US embassy cable - 05TAIPEI478

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