It is “widely known medical knowledge” that hepatitis B patients taking steroids should also be prescribed antivirals, a renal specialist told the Coroner’s Court.

Lui Sing-leung, who chairs the Hospital Authority’s central renal committee, also said a doctor who treated liver disease patient Tang Kwai-sze should have detailed the discussions on the use of steroids during a consultation session in his medical notes.

Tang had been taking steroids to treat her chronic kidney disease before she underwent two liver transplants at Queen Mary Hospital in April 2017. She died in August that year at the age of 44.

The two doctors who treated Tang at United Christian Hospital, Lam Chi-kwan and Chan Siu-kim, were later found guilty of professional misconduct for allegedly failing to prescribe an antiviral drug she needed.

Giving evidence on Monday, Lui said while the Hospital Authority had yet to issue a guideline on antiviral prescription for non-cancer patients at the time of Tang’s steroid treatment, it was “widely known” that such drugs should be given to the patient.

He also told the inquest, before Coroner Monica Chow and a five-person jury, that Lam’s notes only said the patient was briefed on the “pros and cons of steroids” and agreed to using the drug.

“Lam should have written down clearly the pros and cons of steroids that he had highlighted, because [relapse] is an important, serious potential complication,” Lui said.

Lui added that doctors who see the same patient subsequently might only rely on the previous medical notes, but not the hospital’s clinical management system.

Chan, the other doctor who later saw Tang, did not follow up with the patient as to why antivirals had not been prescribed when he should have, the court heard.

Another expert witness, Professor Grace Wong from the Chinese University’s medical school, agreed that a hepatitis B flare-up, in which the level of liver enzymes rises abruptly, is mainly caused by the absence of antivirals during a high-dose steroid treatment.

Wong, a specialist in gastroenterology and hepatology, said a study she’s part of found that even short courses of a large dosage of steroids could increase the risk of a hepatitis flare-up, and such patients should receive antivirals regardless of the duration of the treatment.

She also said while it should be “common sense” to prescribe antivirals along with steroids, the practice was not written “in black and white” before the patient’s case came to light, so one could not expect all doctors to follow as such.

The inquest hearing continues.