This doctor is already middle-aged, and he's only just started practicing medicine.

Chapter 198 Where do so many underhanded tricks come from?
November 10th, Tuesday, sunny.

Zeng Huanqi worked the emergency room night shift, Tian Zhuang worked the ward night shift, and the surgical team was led by 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 casually, "The doctor you're looking for, Dr. Lu, has arrived."

Lu Cheng glanced at the people sitting around the table, and his heart immediately tightened.

Besides familiar faces like Zhang Tiesheng, Huang Haibo, and former director of the emergency department Lin Qianlong, there were several other faces that Lu Cheng didn't recognize.

They were dressed in uniforms and accompanied by hospital leaders.

Du Qiang glanced at Lu Cheng and said in a very official tone, "Lu Cheng, go change into your work clothes."

"Okay, Director Du." Lu Cheng hurriedly left the office, put on his white coat, and rushed back.

Vice Dean Hu Qingshan then said in a rather official tone, "Director Tian, ​​now, all the people you are looking for have been found."

"The medical records that were previously sealed have also been copied here..."

Sitting in the very center, Tian Qi glanced at Lu Cheng with surprise and said inexplicably, "It's Dr. Lu Cheng again."

Lu Cheng thought Tian Qi was calling him by name, so he replied, "Hello, leader, my name is Lu Cheng, I am an emergency room doctor, and my current professional title is attending physician."

Vice President Hu Qingshan then introduced the situation in a businesslike manner: "Dr. Lu Cheng, this is Director Tian Qi from the Legal Affairs Section of the Health and Wellness Bureau, and two other relevant leaders, Zhou Wenshu and Tan Ling, have also come to our hospital for inspection."

"You must cooperate truthfully later."

“Okay!” Lu Cheng nodded and sat down.

Zhang Tiesheng got up and went back to the door, temporarily closing the door to the doctor's office.

Tian Qi said, "Director Lin, although you have already left your job, we have received a tip that you were involved in unauthorized surgeries while working in the emergency department of our county's People's Hospital."

“We’ve discussed these issues in detail before. Now, all the people who were paired with you are here. Do you have anything to explain?”

Lin Qianlong looked a bit embarrassed. After his eyes and lips twitched for a while, he said, "Director Tian, ​​since you have already found me, you must have very detailed information."

"But I need to clarify one point: I did not violate the principle of non-harm. The surgeries we performed were all based on the consideration of preserving the patient's organs and providing the patient with a better quality of life."

Tian Qi gestured for him to speak: "Director Lin, we will address whether the surgery will have any significant impact later."

"What we are going to discuss now is the specific surgical procedure."

"According to the information we have, surgeries including but not limited to spleen preservation surgery, which are not listed in the scope of surgical procedures compiled by the National Health Commission, are all new surgical procedures."

"I would like to ask Director Lin, were the surgeries you performed previously reported to the relevant health departments? Did you strictly adhere to the classification of new technologies?"

"Has the process gone through discussions with the professional committee and approval from the ethics association, among other related procedures?"

Tian Qi's question was very official. Lin Qianlong's Adam's apple bobbed, and he faced the question with a pale face, unable to utter a single word.

Tian Qi's words became more serious: "According to the management system for new technologies and new businesses, new technologies are divided into national, provincial, and institute levels."

"National-level new technology definition, new achievements with international advanced level, projects that have not yet been carried out in the domestic medical field, and new medical and nursing services that have not yet been used."

"Provincial-level new technology definition, new achievements with advanced domestic level, new projects that have not yet been carried out in the province, and new medical and nursing services that have not yet been used."

"At the hospital level, it has advanced level in the province and is a new project or new medical and nursing service that has not yet been carried out in the city or hospital."

"Director Lin Qianlong, have you evaluated the surgeries performed in your department? What category do they fall into?"

Lin Qianlong replied guiltily, "At the department level."

"Which units in our prefecture-level city are operating normally?" Tian Qi continued to press, showing no leniency whatsoever.

Lin Qianlong was unable to answer, remaining silent several times, his mouth opening and closing but still uttering no sound.

Lin Qianlong glanced at Huang Haibo, but Huang Haibo didn't want to pay him any attention, seemingly wanting to perfectly embody the phrase "when people leave, the tea cools down."

Du Qiang wouldn't dare get involved with these things at all.

"Okay, so which units in our province are carrying out these programs?" Tian Qi continued to ask.

"Several hospitals in Xiangya are carrying out this routinely!" Lin Qianlong quickly said.

"Did you report it? Did you organize a discussion with general practitioners? Where are the discussion records? Where is the approval from the ethics association?" Tian Qi reached out to ask Lin Qianlong for the paperwork.

How did Lin Qianlong manage to provide that information?
"Do you have the safety risk assessment form from the professional committee?" Tian Qi continued to reach out to Lin Qianlong for the document.

It's not that they're forcing people; it's just that if something is truly good, then the process will naturally work.

If the process cannot be just, then medical technology is also unlikely to be positive; otherwise, why don't you follow the procedures?
Lin Qianlong thought for a moment, recalling his previous response to Lu Cheng, and immediately replied, "Director Tian, ​​I have something to say here. We never intended to preserve the patient's spleen... it's just that the patient was unable to be transferred due to his condition at the time."

"So we tentatively stitched it up, trying to..."

Tian Qi said, "What are you trying to fight for? There's no recommended standard surgical procedure for a ruptured spleen, is there no standard surgical treatment?"

Is splenectomy a recommended procedure according to guidelines? Can our hospital routinely perform it?

Hearing this, Lu Cheng felt a chill run down his spine!
Wow, so that's where the loophole was.

Spleen preservation surgery is different from limb replantation surgery. There is only one standard surgery for limb replantation.

A crucial component of limb replantation is suturing, so it's perfectly acceptable for you to say that you only performed suturing and temporarily created all the favorable conditions for the patient.

Otherwise, if we encounter someone like that, we'll just amputate their limb, right?
That definitely won’t work.

But spleen-preserving surgery is different. The officially recommended procedure is splenectomy. Why would you suture it up?
Lin Qianlong said in a strained voice, "We can't just let the patient's spleen be removed when there's still a chance to save it, can we?"

Tian Qi pressed further: "Why is there still room for rescue? How did you arrive at this conclusion? What are the professional standards?"

"Based on which standard?"

"You say you made the decision on your own? Director Lin, as far as I know, an associate chief physician doesn't have that kind of autonomy, does he?"

Lin Qianlong fell silent again.

This was deliberately targeted at him; all the evidence from all sides must have sealed his fate. How could he possibly escape?

Tian Qi continued, "Director Lin, do you know what the basic qualification requirements are for performing new surgical procedures? And what is the relationship between them and our hospital's level?"

"First of all, you must pass the assessment for special training or advanced studies in new technologies."

"Excuse me, where are your team's new technology training certificates and assessment certificates? Please show them to me."

Tian Qi continued to reach out to Lin Qianlong, asking for things.

Lin Qianlong shook his head and closed his eyes: "Director Tian, ​​this one is not available either."

"Who were the people involved in the surgery?" Tian Qi continued to question, seemingly just going through the motions.

Lin Qianlong immediately replied, "I am the chief surgeon; everyone else is an assistant."

This was written in the surgical record, and Lin Qianlong couldn't refuse it. If he tried to refute it, it would only create more complications.

For example, if you are an associate chief physician on the operating table, why would you let an attending physician perform the surgery? What are the considerations behind that?
Tian Qi then looked at Zhang Tiesheng: "Associate Chief Physician Zhang, you were also on the stage at the time. Are you familiar with the standard procedures for performing the new procedure?"

"If you had known, why didn't you stop it in time?"

Zhang Tiesheng knew nothing about it, shaking his head vigorously: "I didn't expect it either, and I didn't check so thoroughly beforehand."

"Furthermore, everyone was in a hurry when the patient arrived, so they didn't think about these details."

"Where is Dr. Lu Cheng?" Tian Qi only mentioned Lu Cheng casually.

There were two associate chief physicians present, and Lu Cheng, the attending physician, was the least important, but he still had to continue the review.

Lu Cheng also shook his head: "I don't know either."

There are so many medical regulations, it's a thick book, and very few people can remember them all.

Moreover, Tong Yuan'an gave Lu Cheng a set of explanations, which was to simplify the operation.

Lu Cheng never expected that this set of "sales pitches" only applies to limb replantation, but spleen preservation surgery cannot be "fooled off"!
"In other words, Director Lin, you admit that the surgery you performed in the operating room was not illegal."

"Everything recorded here is authentic, not falsified?" Tian Qi continued to ask.

Lin Qianlong thought for a moment but still didn't nod: "Director Tian, ​​I didn't violate the principle of not harming anyone, and the patient's postoperative prognosis is very good! Otherwise, the patient's family would have filed a complaint long ago."

Tian Qi said, "Yes, the patient's family did not complain, but the problem now is that these surgeries have been discovered."

"Several issues. First, this patient's surgery cost more than that of patients with similar conditions, even though there were no complications such as infection."

"The medical insurance reimbursement rate is also higher than that of other patients. How do you explain that?"

"Secondly, these patients have longer hospital stays and no unexplained complications. If you report these data, wouldn't that be considered a special case?"

"Third, if you were to implement these technologies, you would not have reported them, nor would you have seen the departmental discussion records in the medical records, let alone the risk reporting form from the medical affairs department."

Upon hearing this, Hu Qingshan scratched his head vigorously and added, "Director Lin, the current problem is that the inspection team has their eyes on these medical records and has found logical loopholes in them."

"The State Health Commission and the medical insurance department are ordered to conduct a thorough and rigorous investigation, not only into economic issues, but also into procedural justice issues."

“To conduct new procedures without reporting them is, to put it mildly, a means of making money; to put it more seriously, it’s human experimentation!” Hu Qingshan emphasized.

Live experimentation is one of the medical taboos, and live human experimentation is the absolute taboo.

Once it rises to that level, let alone an associate chief physician, even a top professor can be torn to pieces in no time.

Lin Qianlong was exhausted: "Director Tian, ​​Dean Hu, my resignation is not because I want to shirk responsibility for these surgical procedures. Besides, you can investigate my financial situation as you see fit." "Furthermore, the patient recovered well, and both the family and the patient are satisfied with the treatment."

Tian Qi immediately started cursing: "What qualifications and eligibility do you, Lin Qianlong, have to develop new techniques? And why did you do it without reporting it to the authorities?"

"Where are your qualifications? Show them to me. Use your brain, will you?"

Is this a matter for the patient's family to pursue legal action now?

Tian Qi's voice was angry, but he wasn't cursing Lin Qianlong for being brainless; he was deliberately causing trouble for the hospital and the county at this critical juncture.

Lin Qianlong was unaware that the inspection team was coming. He was only trying to help the patients, and in fact, the hospital had previously "encouraged" the development of new services.

Neither the hospital nor the health bureau expected an inspection team to come.

Of course, the hospital did not expect that the surgical techniques Lin Qianlong performed in the emergency department could be elevated to such a level.

Tian Qi continued, "This business transaction did not cause any serious consequences, therefore it is classified as 'practicing beyond the scope of one's license.' Do you agree?"

"Dean Hu, on behalf of the County Health and Wellness Bureau, I hereby issue a stern warning to your hospital and impose a fine of 20000 yuan. Do you agree?"

Hu Qingyuan's attitude was very proper: "Our hospital accepts the punishment from Director Tian and the higher authorities. We will definitely rectify the situation promptly and pay more attention to procedural compliance in the future."

Tian Qi then raised both hands in protest: "The relevant key medical personnel involved are ordered to suspend their practice for three months."

"To be more specific, after our bureau reported to the higher authorities for verification, the higher authorities instructed that Associate Chief Physician Lin Qianlong be suspended from practicing for three months."

"Associate Chief Physician Zhang Tiesheng and Attending Physician Lu Cheng were given warnings and suspended from practicing for one week, and hospital-level disciplinary actions were issued in accordance with hospital notices."

"Doctors, do you have any other opinions or objections on this matter?"

Upon hearing this, Hu Qingshan immediately said, "Director Tian, ​​our emergency department is already severely understaffed. If Associate Chief Physician Zhang and Attending Physician Lu Cheng are suspended from their practice, we really won't be able to operate normally."

"We hope that the bureau can carefully consider this matter."

Tian Qi sighed and put away the documents in his hand: "We didn't really want to make such a punishment, but this is the punishment result given by the higher authorities, and we are only responsible for conveying it."

Tian Qi continued, "Here's a reminder: Professor Chen Song from your department performed spleen-preserving surgery at the hospital, which was legal and compliant."

"He was approved by his institution to conduct outpatient consultations and practiced medicine in compliance with regulations within the medical consortium."

When Zhang Tiesheng heard that he was involved, he said, "Director Tian, ​​we are just assistants, do we have to be punished too?"

Tian Qi had already received the documents, and now he scratched his head: "Whether or not I was the lead surgeon, I've been discovered, so I'll have to be punished to some extent."

“I just asked you, and you all said you didn’t know anything about these things. As clinical doctors, you have an obligation not to participate in illegal activities.”

“Just because you were unaware of it doesn’t mean you can participate. According to the regulations, you have an obligation to advise against it and not participate.”

"Of course, there will definitely be a warning. As for the specific decision regarding the suspension of practice, we will go back and report to the county hospital to see if the higher authorities can make an exception."

"This time, the main reason is that the patient did not have any unexpected accidents."

At this point in Tian Qi's speech, Director Huang Haibo suddenly said, "Director Tian, ​​among the categories of medical personnel practicing beyond their scope of practice, there are only two: practicing beyond their professional scope and practicing beyond their place of practice."

"The punishment you just mentioned doesn't fall into either of the two categories, does it?"

Upon hearing this, Tian Qi glanced at Director Huang Haibo.

"And who is this?" Huang Haibo asked, looking at Hu Qingshan.

"This is our Emergency Department Director Huang Haibo. He is also the Deputy Director of the Emergency Department."

Tian Qi then explained, "Director Huang, their situation is a violation of regulations by carrying out new procedures, which is classified as practicing beyond the scope of their expertise. It doesn't necessarily mean they have to practice beyond their professional scope."

Huang Haibo continued to shake his head: "No, no, no, Director Tian, ​​practicing beyond the scope of one's license is practicing beyond the scope of one's license; it is an irregular practice scope."

“Performing new surgical procedures in violation of regulations, strictly speaking, falls under the category of ‘surgical procedures performed beyond one’s level’.”

"Since Director Lin did not perform surgeries for any surgical conditions outside of his scope of practice, it should not be defined as 'practicing beyond his scope of practice'!"

"Moreover, according to the case information I have, the patient did indeed have a ruptured spleen at the time. Therefore, during the emergency room admission process, the suturing and hemostasis performed by Director Lin and other doctors is also one of the standard emergency rescue procedures."

"Why was it classified as another type of technique or a new technique?"

"Splenic suturing is indeed one of the most effective treatments for stopping bleeding from a ruptured spleen, isn't it?"

"According to relevant medical regulations, in particularly urgent situations, those who provide emergency medical care to patients can be exempted from liability for 'practicing beyond their scope of practice' or 'performing surgeries beyond their level of expertise.'"

"Based on the existing case data, we can determine that the patient was in a particularly dangerous situation at the time, so it was reasonable, legal and in accordance with medical practice guidelines to provide emergency hemostasis."

"If we have to say there was a violation, it should be that Director Lin did not perform the most standard guided surgical treatment according to the standard guidelines, rather than performing a procedure beyond the scope of his authority."

"Director Lin simply didn't perform a splenectomy, not that he didn't stop the bleeding. What's wrong with that?"

After listening attentively, Tian Qi looked at Huang Haibo in surprise: "Director Huang, you?"

Huang Haibo said, "Oh, I personally have a certain understanding of medical-related regulations."

"As the saying goes, anything not prohibited by law is permissible. Since medical regulations do not explicitly state that the treatment of all emergency cases must be carried out in strict accordance with the surgical procedures recommended by the guidelines, the attending physician can take effective rescue measures according to his own understanding, provided that the most basic medical practice principles are not violated."

“Our hospital is just a county hospital, which is a relatively basic medical institution. We have done our job well, and we cannot put the high praise on the new surgical procedure.”

"Director Tian, ​​I know that in addition to conveying the message from the higher authorities, you must also be here to provide feedback on the incident."

"We can admit our mistakes, and we can also explain things that are not wrong."

"This is not an excuse, but rather my personal feeling that there may have been a slight lack of rigor in the process of supervising medical regulations by higher-level leaders."

"Director Tian, ​​why don't you offer some private advice and try to make an exception?"

"The main point is that the patient is recovering well, with no adverse consequences, and the treatment effect is far higher than the average level of treatment for the same disease."

"This is in accordance with medical practice guidelines."

Tian Qi said, "But Director Lin just said that he did indeed develop a new technique?"

Huang Haibo replied, "Director Tian, ​​our leaders from the Health and Wellness Bureau have held meetings with us repeatedly to explain the relevant laws and regulations. How could our hospital possibly be violating regulations by performing new procedures?"

"Isn't this the fact you've specifically identified?"

"We've caused you trouble this time. We hope that you leaders can take the trouble to check the relevant information again and make things easier for us clinicians."

One of the people next to Tian Qi, through Huang Haibo's words, found out more specific details about the clockwork and whispered a few words to Huang Haibo: "Director Tian, ​​it seems that what Director Huang said is correct."

“The regulations on ‘practicing beyond one’s scope’ and emergency avoidance contain the things that Director Huang mentioned.”

Tian Qi thought about it carefully for a moment and asked, "Director Huang, could you come with us? We need to come up with a more comprehensive response."

Huang Haibo said, "That's no problem. I'd be happy to help you leaders if I can."

Hu Qingshan then said, "Director Tian, ​​our hospital's Director Huang has a lawyer's license."

"That's even better!~"

"If we are more familiar with the relevant provisions, we will be able to provide better feedback. In fact, we don't want to cause any unnecessary trouble at this time."

"However, due to some external reasons, our hospital is being closely monitored, and any slightest disturbance will be noticed... Let's leave it at that for now, Director Huang and I will go back and discuss it further..."

After Tian Qi finished speaking, he looked at Director Lin Qianlong and said, "Director Lin, no matter what, you still have to bear the main responsibility for this matter."

Lin Qianlong let out a long sigh.

……

After Tian Qi and the others left, Zhang Tiesheng and Lu Chengcai glanced at Du Qiang with some 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 didn't show much emotion, as if he didn't think Du Qiang's words made sense.

This matter is temporarily 'unrelated' to Du Qiang, so he didn't linger: "Director Lin, I'll go 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 is a routine procedure we perform in emergency surgery?"

"We didn't explicitly name the procedure 'spleen preservation surgery'."

Lin Qianlong said, "Zhang Tiesheng, do you think those leaders are all fools?"

"The same spleen injury, different surgeries and hospitalizations have such different costs, are they trying to cheat each other?"

Fortunately, nothing serious happened to the patient.

"Although Director Huang Haibo helped with this matter, it is still unknown whether he can get away unscathed."

"Dean Peng has caused our hospital too much trouble," Lin Qianlong sighed.

Zhang Tiesheng said, "So what do we do now? Director Lin, should we find out what the higher-ups think about this?"

"The most important thing now is to investigate the economic issues in healthcare; our problem is definitely not the core issue."

Lin Qianlong nodded: "In recent years, because of Huang Haibo's troublemaking, although we have lived a poor life, we have not had too many loopholes."

"Director Huang is quite farsighted."

Zhang Tiesheng said, "Director Huang is indeed very farsighted, but he just doesn't want to stay..."

Lu Cheng was certain that this was not some underhanded tactic, but rather that he had been implicated and "caught in the trap."

(End of this chapter)