The increasing cost of saving lives

By Chiang Sheng 江盛  / 

Wed, Apr 11, 2012 - Page 8

Seven years ago, surgeons at Tung’s Taichung MetroHarbor Hospital operated on a man who had suffered a head injury in a traffic accident, but the outcome was that the man ended up totally paralyzed and blind. At the end of last month, the -Taichung branch of the Taiwan High Court ruled that the hospital and the three doctors who performed the operation must pay the man’s family more than NT$33 million (US$1.1 million) in compensation.

One of the doctors is neurosurgeon Lee Ming-chung (李明鍾), who is famous for his valiant, though ultimately unsuccessfu, efforts to save the life of another brain trauma patient, a little girl surnamed named Chiu (邱), who had been turned away by several other hospitals.

The neurosurgeons who spoke out after the court expressed firm support for their peers. They cast doubts on the court’s decision and voiced strong indignation. However, the courts and the medical review board each have their own views, so it remains to be seen whether the support these surgeons expressed for their colleagues will have the desired effect.

This case is consistent with other court verdicts over the last few years that have awarded high payouts to patients involved in medical disputes, so it is important for doctors and the general public to understand the implications and wide-reaching social effects of this trend.

Evidently, the way courts decide such cases at present is to include in compensation awards all the costs involved in caring for patients who end up in a persistent vegetative state (PVS), and these costs must be borne by both the hospital and doctors who made mistakes or just had the bad luck to be on duty when the incidents occurred.

The knock-on effect of this is that young doctors are no longer willing to enter departments that involve high levels of risk. Another effect is that doctors are erecting ever-higher protective walls around themselves, and this is going to place an ever-greater burden on the nation’s health insurance system.

Doctors and patients have a common interest in finding out the real reasons behind medical errors. While healthcare providers can use this information to improve the quality of medical treatment, the victims of medical failures can get compensation based on facts. However, the current litigation system puts heavy blame on doctors, treating physicians who have no motive to hurt people as though they were criminals.

Putting such cases through the lengthy and drawn-out litigation is an inefficient use of resources. It is also unfair, because 80 percent of victims of medical errors fail to get any compensation via the judicial system.

One reason why medical care in Taiwan is so cheap is that much of it is not covered by insurance for medical accidents. Taiwanese doctors are often uninsured, so they come under intense pressure if anything goes wrong. The most important and urgent thing, then, is for medical institutions, the government and the public to work together and establish an effective and fair medical litigation and compensation system.

Taiwanese are rather careless about safety, so traffic accidents are all too common. Accident victims range from those with broken bones to those who remain in a PVS and never recover consciousness.

Taiwan has the highest rate of PVS in the world. The number of PVS patients in the US is estimated to be somewhere between 15,000 and 40,000. According to available information, Taiwan had a total of 4,792 PVS patients as of 2008, and 6,000 PVS patients are now registered for care with the Genesis Social Welfare Foundation, a charity that specializes in this field. These figures suggest that not only does Taiwan have a very high rate of PVS, but the number of cases is increasing very fast. As to why people end up in this condition, the most common cause is scooter accidents, followed by overmedication.

If the incidence of PVS in relation to total population were the same in Taiwan as in the US, Taiwan would have approximately 3,000 PVS patients, but the fact is Taiwan has a 60 percent higher rate of PVS than the US. The chance of any Taiwanese becoming a PVS patient is far greater than for an American. In view of this, while it is a good thing to keep donating to support PVS patients, we also need to think about the medical and social implications.

According to statistics compiled by the Genesis foundation, 62 percent of the PVS patients they care for are in that condition as a result of traffic accidents, and most of those were scooter and motorcycle accidents. Clearly, the widespread use of scooters is the main reason why Taiwan has so many PVS patients. Figures show that nation has the highest rate of scooter ownership in the world, and the most scooters per kilometer of road.

While the legal system demands perfection from doctors, society should also reflect on the heavy price the state pays for its scooter-based transport culture.

At the same time, if the healthcare system gives sole emphasis to how many lives can be saved, without considering quality of life, the result will often be that people’s lives are saved only for them to end up as PVS patients. Doctors have to think long and hard about the rights and wrongs of saving people and leaving them in this condition.

The choice doctors have to make about whether to save a particular patient can sometimes be a very tough ethical decision indeed.

Chiang Sheng is an attending physician in the department of obstetrics and gynecology at Mackay Memorial Hospital.

Translated by Drew Cameron