HENGYANG, China (AP) — Dr. Chen Yuna had just eaten her lunch and
was seated at her desk updating patients’ medical records when a masked man
entered her office. He pulled out a dagger and stabbed her 28 times in her
neck, chest, stomach and elsewhere. Then he left her to die in a pool of blood.
He knew the hospital well enough
to slip out easily: Before he became Chen’s killer, the man had been her
patient.
Chen’s murder in central Hunan
province is one of thousands of violent attacks in recent years by patients
that have crystallized public discontent with China’s health care system, the
largest in the world.
Despite an injection of more than
$240 billion in government funding into health care over the past three years,
the doctor-patient relationship has continued to break down. Doctors are
overworked and underpaid, and many push drug sales or charge extra for services
such as deliveries to make more money. Patients are faced with high medical
expenses, brief consultations and often poor quality care.
The government’s attempts to fix
the system may even have made some things worse. Its rapid expansion of
insurance coverage means that more patients can pay for health services, which
are mostly provided by public hospitals. But even as demand has gone up,
doctors and funding are still in short supply. Hospitals are often scenes of
disarray, with beds overflowing out of wards into corridors and shouting
matches between patients and medical staff.
The anger built up over years is
now exploding into violence, with doctors, nurses and interns around the
country stabbed, punched or otherwise assaulted by patients or their relatives
over the past year. A few have died. Although official data is unavailable,
state media reports say there were more than 17,000 “violent incidents” at
health care facilities nationwide in 2010, a 70 percent increase from 2004.
In a top Beijing hospital in
September last year, a 54-year-old cancer patient stabbed a doctor 17 times
after a dispute. In the northeastern city of Harbin in March, a 17-year-old
patient with a spinal disease attacked doctors with a fruit knife, leading to
the death of an intern. One month later in Beijing, a man identified as a
patient stabbed two doctors.
“China’s doctors are in crisis,”
the British medical journal Lancet said in a May editorial urging a government
inquiry into the spate of violence and solutions to ending it.
___
The story of Chen’s murder is
told through interviews with Chen’s husband, her co-workers, a patient and
police, and supported by photos and reports from the local health bureau and
state media. The alleged assailant’s family could not be reached despite
numerous attempts; very little is publicly known about him. He has been charged
with murder.
Chen grew up surrounded by the
medical profession. As a child in the late 1970s, she lived on a hospital
compound with her parents, who both worked as doctors. Many of her relatives
were also doctors.
Around her, however, the world of
Chinese health care was changing.
When the Communist Party took
control in 1949, it created a centrally planned medical system that ran large
facilities in cities and deployed barefoot doctors into the countryside to
vaccinate children and promote hygiene. But by the early 1980s, free-market
reforms were virtually dismantling the health care system.
The government cut funding to
hospitals. They were allowed to make hefty profits from new drugs and
technologies instead, and doctors’ bonuses were tied to these revenues. So
doctors had an incentive to sell more drugs and tests even if they weren’t needed,
and expenses skyrocketed.
Chen graduated in medicine from a
local university in 2001 and joined her father at the Hengyang No. 3 People’s
Hospital. She kept journals with detailed medical notes about her patients and
a Chinese-to-English glossary of medication names in the back.
Chen specialized in tuberculosis
because most of her patients suffered from it — including the man who would
later kill her.
By many accounts, Chen, 34, loved
her profession and worked hard. “She was very warm, very caring,” said Jian
Hongjiang, who was Chen’s patient when he was hospitalized in June for TB. “She
came to see me every day and always asked me if I was feeling better. I was
shocked when I heard what happened to her.”
Chen, like most doctors, rarely
had public holidays off and worked many weekends. Her phone rang daily with
calls from patients with questions and requests.
One of the last text messages she
sent was to her department head on April 21, when she was out of town with her
husband. “I’ve already accounted for my patients, their conditions are all
stable,” she wrote. Some days she came home from work and remarked: “Today was
such a hard day.”
Chen’s workload was not unusual.
In a survey released February of more than 10,000 doctors by the online medical
network Dingxiangyuan, a third said they saw more than 50 patients a day, some
more than 100.
Hard work and low government-set
salaries have made the medical profession one of the least popular in China.
Entry-level doctors in major cities earn about 3,000 yuan ($500) a month,
doctors say, about the average income of university graduates despite more work
and more risk. In grassroots facilities like the hospital Chen worked in,
salaries are even lower. After 11 years, Chen was earning only around 3,500 yuan
($550) a month, more if she saw more patients.
The low wages have led to
widespread and well-known corruption, which fuels hatred of doctors. Many users
of popular online microblogs have cheered the attacks on doctors as rightful
punishment for corrupting the health care system.
The April stabbing was not Chen’s
first encounter with violence. In September, a patient threatened her with a
knife over a dispute about him cuddling with his girlfriend in front of other
patients in the ward.
Terrified, she called her
husband, Liao Chongzhou, who rushed to the hospital. Police took statements but
the patient was discharged without incident.
Liao did not think too much of
it. “This kind of thing happens all the time in grassroots hospitals,” said
Liao, who used to be a doctor too until he quit last year, fed up with what he
described as overly demanding patients.
It was only after reports of
doctors being severely attacked elsewhere earlier this year that he called his
wife’s hospital and suggested they beef up security. Liao told a hospital
official: “If something happens, it will be too late for regrets.”
___
Meanwhile, Wang Yunsheng was
growing more frustrated by the day.
A decade ago, Wang left his rural
home in Hunan at 15 for the prosperous south to work to help support his
family. Last year, while doing construction in Guangdong province, he started
coughing incessantly. Several hospital trips later, he was diagnosed with
tuberculosis.
The 25-year-old migrant worker
took two courses of medication and showed signs of improvement, but suffered
from insomnia and a rash on his arms, possibly as side effects.
In July last year, Wang went home
to Hengyang and turned to the No. 3 hospital for help. He spent 28 days in the
hospital and at least 8,600 yuan ($1,350) — about one and a half times the
annual income of a farmer. He was told that he had drug-resistant TB that is
hard to cure.
About half his hospital expenses
were covered by insurance, one report says, but drug-resistant TB is expensive
to treat and would have cost him tens of thousands of yuan over the next few
years. With a family to feed, medical bills were the last things he needed.
In general, the government’s expansion
of health insurance coverage — from 30 percent of the population in 2003 to 96
percent last year — has made it more affordable for people to seek health care.
As one result, hospital admissions have surged by two and a half times over the
same period. At many top city hospitals, patients line up overnight for
consultation tickets or are gouged by scalpers for them.
“The supply cannot catch up with
demand, you have long waiting times, doctors on average spend five minutes with
patients and don’t have time to communicate well with their patients and that
creates problems,” said Yanzhong Huang, an expert on China’s health reforms at
the Council on Foreign Relations.
At the same time, insurance
benefits are still too shallow to cover major illnesses such as cancer,
HIV/AIDS or TB, described by health economists as “catastrophic” because
treatment often wipes out family savings. Spending on health care as a share of
household expenditure in China has gone up by 2.3 percent a year in the past
few years, according to a Lancet study in March.
Because patients are spending a
lot, their expectations increase, doctors say.
“Part of the violence against
health workers is because people don’t know the limitations of medicine and
medical care and they expect that if they pay, the cure will come,” said Sarah
Barber, a health expert at the World Health Organization’s office in China. “I
think you have a gap between the expectations and what can realistically be
achieved.”
Wang believed that doctors were
lying to him when they called his condition hard to treat, and that he
developed drug resistance due to bad treatment.
He grew despondent. His anger
zeroed in on his main physician: Chen.
___
April 28 began like any other
day. Chen started a 24-hour shift at 8 a.m. by checking on her patients at the
decades-old, rundown hospital, in a forested area in the rural outskirts of
Hengyang. The three nurses on duty on her floor left to check on patients. Chen
was alone.
Wang walked into her office
unnoticed around midday.
Ten minutes later, nurses found
Chen lying on the floor bleeding to death. Bloody footprints marked the
corridor and a staircase leading to the ground floor.
Liao, her husband, was returning
to his office from lunch when his in-laws tried to reach him. He rushed to the
hospital, but police would not let him near the crime scene. Finally, they told
him she was in a morgue.
There, Liao stroked his wife’s
face and thought how she looked like she was just asleep. Then he examined the
wounds on her neck, heart, liver, back, chest and left arm. He fell to the
floor.
“At that time, I lost control, I
could not feel my limbs,” Liao said. “I studied medicine and so I’m used to
seeing things like this, but this is a person I loved… I could not take it.”
The next day, several dozen
former schoolmates joined him in a protest at the hospital over the safety of
medical staff. They blocked the entrance, strung up a banner across the gate
and set up a picture of the slain doctor.
A passing taxi driver had seen a
man with bloodied hands outside the hospital, and helped police identify Wang
from a list of Chen’s patients. They arrested Wang near a train station with a
dagger in his possession. Police said he was angry and asked why they did not
take his side against the doctor.
Now the hospital has set up a
security post in the middle of the sprawling compound, though three guards on
duty were napping or otherwise not watching during a recent visit by The
Associated Press.
“It can be said that my wife’s
life has been given up in exchange for a security post,” Liao remarked.
Hospital officials reached by
phone said they had no comment on the attack on Chen or the state of security
at the facility.
A few days after Chen was
murdered, the Health Ministry and Public Security Ministry issued a joint
notice saying people who threaten, insult or injure medical staff or who bring
flammable or explosive materials into hospitals will be held criminally
responsible. People are also barred from setting up mourning halls or burning
funeral money in these facilities — common methods of protest. Police posts
have been set up in hospitals across the country, while doctors in some cities
have been trained in self-defense.
The government has also announced
a code of conduct barring doctors from seeking bribes and accepting kickbacks
from medical companies. It is also testing different models of funding at many
hospitals to reduce reliance on drug profits, but the situation is not expected
to improve soon.
For Liao, the death of his wife
was “like the sky had fallen.” He tells their 6-year-old daughter that her
mother is in heaven getting treatment for an illness; one day when she is
older, he says, he will tell her the truth.
He waits for the day the killer
is put on trial and expects the maximum sentence.
“For the murderer, he should
repay the life he has taken with his own life, and that should serve as a
lesson for others,” Liao said. “It should serve as a wake-up call for patients
and doctors… Because if this kind of thing happens again, it will mean that my
wife died in vain.”
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