Patients’ Families Protest ‘Wolves in White Coats’

Yu Jiyuan is the father of two dead sons--one a statistic in China’s appalling medical malpractice record, the other a casualty of a legal system that protects doctors who do wrong.

A single thought keeps Yu going: His 21-year-old son never should have died from a routine asthma attack.

Yu has gathered evidence that doctors in a Shanghai hospital denied his son emergency medication, tied him up, forced oxygen on him and went out to lunch as the young man lay dying.

But 14 years and countless legal proceedings later, the courts still back the hospital, which insists it did nothing wrong.

Yu’s other son couldn’t bear to watch his father smash his head against China’s great wall of bureaucracy. Two months before he was to be married last year, the 31-year-old leaped off the balcony of his fourth-floor apartment.

“My son had told me, ‘You can’t get justice in this life,’ ” Yu recalled recently. “ ‘I will avenge my brother’s death in the afterworld.’ ”

Medical malpractice complaints have skyrocketed in China since market reforms in recent years have turned health care for the majority of Chinese from a government handout to an expensive privilege. Citizens of the world’s most populous country are shedding their old image as demure comrades and standing up as defiant consumers.

They are declaring hospitals with dismal safety records “execution grounds.” They are calling irresponsible doctors “wolves in white coats.” They are learning to hire lawyers and use the media, flexing muscles of public opinion in an emerging civil society.

But except in the most sensational cases, many victims’ families, like the Yus, find themselves abandoned by an inadequate judicial process, waging an uphill battle on a trail of tears.

“I have no hope,” said Yu, sobbing in the sparse apartment the 58-year-old engineer shares with his wife. They have sold practically everything of value to finance his crusade, including their wedding bands. “Nothing will bring my sons back. But how can I let them die in vain?”

The Ministry of Health does not release official data on malpractice cases. But last year, a national consumer hotline received more than 17,000 medical complaints. Horror stories become screaming headlines. Live newborn twins are tossed into the garbage as dead fetuses. An appendectomy leads to a missing ovary. A loose tooth turns into death from an overdose of anesthetic.

It goes on and on.

“That’s only the tip of the iceberg,” said Yu Weihua (no relation to Yu Jiyuan), a 31-year-old surgeon whose newborn daughter died in a Guangdong delivery room because of what he calls hospital negligence. “The actual numbers are much higher.”

Medical mistakes, of course, are not unique to China. In the U.S., a special alert issued last month by a hospital regulatory agency said that more and more surgeons are performing operations on the wrong patient or the wrong part of the body. The Joint Commission on Accreditation of Healthcare Organizations said 58 such errors had been reported last year, up from 16 in 1998.

U.S. physicians and hospitals, however, pay hefty premiums to insure themselves against liability for any mistakes they make--a concept all but unheard of in China.

In this country, by contrast, many cases go unreported because potential plaintiffs give up. At the heart of the matter is an outdated redress system that almost guarantees failure for the victims.

The single most important piece of evidence required to prove medical malpractice in court is a medical appraisal by the local branch of the national health bureau, the parent organization for all public hospitals. Without that, there is no case. But such reports almost invariably exonerate hospitals because most of the arbiters are local doctors with a vested interest in the outcome of the rulings. Many hospitals’ rankings and revenues depend on avoiding malpractice blemishes.

Some Doctors Driven to Take Victims’ Side

The system is so rigged against patients, according to Chen Zhihua, a Beijing lawyer who specializes in malpractice complaints, that they do not even have access to their own records. Hospitals can easily falsify or erase incriminating information to deny responsibility.

The senselessness of it all has pushed even some doctors, like Yu Weihua, to pick up the torch for disenfranchised patients by organizing and speaking up for victims’ families from around the country.

“Open up the lawmaking process. Let us speak!” read an open letter Yu posted on the Internet on behalf of fellow victims seeking to scrap one old law that tips the scale in favor of doctors.

Hospital supporters, however, argue that no legislation will be good enough if victims don’t temper the unrealistic expectation that doctors never make mistakes.

“I’m not saying there are no bad doctors who are irresponsible,” said Tong Jianyun, an internist turned attorney who primarily represents large state hospitals in malpractice suits. “Hospitals are not five-star hotels. You take a chance any time you receive medical treatment. It’s unrealistic to expect a hospital visit to be a complete risk-free experience.”

Unlike doctors in the West, Chinese physicians are notoriously low-paid. At a few hundred dollars a month, salaries are not much better than what workers at state-owned factories earn. The only way to motivate physicians to take extra care, it often seems, is to bribe them with “red envelope” money, an illegal but widely used option of last resort.

Chinese doctors’ workload, moreover, is surely among the highest in the world. Some physicians treat 40 to 50 patients a day. “That’s an average of about six minutes per patient each morning,” Tong said. “Objectively, how can they give quality service?”

What’s happened at some hospitals, victims argue, seems to defy common sense.

Jan Zhuang said she lost her mother not to cancer but to its treatment. She watched doctors at a Shanghai hospital repeatedly drain high volumes of fluid from her mother’s stomach. But they failed to replenish the patient’s weakening body with the adequate amount of blood serum as clearly instructed by their own medical manual, Zhuang said, pointing to the text.

“I begged them to give her more blood,” said Zhuang, who herself trained as a nurse. “Her pulse was fading. I almost got on my knees. The doctor told me what they gave her was enough.”

That evening, Zhuang’s mother died.

The incident confirmed another unwritten rule, Zhuang said. Unless the patients have special connections, hospitals tend to ignore cancer sufferers, because “they are just someone waiting to die.” The hospital denied any wrongdoing.

Yu Jiyuan’s son wasn’t suffering from a terminal illness. The circumstance of his death were equally avoidable.

As a computer whiz, Yu Haiwen had impressed his teachers at a young age. In college, he was an ace student working on a transfer to Yale University.

But because of his background as a student activist, school officials refused to release his transcripts, which made it impossible for him to leave the country. In protest, he went on a hunger strike. Officials ignored him. He fell into a depression. They sent him to a mental hospital.

Twelve days later, he was dead.

Asthma Attack Proved Fatal for Youth

“My son had asthma all his life, so he knew what medication he needed,” his father recalled of the day his son suffered what appeared to be a routine asthma attack. “He was on the floor begging for his respirator.”

The hospital said it didn’t have one. Apparently, the doctors initially thought the patient was faking, his father said.

When the young man continued to beg for help, the doctors forced oxygen on him--also dangerous because he could not breathe. When he refused the oxygen, according to witness accounts, he was tied up with a tube taped to his nose.

“They tied him up because it was lunchtime and they needed to go eat,” his father said.

By the time they came back, Yu Haiwen had stopped breathing.

The hospital claimed it had done everything for him that it could.

The father demanded an autopsy. The hospital insisted that the body had to be cremated immediately because its freezer was broken. The father refused and called the police. A medical examiner looked at the body and found no evidence of any emergency rescue.

“That means the hospital fabricated the medical record,” Yu said.

Despite this critical finding, a court ultimately could not rule against the hospital because of the all-powerful appraisal committee’s verdict: not guilty.

The best the judge could do was order the hospital to pay the patient’s family the equivalent of $85, minus $73 in legal fees. “Probably because the judge realized they shouldn’t have tied him up,” Jiang Weizhong, Yu’s lawyer, said. “But that’s not an admission of negligence.”

The outraged father has been appealing ever since.

“His case seemed pretty clear-cut to me,” Jiang said. “But under the current law, there’s no way he could win because the courts could not overturn the decision of the appraisal committee.”

China may have no choice eventually but to eliminate outdated laws that don’t meet international standards, especially as the country adjusts to life after joining the World Trade Organization. Rising competition among local medical centers and shrinking financial support from the state are also forcing many Chinese hospitals to improve standards and accountability.

Until things change, however, health care in China remains shrouded in a dark cloud of fear and distrust. And people like Yu will keep pursuing their wrenching quests, reaching out to anyone willing to listen.

“My younger son had told me to stop writing. We had already four boxes full of material,” Yu said. “He said words are useless, there is no justice. But I won’t give up until the day I die.”