Sat, Jan 19, 2013 - Page 8 News List

Mediation in medical disputes an expert’s job

By Andrew Huang 黃達夫

A set of amendments to the draft medical dispute act recently passed the first reading in the legislature’s Social Welfare and Environmental Hygiene Committee. News reports have said that the amendments state that when a medical dispute occurs those involved can request mediation where the dispute arose, where they live or in a county or provincial municipality agreed to by the two parties and that the mediation must be completed within three months.

This may be well-meaning, but it is questionable whether such rapid resolution will be possible.

The passed version of the draft act says that the special municipalities, counties and provincial municipalities should set up medical dispute mediation committees, that these committees should consist of between nine and 27 upstanding members with medical, legal or other specialist knowledge and that at least one-third must have specialist knowledge in a field other than medicine.

While adding further bureaucratic red tape, the amendment continues to entrust non-specialists with handling these issues, which creates the distinct impression that it is a case of old wine in new bottles.

The question is whether those who proposed the act have analyzed the reasons why resolution of medical disputes has previously been so time-consuming. The key reason is that the reviews lacked sufficient expertise and clarity resulting in varying interpretations. If right cannot be separated from wrong, there is no foundation on which to base mediation.

In more advanced countries, medical evaluation and mediation is a field of expertise in its own right. In Taiwan it is dealt with by people on a part-time basis.

If hospitals and doctors are allowed to conduct evaluations themselves, then conflicts of interest may arise, meaning that people of the same profession may let each other off the hook too easily, making it difficult to gain patients’ trust.

In a few medical reviews the evaluation standards were very uneven.

It was reported that a well-known case, in which the patient was awarded NT$30 million (US$1.04 million), was submitted to the medical review committee for evaluation three times and that committee members felt that if doctors had installed an intracranial pressure monitor or arranged for computed tomography, the patient’s injuries could have been prevented or minimized.

In this case the key factor was that necessary bedside monitoring –– such as the Glasgow Coma Scale, blood pressure, heart rate, pupil size and light reflection and a full neurological examination had been neglected post-surgery. Any change in these must be promptly attended to; a fundamental requirement of medical treatment.

When the medical review committee determined that it was a matter of medical neglect not to have installed an intracranial pressure monitor, it misled both younger physicians and patients, which could lead to the misuse of monitoring equipment and a waste of National Health Insurance funds.

Taiwan does not need to spend taxpayers’ money on setting up dozens of useless evaluation and mediation committees. Decisionmakers should avail themselves of the opportunity that has presented itself through the amendments to the draft act and organize a team of expert physicians, legal experts, social workers and psychologists with a sense of justice to take exclusive charge of all evaluation and mediation.

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