Seven years ago, surgeons at Tung’s Taichung MetroHarbor Hospital operated on a man who had suffered a head injury in a traffic accident, but the outcome was that the man ended up totally paralyzed and blind. At the end of last month, the -Taichung branch of the Taiwan High Court ruled that the hospital and the three doctors who performed the operation must pay the man’s family more than NT$33 million (US$1.1 million) in compensation.The Chiu case was quite sad. Readers probably recall it. The girl had been beaten unconscious by her father and then refused at hospitals all over Taiwan claiming they had their quota of neurosurgical cases. She finally wound up at a hospital in Taichung, where she died.
One of the doctors is neurosurgeon Lee Ming-chung (李明鍾), who is famous for his valiant, though ultimately unsuccessfu, efforts to save the life of another brain trauma patient, a little girl surnamed named Chiu (邱), who had been turned away by several other hospitals.
Tung's is the big building with the rotating restaurant easily visible from almost anywhere between the slopes of Tatu Mountain and Taichung Harbor west of Taichung city. Despite its unusual name it is a first-rate and extremely well run hospital, where foreigners from ships in the harbor are taken for medical help. The sons of the founder ran for legislator posts in the recent election, some Blue, some Green.
The Taipei Times piece observes that one reason health care is cheap in Taiwan is because doctors are often not insured. Because litigation is so common -- it is not even more common because of the undersupply of lawyers -- doctors are becoming shy about entering professional specialties where the likelihood of lawsuits increases. The writer goes on:
Taiwan has the highest rate of PVS [persistent vegetative state] in the world. The number of PVS patients in the US is estimated to be somewhere between 15,000 and 40,000. According to available information, Taiwan had a total of 4,792 PVS patients as of 2008, and 6,000 PVS patients are now registered for care with the Genesis Social Welfare Foundation, a charity that specializes in this field. These figures suggest that not only does Taiwan have a very high rate of PVS, but the number of cases is increasing very fast. As to why people end up in this condition, the most common cause is scooter accidents, followed by overmedication.I found this paragraph astonishing, since I'd never heard this distressing claim. The author notes that rates of PVS in Taiwan are 60% higher than in the US. In Taiwan PVS patients cannot be taken off life support at the request of the family; who must also help pay for the upkeep. This probably increases the number of PVS cases. Another cause is likely the enormous number of scooters in Taiwan. Maintaining such patients is presented by the MOI as a "pro-life" position. Taiwan Panorama had an article on the local hospice system a while back, with some comparisons to similar systems in Japan:
The costs, in terms both of money and manpower, of the Japanese model are huge-monthly care for the average patient costs roughly NT$380,000, a world apart from the NT$50,000 spent by CSWF. As the majority of PVS patients in Japan entered their states through automobile accidents, much of the funding for their care comes from fees levied on vehicles for that very purpose. CSWF, on the other hand, receives only 10% of its funding from the government, with the remaining 90% coming from public donations.The GSWF home page is here.
After starting initial work on the hospice in 1980, Cao was finally able to open the hospice six years later, taking on patients from poorer families free of charge. To date, CSWF has cared for nearly 500 such patients.
Patients in vegetative states are cared for by professional caregivers at CSWF, with nurses providing care 24 hours a day over three shifts. Every two hours the patients are rolled over, patted on the back to help clear their airways, and have their linen changed, and they are fed once every four hours. They are washed every two days, to help maintain their cleanliness and hygiene, as well as their dignity.
Over the past 18 years, CSWF has opened branch hospices around the country. The goal is to have 23 locations in cities and counties throughout Taiwan, Cao says. Thus far they have completed 13, with another four in the planning stage, and the organization hopes to meet its goal within the next five years.
UPDATE: A nursing professor explained to me that in cases of terminal disease, if the entire immediate family and the succeeding generation signs a DNR and the hospital ethics committee approves, then the tubes can be removed by doctor. This change was made last year. But for a coma patient whose prognosis is uncertain, that is still not possible.
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