Identifier
Created
Classification
Origin
05TAIPEI478
2005-02-03 23:32:00
UNCLASSIFIED
American Institute Taiwan, Taipei
Cable title:  

TRAGIC DEATH WON'T LEAD TO HEALTH CARE REFORMS

Tags:  ECON ETRD TW ESTH 
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This record is a partial extract of the original cable. The full text of the original cable is not available.
UNCLAS SECTION 01 OF 02 TAIPEI 000478 

SIPDIS

FOR EAP/RSP/TC, STATE PASS AIT/W AND USTR, USTR FOR KI,
COMMERCE FOR MBMORGAN, JDUTTON

E.O. 12958: N/A
TAGS: ECON ETRD TW ESTH
SUBJECT: TRAGIC DEATH WON'T LEAD TO HEALTH CARE REFORMS

UNCLAS SECTION 01 OF 02 TAIPEI 000478

SIPDIS

FOR EAP/RSP/TC, STATE PASS AIT/W AND USTR, USTR FOR KI,
COMMERCE FOR MBMORGAN, JDUTTON

E.O. 12958: N/A
TAGS: ECON ETRD TW ESTH
SUBJECT: TRAGIC DEATH WON'T LEAD TO HEALTH CARE REFORMS


1. Summary: The tragic death of a four year-old abuse
victim, refused treatment in Taipei and instead transferred
more than two hours away to a hospital in Taichung, has
raised calls for reforms to the Taiwan health care system.
The Department of Health disputes accusations that the
victim's lack of medical insurance led the staff of Jen-Ai
Hospital to seek to transfer her to another facility. DOH
believes this was an isolated incident caused by physician
malpractice, poor management, a flawed referral system, and
inefficient emergency care. The on-duty physician at the
referring hospital is expected to receive an administrative
punishment and may face criminal charges of negligence, his
supervisor and the president of the hospital may also be
sanctioned. DOH is not seizing upon this incident as an
opportunity to address concerns about patient dumping or
press for needed reforms in patient care, instead choosing to
focus on ways to adapt current emergency mechanisms to
coordinate patient referrals. End Summary.


2. The tragic death of a four year-old child abuse victim in
a Taichung hospital January 24, has led to media calls for
reform of the health care system. The victim, brutally
beaten in public by her alcoholic, unemployed father, was
initially taken to the Jen-Ai Hospital in Taipei for
emergency treatment. The on-duty resident reportedly called
for a neurosurgical consultation, but the on-duty specialist
refused to come in to examine the girl and, claiming a
shortage of ICU/neurology beds, instructed the staff to
transfer her to another hospital. Jen-Ai staff reportedly
attempted to contact several Taipei area hospitals, but was
told in each case there were no ICU/neurology beds available.
Finally, the girl was transferred to Taichung's Tung General
Hospital where she received surgery, but later slipped into a
coma, was eventually declared brain dead, and removed from
life support.


3. The incident prompted a round of criticism in the media,
both of the callous disregard for the welfare of the victim
by the hospital staff and for the failings of the Taiwan
health care system. The on-call doctor initially said he had
examined the victim's test results, but later admitted he

never saw the patient, nor did he see her medical exam
results. His story was supported by his supervisor who
reportedly falsified the records to make it appear that the
girl had been examined by the doctor. This initial tragedy
was compounded by the failure of some local hospitals to
report the availability of beds to the centralized Emergency
Operations Center (EOC) as required and the failure of the
Jen-Ai hospital staff to even check the computer record.
Calls by Jen-Ai hospital staff to other Taipei hospitals were
unsuccessful in finding an ICU/neurology bed for the victim,
in spite of the fact that DOH records show that there were
vacant beds.


4. The catastrophic nature of the child's injuries and the
father's lack of health insurance have led commentators to
bemoan the phenomenon of patient dumping -- refusing to
provide service to some patients who are chronically ill or
require expensive treatments and/or constantly transferring
these patients out of the hospital as a cost-cutting measure.
Rumors of critically ill patients being refused service and
constant transfers of difficult cases have led to strong
criticism of the "global budget" system adopted for all
hospitals in July 2004. Under the global budget system,
hospitals received a fixed amount from the Bureau of National
Health regardless of their patient needs. According to
critics, this forces hospitals to reduce medical services and
to try to avoid expensive and complicated cases. Although
egregious cases are rare after a DOH warning to hospitals in
July 2004, many observers believe patient dumping continues.


5. DOH views this tragic case as an isolated problem,
compounded by an inexperienced doctor's poor judgment.
Rather than taking this opportunity to address public
concerns about patient dumping and the trustworthiness of the
health care system, DOH has chosen to focus on ways to
improve accountability and communication in the hospital
referral system. Hospitals are being asked to standardize
their internal controls and DOH is considering how to codify
current regulations that require hospitals to report hourly
the status of vacant beds and create penalties to ensure
compliance. DOH also plans to use the existing regional
Emergency Operations Center to coordinate six regional care
systems based on current Center for Disease Control and
National Health Insurance practice. Hospital transfers will
be limited to within the region, barring exceptional cases.
To this end, DOH plans to press for amendments to the
emergency medical care act in the current legislative session.


6. In a surprising move, and after a direct appeal from the
former Minister of Health Li Ming-liang, the parents of the
victim agreed to donate the girl's organs. Organ donation,
while legal in Taiwan, has not been encouraged by the
government. DOH maintains an organ database, but for
religious and cultural reasons, organ donations are not
popular and there is a serious shortage of transplantable
organs in Taiwan. Many patients reportedly travel to China
or the US for transplants. The Tzu-Chi Foundation, a
respected Buddhist charity, has been advocating organ
donation and has established a bone-marrow donation center.
Interestingly, about half of the donations go to patients in
China. DOH has begun to consider allowing organ donors to be
identified as such on their National Health Insurance Card.
The decision by the parents of this little girl to donate her
organs resulted in some positive publicity for organ
donations, but was tempered when the mother refused to donate
the girl's corneas for fear she would not be able to "see the
way home."


7. Comment: The tragic death of this little girl is a
missed opportunity for Taiwan's DOH. Although improvements
in regional coordination of emergency care are welcome,
family abuse and patient dumping are far more serious
concerns. DOH and other government agencies appear to have
no plans to tackle these more difficult problems. While
family abuse issues will require long term education and
legal changes to address, patient dumping is a direct result
of the global budget system adopted by the Bureau of National
Health Insurance (BNHI) at all hospitals last July. Although
the fiscal crisis at BNHI makes cost control measures
essential, patients suffer from reduced services -- including
costly emergency services. DOH has been unable to
effectively regulate patient dumping out of existence and DOH
leadership does not appear to be focused on taking steps to
remove the incentives to refuse service or transfer difficult
cases. With the death of the victim, the need for reform
quickly moved off the front pages and out of the public
consciousness. Although newly chosen Premier Frank Hsieh
announced February 1 that the new government would seek to
cooperate with the opposition parties on health care reform,
it remains to be seen whether Hsieh's direct involvement will
be sufficient to energize health care reform efforts.


8. This case also became emotive grist for Taiwan's
political mill. Green-affiliated media and 24-hour news
channels focused on how, in two weeks, Taipei's city
administration allowed two needless tragedies to occur (the
previous involved two women whose hair became entangled in a
subway system escalator.) This was an opportunity to tarnish
Mayor Ma Ying-jeou's lustrous political image as he prepares
to contest the leadership of the Kuomingtang party. Mayor Ma
is actively trying to recover through aggressive pursuit of
the facts in the girl's death and public relations
advertising. End comment.
PAAL