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Fund or no, doctors are responsible for errors

A DRAFT LAW on resolving medical disputes and a draft compensation act have been discussed for more than 10 years. To resolve disputes involving hospitals, doctors and family members, the Department of Health recently came up with a plan for a childbirth risk compensation fund that would pay up to NT$2 million (US$65,000) without assigning blame if a mother or newborn dies or is harmed.

The Taiwan Health Reform Foundation believes that only by being fair and just will this system be acceptable to the paying public and medical professionals.

Quick compensation for patients in the case of no-fault medical injuries will minimize conflict between the patient's family and doctors and is a direction that the foundation supports, although methods of financing need to be discussed further.

According to the current plan, obstetricians pay NT$2,000 to the fund for every child they deliver, and the government pays the rest -- the lion's share -- through the budget.

This means the public as a whole bears the cost of medical risk, which is reasonable. However, the authorities must give further consideration to whether the contributions of obstetricians should be shifted onto all pregnant women so that healthy mothers and babies also shoulder the cost of risk.

The plan would have a pregnant woman or a family member sign a standard agreement through which compensation from the childbirth risk compensation fund can be issued in case the mother or her child is injured or dies during childbirth in lieu of formal legal action.

Whether or not the agreement is signed, however, problems arise. If it is not signed, will the doctor be more careful, or will he or she refuse to help the patient altogether?

If the agreement is signed and injury occurs, the lack of a thorough explanation might mean that the patient and her family are unaware that they retain the right to take legal action provided that they do not accept the compensation. The standard agreement must clearly explain that this choice exists. Even more important, if medical negligence is established, will the doctor or the hospital avoid responsibility because compensation is paid by a third party? Is it proper that responsibility for medical negligence not be investigated?

The foundation thinks that if the issue of responsibility is ignored and there is no investigation, then hospital management and medical personnel may not learn from any mistakes.

Action should therefore be taken so that personnel who are negligent face the consequences of their actions and act to avoid repeating their mistakes. The managing committee for the compensation fund should therefore be able to recover compensation money from negligent practitioners.

This system has been influenced by the Birth-Related Neurological Injury Compensation Act of Virginia in the US, as well as laws to solve no-fault medical disputes in New Zealand and Sweden.

It is, however, important to note that Sweden and New Zealand have a complete social welfare system to take further care of seriously injured patients, while compensation money is only a supplementary resource.

Taiwan, on the other hand, doesn't have a well-planned support system for early intervention for children, or long-term care for comatose patients or physically disabled people.

How long can compensation of up to NT$2 million support these patients? These are all matters that the government should consider when drafting the law on resolving medical disputes.

Chang Ly-yun is the chairman of the Taiwan Health Reform Foundation.

TRANSLATED BY ANNA STIGGELBOUT
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