The power of the medical lobby in reversing China's medical negligence law reforms

This week I came across a very revealing legal article (no, don't go away!)  that illustrates the power of the medical lobby in China - and also how the Chinese government is no longer a monolithic closed entity where laws are rubber stamped. 
The article by two leading law professors from China and Hong Kong describes how China medical negligence laws were overhauled by judges in 2002 because they were widely viewed as favouring doctors and hospitals over patients who had suffered from medical negligence. Until 2002 the burden of proof in any medical negligence case lay with the patient - in other words, they had to prove that the doctor had made an error that had resulted in harm.

As the article notes: "In practice, it was not uncommon that medical care providers, during the course of dispute resolution (court proceedings), denied patients ready access to their own health records.
Many medical care providers have reportedly submitted false or falsified medical records. In extreme cases, hospitals went as far as destroying the original records that evidenced the medical staff’s breach of standard of care and replaced them with fake ones."

In a radical move, the burden of proof requirement was reversed - medical providers had to prove that they had NOT made a mistake. This boosted the chances of patients successfully suing their doctor or hospital and not surprisingly led to a large rise in the number of medical negligence cases.
Doctors and hospitals hated the new law, and they claimed that it led them to practice defensive medicine and that it exposed them to a high financial burden.
The courts then decided to try adopt a "Third Way" compromise and developed amendments including a so-called "Article 59" that would balance the burden of proof requirement. The medical profession and hospitals, were not satisfied with this compromise, however, and wanted to veto Article 59 and revert to the former protections they had. It's worth quoting the article on this to give some background to the lobbying power:

"The most vocal advocates for removing Article 59 were two national-level medicine professional associations, that is, the Chinese Medical Doctor Association (CMDA) and the Chinese Hospital Association (CHA). The CMDA is the statutory self-regulatory body of all practicing physicians in China.64 The CMDA is also resourceful in terms of its government connections. Its president is a former vice minister of the MoH, and many of its vice-presidents are incumbent senior officials of the MoH and local BoHs. More notably, one of its two honorary presidents is a vice-chairman of the National People’s Congress Standing Committee (NPCSC). Renamed from the China Hospital Management Association, the CHA is the self-regulatory body of medical care providers (exclusive of rural medical clinics) in China, and is affiliated to the MoH. Its president is also a former MoH vice-minister."

In the end, the doctors won the day. When the medical negligence law was released for consultation they lobbied hard. When the amendment was debated at the NPCSC, the offending clause was dropped altogether. As the authors of the article conclude:
"The associations representing medical practitioners and medical care institutions exhibited remarkable ability to mobilize and lobby the national legislature. The outcome of the legislative process was thus unsurprisingly the removal of Article 59, a rule that the medical profession strongly disfavored."

Two conclusions from this article:
1. The medical profession and medical institutions have remarkable influence and lobbying power in China.
2. The process of  lawmaking in China is no longer behind-closed-door rubber stamping, but is subject to more open consultation and interest group lobbying. .

The article by Professor Yang Lixin of Renmin University and Professor Xi Chao of the Chinese University of HK is published in The China Review and can be downloaded here.

Shanghai hospital gives children cancer chemo by mistake

Three children at the Xinhua hospital, Shanghai, were given the anti-leukaemia drug cytarabine by mistake

At least two more children were mistakenly given an anti-cancer drug at Xinhua Hospital, a day after the hospital admitted it gave the drug to a four-year-old boy.
The two girls given the wrong medicine, cytarabine, had adverse reactions, including vomiting and fever, the parents told a Shanghai television station. The girls got the wrong drug at Xinhua's emergency department on December 4, the same day as it was given to the boy.
All three children were supposed to get an anti-viral drug and all three were believed to have been prescribed the wrong drug by the same doctor, who was training at the hospital.
The medicine they were given, cytarabine, is meant to treat acute leukemia and acute lymphoma. Its side effects can include injury to the body's blood cell production system, resulting in low white cell counts and low platelets.
Hospital officials were not available for comment yesterday. The parents of both girls said the hospital had admitted the mistake and apologized. The parents said they were angry that the hospital didn't tell them until a week later.
"When we questioned them about the delayed apology, they said they were afraid that the parents might lose control if informed of the bad news in a timely manner," the father of a four-year-old girl said.
They also questioned the hospital's explanation, that the doctor picked the wrong drug because of a similar Chinese name from the medicine list in the computer, instead saying it appeared the doctor didn't know the effects of the medicine.
"Because he also prescribed the anti-cancer medicine, a cytarabine injection, by handwriting on my child's medical record," said the father of an eight-year-old girl, who was sent to the hospital for mumps.
The mother of the eight-year-old said the girl received 200 milligrams of intravenous injection and started to vomit and have fever after returning home. She was sent to another hospital, which found her white cell counts were in the lowest limit of normal. The quantity of the drug was what would be given an adult of 100 kilograms.
The hospital said it had trouble finding the boy given the drug, but after tracking him down after 10 days, all his medical tests were normal.
Source: Shanghai Daily