially so when Hong Kong is compared with like jurisdictions coping with the same challenge at the same time. Singapore, Toronto and Vancouver, like Hong Kong, all enjoy what might be termed ‘first world’ public health infrastructures. Of all these jurisdictions, Hong Kong comes across worst in terms of its management of the SARS crisis even though Toronto, also, has not handled the crisis especially well.
When compared to less welldeveloped jurisdictions, like Mainland China and (comparatively less wealthy) Taiwan, Hong Kong fares better. But Vietnam, the poorest of all the jurisdictions badly afflicted, still managed its SARS crisis better than Hong Kong.
Overall, the HKSAR was slow to respond to the initial warning signs and continued to hesitate at both governmental and central health management levels over a period of some weeks. Crucially, Hong Kong allowed the outbreak at the PWH to spread through that hospital and from there into the community, precipitating the worst single community SARS outbreak in the developed world.
It is clearly unacceptable, in terms of proper accountability, that the HKSAR Government has thus far refused to set up a full and independent public inquiry into the SARS crisis. The SARS Review Panel to be headed by the Secretary for Health, Welfare and Food, Dr Yeoh Eng Kiong, announced by the Government is widely – and rightly – seen as lacking credibility. There have been similar calls for an independent inquiry in Toronto. There too, the Ontario Government has announced plans to set up, instead, a Government appointed Review Panel. But the idea of putting the Health Minister in charge is simply unthinkable. The Health Minister, Tony Clement, announced that the Ontario SARS Review Panel would be headed by ‘an individual who will be seen as respected and independent of the Government’.
Apart from important public policy issues, it is likely that the SARS crisis will give rise to many private law questions over the coming months. There are significant legal issues to be addressed by any wouldbe plaintiffs. However, this is not to say that potential defendants have no cause for concern. The relevant legal position (in contract, usually) appears to be fairly favourable for some potential plaintiffs such as certain frontline medical staff.
Others, such as persons who caught SARS in hospital either as patients or visitors, face additional difficulties arguing their case, especially when arguing a claim in tort. Those who caught SARS in the community encounter a further level of difficulty. The outbreak at Amoy Gardens appears to present a possible exception with respect to the lastnamed class. The Government’s own reporting identifies a direct link between a patient from the PWH, the public hospital which suffered the worst SARS infection rate, and Block E at Amoy Gardens.
Litigation is expensive. The absence of a specific class action regime in Hong Kong heightens the risk for individual plaintiffs considering SARS-related legal action. The existing provisions in the Supreme Court Rules leave open the possibility, though, of gaining court approval for what might be termed a ‘de facto class action’ using a test case for a particular group of plaintiffs.
The Government, to its credit, has already committed itself to a range of ex gratia payments to certain SARS victims from the medical frontline. The principle (of recognizing a need to make payments in exceptional circumstances) underlying this initiative could be used to underpin a wider SARS compensation initiative. The Government might usefully consider setting up a general SARS compensation scheme. Such a scheme would address the needs of (and be limited to) victims of this first ever SARS outbreak on the basis of this being an entirely new public health menace. Applicants would have their cases heard by an impartial tribunal and would need to forgo any rights to sue in tort in order to proceed. The compensation payable, funded from general revenue, would not be in a lump sum. Rather, it would meet all additional medical, hospital and related costs and cover reasonable income shortfalls arising directly from a SARS infection (in the case of surviving victims) and appropriate medical, hospital and funeral costs plus ongoing compensation (for the surviving immediate families of persons killed by SARS). The model would be that prevailing in almost all ‘no-fault’ compensation schemes (used to replace liability for workplace and motor car accidents in many jurisdictions) where the emphasis is on compensating direct medical and similar expenses plus clearly related ongoing expenses, rather than on Mark 6-style jackpot payouts.
An initiative such as this would lower the transaction costs hugely (including for the Government) compared to any mass seeking of compensation through normal litigation processes. It also would provide an excellent means for the Government to build trust with the community following what has been one of Hong Kong’s most harrowing public health scares in more than a century.
DK Srivastava
Professor, School of Law
City University of Hong Kong
Richard Cullen
Visiting Professor, School of Law
City University of Hong Kong and
Professor, Monash University
Melbourne, Australia
Thanks to:
Associate Professor Elsa Kelly
Professor Rick Krever
C Raj Kumar and Catherine Frid
兩位作者將與各位討論有關受非典型肺炎疫症影響的人士的法律問題
引言
嚴重急性呼吸系統綜合症（又稱「非典型肺炎」）襲擊全球多個國家，至今已奪去 800 多條性命，受感染人數多達 9,000 人。對香港來說，這場疫症似乎是開埠以來最嚴重的醫學災難。非典型肺炎為本港帶來重大及深遠的影響。不幸染病身故者的家屬固然深受打擊，即使戰勝病魔的人士亦可能會長期受到副作用的影響。許多病者、健康工作者以及他們的家人均有機會出現創傷後因壓力而出現失常的情況，以及患上其他精神病。非典型肺炎的悲劇亦對本港各行各業造成嚴重的打擊。政府較早前宣布本地的經濟增長率已由原來的百分之三調低至百分之一點五。航空、酒店、旅行社、戲院、食市、零售商等全都面對重大的經濟損失。部分公司甚至瀕臨結業的邊緣。
在未來的日子，受非典型肺炎疫症影響的人士將會慎重考慮與他們有關的法律問題，以及採取法律行動的方式 – 或在任何法律行動中作出抗辯。該等人士包括：非典型肺炎患者、受非典型肺炎影響或死亡的人士的家屬、醫院及醫學界的醫護人員及其他職員、公共衛生管理人員以及政府官員及公務員。
本文將會討論非典型肺炎可能在本港引起的個人法律問題。我們將會探討如何按照相關的侵權法律及適用於香港特區的相關體制來解決該等問題。
此外，非典型肺炎亦引起了部分相當重要的公共法律問題，包括政府通過實施隔離政策及強制執行的醫療制度來控制傳染病的權利。本文將不會探討這些問題，而戴大為教授及古朗哲講師已在《香港律師》二零零三年五月號內題為「魚與熊掌：人權與公眾衛生是否可兩者兼得?」一文中論述有關問題。
本文主要探討：法律責任的一般原則、公立及私家醫院的潛在法律責任，以及醫護人員和有關員工的潛在法律責任。我們的討論主要環繞侵權的法律責任，但亦會提到合約（例如僱傭合約）中的法律責任問題。這場疫症已為香港帶來一連串不尋常的問題，因此，本文提出的部分意見仍屬初期的討論。
由於篇幅所限，我們不會在這裡討論：住戶的法律責任問題、導致精神病的法律責任、非典型肺炎對航空、酒店、旅行社、零售商等造成的純粹經濟損失，以及由香港的公共衛生行政機關（例如醫院管理局（以下簡稱「醫管局」）及衛生署）違反了法定責任而可能引起的法律責任問題。此外，本文亦不會討論世界衛生組織（以下簡稱「世衛」）在本港處理非典型肺炎事件而可能引起的法律責任。
簡單來說，沒有真正經歷身體傷害，但遭受所謂的「純粹經濟損失」的準原告人如要展開與非典型肺炎有關的法律訴訟，這類人士將會遇到最大的困難。故此，受疫症影響而使生意大受打擊的航空業、酒店、旅行社、食市、零售商等，均無法控告政府疏忽而使他們蒙受損失。一般而言，適用於在本港發生涉及純粹經濟損失案件的一般法例是不利於原告人的。
2003 年 2 月底，非典型肺炎從內地廣東省傳入本港。迄今為止，這場疫症已導致接近 2000 名人士在醫院接受治療及引致近 300 名人士喪命。內地的情況較本港更為嚴重。
與流行性感冒的病毒不同，非典型肺炎的病毒足以致命。由於這是一種全新的病毒，因此我們並沒有先天的免疫力，病毒一旦散播開去，大家也很容易會受到感染。同時，由於有人在乘搭飛機期間感染非典型肺炎，因而使數個東南亞地區及加拿大相繼出現大規模爆發疫症的情況。
在侵權法中，我們過往一直是在一段特定的時限內處理獨立的疏忽事件。試想像，假如我們可以對六個不同地區的六名司機（六人均駕駛類似的車輛）進行研究，而這六名司機在相同能見度的類似道路上均遇到突發的災難（全部災難發生在幾乎相同的時限內）。在這樣的情況中，假設部分司機的處理手法較其他司機優勝，我們預料在比較過各種事實後，將會對有關事件是否涉及指稱的疏忽的評估工作造成一定的影響。由於世界各地均對非典型肺炎作出廣泛的報導，這無疑為我們提供了可供比較的機會。故此，我們可以想像到，人們一旦提起有關非典型肺炎的訴訟，原告人可能會提出比較的論點來支持他們的證供。根據在控制疫情期間獲得的可作比較資訊，香港的前線醫護人員一般都獲得很高的評價，各界對香港特區的疫情控制均表示讚賞。但是當提到這場疫症的中央管理時，衛生署和香港政府的處理手法相對於其他已發展國家（甚至是發展中國家）的做法便較為遜色了。
現在就讓我們一同回顧這場疫症在這數個月來的發展。假如要就非典型肺炎事件提起訴訟，政府作出決策的時間將會是決定有關法律行動能否成功的關鍵。下文提到的事件主要環繞香港的情況，但是我們亦會簡述在其他地區發生的事件。接著，我們會扼要地就事件作出分析，然後便會討論當中涉及的法律責任問題。
很多公開的資料都能印證這些事件的發展過程、比較研究以及其後的法律討論。這些資料的來源包括：判例法、第二手的法律評論、公開報告，以及多不勝數的剪報和期刊的專題報導。如欲查閱有關文件（尤其是 DK Srivastava 與 AD Tennekone 編寫的 偲he Law of Tort in Hong Kong掑@書 (Butterworths Asia， 1995)），可向兩位作者查詢。
非典型肺炎事件的發展過程
下文提出的事件並非巨細無遺的記錄，我們只是提出了一系列與隨後討論有關的重要事件。與本文討論最有關連的事件是在本年 5 月初或以前發生的。有關記錄亦以該段期間內的事件為終結。
2002 年 10 月至 11 月
世衛接到多份報告，指中國福建省出現大量屠宰家禽的情況。這項消息令公眾十分憂慮「禽流感」會再度從雞隻傳播到人類身上。同時，世衛並接到報告指廣東省南面的三個城市（包括河源市）出現了一種類似感冒病毒的新型疾病。
2003 年 12 月至 1 月
廣東省河源市一名專門負責烹調野味的廚師黃杏初患上呼吸系統疾病，並曾往河源市人民醫院求醫。不過，院方當時未能確認有關疾病的病源和病因。黃氏其後輾轉到廣州接受治療。2003 年 1 月，有報導指黃氏把病毒傳染給一名呼吸系統疾病專家劉劍倫教授（疾病其後被稱為「非典型肺炎」）。及後，黃氏的病情受到控制，於本年 1 月痊癒出院。研究人員其後提出，非典型肺炎病毒可能來自果子狸這種野生動物身上。廣東省南部的餐館一般也有提供這類野生動物供食客享用。2002 年 12 月 12 日，香港衛生福利及食物局一位官員在回應有關在廣東省出現變種禽流感的問題時表示，「香港政府現正與內地有關當局緊密聯絡，了解有關情況。」2003 年 1 月 3 日，《羊城晚報》報導疾病的源頭為河源市。2003 年 1 月 17 日，廣州《新快報》報導中山市亦出現一宗非典型肺炎的病例。
2003 年 2 月 10 日至 15 日
2003 年 2 月 10 日，廣東省有關當局公布在世界各地和由世衛廣泛報導的變種疾病的資料。2003 年 2 月 11 日，本港成立了一隊專責小組，負責監察「病毒是否在社區散播」。2003 年 2 月 15 日，劉劍倫教授開始出現非典型肺炎的病徵。
2003 年 2 月 20 日
劉教授乘搭巴士來到香港，抵港後一直入住何文田的京華國際酒店。原本他打算出席一個在本港舉行的婚宴。劉教授在入住京華國際酒店期間，先後使其他七人受到感染，其中一名病者其後前往沙田威爾斯親王醫院（以下簡稱「威爾斯醫院」）求診。另一名患者則被送往銅鑼灣的聖保祿醫院接受治療。其餘的患者相繼把非典型肺炎傳到加拿大、新加坡和越南等地。
2003 年 2 月 22 日
劉教授（第零號病者）前往旺角廣華醫院求診。劉教授的病情轉趨嚴重，故此他無法出席原定的婚宴。他在入院後即向廣華醫院的醫護人員警告其疾病的威力。由於劉教授的警告，醫院採取了高度的預防措施。
2003 年 2 月 22 日
廣華醫院向衛生署和醫管局報告劉教授的嚴重個案。衛生署並於同日調查有關個案，但直至兩周後才正式向公眾發出警告。
2003 年 3 月 4 日
劉教授於廣華醫院病逝。
2003 年 3 月 5 日至 7 日
在劉教授入住京華國際酒店期間，一名香港男子（第一號病者）曾於 2 月21 日及 22 日到訪該酒店，這名男子後來亦在威爾斯醫院接受治療。3 月 7 日，「社區感染」專責小組向政府表示，香港現正面對一種不尋常的病毒。
2003 年 3 月 8 日至 11 日
3 月 8 日，一名威爾斯醫院的醫護人員證實受到感染。3 月 11 日，再有兩名威爾斯醫院的醫護人員染上非典型肺炎。同日，威爾斯醫院向員工發出警告，呼籲他們小心處理非典型肺炎患者，不過並沒有向員工派發口罩或採取其他特別措施。衛生署亦於同日首次發表有關非典型肺炎的聲明，這次的聲明與收到廣華醫院對該高度危險疾病的初次報告相距兩週的時間。而於 3 月 12 日，香港大學醫學院院長鍾尚志向衛生署建議暫時封閉威爾斯醫院。但是，有關當局並沒有接受這個建議。
2003 年 3 月 12 日至 13 日
世衛宣佈病毒的學名為「嚴重急性呼吸系統綜合症」（這名字由世衛的一名專家卡洛．烏爾巴尼醫生創造，他曾為越南首名非典型肺炎患者進行治療），同時宣佈非典型肺炎已在香港爆發。3 月 12 日，衛生福利及食物局局長楊永強作出否認。
2003 年 3 月 14 日 27 日
3 月 14 日，威爾斯醫院向員工派發口罩。同日，一名在威爾斯醫院接受慢性腎病治療的深圳居民出現非典型肺炎的病徵（第二號病者）。他曾於 3 月 14 日前往牛頭角淘大花園 E 座探訪其兄弟。3 月 15 日，第二號病者入住威爾斯醫院，被列為懷疑受感染個案。可是，院方以治療流行性感冒的方式對他進行治療，他並於 3 月 19 日出院。出院後，他再次到淘大花園探訪其兄弟。沒多久，第二號病者再度前往威爾斯醫院求診。3 月 21 日，醫院管理局行政總裁何兆瑋向政府發出警告，指出非典型肺炎已擴散到社區中。他建議當局迅速採取行動，防止疫症進一步擴散。第二號病者於 3 月 22 日終被證實染上非典型肺炎。這時候，威爾斯醫院已有超過 100 名醫護和非醫護人員受到感染。在疫症爆發後第二個星期，院方
禁止所有公眾人士到病房探病。3 月 26 日，淘大花園開始出現大規模爆發。三週內先後有逾 300 名淘大花園居民受到感染。3 月 27 日，香港大學宣佈非典型肺炎是由冠狀病毒形成的疾病。
2003 年 4 月至 5 月
4 月 1 日，網上流傳一宗有關非典型肺炎的虛假報導，報導迅即在香港坊間引來一陣恐慌。翌日，世衛人員建議旅客不要前往香港。同時，教育署宣布各中、小學和大學停課兩週。牛頭角下（位於淘大花園附近）近 30 名居民感染非典型肺炎。媒體報導指香港大學和中文大學醫學院在非典型肺炎一事上互相競爭。此外，傳媒亦揭發浸會醫院（私家醫院）隱瞞該院在 4 月 27 日至 5 月 6 日期間曾出現醫護人員感染非典型肺炎的情況。
比較性的評估
香港的情況
我們無法掌握本港多間醫院醫務和非醫務人員，以及患者的確實感染率。雖然如此，在全港的醫院中，威爾斯醫院看來是感染率非常高的一間醫院（超過 150 名職員、家屬、病人和訪客受到感染），而接收第零號病者的廣華醫院卻能成功阻止大規模的爆發。而且，威爾斯醫院與重災區牛頭角的爆發有著千絲萬縷的關連。牛頭角一帶曾於數周內錄得幾百宗的感染個案。
其他地區的情況
除香港外，非典型肺炎亦在全球多個地區蔓延，包括內地、台灣、加拿大、新加坡及越南。我們不會在此贅述這些地區的詳細情況，但會扼述其中的重點。
內地
直至 2003 年 4 月 20 日止，內地對非典型肺炎事件一直採取隱瞞和否認的態度，結果令疫症一發不可收拾的擴散各地，其中北京的情況尤為嚴重。其後，中央政府下令各地政府不得繼續採取令中國蒙羞的政策，不但把某些高級官員革職，還大方邀請世衛專家前往內地進行調查，同時更在全國進行「打擊非典」的行動。北京醫院的疫情亦日趨嚴重，這情況似乎是由於隔離措施欠缺妥善所致。
台灣
起初，台灣的疫症似乎比其他地區較早受到控制。不過，到了 5 月下旬的時候，台灣卻成為繼內地和香港之後疫情最嚴重的地區。公共衛生部門缺乏合作、官員間的爭拗以及部分醫院隱瞞非典型肺炎個案等，這些似乎都是導致疫情擴大的原因。
加拿大
安大略省多倫多市為加拿大發病最嚴重的地方。有趣的是溫哥華、英屬哥倫比亞與多倫多（甚至是香港）在處理非典型肺炎所採取的不同處理手法。
雖然溫哥華和多倫多是在差不多相同的時候發現首宗非典型肺炎病例（兩個城市起初並不知道另一個城市的情況），但是溫哥華在 2003 年 2 月 13 日接收首名非典型肺炎患者後迅即採取行動，因此成功阻止疫情擴散。該名患者即時受到隔離，院方並採取高度的防預措施。2003 年 2 月 20 日，即在首名非典型肺炎出現之前，英屬哥倫比亞疾病控制中心向英屬哥倫比亞整個衛生系統發出「紅色警告」，要求醫院提防任何不尋常的流行性感冒個案。英屬哥倫比亞是考慮到世衛（和廣東省）在該段期間提供的資料，以及世界各地（包括香港）的有關資料而作出這個決定。英屬哥倫比亞只有數宗非典型肺炎病例，醫護人員亦沒有受到感染，而且當地也沒有出現交叉感染的情況。
2003 年 3 月 7 日，首名加拿大非典型肺炎患者被送進多倫多士嘉堡慈恩醫院。這名病者（和溫哥華首名非典型肺炎病者）相信是在香港京華國際酒店入住期間受到感染。多倫多並沒像英屬哥倫比亞般，向安大略省的衛生系統發出特別的警告。此外，醫院在治療該名患者時亦沒採取特別的預防措施。至 2003 年 6 月為止，多倫多一共發現 350 宗非典型肺炎的病例，超過 30 人在病發後死亡。與香港的情況一樣，多倫多主要是透過醫院散播病毒的。
新加坡
新加坡疫情的源頭可追溯至三名曾於 2003 年 2 月底入住香港國際京華酒店的旅客。三名旅客返回「獅城」後，於 2003 年 3 月 1 日至 3 日期間（即在香港第一號病者在 3 月 5 日入住威爾斯醫院之前）被送進新加坡的醫院。
截至 2003 年 6 月止，新加坡只有逾 200 宗非典型肺炎病例。同一段時間，香港已累積了 1,700 宗的病例。這就是說，香港的感染率相當於新加坡的八倍。在 2003 年 3 月底，新加坡共發現 90 宗感染個案，而當時香港則只有 500 宗，香港的數字是新加坡的 5.5 倍。而在早一個星期，香港只有 165 宗病例，而新加坡則有 50 宗，香港的數字是新加坡的 3.3 倍。
新加坡和香港差不多是在同一時間發現首宗非典型肺炎的個案。所有「編有號碼的病者」差不多都是在劉教授入住京華國際酒店期間染上此病的。
香港的感染率較新加坡快速上升的原因，大致上可歸納為以下幾點。其中一點可能是有關新加坡政府在短時間內採取了果斷的控制措施，以防止疫情擴散所致。舉例說，新加坡政府在 3 月 24 日便宣佈實施隔離政策，相反，香港政府要在 2003 年 4 月 10 日才公布相同的政策。
世衛人員其後讚揚新加坡在處理非典型肺炎事件的手法堪作「楷模」。
越南
一名美籍的中國商人於 2003 年 2 月底曾經入住京華國際酒店。他乘搭飛機前往河內，及後被送進河內一家醫院，身體出現與非典型肺炎相似的徵狀（第五號病者）。於是，非典型肺炎便開始在越南爆發。不過，與大部分地方一樣，疫症主要是在醫院傳播。其後疫情在當地擴散。雖然越南是亞洲內其中一個最貧窮的國家，可是，越南較其他疫區更快使疫情受到控制。2003 年 4 月 28 日，世衛把越南剔除在疫區名單之外。至 2003 年 6 月為止，越南總共發現 63 宗非典型肺炎病例，死亡人數為五人。
導致越南成功控制疫情的一個重要原因或許是得到多位世衛專家（包括卡洛．烏爾巴尼醫生）長期逗留在該國所致。世衛人員為越南提供了有關控制疫情的建議，看來越南政府應有遵照專家的建議。
摘要
以上的回顧揭示了以下幾點。第一，溫哥華在疫症爆發之初便採取適時的預防措施，這使該市避免淪為嚴重爆發的疫區。第二，從這個例子（以及少部份正面的例子）可以顯示，醫院在開始接收任何出現與非典型肺炎相似病徵的病人時，採取最為謹慎的保護和隔離措施是十分重要的。第三，當非典型肺炎傳到海外後，那些國家的衛生機關如具有一套清晰的計劃，並能迅速及堅決執行有關計劃的，一般都能在短時間內使疫情受到控制。第四，積極、目標清晰及受人尊重的領導班子和強大的團隊將有助取得最佳的結果。
另一方面，以往在「平常」的時期，我們還可以忍受決策有所延誤，但是在處理這場疫情時出現決策上的延誤，很有可能要賠上沉重的代價。同樣地，公共衛生部門缺乏清晰、協調及適時的整體管理方向也令非典型肺炎得以肆虐。毫無疑問，最具損害性的事莫過於政府、醫院或其他人士隱瞞任何與非典型肺炎有關的資料。
非典型肺炎事件與私法的法律責任
疏忽責任的一般原則
疏忽法涵蓋一切形式的人類活動，並已承認對影響他人、危害性命或擾亂安全的活動加以管制是越益重要的事情。治療疾病時，尤其是透過新的藥物來對病人進行治療，會令造成「傷害」的機會增加，而這些史無前例的情況亦可能會引起法律責任的問題。有人會說，部份醫院在為非典型肺炎患者進行治療時並沒給予病人足夠的照顧。亦有人指控某間醫院沒有通知醫院內的其他病人，院方正為非典型肺炎患者治療。亦有報導指稱，醫院的管理層懷疑數名病人患有非典型肺炎，不過卻沒有把情況通知衛生署或住在同一間病房的其他病人。
現代的侵權法可透過 Donoghue v Stevenson [1932] AC 562 這個具有代表性的案例予以闡明。在該案中， Atkin 法官指出，任何人士必須採取合理程度的謹慎，防止作出使人合理地預知，相當可能會導致與使人合理地注意的該等行動密切相關或會直接受影響的人士受傷的行為或不作為。不過，這當中並不涉及任何法律責任，正如 Cardozo 法官所述：「難以確定的時間對難以確定類別的人士而帶來難以確定的價值」（Ultramares Corp v Touche [1931] 174 NE 441）。這種限制的目的就是建基於政策的考慮，避免令原告人的數目增加。倘使要在關乎醫療疏忽的案件中獲得勝訴，原告人（如在其他案件中一樣）必須證明被告人所須承擔但沒有履行的謹慎責任，以及由於被告人沒有履行該責任而引起可預見的傷害或損害。可是，單單符合這些元素並不會自動使原告人獲勝。
Atkin 法官在 Donoghue 一案的意見創造了所謂的「同類原則」。這項原則可概括為包含以下三個元素：傷害的可預見性；接近程度；以及公平性、公正程度及合理性。可預見性意味著原告人必須證明他屬於某一種類的人士，而這個種類的人士相當可能基於被告人的疏忽行為或不作為而受到影響。要證明某個醫生在治療某個病人時曾有疏忽行為而導致病人受到傷害或損害並不困難。原告人除要符合可預見性的元素外，還須證明接近程度這一點。原告人和被告人之間若存在醫生和病人的關係便會使這個元素得到符合。在 Chung K Leung and Chung Kwok Keung Administrators of the estate of Lau Siu Chun deceased v Attorney General of Hong Kong & Another [1991] HKLR 338 一案中，提出了政府對某名病人在醫院死亡一事的法律責任問題，而該名病人是受到政府的財政幫助。這案的爭論點在於政府是否須為該病人的死亡負上責任。法庭裁定，由於政府無權干涉醫護人員的聘用和解僱，因此政府和病人之間並不存在接近的關係。而涉案醫院才是與死者有緊密關係的一方。涉案醫院對該名死者因此便負有普通法的謹慎照顧責任。
施政者在香港公共衛生 管理制度下的責任
非典型肺炎事件引伸到政府（以及轄下的部門和人員）對非典型肺炎相關個案的法律責任問題。雖然實際的治療由醫院進行，但香港特區政府才是主導非典型肺炎治療及康復措施的領導者。政府（或轄下部門或官員）如未有履行職責確保醫院採取足夠的預防措施，控制非典型肺炎疫情的擴散，那便相當於疏忽。若疏忽控罪成立，政府須因此承擔法律責任便不會是不公平、不公正或不合理的事情了。
可是，疏忽的法律責任可以政策為理由而予以否定。在某些情況下，法庭可拒絕向警方、香港期貨交易所、法律援助署署長和接受存款公司監理專員施加法律責任。在上述這些情況中，公共政策因素會獲引用，以避免向政府、半政府或公共機構施加法律責任。
不過，我們或可區分由非典型肺炎引起的個案，並提出政府（透過轄下部門及官員）可能要向某些非典型肺炎病人支付補償性損害賠償。公共衛生是每個政府的重要工作。倘若政府在公共衛生政策上嚴重出錯，很可能會帶來死亡及延長痛苦的重大風險。如上文所述，非典型肺炎同時在多個地區爆發，情況特殊。而香港政府部門的做法是否（直接）存在相對疏忽的爭論仍有待討論。此外，政府（透過轄下官員及部門）可能沒有採取所有合理及必須的預防措施以保障非典型肺炎患者，這便足以使政府承擔責任。
醫院及醫護和 其他人員的法律責任
假如存在醫院及病人的關係，則醫院或醫院行政部門便須承擔應有的謹慎照顧責任。我們不能期望醫生和外科醫生可創造奇蹟或保證病人痊癒。市民對醫院及醫護和其他人員的醫護水平的要求，就是要有合理的專業水平。醫院（或其職員）倘作出下列行為，即屬沒有履行謹慎照顧責任：（一）基於規管醫院和病人的行為考慮，沒有作出理性的醫院行政部門（或其職員）應作的事；或（二）作出一些謹慎及理性的醫院行政部門（或其職員）不會作的事情（見 Blyth v Birmingham Waterworks Co (1856) 11 Exch 781, 784）。
醫生無須擁有阿基理斯的勇氣、尤利西斯的智慧、海格立斯的力量，又或千里眼的預知能力（見 Winfield & Jolowicz on Tort (13th Ed, 1990), pp 46-47）。他或她無須是一位完美的醫生，但必須展示與進行醫療工作有關的技能和能力。舉例說，如他聲稱是外科醫生或內科醫生，則法例規定該人必須展示可證明其職業的技能。此外，醫護人員因工作性質關係，必須具有充足的酌情權，讓他們決定治療的方法。就非典型肺炎事件來說，在衡量法律責任時，法官必須考慮高感染率及成因不明的傳染途徑這兩項因素。醫生或外科醫生不能因選取其中一種治療方法，而要負上法律責任。即使醫生沒有跟從獲全球接納的做法，也無須為此而負上責任。面對法律行動時，醫生或外科醫生必須證明他已盡其所知或能力而作出有關行為，以及證明理性的醫生或外科醫生也會以類似的療法來治療病人。
醫生或外科醫生亦不會單單因判斷錯誤而要負上法律責任。法庭會考慮醫生是否處於緊急或一般的情況中。這是十分客觀的標準。這個標準假定所有醫生或外科醫生都是理性的。在非典型肺炎爆發初期，醫生只循流行性感冒病毒的方向尋找病源，而不是向後來證實為引致非典型肺炎的冠狀病毒入手，不過，醫生或外科醫生均不能被認為在事件上出現疏忽。
在十年前足夠為病人預防疾病的措施，今日可能已不合時宜。雖然我們不能預計來歷不明的傳染性疾病可能帶來的災害，但由於全球出現傳染性疾病的情況（以及病毒的變種機會）十分普遍，醫院及醫護人員一旦懷疑出現嚴重傳染性疾病時，便必須採取額外的預防措施。衛生服務界代表麥國風先生表示，以塑膠窗簾隔離非典型肺炎病人，實在令人難以接受。
醫院的行政部門及醫護或其他職員如已採取合理的預防措施，例如是其他醫院或醫護人員在類似情況所採取的同類措施，則便是已履行了其責任。不過，假如慣常做法必定招致失敗，如醫生仍然採取該種做法便屬不合理的行為。衛生署署長陳馮富珍曾公開指責一所醫院對院內非典型肺炎爆發反應緩慢，導致數人受到感染。
「合理的謹慎水平是由慣常會採取的做法，而不是由慣常做法來釐定。」(Fleming, The Law of Tort (8th ed, 1992) 120; 亦見於 Edward Wong Finance Co Ltd v Johnson Stokes & Masters [1984] 1 AC 296)。醫院一旦得悉必須採取什麼預防措施以遏止非典型肺炎的擴散，可是卻沒有採取該等預防措施的話，醫院可能要負上法律責任。舉例說，醫院必須確保通風設施運作良好、空氣過濾器獲定期清洗、冷氣房間的窗戶定期打開以確保空氣流通、經常使用的設施獲定期清潔，以及遵從隔離病人的程序。此外，醫生必須準備好轉換治療非典型肺炎病人的一般療程。假如把治療愛滋病藥物與利巴韋林混合使用，會較混合利巴韋林和類固醇更有效的話，則應該採取這個療法。
我們不妨參考以下的個案，或許可以幫助我們理解醫護人員的法律責任問題。朱律師在二零零三年三月十五日在乘搭前往北京的航機上感染了非典型肺炎，隨後被送往將軍澳醫院治理，不久之後證實不治。他的遺孀聲稱，其丈夫在入院時已出現所有非典型肺炎的徵狀，但院方很遲才施以抗病毒及類固醇混合治療。她的丈夫是在入院後的第六天才接受利巴韋林和 methylpredisolone 的治療。醫院則表示：「朱先生初期被列作懷疑個案處理，並獲施以當時常用的抗生素治療。後來，他的情況沒有什麼進展，於是院方便給他類固醇的混合治療。」這個個案提出了一個問題，就是理性的醫生是否應該在該律師送院後即時施以抗病毒及類固醇的治療，或起碼在早幾天施以有關治療，因為抗生素療法對其病情並無起色。
起因
非典型肺炎病人在尋求賠償時遇到的另一個困難，就是受害人必須證明，若非被告疏忽的緣故，原告人就不會受到傷害或蒙受損害。舉例說，不論非典型肺炎病人是否獲得適當的治療，該病人均會因感染而死亡，則醫生或醫院便不會受到譴責。此外，即使原告人可證明被告人導致非典型肺炎病人死亡或感到痛苦，被告人也只能追討可預見的損害賠償。由於非典型肺炎是不可預測及難以辨認的新病毒，即使理性的醫生也未必能預知病人的死亡或引致嚴重的健康問題，那麼原告人要令被告人入罪是十分困難的。
中文大學精神科學系榮潤國醫生及香港大學李美英醫生警告，非典型肺炎患者及其家人很可能會患上創傷後壓力症後群。不過，非典型肺炎病人如經初步治療後呈現康復的情況，那麼法庭會否判非典型肺炎病人其後的醫療費用必須由醫院支付，實在是個疑問。
醫院管理局及醫院的轉承責任
根據轉承責任原則，管理公立醫院的醫管局必須就醫護人員在工作期間引起的傷害或損害負上責任（見《醫院管理局條例》（第 113 章）第 1 及 2 條）。公立及私家醫院也須就其僱員對病人造成的傷害或損害負上轉承責任。在這方面，醫管局轄下的公立醫院與私家醫院並無分別。簡而言之，這個責任的基本原則就是：某人透過其他人作出的行為相當於由其本人所作一樣。作為僱主，醫院必須就其職員對病人的疏忽或過失負上轉承責任。
醫院必須負上嚴格法律責任，即使他們不能控制其僱員的工作模式，但仍必須確保他們不會出錯。因此，醫院必須就醫生、護士、放射技師、顧問及麻醉師的疏忽負上責任。醫管局及醫院的法律責任也可推展至兼職員工身上。不過，醫管局及醫院無須為病人選擇及僱用的出診家庭醫生、外科家庭醫生或家庭顧問醫生的錯誤負責。(Ellis v Wallsend District Hospital [1990] 2 Med LR 103)。雖然如此，假如部分服務（例如護理服務）是由醫院的人員提供，而該人員卻疏忽職守，醫院仍須負上法律責任。
醫院對病人的謹慎照顧責任不但引起轉承責任的問題，更重要的是，這是涉及基本職責的問題，是不能轉授的職責。醫院不能基於把工作委予他人而逃避法律責任。因此，無論是根據僱傭合約而聘用的醫護人員（僱員）還是根據僱用服務合約而聘用的醫護人員（獨立承辦商），醫院均須為他們的行為負上責任。在以上兩種情況中，醫院負有首要及直接的法律責任。我們可從 Brown-Wilkinson VC 在 Wilsher v Essex Area Health Authority [1987] 2 WLR 425 一案的判詞中找到支持這個看法的論點：
「醫護機構在經營醫院時，如沒有提供具備足夠技能或經驗的醫生以進行在醫院提供的治療，可能須要對病人負上直接的法律責任。」
Lord Denning 在 Cassidy v Ministry of Health [1951] 1 All ER 574 表示，
「當醫院管理機構接收一名病人為他們提供治療時，他們必須向病人提供合理的照顧及使用合理的技能為該人治病。當然，醫院管理機構不能親自為病人治病。他們既沒有耳朵可以透過聽診器診症，也不會手持手術刀進行手術。醫院管理機構必須由他們所聘用的僱員進行治療，若其僱員在治療時疏忽職守，醫院管理機構必須為其僱員的疏忽負上責任，一如所有僱用他人執行職責的人一樣。」
因此，醫護人員如沒有履行對非典型肺炎病人的謹慎照顧責任，醫院是難辭其咎的。至於有關的錯誤是故意或因疏忽造成，這倒不重要。有關僱主責任的現行法例，已足以處理因非典型肺炎引起的法律責任問題。侵權法所涵蓋的較廣闊的僱主責任，是要確保僱主必須承擔責任。「獲取他人工作成果的人，必須承擔由此項工作引起的責任。」
醫院對僱員的法律責任
數位因曾接觸非典型肺炎患者的醫護人員相繼死亡，另有數百名醫護人員透過接觸病者而受到感染。醫院與其僱員存在特別的（合約）關係，醫院有責任採取足夠的措施，確保員工的安全及健康，並對他們的安全給予合理程度的照顧。
當工作情況較平常危險，工作人員便必須更加謹慎。僱主如無法消除危險，則必須採取合理的預防措施，盡量把危險減至最低。(Wong Wai Ming v Hospital Authority [2001] 3 HKLRD, 209 at 212 (祈彥輝法官)。提供安全的工作地方，以及維持工作地方的合理安全，是普通法訂明的責任。根據《職業安全及健康條例》(第509章)，僱主必須確保僱員的安全及健康。假如基於某些原因，醫院變成一個不安全及不健康的地方（例如因可能感染非典型肺炎對僱員的安全及健康構成危險），這項責任訂明醫院必須採取足夠措施保護員工。這可能需要關閉醫院或令工作地方成為真正安全的地方。為使工作地方變得安全，醫院可能需要容許非必要的員工留在家中工作。在非常時期，醫院必須採取非常的預防措施。遇上如非典型肺炎般的疾病，接收非典型肺炎病人的醫院必須採取徹底的預防措施，以保障僱員、病人和訪客的安全。
僱主對僱員的另一項責任，是對致命的疾病，尤其是非典型肺炎等新疾病提供適時的資料。此外，醫院亦須建議員工採取即時的預防措施，以免他們在工作地方感染該疾病。假如工作地方存在潛在的危險，並可能對僱員構成傷害，醫院也不能逃避責任。在某些情況下，僱主必須發出警告，並向僱員解釋如沒有留意警告的話可能會引致人命傷亡，而且也會把病毒散播開去。僱主不能基於其已委派有能力處理有關情況的員工，而令法庭信納其已根據此責任履行職責，因為這是個人的責任，而委任的行為並不能免除僱主的責任 (Mok Kwai v Yin USA Fir Processing Ltd & Anor [1994] 1 HKC 485)。
此外，作為僱主，醫院有責任為僱員提供合適的裝置、儀器及設備，並保持這些裝置、儀器及設備運作正常。裝置及儀器包括合適的保護衣物和設備，例如合適的呼吸設備、口罩、手套、手術袍等等。因此，醫院如接收非典型肺炎病人，他們必須向僱員提供所有合適的設備。這是不能轉授的責任，但並非嚴格法律責任，而醫院可透過顯示他們已採取合理步驟確保僱員的安全，證明他們已履行這項責任。據調查顯示，超過八成的醫護人員投訴醫院缺乏保護裝備，尤其是在三月至四月的感染高峰期。一名在這場疫症中死去的醫護人員的朋友表示，該醫護人員已配備保護袍及口罩保護自己，惟她獲院方通知必須循環使用那些即棄的紙袍。即使醫院為他們供應正規的保護裝備，可是醫院卻沒有採取步驟確保僱員必須在工作期間配戴這些裝備。不過，假如僱員沒有遵從警告的指示使用保護裝備，醫院則無須為僱員的疏忽負上責任。
此外，醫院有責任為僱員提供安全的工作系統。即使系統在剛推出時可能是十分完備，但必須隨時日作出修訂及改良，才可應付全新及困難的情況。假如有關系統沒有在合理時間內予以改善，且不足以應付新的情況，則醫院須負上法律責任的機會便會增加。這項責任是普通法下訂明的不可轉授的責任。即使有關的受傷或損害是由獲委派工作的僱員造成，僱主也不能因此而逃避法律責任 (Speed v Thomas Swift & Co [1943] KB, 557)。至於工作系統安全與否，則取決於個別個案的情況。舉例說，精神病院在治療情緒不穩定的病人時，必須採取足夠的預防措施，例如在接待處設置屏障或提供緊急按鈕，以免員工受到病人襲擊及傷害 (Wong Wai Ming v Hospital Authority [2001] 3 HKLRD, 209 at 217)。法例不會要求這些制度必須完美及完全可靠 (Thomas v General Motors-Holders (1988) 49 SASR 11)。假如醫院能夠證明有關制度並不存在危險，又或者其他醫院在同一情況均會認為採取相同或類似的制度是合理的事情，則醫院便無須負上法律責任 (Ho Mui v Gammon ( HK) Ltd & Anor [1975] HKLR 195)。
最後，醫院有責任確保已受感染的醫生、護士或健康服務員並沒留在醫院工作。假如醫院未有安排合適及健康的僱員執行工作，而該類僱員可能令其他員工（或病人或訪客）感染非典型肺炎，則醫院或須為其違反不可轉授的責任而負上法律責任。
民事訴訟程序事宜
與部分普通法司法管轄區不同，香港沒有就一般所指的「集體訴訟」訂立條文。「集體訴訟」的條文訂明多名原告人（甚至不相關的原告人）可以「集體」的方式，因某一名或多名被告所引起的相同情況而受到的身體傷害或損害，向被告人提起訴訟（通常是以一份令狀入稟）。集體訴訟的主要優點包括：有效利用法庭時間、增加個別原告人的申訴機會，以及分擔訟費。
在非典型肺炎疫症下最有可能提出訴訟的「團體」，應該會是牛頭角淘大花園的居民，尤其是淘大花園 E 座的居民。
香港的法例已就「各方的合併」（《高等法院規則》第 15 號命令第 4 條規則）及「代表的法律程序」（《高等法院規則》第 15 號命令第 12 條規則）訂立了條文。這些條文均由複雜的案例法所規管。基於很多因素，這兩條條文的應用都比較困難。不過，相信大家也可想像到，非典型肺炎的疫症或許已造就一組（或多組）原告人，他們可以說服法庭使用上述的條文。倘行動成功，法庭可把有關團體的這一宗個案作為「測試個案」。屆時，其他的令狀將會按照協議不予辦理。在測試個案獲法庭作出裁決後，其他原告人便會視乎測試個案的結果，而決定和解或撤銷訴訟。原告人是否需要為測試個案的敗訴而承擔巨額的訴訟費用，其實也是問題所在。法庭如受理這類案件，應會在事前處理有關問題。鑒於這類訴訟將會引起廣大市民的關注，而由於政府是主要的被告人，因此政府可能會同意讓原告人無須承擔訟費。
結語
總括而言，香港前線醫護人員及有關人員處理非典型肺炎的表現有目共睹。事實上，這場疫症顯示了醫護人員的專業精神和無比勇氣。而普羅大眾亦能夠以耐心及集體智慧對付這場「戰役」。
假如我們從公共衛生管理方面評估非典型肺炎的處理方法，把香港與處理同一疫症的類似地區進行比較時，香港的表現則並不十分理想。新加坡、多倫多及溫哥華與香港一樣，全都擁有「一流」的公共衛生設施。當中，多倫多在控制疫情方面雖然不甚理想，但香港在處理這場危機的評價，卻是這些地區當中最差的一個。
與內地及（財力稍遜的）台灣相比，香港的情況當然較佳。可是，雖然越南是多個受疫症影響的地區當中最貧困的地區，但控制疫情的表現仍較香港為佳。
整體來說，香港對疫症的初期反應較為緩慢，政府和衛生部門對疫症的處理手法在數星期內遲疑不決。正是香港政府的遲疑不決使非典型肺炎在威爾斯醫院爆發，進而擴散到社區，成為發達國家當中爆發非典型肺炎最嚴重的地區。
關於問責的問題，香港政府拒絕成立一個完全獨立的調查委員會，這是完全不合情理的。由衛生福利及食物局局長楊永強為首的非典型肺炎檢討小組，完全缺乏公信力。多倫多亦接獲類似的要求，就非典型肺炎進行獨立調查。多倫多政府宣布成立一個由政府委任的檢討小組。但是，由衛生部部長掌管這個檢討小組是完全不合理的。衛生部部長 Tony Clement 宣布，多倫多非典型肺炎檢討小組會由「獨立於政府的有名望的人士」擔任主席。
除了重要的公共政策問題，未來幾個月很可能會看到大量的個人法律問題。潛在的原告人必須處理眾多的法律問題。不過，這並不代表被告人無須關注與他們有關的法律問題。有關的法律情況（通常是根據合約而言）似乎對可能成為原告人的前線醫護人員頗為有利。
病人或訪客如在醫院感染非典型肺炎，他們在訴訟過程中將面對很大的困難，尤其是就侵權索償的爭議。在社區感染非典型肺炎的人士，他們在訴訟中將面對更多的困難。不過，淘大花園的受感染居民可能會是例外的情況。政府的報告指出，非典型肺炎感染率最高的威爾斯醫院的一名病人，與淘大花園 E 座存在直接的關係。
訴訟一般涉及高昂的費用。香港並沒有集體的訴訟制度，這就增加了個別原告人採取法律行動的風險。《高等法院規則》的條文准許一班原告人以測試個案的方式進行所謂的「事實集體訴訟」。
值得讚揚的是，政府已承諾向因非典型肺炎而死亡的前線醫護人員提供多種的特惠賠償金。這措施背後的原則（在特定情況下給予賠償的需要）可能會支持政府成立更廣泛的非典型肺炎賠償計劃。政府或可考慮就非典型肺炎成立一般的賠償計劃。這計劃會針對（並限於）第一次受非典型肺炎影響人士的需要，申請人的個案會由一個公平的審裁處處理，但是申請人必須放棄提出訴訟的權利。這些由政府收入支付的賠償，不應該是一次性的款項。賠償應該能夠足以支付所有額外的醫療、住院及其他有關費用，並會顧及由感染非典型肺炎導致收入減少的情況（適用於生還的受害者），以及包括適當的醫療、住院及斂葬費用，再加上持續的賠償（適用於非典型肺炎死者的直屬家人）。這個計劃幾乎是現時適用於所有不涉及「過失」的賠償計劃的常見模式（用以代替很多地區對工作地方及電單車引起意外的法律責任）。計劃主要會支付醫療及其他類似的開支，以及直接有關的持續開支，而不是以彩票式的巨額獎金般向受影響人士發放。
與循其他正常訴訟程序尋求賠償的方式相比，這個措施將可大大減低交易費用（包括政府的交易費用），也為政府提供最好的方法，就過去一世紀以來香港面對最嚴峻的公共衛生問題，重建整個社會的信心。
施法華
香港城市大學法律學院教授
Richard Cullen
香港城市大學法律學院客座教授及
澳洲墨爾本 Monash 大學教授
鳴謝：
Elsa Kelly副教授
Rick Krever教授
古朗哲及
Catherine Frid