I work in a large hospital, and sometimes there are “unfavorable outcomes”, which in hospital-speak translates as a death or life changing mistake. When we have an unfavorable outcome families typically gather in front of the administration offices and battle with the hospital’s security guards (we have a whole police office). These skirmishes have become increasingly common in China, and I’ve written about such an instance before (A fight at the hospital – Abortion in China), but it is a topic that deserves further discussion.
Let’s start with a recent example; a patient committed suicide by jumping out of his hospital room window as a result of being dissatisfied with his treatment, either because his disease was incurable, the pain was intolerable, or the bill was unaffordable (each person seemed to have heard something slightly different). The next day his family attempted to storm the offices of the hospital administrators in an effort to get compensation. This means literally forming an angry mob, and attempting to rush past the front desk and occupy someone’s office. Usually the police arrive first, and a brief brawl transpires. It can be pretty scary.
Something like this happens here about every 4-6 weeks, and each time I feel incredibly torn. These people are clearly in great emotional pain, but it is often unclear if there was actually any malpractice on the part of the hospital.
From talking with many of the administrators about these “events”, which isn’t easy, it seems that there is a single major underlying problem; the legal system would almost always favor the state-funded hospital, so lawsuits are rarely considered, and these violent mobs become the only viable way of seeking compensation. After the suicide, the patient’s family was seeking 100,000RMB in damage because the hospital did not stop him from killing himself (co-worker’s words, not mine, it is possible that the hospital was in someway at fault). This case would almost certainly be thrown out by the courts, but the angry mob approach may earn them some compensation. Occasionally these mobs are successful, which further encourages copycats.
Normally I would be tempted to side with the patients, they are disempowered by China’s flawed legal system. After one of my close friends was accused of malpractice, I realized just how difficult these cases can be. He is a well trained surgeon with years of experience, but one high risk operation did result in a patient losing vision in one eye. For the next week he could not come to work, out of fear that this family may try injure or even kill him. The doctor was completely devastated by the result of the surgery, as he had once prided himself on being the best in the department. It was a complication beyond his control, but he had no way of clearing his name.
With the current system there is no justice for the patients or the doctors. Without an impartial referee there is no real way to establish whether or not this was a case of malpractice, or something that happened as part of the normal risk of treatment. Doctors honestly dread giving bad news to patients, because it could be a matter of life and death for both parties (I’m embarrassed to say that at another large hospital, one oncologist writes patients’ diagnoses in English so they can’t lash out at him). At the same time patients worry that doctors are prescribing unnecessary medications (a topic that will be more completely addressed later) and treatments simply in an effort to increase their own profits (doctor pay is relatively low in China).
Without the law, there is no trust between the parties, and everyone suffers. Hopefully a more transparent system will be created so that China’s clinical gains in medicine are not overshadowed by patient experiences which leave family members contemplating violence as a first choice.
I read this post to a friend, as we were talking about China hospitals just a few moments before.
Both she and I have lived in China longer than you have, but not at the same level, if you understand what I mean. So sometimes we’re left in puzzlement by the things we see and hear; the foliage observable, the root invisible.
Thanks for sharing your insights.
Same thing happened in the ex-Soviet Union, according to my ex-Soviet friends/schoolmates. Which is why my ex-commie mates relocated to the UK back in the 70s and 80s.
I lived in Soviet Union and – no – I have never heard of such cases.
Anyway, regarding the case of suicide – I wonder if in West family would get compensation. I assume that they would. Which leads me to conclusion that even having different systems, both Chinese and Westerners feel what is just and what is unjust in a similar way.
Oh, then I stand corrected. Thank you. Maybe it’s the ex-Soviet crowd I ran with.
This topic is getting more and more attention in the Chinese press. This article (below, in Chinese) from 凤凰网 recognizes the failures of China’s legal system for settling medical disputes and calls for the establishment of an independent third party to settle these disputes. I’m curious if a more rigorous and institutionalized, yet fair, path for settling malpractice claims would be an invitation for an ever-increasing and more expensive malpractice insurance system. Would individual doctors (who are already burdened by low salaries) or hospitals foot the bill for such insurance?
Tom: What is the current state of malpractice insurance in China? Or does it even exist?
http://news.ifeng.com/opinion/gundong/detail_2011_10/03/9629559_0.shtml
LOL, China has a PERFECT malpractice insurance system, including a PERFECT P.I. court system. Didn’t you get the memo? It just hasn’t been IMPLEMENTED yet! And why would they implement a thing that would drain the coffers? China isn’t as stupid or brain-damaged as Hong Kong, you know. That’s why many of the PRC insurance claims are fought in HK courts. LOL.
LOL? I seek not to be a comedian.
I’d argue that stability is a growing concern for those in power in China and that they will address this issue, at least in part. Yes, the system is flawed. In fact, it has comprehensive imperfections. However, I’m still hopeful, for the sake of both doctors and patients, that measures will be taken to help correct this issue.
Tom, question #2: What do your coworkers at the hospital think of “medical dispute resolution centers” that have been opening recently to address this issue (see article below)? I’m in no position to appraise them or to be able to find out how effective they are at equitably resolving disputes.
http://health.dsqq.cn/2011/0825/16102.html
Yes, I echo AndrewThe’s comment. I read in Saturday’s Guardian newspaper an article by their correspondent in Beijing, Tania Brannigan. She reported factually on the Foshan tragedy. Then she reported on a 37 year old woman in Shandong Province who had been coerced into a late term abortion. The woman, who was in a very emotional state, died on the operating table. The medical staff apparently tried to revive her for two hours and then slipped away without informing her waiting family. Four hours later, the operating theatre was suddenly opened and the family entered to find the cold body of their relative. The woman’s 14 year old daughter has become mute with shock. The woman’s 4 year old daughter is crying for her. The family have not told the little girl yet that her mother is dead. Instead they have told the child that her mother has gone away to find work. The husband of the dead woman refused to talk to The Guardian, saying it was not convenient. The family want to sue the hospital but no lawyer will take the case.
Now I can understand (l) why the medical staff slipped away (2) why the bereaved relatives resort to violence. There is no proper communication, no Rule of Law, no way forward for desperately sad people. People in the UK sometimes sue the NHS and sometimes win compensation if there has been malpractice. Increasingly, hospitals here offer Family Bereavement Counselling services. Indeed, my elderly aunt (aged 91) is presently dying in an English NHS hospital and her granddaughter, who is her next of kin has already been offered such a service by the medical staff. The granddaughter, a 39 year old professional lady, has not availed herself of this support but as a family, we were grateful for the offer.
I’m sympathetic to the family suffering and losing in that situation. But then again, I’m in a vicious mood at the moment (har har!), and any red-blood Chinese person would probably tell us all off here that – uh-oh, jungle! – “can’t have British standard here!” LOL.
Joking aside (even insensitively at the bereaved!), if I were running China, I would NEVER implement anything sensible because it just eats into the official coffers. Welcome to the world of professional governance! Where else would the powers-that-be have the wherewithal to build their massive railway tracts and mega-universities? LOL.
I do apologise for my insensitive behaviour here, Tom.
Ah, yes, the old, “###ism with Chinese characteristics…” argument. We can’t impose Western standards in China – a purely political argument that should hold no basis for humanist behavior. There are many Chinese who oppose that argument but are silenced by a vocal minority – those in and with power. It’s a ridiculous argument but I fear I begin to digress and will hence stop before I start to randomly segue into non-sequitur statements.
I still remember the first time I saw a group “storming the airport”, and was amazed that their demands were met, since in the US they would have been arrested as soon as started yelling in an airport with all of our post 9/11 rules. Our flight from Zhengzhou to Beijing was delayed due to snow, and after a few hours they announced that a plane was landing but that it would be taking people to Shanghai instead. The people waiting to go to Beijing began rioting and turning over anything they could find in the waiting area. Then when the plane landed, they stormed the gate demanding to be taken to Beijing. I watched all of this thinking how interesting it was that most people around the world would think nothing like that could ever happen in China since there is so much visible security. But then I was more amazed when the airport announced that the flight would now be going to Beijing. The rioters had won – giving an example to everyone in the airport that day that “storming the gates” was a viable option for their frustration.
I experienced something similar in Lanzhou airport, sans overturned furniture. To be fair to the riotous, the customer service was inadequate to the situation and absolutely overwhelmed.
While it’s sad that some may feel that storming the hospital is their only option, I bet there are those of us in the West whowish we could do the same thing here to get our point across.
Yes!
Except that in most instances in the West, there are valid legal recourses that can be pursued without having to resort to mob behavior – recourses that are, for the most part, unavailable in China. Human behavior (again, for the most part) will devolve to such levels only when they feel there is no other reasonable alternative. Unfortunately, such legal recourse is strictly controlled/prohibited (or at least has the appearance of being so) in China and therefore we are left to mob behavior. I, for one, have no desire to see such behavior either in China or the West (amorphous object though it may be).
Why doesn’t the hospitals provide counseling resources, or even PR people to handle these situations?
My friend works in BJ as a rep for vascular stents and often have to provide tech support during surgeries. One time, a high risk patient did not survive the surgery and the hospital allowed family members to berate the OR staff for hours afterwards, including my friend who does not even work for the hospital. The son of the dead patient was calling my friend a thief and a murderer. I guess the administrators think that by allowing the family to vent, maybe the hospital will pay out less in compensation later. Whatever the reason, it was totally mishandled; the hospital should have professional staff trained to handle these situations.
One other time, her and the entire surgical staff was stuck inside a locked OR because there was a mob of 30+ people outside protesting for compensation. I believe this was at the PLA 301 hospital in Beijing.
Tom. You didn’t mention the sometime role of gangsters in the compensation face-off on behalf of the dead patients rellies.
http://kingtubby1.wordpress.com/ The health care strike hard program
The LA times article I linked to discusses the gangsters. I am not sure if what I have seen is just family or gangs, but it wouldn’t surprise me if there were “professionals” mixed in the groups. Although several of the times I have seen these mobs start actually fighting the police (versus just pushing against them) it has usually included middle aged and older women, so I’m thinking that the violence comes from the emotional frustration of the family rather than the tactics of the gangsters.
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