Last week, 12 seriously ill patients died in a fire started by an arsonist at the Beimen Sinying branch of Tainan Hospital in Greater Tainan. However, the root cause of the catastrophe was administrative failings.
Beimen is a regional branch of the hospital. Originally specializing in the treatment of blackfoot disease, the Department of Health has reincarnated it as a hospital providing long-term care for the chronically and mentally ill. As the hospital is located in a remote area, it is not easy to find enough medical staff, let alone doctors for the night shift or enough nursing staff or long-term carers to fill all the shifts. These staff shortages hamper the hospital’s ability to maintain adequate fire safety measures.
How can a small number of medical and care staff, however committed they are, be expected to deal with a major fire?
It seems that the fate of a hospital is very much tied up with economies of scale.
Another fire broke out not too long ago in a major hospital in the north of the country, but because this hospital was well-staffed and located in a metropolitan area, people were either able to save themselves or were rescued, and so it did not turn into a major problem.
Hospitals with many patients are bustling, chaotic places, and there is always the possibility that somebody will get up to mischief. However, this is usually discovered within a very short time and dealt with. The Beimen branch had only a skeleton staff of medical workers and carers, who were responsible for dozens of seriously ill patients during the night, which was when fire was started. How could they be expected to notice, in the early hours of the morning, that an arsonist had struck until it was too late?
Many of the patients were hooked up to equipment by respiratory siphons, urethral catheters or nasogastric tubes. They were hardly conscious of what was going on around them. When the fire alarm went off, these patients had precious little hope of escaping from the fire unaided. On this occasion, only one seriously ill patient was saved for every four firefighters that went in to rescue them.
In the future this kind of situation is going to become more common as long-term care becomes more important in Taiwan. If the government does not take the issue of future long-term care or care of the elderly seriously, there will be repeats of tragedies like this in the future.
The health department has to pay particular attention to how long-term care centers are run, and to the training of long-term care staff.
Another question is whether it is possible to provide mentally ill patients with adequate guidance and monitoring within the community. Taiwan has an aging population, and arson committed by patients in long-term care is going to increasingly be a problem in the future. It is impossible to keep tabs on the psychological state of all the mentally ill people living in the community. This is the job of psychiatrists and psychologists, and community hospitals do not always have this kind of resident specialist, so are not always able to provide the kind of emergency psychiatric treatment that patients may require.
The efficacy of hospital fire safety spot checks is also questionable, and it is debatable whether those carrying them out are simply just about doing the paperwork and going through the motions, or whether their real purpose is to ascertain the actual quality of care in place.
In the future, it would be better for competent authorities to make it standard practice to conduct these evaluations and assessments independently an without advance notification.
It is the responsibility of the health ministry to foresee any potential risks. If all they are able do is to deal with situations as and when they arise, it is no wonder that the public is complaining that the government cannot do anything properly and is totally incompetent at running the country.
Liu Ching-ming is an attending physician and assistant professor in the department of obstetrics and gynecology at Linkou Chang Gung Memorial Hospital.
Translated by Paul Cooper
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