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China's chaotic health care drives patient attacks

Saturday - 8/25/2012, 9:09am  ET

Associated Press

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.

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