Doctors Busted for Dust Lung Diagnosis

Three doctors busted for dust lung diagnosis

A couple of weeks ago, we just reposted a liquor company arrested a doctor for posting criticising article on their products, these days another 3 Doctors Busted for Dust Lung Diagnosis incident came to public.

When doctor Huang Hengping’s older sister contacted the website yxj.org, Huang Hengping had been taken away by the local police station for over 6 months. Yxj.org is one of the leading medical information platforms in China. Along with Huang Hengping, there were also two other doctors had been taken away. They were Huang Hengping’s co-worker doctor Zhang Xiaobo and the director of the hospital’s medical examination center, Dong Yourui. All these three doctors worked in the Pneumoconiosis (Dust Lung) Diagnosis Team of Guizhou Aerospace Hospital. The reason the police station gave to the three doctors’ families were, “they might be involved in dereliction of duty in the office of State-owned Institution”.

The doctors office with dust lung images

The doctor’s office with dust lung images

The Family members of the three doctors sent appeal letters to the Chinese Medical Doctor Association (CMDA) and several media asking their help. The CMDA soon sent their director of Legal Affair Department, Deng Liqiang, to Zunyi, Guizhou. Deng Liqiang was excepted to inspect on the whole event and in the meantime, showed the three doctors’ families that the CMDA was paying attention to their case.
The director of Pneumoconiosis Department in Shanghai Pulmonary Hospital, Mao Ling, told yxj.org, “This case made it so hard to be a doctor now, even he isn’t a pneumoconiosis doctor. The only way to avoid making mistake is not doing anything. The doctors who worked hard for their jobs ended up in the jail. Who would still want to be doctors in the future?”

A Suspicious Report

According to the memory of the director of the radiology department in Guizhou Aerospace Hospital, Yu Lei, one-day int the second half of the year 2016, Doctor Luo in the department was absent all of a sudden, and he wouldn’t pick up his phone as well. After Yu Lei documented that with the hospital’s administration office, they told Yu Lei that Doctor Luo was arrested by a local county police station of Zunyi City. He was under inspection. Doctor Luo was released in a few days, then they took away Doctor Huang Hengping from the department. Yu Lei was told that Doctor Huang might be involved in an economic fraud case. However, the police station failed to find any economic violations of Doctor Huang, they had to release him after a dozen of days.

When everyone thought that things were finally over, Doctor Huang Hengping was once again taken away by the local police and kept in custody until now, for the reason “involving in the dereliction of duty in the office of State-Owned Institution”. Also, Doctor Zhang Xiaobo and Dong Yourui, who worked with Doctor Huang for dust lung diagnosis, were arrested by the polices. Doctor Luo, who was the first one being inspected, was still working for the department.

Guizhou Aerospace Hospital was the only hospital in Guizhou Province which provided the medical examination for pneumoconiosis as an occupational disease.

However, the Department of Human Resources and Social Security received a complaint from some enterprises. The enterprises reported that the doctors in Guizhou Aerospace Hospital had wrongfully diagnosed “dust lung disease” for their workers.

Arresting announcement from police

Arresting announcement from police

Why can the enterprises challenge the doctor’s diagnosis? According to item 36 of Occupational Disease Diagnosis and Appraisal Management Measures, “If the parties object the occupational disease diagnosis made by the occupational disease diagnostic institution, they may apply for appraisal to the municipal health administrative department in which the occupational disease diagnosis institution is located within 30 days from the date of receiving the occupational disease diagnosis certificate. The municipal occupational disease diagnosis and appraisal committee is responsible for the first identification of occupational disease diagnostic disputes. If the parties are not satisfied with the municipal-level occupational disease appraisal conclusions in the district, they may apply for re-appraisal to the provincial health administrative department where the original appraisal organization was located within fifteen days from the date of receiving the appraisal. The occupational disease appraisal adopts a two-level appraisal system, and the provincial occupational disease appraisal conclusion is final.”

Therefore, even the enterprises have every right not to accept the result of diagnosis of occupational diseases, they could always apply for an appraisal. “Other medical disputes must also be appraised first. They can’t just come to the hospital and arrest the doctors in charge.” Director Yu Lei said.

Who Did the Doctors Offend?

A wrongful (or just disagreed) diagnosis result led to jail time. Who did those doctors offend?

The enterprises in Guizhou Province reported that the doctors diagnosed dust lung disease for the workers who didn’t have it in the first place, so the workers can cheat for social security money. Base on it, the enterprises believed that there were “benefit relationships” between the workers and doctors. However, the polices failed to find any pieces of evidence proving the “benefit relationships” or “economic fraud” after it invented in the case. The alleged fraudulent case of social security funds failed to be established.

After that, the police department identified that the doctors were suspected of dereliction of duty. Through the re-identifications and new identifications of 547 people with dust lung disease diagnosed by 3 doctors, 393 had no dust lung disease, 111 had unacceptable chest radiographs, 1 had to be confirmed, and 42 had dust lung disease. The diagnostic misreading rate is as high as 92.3%, and the police department had thus found that the doctors’ faults caused the loss of the national social security funds.

After this incident, Guizhou Aerospace Hospital had been terminated the business of occupational disease diagnosis and occupational disease examination. As the only hospital in the region to carry out occupational disease diagnosis, workers in Zunyi area who need occupational disease identification did not know what to do.

Questioned the Appraisal Statement — “I also disagreed that they thought us misread the checkup results”

The evidence of the three doctors’ dereliction of duty was an appraisal statement. The family members of the three doctors stated in the letter of appeal to the Chinese Medical Doctor Association that the appraisal opinion was screened out by the police department in a manner that was seriously unfair. In addition, the case evolved to today’s situation, it was also due to the police department was lack of understanding of the professionalism of diagnosis and appraisal and the lack of understanding of the objective conditions that were unique to medicine.

The appraisal statement showed that the diagnostic misreading rate is as high as 92.3%, and the police department had thus found that the doctors’ faults caused the loss of the national social security funds.

It was worth mentioning that between 2012 and 2016, the expert diagnosis team of the pneumoconiosis specialists in Guizhou Aerospace Hospital examed 2,274 cases and diagnosed 1,640 patients with pneumoconiosis.

Director Mao Ling explained to the website yxj.org, “There will be indeed misread in the diagnosis of pneumoconiosis. Not only do Chinese experts pay attention to the misreading rate, foreign medical institutions also concerned it. Physician’s reading techniques, reading experience, film quality, viewer brightness, environmental factors, etc. may all affect the outcome. Occupational diseases diagnosis requires groups of more than three diagnosticians of occupational diseases for collective diagnosis, and that occupational disease diagnosticians participating in the diagnosis cannot abstain. I do not know how the police department selected the 500 plus re-diagnosis cases, but the misread rate was over 90%. We cannot do anything but doubt that the statistical methods are not proper.”

Director Yu Lei also told the website yxj.org that the result of appraisal statement was very irreasonable. “Not only it is irreasonable, I also disagree with the judgment of us having high misread rate.”

The appraisal statement mentioned that 111 people’s chest radiographs were unacceptable. Director Yu Lei explained that it was because the pneumoconiosis was performed with a film processor and rapid development technology. The quality of the radiographs dropped dramatically after being stored for more than half a year. Lawyer Deng Liqiang believes that “No Punishment in Doubtful” for unqualified films. It can’t be the evidence of the wrongful diagnosis.

“Dust Lung” is the Most Common Occupational Disease in China

90% of the occupational disease patients in China suffer dust lung, and 90% of the pneumoconiosis patients were farmers. It meant that the core of occupational disease problem in China was pneumoconiosis, and the core of pneumoconiosis problem in China was the farmer-worker pneumoconiosis.

A dust lung patient showing his lungs image

A dust lung patient showing his lungs image

Wang Keqin was a well-known journalist in China for investigating corruption. He was called the Chinese Lincoln Steffens. In year 2011, Wang Keqin worked with the Chinese Social Assistance Foundation, publishing the Investigation Report on Survival of Farmer-Workers with Pneumoconiosis. The report stated that among the farmer-worker with Pneumoconiosis, only 38% of them obtained the Occupational Disease Diagnosis Certificate, 62.2% of them were found to be medical pneumoconiosis and 4% were diagnosed as suspected pneumoconiosis.

After learned about the three pneumoconiosis diagnosticians being arrested, Wang Keqin told the website yxj.org, “The reason why most of the Chinese farmer-workers can’t receive proper treatments and compensation for pneumoconiosis was mainly because that they can’t obtain the occupational disease diagnosis certificates. Only 10% of the patients in China could receive the certificate, and now they even started to take the doctors who diagnosed the disease in jail. If the last guardians were regarded as criminals, is there still a way of living for those farmers who suffer?”

If convicted with the diagnostic error rate, all doctors could be guilty.

The diagnosis and treatment are highly specialized technical activities. They need to maintain a high degree of independence. If non-technical external forces put their hands into the technical field, it will have a devastating impact on the development of medical technology and the medical order.

Doctors in public hospitals are employees of nation-owned institutions. It was possible for them to neglect their duties or abuse the system. If they fail to perform their statutory duties and lead to serious consequences, as well as acts of corruption, bribery, issuing false certificates, taking out health insurance funds, etc. If their behaviors meet the standards for filing a case, their profession cannot be a disclaimer, and the law should give them corresponding punishment.

However, there must be standards for conviction and there should be a basis for punishment. The way police department used to convict the doctors were ridiculous, for them using the doctor’s diagnostic error rate as one of the reasons for conviction.

Even smartest doctors can’t be 100% diagnosed properly. Advanced inspection equipment can only maintain a certain rate of positive inspections and omissions. What’s more, the chest radiograph of pneumoconiosis is complicated, and there are many difficulties in differential diagnosis with many other lung diseases.

A letter for help from doctors families

A letter for help from doctors families

If diagnostic error rate could be one of the reasons for doctor’s conviction, then any doctors could be guilty at some point. It would be a waste of money if the patients who were receiving treatments were wrongly diagnosed, and it also leads to the waste of social security fund. If doctors have to take legit responsibilities for their diagnosis errors, there soon won’t be anyone who was willing to work in the medical care.

Diagnosing occupational diseases is indeed related to the interests of some companies. However, these companies, as stakeholders, must not be convinced of their one-sided belief, and the judiciary should be conscious of this.

This case will have a great impact on the mental health of the local medical staffs, especially the doctors responsible for the diagnosis of occupational diseases. It is conceivable that when doctors feel it’s difficult to protect themselves, they will be very difficult to diagnose for pneumoconiosis patients. Therefore, the rate of diagnostic errors as a reason for conviction will not only affect the three doctors who were arrested, but also the vast number of medical workers, as well as pneumoconiosis patients whose legal rights and interests, are not guaranteed. Hopefully, the law can bring justice to the three doctors, and bring hope to all the medical care staffs to carry on.

Summary
Article Name
Doctors Busted for Dust Lung Diagnosis
Description
Weeks ago, a liquor company arrested a doctor for posting criticising article. Today, 3 Doctors Busted for Dust Lung Diagnosis incident came to public.
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