8 in 10 Koreans support installing CCTVs in operation rooms, but…

The 21st Century Hospital, a spinal clinic in Incheon, west of Seoul, made headlines early this year.

Ansung Hospital in Gyeonggi Province has been operating CCTVs since October 2018 with few problems, but the debate over installing CCTVs in hospital operating rooms still goes on.
Ansung Hospital in Gyeonggi Province has been operating CCTVs since October 2018 with few problems, but the debate over installing CCTVs in hospital operating rooms still goes on.

Throughout an operation that lasted more than three hours, the hospital director was allegedly involved in it for only 15 minutes or so. The surgeon left the rest to an “administrative worker,” according to media reports.

A few months ago, the police raided another spine hospital in Gwangju, some 330 km southwest of Seoul, upon a tipoff that “nursing aides” routinely performed surgeries. Recently a news report confirmed that a patient died at a hospital in Busan after receiving shoulder surgery by a “marketing representative” of the hospital's medical equipment supplier.

Foreigners may find it hard to believe these stories.

Ridiculous as these reports are, they may be the tip of an iceberg, say many patients and medical experts familiar with various irregularities occurring at Korean hospitals, especially operation rooms. It is a small surprise then they demand the installation of CCTVs to eradicate the so-called “ghost surgery.”

Ghost surgery refers to a situation where a hospital changes a patient's surgeon without the patient's consent. That, of course, violates Article 27 of the Medical Act, which prohibits unlicensed medical practices.

Despite mounting public concerns about the problem, efforts to introduce rules to obligate installing surveillance cameras in operating rooms have been staging an uphill struggle due to adamant opposition from doctors.

Last month, the National Assembly Health and Welfare Committee put off the decision once again on amending the Medical Service Act to include a mandate on closed-circuit TVs in hospital operating rooms.

According to the Ministry of Health and Welfare, lawmakers from both parties agreed that the CCTVs should film the operation only if the patient gives consent and that the videos should be available only at the request of courts or investigative agencies.

However, there were considerable differences between ruling and opposition parties in details, including whether the CCTV should be inside or outside of the operating rooms, the scope of medical institutions to install CCTVs, the range of the patient access for the CCTV data, and who will pay for the installations, indicating the bill has several legislative hurdles to clear.

However, a recent survey by Realmeter, a polling agency, showed that nearly eight out of 10 Koreans agree with patient advocacy groups on installing surveillance cameras in hospital operating rooms.

According to the opinion poll, 78.9 percent of respondents said they support installing CCTV cameras -- 48.8 percent showing strong support and 30.1 percent moderate support.

Adamant opposition from doctors

As expected, the Korean Medical Association (KMA), the country's largest doctors' group, is going all out to scuttle the bill.

The association argues that CCTVs will make physicians take more defensive attitudes during operations to avoid potential malpractice lawsuits.

"The installation and operation of CCTV in the operating room cannot solve problems such as surrogate surgery and preservation of evidence of medical accidents," the association said. "The installation of CCTV in the operating room is highly likely to lead to a paradoxical situation that puts medical staff under constant surveillance, impairing the concentration of medical personnel and causing excessive tension among medical workers, pulling down the overall quality of medical services."

According to the KMA, the World Medical Association (WMA) also shared their concerns about installing CCTVs in operating rooms. The WMA includes nine million doctors and medical associations from 115 countries.

"The installation of CCTV in the operating room will not only undermine trust between doctors and patients but will ultimately reduce the number of treatment options that are necessary for many patients," WMA President David Barbe said. "This bill has a strong Orwellian tendency, so it is closer to totalitarian national thinking than a free citizen-state."

Barbe stressed that all medical practices such as surgery, medication, and medical advice are based on mutual trust and confidence between the patient and the doctor.

"A key element to ensure this is privacy," he said. "Forcibly installing and monitoring CCTV in the operating room not only causes constant mutual distrust and does not help any treatment process."

The WMA supports the position of the KMA, which opposes the implementation of a bill requiring CCTV installation, which can break trust and confidence with patients, and urge the National Assembly to repeal the bill as soon as possible, he added.

Few problems at CCTV-installed hospitals

Despite the fierce backlash from the KMA, some hospitals have installed CCTV voluntarily and preemptively to regain patients' trust amid the intense debate over the obligatory CCTV in the operating room.

For instance, Kookmin Hospital in Namyangju, Gyeonggi Province, has been operating CCTVs in its operating rooms since November last year after applying for the province’s experimental project to operate CCTV-installed operation rooms.

The hospital said the installation of the camera had raised no issue for the hospital.

"Of the hundreds of surgeries conducted at the hospital, 80 percent of patients agreed to turn on the camera during operation," the hospital said. "However, there were no requests to view the footage due to operational complaints or medical accidents."

The hospital's president Choi Sang-wook said, "Installing CCTV in the operating room is not a big deal. I thought that installing cameras will serve as a way to protect doctors and restore people's trust in doctors."

Choi also refuted some of the concerns raised by the KMA.

"Regarding the concern about leaking sensitive footage, only limited people can access the CCTV system, so there is little chance of it being leaked," he said. "Also, there is no reason to illegally leak videos about who is in the operating room and who is not, and who entered and left the operating room."

He also refuted the claim that medical disputes could increase.

"The possibility of an increase in medical disputes is absurd," he said. "The possibility of reducing medical disputes is much higher because the operating room CCTV proves that the medical staff is working properly."

At other hospitals, reactions to CCTVs were mixed.

Mokdong Himchan Hospital has installed CCTVs in all operating rooms to restore the credibility of the medical community, including the recent suspicion of proxy surgery and medical accidents, and began operation on June 11.

Hospital President Lee Su-chan, who ordered the installation of such CCTVs in his hospital, said that he agrees with the medical association's position that the installation of CCTVs in operating rooms may treat all doctors as potential criminals and make dangerous surgeries burdensome.

Nevertheless, he added that it is unfortunate that the patient's medical reliability has fallen to the point that he had to install CCTVs.

Since operating the cameras in the hospital's surgery rooms, Lee stressed that the satisfaction of patients and caregivers has significantly increased.

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