Beyond the 'Imperial Sword': Rethinking Solutions to Medical Violence in China

In recent years, violence in Chinese healthcare settings has been on the rise, with frequent incidents of bloodshed occurring within hospitals. According to incomplete statistics,In June alone, there were more than 12 cases of violence against medical staff nationwide in China, exceeding the total number of such incidents in 2012 (11 cases).

Just last month, in the early hours of July 15, an emergency orthopedic surgeon at the Chinese PLA General Hospital (301 Hospital) in Beijing was assaulted by a patient. On the same day, at approximately 9:11 a.m., Dr. Ou, a neurologist at Longmen County People’s Hospital in Huizhou, Guangdong Province, was attacked with a blade by a patient, sustaining multiple injuries to his back and hands.

An anonymous physician pointed out that the “doctor-killing cases” stem from systemic issues in the healthcare system, as Chinese hospitals have long grappled with the problems of difficult and costly access to medical care, which has significantly exacerbated doctor–patient tensions.

In response, local authorities in China began implementing physician protection measures in 2004.

Based on the aforementioned policies, China primarily focuses on police-medical collaboration to forcefully control situations and ensure the safety of medical personnel. However, these measures rarely address the root causes for resolving doctor-patient conflicts, such as improving the quality of medical services at healthcare institutions at all levels and establishing channels for patients to assert their rights. Consequently, no matter how robust these enforcement efforts may be, they merely treat the symptoms rather than the underlying disease.

In other countries, VCBeat has observed that issues are more often resolved through legal means.

★ United States
In the United States, it is also common for patients to express dissatisfaction with billing charges and physician services. Laws vary from state to state; except for a few states such as Florida, which do not mandate health insurance coverage,In nearly all U.S. states, physicians are mandated to carry medical malpractice insurance. Consequently, in the event of a dispute, the insurer assumes liability for compensation, thereby eliminating any direct financial conflict of interest between physicians and patients.This significantly reduces the incidence of medical disturbances. It not only lowers the occupational risks for physicians but also ensures that patients’ legitimate rights and interests are reasonably compensated.

Hospitals in the United States often establish ethics committees to handle cases of medical negligence.(Ethics Committee: An organization composed of medical professionals, legal experts, and insurance specialists that reviews the rationality and safety of clinical medical practices to ensure that patients' safety and interests are not compromised; it is generally an independent third-party organization separate from the hospital.) Their involvement can help resolve disputes.

The vast majority of U.S. states have alreadyCriminalizing Assaults on Medical Personnel. Even the most minor assault on medical personnel will incur a fine of $1,000 or up to six months’ imprisonment. A Class 4 or Class 3 felony will result in a fine exceeding $15,000 or three to five years’ imprisonment.

Therefore, in the United States, where the legal system is well-established, it is highly disadvantageous for patients to cause disturbances directly at clinics or hospitals. Instead, initiating legal proceedings to seek compensation paid by third-party insurers is a common approach for patient claims.

★United Kingdom
In the UK, when dealing with medical malpractice or medical disputes,Primarily through judicial channels, unlike in our country where administrative measures play a dominant role. Conceptually, there is no strict distinction between liability accidents and technical accidents in medical malpractice; all cases are legally characterized. When disputes arise between patients and physicians regarding diagnosis and treatment, the court determines whether the physician was negligent. Compensation for damages is adjudicated solely based on evidence and applicable laws, rather than on sympathy for the patient’s suffering.

They proactively prevent issues by optimizing services, offering extensive coverage of free services.Foreigners who have legally resided in the UK for more than six months are entitled to free services at public hospitals.

Similarly,The United Kingdom also has ethics committees to handle medical disputes.If the issue cannot be resolved internally, patients may file a complaint. UK courts maintain a specialized medical journal that compiles healthcare dispute cases from around the world, which can be cited by both patients and healthcare providers to help resolve conflicts. The vast majority of doctors and clinics also carry medical malpractice insurance; in the event of an incident, the insurer will cover part of the losses.

In the UK, any act of violence against healthcare workers carries a prison sentence of at least six months. If grievous bodily harm is caused, the offender may face life imprisonment.

★Germany
Germany’s medical malpractice incidence rate is remarkably low, a fact closely attributable to its rigorous work practices and advanced technological capabilities.Germany has two models for resolving medical disputes:

1. Non-Litigation Medical Dispute Resolution Models
○ Mediation Committee: Conduct investigations into medical disturbances and determine whether the conditions for claims are met.
○ Medical Dispute Appraisal Committee: Conducts purely medical appraisals, addressing only issues related to treatment errors; it does not adjudicate liability or consider case-specific circumstances.

The collaboration provides solutions for both physicians and patients.

● Advantages: Eliminates substantial litigation costs; employs a relatively professional appraisal method; reduces blame directed at physicians; swift and efficient;
● Disadvantages: Eliminates substantial litigation costs; mediation procedures vary across states;

2. Legal Measures
Specifically, if one is dissatisfied with the mediation outcome, they may file a lawsuit directly. Plaintiffs are not required to find their own doctors or lawyers; specialized associations are responsible for assigning them. Once a case goes to court, German courts tend to favor patients. The specific principle of "reversal of the burden of proof" requires physicians to provide evidence, thereby ensuring the availability of professional evidentiary data.

German hospitals strongly favor out-of-court settlements, striving to provide satisfactory services to patients. This is because, once a case goes to court, the hospital’s chances of winning are slim.

Of course, if a patient improperly attacks or even beats a doctor, the patient shall bear full responsibility.

★Japan
JapanA medical evaluation agency was established in 1995., oversee hospitals in providing high-quality services to patients, conduct comprehensive evaluations of all hospitals, issue certificates of compliance to those that meet the standards, and publish the results online. Hospitals typically purchase insurance coverage for physicians, enabling many minor disputes or incidents to be resolved through insurance companies, thereby preventing them from escalating into major disputes.

In Japan,The primary avenues for resolving medical disputes include: settlement between the parties involved, judicial resolution through the courts, and mediation by the Japan Medical Association., unless the liability is unequivocally clear and the parties opt for dialogue to resolve the dispute, the latter two methods are generally more commonly employed. Litigation filed in court can typically be resolved through judgment, settlement, withdrawal of the lawsuit, or waiver of claims; however, withdrawals of medical malpractice lawsuits are rare.

In recent years, medical malpractice lawsuits have surged in Japan, yet the plaintiff win rate remains low. This is primarily due to difficulties in evidence collection, prolonged litigation periods, and high costs. Furthermore, when the defendant is a hospital established by national or local governments, settlements require approval from the corresponding legislative assembly. Consequently, court-approved settlements and out-of-court mediation have become important avenues for resolving medical disputes in Japan.

The government requires hospitals to purchase "malpractice insurance" for doctors, so that they can be protected in the event of disputes.In Japan, assaulting a medical practitioner carries a prison sentence of more than two years.

★Canada
“Prevention and Management of Aggressive Behavior (PMAB) in Healthcare Settings,” issued in April 2008.The core component of this hospital anti-violence response mechanism system is the “White Alert,” which primarily refers to the deployment of specialized emergency safety teams within hospitals to assist healthcare workers in managing violent threats from patients.

★Australia
Australia’s universal healthcare system is regarded as one of the “fairest and most exemplary” in the world today. It features advanced and comprehensive medical equipment, highly skilled healthcare professionals with strong service orientation, and provides care free of charge. While low-income individuals typically utilize public hospitals, those who can afford private health insurance have access to high-quality private facilities, ensuring that no one is denied medical care due to financial constraints. The most common complaints from patients’ families generally concern medical errors or staff attitude. However, such issues are usually resolved within the hospital system, and rarely escalate into violent incidents.

The 2014 law stipulates that,Anyone who attempts to assault a doctor will face up to 14 years in prison.Furthermore, Australian hospitals have robust security systems in place; security personnel respond promptly to calls and arrive quickly at the scene to maintain order. If necessary, the police can be contacted for legal assistance.

By Yang Chengxiang; Edited by Mo Renying