Throughout the past year, Seoul National University Hospital (SNUH) was at the center of social controversy.
It was only the start that Professor Suh Chang-suk서창석, attending physician for former President Park Geun-hye, became the president and CEO of SNUH서울대병원, triggering controversy about “parachuting” appointment.
The hospital’s pride as Korea’s best medical institution suffered a huge setback when the public accused SNUH of distorting activist farmer Baek Nam-ki백남기’s cause of death. Baek collapsed after being hit by the police’s water cannon, underwent medical treatment at SNUH for more than 300 days, and died on Sept. 25. Baek’s personal doctor, Professor Paek Sun-ha백선하, however, wrote his cause of death as “natural death” – instead of “unnatural death”-- unlike what most people thought.
Accusations from the medical community also rained down on SNUH. Students and alumni of Seoul National University College of Medicine called for correcting the late farmer’s cause of death, and Korean Medical Association also expressed its position, saying “Baek’s death certificate is wrong.” Even the National Assembly came forward by activating special panels to investigate the university and its hospital. But nothing made Professor Paek who operated on the farmer change his conclusion that the activist “died of a disease.”
On June 15, however, SNUH suddenly changed the cause “from natural to unnatural” death. Since the change was so abrupt that many people said “the hospital was watching the new government’s face” or “there was pressure from outside.” But SNUH explained it had dozens of discussions since January through various procedures and wrapped up the process recently.
Leading that process was Chief Medical Officer Kim Yon-su김연수. Since taking the current post on Dec. 19, Kim has held several meetings with Professor Paek and medical residents and collected opinions from other hospital staffs, taking the lead in changing the death certificate. Korea Biomedical Review met with CMO Kim to talk about the process and the direction SNUH will go in the future.
|Kim Yon-su, CMO of Seoul National University Hospital, explains the change in the controversial death cause of an activist farmer and the future direction of the hospital, during a recent interview with Korea Biomedical Review.|
Question: Six months have passed since you took office as the chief medical officer. What was the most memorable event?
Answer: Things related to the death certificate of Mr. Baek Nam-ki. I need to resolve the issue, as it was the first hurdle to surmount for SNUH to move forward. When the death certificate became a social issue, the university and hospital formed a special joint investigation committee, which concluded the death certificate was not made as directed in our guidelines.
But Professor Baek Sun-Ha did not accept the committee’s position, and there was no way forcing him to change it. After that, the controversy surrounding the death certificate continued, and former CMO Shin Chan-Soo had to step down, and I had to take over his job, resuming the discussion in earnest. I am glad we could change the death certificate.
Q: In regards to changing the death certificate, what kind of discussions did you have within the hospital?
A: In late January, the bereaved family filed a lawsuit against the hospital’s president, Professor Paek and a medical resident to change the death certificates while demanding compensation. The lawsuit has become an opportunity to modify the death certificate.
Our hospital has a medical ethics committee, which discusses medical disputes when they occur. If a medical lawsuit is filed, we provide doctors in charge with opportunities to explain why it happened and what their opinions are about it. I have met with Professor Paek and the medical resident several times. Paek has been consistent with his opinion that it was “natural death.” I have argued against him that it wasn’t. In the end, it was a battle between conviction and conviction.
Nonetheless, it was clear that they violated guidelines in making death certificates. We had listened to their opinions until early March and discussed them. However, from March to April, Professor Baek and the resident worked together, during which we suspended the discussion for fear of causing damage to the resident.
During that period, the medical ethics committee concentrated on this issue. We resumed the discussion in May. We first asked for neurosurgeons’ opinions. The neurosurgeons said that they would form a subcommittee to discuss the issue, and report the results to faculty council. The subcommittee consisted of the medical resident, Professor Paek, chief of neurosurgeon department, professor of nephrology and infectious diseases, and a forensic doctor. But Professor Paek did not attend the meeting
The subcommittee reached a conclusion that “Baek Nam-ki’s death certificate did not follow the guidelines, ” and this result was given to the neurosurgeons’ faculty meeting. Professor Paek attended this session, debating the issue hotly. Finally, the faculty meeting also decided the death certificate violated the guideline, sending it to the medical ethics committee.
There was a fierce debate in the medical ethics committee, too, over whether a medical resident should be allowed to make the death certificate independently, and who have the authority to change death certificate made by a resident. Professor Paek said he should take responsibility for the death certificate because he carried his point in it although the medical resident made the certificate under his name.
Professor Paek’s argument made some senses from the standpoint of a teacher, but the change of death certificate was a legal issue. So I made it clear Paek has “no authority.” About the problem of whether a medical resident can draw up a death certificate independently, we judged a resident in his third year could write his views in it as a licensed doctor. Legal reviews also concluded only the medical resident could revise the death certificate.
Later, the medical ethics committee made a four-point decision and had been following it: first, the medical resident has the responsibility and right to make the death certificate. Second, we recommend the document be revised.
Third, the hospital head should do all he can to ensure such efforts are made without problems, and to resolve the legal dispute at an early date. Fourth, we hope the “medical professionals’ ethics committee will start its work to make this discussion sooner than now.
Q: The timing of the change is quite delicate. There are suspicions about outside pressure or SNUH’s currying favor with the new government. What do you think?
A: I admit the timing was delicate. We have also heard peoples say, “SNUH is watching the face of new power elite” or “As the president changed, so did the death certificate.” But the truth is, we started this process in January. At least I can say this with confidence and feel as if we were victimized somewhat. Nor do I know why they link this issue to the annual inspection by the Board of Audit and Inspection (BAI). The BAI inspection is an annual procedure. It has nothing to do with the issue whatsoever.
We also thoroughly explained the changing procedure and reasons for the delay to the late Baek’s daughter Baek Doraji, and she understood all that.
I would like to give meaning to the revision itself rather than its process. We have found a way to coordinate the difference of views between an individual professional and a group. I think this was the real working of collective intelligence within a professional group and a significant milestone. I believe that the conclusion contains all the SNUH staffs’ opinions
Q: There seems to be a gulf between medical judgment and normative judgment about the making of death certificates. What is the problem with the death certificate in our country?
A: A death certificate must contain why this person died, but that is not the case with a Korean certificate. If we can say like, “a person had a disease called “A,” underwent the treatment of “B” but died because of the reason “C,” this contains all the information that a doctor wants to say. In Korea now, however, the rules call for us to only categorize them into three – violent (unnatural) deaths, deaths from disease (natural death) and other undetermined deaths – causing gaps between medical and normative judgments.
It may be significant to divide natural from unnatural deaths for national statistics, but that results in various distortions. We need social discussions on how to narrow the gap. We will, along with related institutions such as Korean Medical Association (KMA) Korean Academy of Medical Sciences (KAMS), and Korean Society of Law Medicine, make this a joint task and start discussions about the contents of death certificates. This is a work that requires a continuous study.
Q: Experiencing various controversies in the past year, Koreans have lost much of their trust in SNUH.
A: Without haste, I will proceed with a project to restore public confidence in SNUH. SNUH is an important for the public, too. If we leave it as it is now, both the hospital and people have much to lose. I am considering two solutions. First, we will make an extensive investment in hardware. Over the past decade, there have been no investments in hardware. Research equipment and other facilities have fallen far short of public expectations. We will push ahead with the ongoing projects step by step, including the construction of a state-of-the-art facility, the expansion and remodeling of operating rooms and the establishment of a comprehensive treatment support center.
Second, I will do my utmost to stress the sense of ethics SNUH must have, and strengthen clinical excellence. We will no longer compete against ASAN Medical Center, Samsung Medical Center, and Severance Hospital. We are not going to care about titles like “big four or five.” Instead, we will try our best to be a hospital that can stand in the middle of people’s trust. It will be not about we receive how many new patients but how many severe patients we accept, to serve as the nation’s central hospital true to its name.
I think Seoul National University Hospital is a national intensive care unit. I hope people will have the confidences they can be treated at SNUH when they are sick and troubled. We have been criticized by being embroiled in inappropriate scandals, but we will resume the role of the nation's intensive care unit again. We will put up with “good deficit” arising from this process and will demand the state’s support in open and square manners. I believe that is what people want from SNUH.
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