Tot's Misfortune Opens Medical Can of Worms
Teng Sue-feng / tr. by Christopher J. Findler
February 2005
A four-year old girl is subjected to domestic violence. She is then misdiagnosed and her treatment delayed by a series of medical blunders. The story is reported at length by the media, generating waves of sympathy from around the globe. But hers is not an isolated case. Although the actions, whether deliberate or otherwise, of a few medical professionals have stirred up public criticism, the top priority at this point is leveraging that outrage to push through reforms and rid the medical and National Health Insurance systems of the deep-rooted problems that allow such cases to occur in the first place.
A cold front had enveloped Taiwan on January 10th. Late that night, four-year old Chiu Hsiao Meimei was still out roaming the streets with her father. The tired and sleepy child pleaded with him to carry her. Instead, her unemployed father, who was drunk at the time, gave her a severe beating that induced intracranial hemorrhaging. The police transported her to the emergency room at Taipei Municipal Jen-Ai Hospital, but despite repeated telephone calls to the doctor on call, the ER doctors were informed that surgery would be impossible as the intensive care unit was full. They then enlisted the assistance of the Emergency Operations Center which called 19 other hospitals in northern Taiwan. All beds were reported occupied. Left with no choice, the very sick little girl was transported by ambulance to Tung's Taichung MetroHarbor Hospital-over two hours away in Taichung County. In a deep coma by the time she arrived the following morning at 7:30, she underwent emergency surgery to remove blood clots. Sadly, however, she never regained consciousness, and 14 days later was declared brain-dead. Her family agreed to donate her organs to help others in need.
The little girl's plight stunned the entire island as it pulled back the curtain to reveal all kinds of problems-domestic violence, lack of transparency on hospital bed information, the contingency capabilities of the emergency medical network, as well as the professional judgment and medical ethics of physicians.
Closer scrutiny revealed that Chiu Hsiao Meimei's misfortune was merely the tip of the iceberg. The problem of patients not being able to find hospital beds has been around for a long time, because beds are traded for influence or other advantages. Seriously ill individuals that don't "know the right people" have a terrible time getting hospital beds. Rigid caps set forth in the National Health Insurance Global Budget System on the amount of money reimbursed to hospitals exacerbates the situation, while causing a number of additional side effects.
Moreover, after being taken through the paces two years back by the SARS epidemic, the Taipei City Government established the Emergency Operations Center, which has the capability of checking various hospitals for empty beds. This illustrates that medical and health agencies realize the importance of flexibility in times of emergency. But merely having such a system in place doesn't guarantee that it will function properly when it's actually needed. Pediatrician Lee Ping-ing of NTUH points out that when the physicians in Jen-Ai Hospital's emergency room were looking for ICU beds and checking other hospitals for empty beds, they should not have just asked about neurosurgery ICU beds; rather, they should have asked if it were possible to make a bed available.
Following the incident, inquiries were made to determine why Jen-Ai Hospital did not try harder to make a bed available when it could have added one or freed one up. Six days after the incident, a task force charged by the city government to investigate the incident made a surprising discovery-Dr. Lin Chih-nan, a neurosurgeon and the doctor on call on the night in question, simply decided to order Chiu Hsiao Meimei transferred to another hospital without even looking at the CAT scan pictures of her injury as required by regulations. What's more, attending neurosurgeon Liu Chi-hua was aware of the situation, but did not report it. The two are also suspected of later illegally altering the patient's medical records.
These two frontline doctors have already been put on "public trial" by society, but does that really help resolve such urgent matters as the hospital transferal system, the city hospital personnel shortage, and management problems? Taipei City mayor Ma Ying-jeou feels that there is a need to look into why Dr. Lin was on call 15 days a month, much more than the seven or eight days required of most residents. When a doctor is unable to physically keep up with his workload, he will burn out, regardless of how much passion he might initially have had for medicine. In the end, it is the public's health that is sacrificed.
While the medical sector is being crucified, social workers explain that when it comes to domestic violence, an ounce of prevention is truly worth more than a pound of cure. Young, fragile, and helpless, Chiu Hsiao Meimei is a classic example of one group most at risk of domestic violence. Mr. Chiu had been out of work for a long time, was an alcoholic, and had a record of domestic violence. Obviously unfit to be a parent, he was still awarded custody of Chiu Hsiao Meimei after his divorce from her mother. Friends, relatives, the mother and neighbors were all aware of Mr. Chiu's temperament. But nobody stepped forward to report it to the local police or social workers, so that Chiu Hsiao Meimei could get protection. This shows that the public is insufficiently informed about domestic violence and lacks crisis awareness.
Let us hope that Chiu Hsiao Meimei's situation serves as a wake-up call for people both in medicine and society as a whole, that it causes us to honestly reassess our social care mechanisms and medical system, and that it reminds us that concern for the patient is what medicine is all about. Let hospitals be an end to pain and suffering, not their source
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