China trying to stop patients from killing doctors

Calum MacLeod | USA TODAY

BEIJING – China plans to beef up security in its hospitals to prevent the deaths of doctors and nurses in attacks by patients' relatives outraged over the cost and quality of care.

Experts say that without significant health care changes to tackle the causes of conflict, the measures will not improve safety.

Attacks on medical staff, mostly by angry relatives, killed seven people and injured 28 in 2012, according to the National Health and Family Planning Commission, which issued security guidelines with the Ministry of Public Security, China's police force.

The guidelines suggest that the number of security guards in each hospital should be at least one per 20 patient beds, or no less than 3% of medical staff. The guidelines also call for alarm buttons, security doors and scanning equipment to detect weapons, plus more camera surveillance and foot patrols.

Besides the increased hardware, the authorities say better mediation of medical disputes is necessary and more education to "guide patients to safeguard their rights in a rational manner."

Emotions often run high at Chinese hospitals, a result of resentment over expensive and hard-to-access medical treatment. Anger can be compounded by the need to pay bribes to guarantee good service and supplement doctors' usually low wages.

Monday, several people severely beat three doctors at a hospital in south China's Guangzhou city after they were unable to immediately take home the body of a deceased, elderly relative.

"All medical personnel feel insecure!" wrote Eric Chong, deputy secretary general of the China Hospital Association, on Sina Weibo, China's Twitter equivalent, after the incident. "We need all sectors of society and the government to face up to this, and make a self-criticism! Otherwise China's medical service has no future!" he wrote.

Chong shared a photo of a masked medical worker holding a sign about the Guangzhou case that read, "Demand that the perpetrators are dealt with by law! Zero tolerance for violence in hospitals starts with you and me! No safety for doctors and nurses, no health for patients!"

A survey by Chong's association, released in August, showed the annual average number of assaults on doctors increased to 27.3 per hospital in 2012, up from 20.6 in 2008.

Reasons for the violence included unsatisfactory treatment, poor doctor-patient communication, high expenses for patients and insufficient medical resources, the survey found. Nearly 40% of the medical staff surveyed at 316 hospitals said they planned to give up their profession because of the increase in violence, the survey said.

Zhu Youdi, a medical expert and writer, blamed the violence on "a crisis of mutual trust and mutual communication between hospital and patients."

If a doctor succeeds in curing them, "patients are happy and willing to give bribes. But if a doctor receives bribes but fails to cure the patient, they lost both life and money, and the relatives will be extremely angry, it's impossible to ask them to behave in a rational manner," he said.

The new measures fail to tackle the problem, Zhu said. Only a thorough overhaul of China's medical system will reduce hospital violence, he said.

Huang Jiefu, a former deputy minister of health, says China needs an independent agency to handle medical malpractice disputes for patients who have no confidence in the hospital-run system, according to the Beijing Morning Post newspaper.

China's hospitals must lose some of their administrative authority, Zhu suggested. In U.S. hospitals he has visited, where malpractice may end a doctor's career, "they treat their work carefully, but for doctors in China, an accident is the hospital's business, as the hospital runs everything, including buying medicines, equipment and doctors," he said.

The guidelines are aimed at hospitals of "secondary level and above," which means half of China's 24,000 hospitals, but the nation's remaining 900,000-plus health care institutions, mostly at grass-roots level, should use them for reference, the commission said.

The measures form the latest salvo in China's "Safe Hospitals" campaign begun in 2007. Many urban hospitals have bought helmets and anti-stab vests for security guards and long sticks to keep attackers at bay. The most common weapon in China is usually a knife or kitchen chopper; guns remain rare.

"The strength of security guards is insufficient," joked Dong Guining, an IT salesman in Beijing, on Sina Weibo. "You must use the People's Armed Police, or, when necessary, the chengguan," urban management officials infamous in China for beating street vendors to death.

Contributing: Sunny Yang