Chapter 198: Where Are There So Many Underhanded Tactics?
November 10th, Tuesday, clear weather.
Zeng Huanqi’s emergency clinic night shift plus Tian Zhuang’s ward night shift, the surgery shift is Director Du Qiang.
When Lu Cheng arrived, Director Du Qiang had already arrived at the department, standing proudly with his hands clasped together.
As Lu Cheng entered the doctor’s office, Du Qiang glanced at him and said nonchalantly, “The Doctor Lu you were looking for has arrived.”
Lu Cheng glanced at the people sitting around the table, and his heart immediately tensed.
Besides familiar faces like Zhang Tiesheng, Huang Haibo, and former Emergency Department Director Lin Qianlong, there were also a few unfamiliar faces.
They were wearing uniforms, accompanied by hospital leaders.
Du Qiang glanced at Lu Cheng and said very officially, “Lu Cheng, go change into your work clothes.”
“Yes, Director Du.” Lu Cheng quickly left the office, changed into his white coat, and rushed back.
Vice President Hu Qingshan said rather officially, “Director Tian, the people you were looking for are now all here.”
“The medical records that were previously sealed have also been copied here…”
Tian Qi, sitting in the center, looked at Lu Cheng with surprise and said inexplicably, “It’s Doctor Lu again.”
Lu Cheng thought Tian Qi was calling him out, so he replied, “Hello, sir. My name is Lu Cheng. I am a doctor in the Emergency Department, and my current title is Attending Physician.”
Vice President Hu Qingshan introduced him in a business-like manner, “Doctor Lu Cheng, this is Director Tian Qi from the Legal Affairs Section of the Health Bureau, and two relevant leaders, Zhou Wenshu and Tan Ling, have also come to our hospital for an inspection.”
“You must cooperate truthfully later.”
“Okay!~” Lu Cheng nodded and sat down.
Zhang Tiesheng then stood up and returned to the doorway, temporarily closing the door of the doctor’s office.
Tian Qi said, “Director Lin, although you have resigned, we received a tip. The tip mentioned that when you were working in the Emergency Department of our county People’s Hospital, there were allegations of irregular surgeries.”
“We have discussed these issues in detail before. Now that all the personnel who collaborated with you are present, do you have anything to explain?”
Lin Qianlong’s expression was a bit pained at this moment. His eyelids and mouth twitched for a while before he said, “Director Tian, since you have found me, you must already have very detailed information.”
“However, I want to clarify one point: I did not violate the principle of ‘do no harm’. The surgeries we performed were all considered with the goal of preserving the patient’s organs and providing a better quality of life for the patient.”
Tian Qi raised his hand: “Director Lin, whether the surgery had a significant impact will be discussed separately.”
“What we need to discuss now is the specific surgical procedure.”
“According to the information we have, surgeries such as spleen preservation surgery that are not listed within the scope of procedures listed by the National Health Commission are considered new surgical procedures.”
“I would like to ask Director Lin, were the surgeries you performed previously reported to the relevant health authorities? Were the new technologies strictly graded?”
“Was it discussed by a professional committee and approved by an ethics committee, among other related work?”
Tian Qi’s questions were very official. Lin Qianlong’s Adam’s apple bobbed, and he faced them palely, unable to utter a word.
Tian Qi’s tone became more serious: “According to the management system for new technologies and new services, new technologies are graded at the national, provincial, and hospital levels.”
“National-level new technology is defined as a new achievement with international advanced level, projects not yet carried out in the domestic medical field, and new medical or nursing services not yet used.”
“Provincial-level new technology is defined as a new achievement with domestic advanced level, new projects not yet carried out within the province, and new medical or nursing services not yet used.”
“Hospital-level is of advanced level within the province, new projects not yet carried out in this city and this hospital, and new medical or nursing services not yet used.”
“Director Lin Qianlong, have you assessed the surgeries performed in the department? What category do they belong to?”
Lin Qianlong answered guiltily, “Hospital level.”
“Which units in our prefecture-level city are performing them normally?” Tian Qi continued to press, showing no respect.
Lin Qianlong could not answer, stammered several times, his mouth opened and closed but no sound came out.
Lin Qianlong glanced at Huang Haibo, but Huang Haibo didn’t want to pay attention to him, seemingly embodying the saying “when the master falls, the followers scatter.”
Du Qiang certainly didn’t dare to get involved in these matters.
“Alright, then, which units in our province are performing them?” Tian Qi continued to ask.
“Several Xiangya hospitals are routinely performing them!~” Lin Qianlong quickly replied.
“Then did you report it? Did you organize a discussion for all doctors, where are the meeting minutes? Where is the approval from the ethics committee?” Tian Qi extended his hand, asking Lin Qianlong for the paperwork.
How could Lin Qianlong produce it?
“Do you have the safety risk assessment form from the professional committee?” Tian Qi continued to extend his hand, asking Lin Qianlong for documents.
It wasn’t that they were intentionally trying to force him; it was just that if something was truly good, the procedures should have been followed.
If the procedures were not justified, then the medical technology was likely not progressing positively. Otherwise, why wouldn’t you follow the procedures?
Lin Qianlong thought for a moment. He remembered Lu Cheng’s previous answer and immediately replied, “Director Tian, I have something to say here. We didn’t intend to perform spleen preservation… It was just that the patient, under the circumstances at the time… they couldn’t be referred anymore.”
“So we attempted to suture it, to try and…”
Tian Qi said, “Try to what? Is there no recommended standard procedure for spleen rupture? Is there no standard surgical treatment?”
“Is splenectomy the recommended surgery in the guidelines? Can our hospital routinely perform it?”
Hearing this, Lu Cheng’s spine chilled!
Good heavens, so that’s where the loophole was.
Spleen preservation surgery is different from limb replantation. For limb replantation, there is only one most standard procedure, which is limb replantation.
The important component of limb replantation is suturing, so if you say you only performed suturing, creating all favorable conditions for the patient temporarily, there would be no problem.
Otherwise, would you just amputate them when you encountered them?
That would certainly not be acceptable.
But spleen preservation surgery is different. The officially recommended procedure is splenectomy. Why would you suture it?
Lin Qianlong said with a constricted throat, “Then we can’t just watch the patient’s spleen have a chance of being saved and let it be cut out directly, can we?”
Tian Qi continued to press, “Why is there still a chance of rescue? How did you arrive at this conclusion? What is the professional standard?”
“Based on what standard?”
“You say you assessed it yourself? Director Lin, according to my understanding, a Deputy Chief Physician does not have such independent authority, does he?”
Lin Qianlong fell silent again.
This was clearly targeted at him. All the evidence had surely been locked down; how could he escape?
Tian Qi continued, “Director Lin, do you know the basic qualification requirements for carrying out new surgical procedures? And how they relate to our hospital’s level?”
“First, one must have undergone specialized training or passed an assessment for new technologies.”
“May I ask, where are your team’s new technology training certificates and assessment qualification certificates? Please show them to me.”
Tian Qi continued to extend his hand, asking Lin Qianlong for the documents.
Lin Qianlong shook his head and closed his eyes, “Director Tian, I don’t have those either.”
“Who were the participants in the surgery?” Tian Qi continued to question, seemingly going through the motions.
Lin Qianlong immediately replied, “I was the chief surgeon, and the others were assistants.”
This was recorded in the surgical record, and Lin Qianlong couldn’t deny it. If he were to refute it, it would only lead to more complications.
For example, why would a Deputy Chief Physician on the operating table let an Attending Physician be the chief surgeon? For what reason?
Tian Qi then looked at Zhang Tiesheng, “Deputy Chief Physician Zhang, you were also on the operating table at the time. Were you aware of the standard procedures for carrying out new surgical procedures?”
“If you were aware, why didn’t you stop it in time?”
Zhang Tiesheng knew nothing, shaking his head vigorously, “I didn’t expect it either. I hadn’t investigated it so clearly before.”
“Besides, everyone was in a hurry when the patient arrived, so we didn’t consider these details.”
“Doctor Lu Cheng?” Tian Qi casually mentioned Lu Cheng.
With two Deputy Chief Physicians present, Lu Cheng, an Attending Physician, was the least important, but he still had to be investigated.
Lu Cheng also shook his head, “I don’t know either.”
There were too many medical regulations, a thick book, and few people could remember all the situations.
Moreover, Tong Yuan’an had given Lu Cheng a set of talking points, which was to simplify the surgery.
However, Lu Cheng hadn’t expected that this “set of talking points” was only applicable to limb replantation, and spleen preservation surgery could not be ‘fooled through’!
“So, Director Lin, you admit that the irregular surgeries performed in the operating room were not violations.”
“Are all the things recorded here true, and not tampered with?” Tian Qi continued to ask.
Lin Qianlong thought for a moment but still didn’t nod, “Director Tian, I did not violate the principle of ‘do no harm’, and the patient’s postoperative prognosis was very good! Otherwise, the patient’s family would have complained long ago.”
Tian Qi said, “Yes, the patient’s family did not complain, but the problem now is that these few surgeries were discovered.”
“Several issues: First, the cost of surgery for this patient was higher than for patients with parallel conditions, and there were no infections or complications.”
“The proportion paid by medical insurance was also higher than for other patients. What is your explanation?”
“Second, the length of hospitalization for these patients was longer, and there were no explainable complications. If you report these data, wouldn’t it be considered a special circumstance?”
“Third, for these procedures, if you were to perform them, you did not report them, and the full department discussion records are not found in the medical records, let alone the risk report from the Medical Affairs Department.”
Hearing this, Hu Qingshan also scratched his head vigorously and added, “Director Lin, the current trouble is that the inspection team has focused on these few medical records, and they have found a logical loophole.”
“They have ordered the Provincial Health Commission and the medical insurance departments to conduct a thorough investigation, not only for economic issues but also for procedural justice.”
“Performing new surgical procedures without reporting them can be considered profiteering at the lightest, and human live experimentation at the heaviest!” Hu Qingshan emphasized.
Live experimentation is one of the medical taboos, and human live experimentation is a major taboo of taboos.
Once it rises to this level, let alone a Deputy Chief Physician, even a top professor can be completely ruined in minutes.
Lin Qianlong was very tired, “Director Tian, President Hu, I resigned not because I was evading responsibility for these surgical procedures, and you can investigate my financial issues freely.”
“Furthermore, the patients had good outcomes, and the family and patients were satisfied with the treatment results.”
Tian Qi directly scolded, “What qualifications and eligibility do you, Lin Qianlong, have to perform new surgical procedures? And to do so without reporting them?”
“Where are your qualifications? Show them to me! Use your brain a little, won’t you?”
“Is this a matter of the patient’s family pursuing a lawsuit now?”
Tian Qi’s scolding was angry, but not because Lin Qianlong was stupid, but because he was intentionally causing trouble for the hospital and the county at this juncture.
Lin Qianlong didn’t know the inspection team was coming. He also did it for the patients’ well-being. In fact, the hospital had “encouraged” new business in the past.
The hospital and the Health Bureau also did not expect the inspection team to come!
Of course, the hospital also did not expect that the procedures Lin Qianlong carried out in the Emergency Department could be elevated to such a level.
Tian Qi continued, “This time, the service did not cause serious consequences, so it is classified as ‘practicing beyond scope.’ Do you agree?”
“President Hu, on behalf of the County Health Bureau, I am issuing your hospital a stern warning and a fine of 20,000 yuan. Do you agree?”
Hu Qingshan’s attitude was very proper, “Our hospital accepts the punishment from Director Tian and the higher authorities. We will rectify it promptly and pay more attention to procedural standardization in the future.”
Tian Qi continued, clasping his hands, “Relevant key medical personnel involved will be ordered to suspend practice for 3 months.”
“More specifically, based on the report submitted by our bureau to the higher authorities for review, the higher authorities have instructed that Lin Qianlong, Deputy Chief Physician, be suspended from practice for three months.”
“Deputy Chief Physician Zhang Tiesheng and Attending Physician Lu Cheng will receive a warning plus a one-week suspension of practice, with a notice within the hospital and other hospital-level disciplinary actions.”
“Do any of the doctors here have any other views or objections to this?”
Hu Qingshan listened and immediately said, “Director Tian, our Emergency Department is already severely understaffed. If Deputy Chief Physician Zhang and Attending Physician Lu are suspended from practice, we really won’t be able to operate normally.”
“We hope the bureau can carefully consider this aspect.”
Tian Qi sighed and put away the documents in his hand, “We actually don’t want to impose such penalties, but this is the result of the punishment given by the higher authorities, and we are only responsible for conveying it.”
Tian Qi then offered a reminder, “Let me remind you here: Professor Chen Song from your department performed spleen preservation surgery at the hospital before, which was legal and compliant.”
“He was on an approved external consultation trip organized by his institution and was practicing compliantly within the medical alliance.”
Zhang Tiesheng, hearing that he was involved, said, “Director Tian, we were only assistants, do we also have to bear a punishment?”
Tian Qi had already put away the documents and was now scratching his head, “Regardless of whether you were the chief surgeon or not, since it was discovered, some disciplinary action will be taken.”
“I asked you earlier, and you all said you didn’t know about these things. As clinicians, you have an obligation not to participate in illegal activities.”
“It’s not that you can participate just because you’re unaware. According to regulations, you should have exercised your obligation to dissuade and not participate.”
“Of course, there will definitely be a warning. As for the specific decision regarding the suspension of practice, we will feedback the specific situation at the county hospital and see if the higher leadership departments can show some leniency.”
“The main reason this time is that the patient did not experience any accidents.”
When Tian Qi said this, Director Huang Haibo suddenly interjected, “Director Tian, among the classifications for medical personnel practicing beyond scope, there are only two: practicing beyond professional scope and practicing beyond the place of practice.”
“The punishment you just mentioned does not conform to these two classifications, does it?”
Tian Qi heard this and glanced at Director Huang Haibo.
“And who is this?” Huang Haibo looked at Hu Qingshan.
“This is Director Huang Haibo from our Emergency Department. He is also the Deputy Director of the Emergency Department.”
Tian Qi then explained, “Director Huang, their situation was that they performed new surgical procedures in violation of regulations, which is classified as practicing beyond scope. It doesn’t necessarily have to be practicing beyond the professional scope.”
Huang Haibo continued to shake his head, “No, no, Director Tian, practicing beyond scope is practicing beyond scope, it’s an irregular scope of practice.”
“Performing new surgical procedures in violation of regulations, if speaking more strictly, falls under the category of ‘over-level surgery’.”
“Director Lin did not operate outside of general surgery, so it should not be defined as ‘practicing beyond scope’!”
“Furthermore, according to the medical record information I have, the patient did indeed have a spleen rupture at the time. Therefore, during the emergency reception, Director Lin and other physicians performing suturing and hemostasis is also a standard emergency rescue procedure.”
“Why was it identified as other surgical procedures and new surgical procedures?”
“Is spleen suturing not one of the most effective treatment methods for spleen rupture?”
“And according to relevant medical regulations, in particularly urgent situations, for emergency medical care provided to patients; ‘practicing beyond scope’ and ‘over-level surgery’ can be exempted from liability.”
“Based on the existing medical record information, we can determine that the patient was in a particularly dangerous situation at the time, so performing emergency hemostasis was reasonable, legal, and in line with the principles of medical practice.”
“If there is to be a violation, it should be that Director Lin did not follow the standard guidelines for the most standard guided surgical treatment, rather than over-level surgery.”
“Director Lin did not perform a splenectomy, but he did perform hemostasis. What is the violation in this case?”
Tian Qi listened carefully and looked at Huang Haibo in surprise, “Director Huang, you…?”
Huang Haibo said, “Oh, I have some understanding of relevant medical regulations.”
“As the saying goes, what is not forbidden is permitted. Medical regulations do not explicitly state that all emergency conditions must be treated strictly according to guideline-recommended surgeries. Therefore, during rescue, the receiving doctor can proceed with effective rescue measures according to their own understanding, as long as it does not violate the basic principles of medical practice.”
“Our hospital is just a county hospital, which is a relatively grassroots medical institution. We are doing our best, and we cannot be accused of carrying out new surgical procedures.”
“Director Tian, I know you are here not only to convey the instructions from higher leadership but also to provide feedback on the incident.”
“If we have made mistakes, we can admit them. If we have not made mistakes, we can also provide explanations.”
“This is not an excuse, but I personally feel that there might be a slight lack of rigor in the supervision of medical regulations by the higher authorities.”
“Perhaps Director Tian could privately offer a suggestion to be more accommodating in this matter?”
“The main thing is that the patient has recovered well and no adverse consequences have occurred, and the treatment effect is far higher than the general average level of treatment for the same condition.”
“This is in accordance with the principles of medical practice.”
Tian Qi said, “But, Director Lin just said that he did indeed perform a new surgical procedure?”
Huang Haibo then said, “Director Tian, the leaders of our Health Bureau have held meetings with us repeatedly, explaining the relevant laws and regulations. How could our hospital illegally perform new surgical procedures?”
“Isn’t this precisely the fact you have determined?”
“This time, we have caused you trouble. We hope that all leaders can bear with us and re-examine the relevant information to provide some convenience for us clinicians.”
Someone next to Tian Qi, based on Huang Haibo’s words, found a more specific clause and whispered a few words to Tian Qi next to Huang Haibo, “Director Tian, Director Huang seems to be right.”
“There are things Director Huang mentioned in ‘practicing beyond scope’ and the emergency avoidance regulations.”
Tian Qi thought carefully and asked, “Director Huang, could you accompany us? We want to provide a more comprehensive response.”
Huang Haibo said, “That’s no problem. If I can help you leaders, I am happy to oblige.”
Hu Qingshan then said, “Director Tian, our hospital’s Director Huang has a lawyer’s license.”
“Even better!~”
“If you are more familiar with the relevant provisions, we can provide a better response. In fact, we don’t want to create further complications at this time.”
“It’s just that, due to some external reasons, our hospital is being watched very closely, and any slight disturbance will… So, let’s leave it at that for now. Director Huang and I will study this further back at the hospital…”
After Tian Qi finished speaking, he looked at Director Lin Qianlong again, “Director Lin, regardless, you still bear the primary responsibility for this matter.”
Lin Qianlong let out a long sigh.
…
After Tian Qi and the others left, Zhang Tiesheng and Lu Cheng looked at Du Qiang with surprise.
Du Qiang did not explain to Lu Cheng and Zhang Tiesheng, but looked at Lin Qianlong and said with a smile, “Director Lin, this time, Director Huang should bring you good news.”
Lin Qianlong’s face did not show much emotion, as if he did not believe Du Qiang’s words.
This matter was temporarily ‘unrelated’ to Du Qiang, so Du Qiang did not stay long, “Director Lin, I’ll be going out for a bit.”
After Du Qiang left, Zhang Tiesheng quickly asked, “Director Lin, what exactly happened today? Didn’t we say before that spleen suturing was a routine procedure in our emergency surgeries?”
“We didn’t explicitly write the name ‘spleen preservation surgery’.”
Lin Qianlong said, “Zhang Tiesheng, do you think those leaders are fools?”
“The surgical and hospitalization costs for the same spleen injury differ so much, how could they not suspect something?”
“Fortunately, the patient was fine.”
“Although Director Huang Haibo helped with this matter, it is still uncertain whether he can escape unscathed.”
“President Peng has caused our hospital too much trouble.” Lin Qianlong sighed deeply.
Zhang Tiesheng said, “Then what do we do now? Director Lin, should we inquire about how the higher-ups view this matter?”
“The main issue now is investigating economic problems in healthcare. Our problem is definitely not the core point.”
Lin Qianlong nodded, “In recent years, due to Huang Haibo stirring up trouble, although we have lived frugally, we haven’t had too many loopholes.”
“Director Huang is indeed far-sighted.”
Zhang Tiesheng said, “Director Huang is indeed far-sighted, but Director Huang just doesn’t want to stay…”
Lu Cheng was certain that this matter was not some underhanded tactic, but rather that he had been implicated and “caught”.
