Shanghai mediation service offers cure for patient-hospital disputes

Shanghai's introduction of a mediation service to resolve patient-hospital disputes before they lead to lawsuits or even violence seems to be easing strains in the system, city authorities said.

Almost 7,000 cases were heard in the first 30 months of the program, 82 percent of them with successful outcomes. In the first quarter of this year alone, mediation offices handled 855 cases, a 20 percent increase from last year, and 517 of them resulted in settlements involving nearly 25 million yuan (US$4 million) in compensation.

"Mediation is free and fast, while litigation can be expensive and drawn-out," said Zhang Jie, a lawyer and experienced mediator in Shanghai.

Mediation straddles a growing breach between the public and the public health system. It was introduced in August 2011 amid growing anger that threatened to disrupt hospital operations.

In some cases, families hired agent provocateurs to enter hospitals, posing as relatives, and threaten violence if compensation weren't paid. In several incidents, doctors were beaten and equipment was damaged.

On the other side, many families complain about medical malfeasance in hospitals and about medical authorities refusing to consider their legitimate claims for compensation.

Cyst in pelvis

One such case involved a woman surnamed Li, who died in hospital in June 2012 after being diagnosed with a cyst in the pelvic region that can grow to the size of a soccer ball. Such masses can be cancerous or benign.

Her family alleged that she was given an experimental contrast agent prior to ultrasound imaging in preparation for surgery. She died three hours later.

Li's family members asked the hospital for an immediate compensation of 3 million yuan, authorities said.

The hospital rejected the compensation claim, saying that it would do nothing before an autopsy.

As tensions escalated, the hospital called the local medical mediation service and Yang Bo, a lawyer and part-time mediator, was put on the case.

Yang informed the family that the most they could expect under existing laws was 825,688 yuan, even if the autopsy confirmed hospital liability. Medical experts said Li's medical situation was critical before she entered hospital and she may have died of a pulmonary embolism unrelated to her treatment.

The family finally signed a settlement agreement with the hospital two weeks after the mediation office was called, accepting a compensation figure much lower than what they had demanded.

The Shanghai Justice Bureau said Li's case was one of 6,784 handled between August 2011 and the end of last year.

The service, which is free, is administered by 17 mediation committees employing 123 people from the medical, legal and social services realms. Of these, 87 are full-time staff. The system also taps into the expertise of 1,000 outside consultants.

A deadline of 60 days is imposed on each case. According to a document released by the bureau in March, mediators spent an average 24 days on each case last year, considerably shorter than lawsuits that can last months.

"Mediation can save time both for hospitals and patients' families, as well as ensure a safe and orderly environment in hospitals," said Zhang. "It is a very effective way to resolve these disputes and should be promoted."

Still, some families and hospitals balk at the approach, Zhang admitted.

"Mediators still have to do more to improve their skills and working methods so that families and hospitals believe the process is thorough and fair," he said.