If there hadn’t been that accidental discovery, would the father’s ending be better? This article is from the WeChat official account:HealthInsight at eight points author: Fang Shu Chen, Editor: Li Ying, from the title figure: vision China

After studying the Jiangsu Medical Insurance Catalogue, Zhang Peishuang, a boy born in the 1990s, had a bad impression of his father’s doctor.

It was March 2020. His 58-year-old father Zhang Ailin was hospitalized in Wuxi People’s Hospital for more than ten days due to infection after lung transplantation. He accidentally discovered that the drugs they bought at their own expense for more than 500,000 yuan were in the medical insurance catalog, and the pharmacy was on the first floor of the hospital.

He has repeatedly negotiated with the hospital and has never received an explanation that he agrees with. In a hurry, he reported the behavior of the hospital to the local health committee. After the report, the doctor once changed the medication plan.

During this period, Zhang Ailin’s condition gradually deteriorated and he passed away ten days later.

Subsequently, Zhang Peishhuang took the hospital and pharmacy to court, demanding compensation of more than 440,000 yuan for medical expenses. This is the reimbursable part of his family’s self-financed medicines.

“This may be the first case to sue the hospital over medical insurance issues.” A medical lawyer who requested anonymity commented on Eight Jianwen.

Change lungs

Zhang Ailin suffers from chronic cor pulmonale and his condition has gradually deteriorated over the years. By 2019, he will not even be able to take a bath on his own. He needs the help of his family and inhaling oxygen to complete it. It’s also difficult to walk, and I lose my strength after walking tens of meters. After many discussions, the whole family decided to change his lungs.

The location of the operation is Wuxi People’s Hospital, “China’s most famous lung transplant hospital” in their minds. A few years ago, Zhang Ailin and his wife moved from their hometown in Weihai, Shandong to Nanjing. They lived with their daughter, and it was more convenient to choose Wuxi for surgery.

The double lung transplant operation is scheduled in July 2019 and will be performed by Chen Jingyu, the vice president of the hospital and the “first lung transplant recipient in China”. The operation was a success, Zhang Ai after the operationLin recovered very well, “basically like a normal person,” and even took care of the daily work of mopping the floor and cooking at home.

However, in only half a year, at the end of February 2020, he suddenly developed a fever and became weak. The most common complication after lung transplantation-lung infection, came to him.

Due to the effects of immunosuppressants, patients who have received lung transplantation are immunosuppressed and risk infection throughout their lives. Once the elderly patients are infected, the situation is more troublesome-they are universally resistant to multiple antibiotics and require doctors to carefully formulate medication plans.

At the time when the new crown epidemic was raging in many parts of China, hospitalization was quite difficult. After several setbacks, Zhang Ailin was admitted to Wuxi People’s Hospital again. At that time, the family was grateful for this hospital. He was judged by the Nanjing hospital as “no good”, he was hospitalized here for less than a week, and he got better, “walking in the corridor of the hospital every day, can walk thousands of steps a day”. This made Zhang Peishang relieved and returned to Beijing to continue working, leaving his mother and sister and brother-in-law to take care of his father.

Father is saved. While rejoicing for Zhang Ailin’s improvement, the large expenditure of frequent self-finance purchases also made the family worry.

Zhang Peishuang told 8:00 Jianwen that in 2019 and 2020, during the two hospitalizations of his father, the attending doctor issued prescriptions many times, saying that some medicines need to be paid at their own expense, and asked them to go directly to the Kangda Pharmacy on the first floor of the hospital outpatient building. . He and other family members did not think much about it at the time, and they did it.

“At that time, we trusted doctors 100%. The only thought was that many self-paid medicines were too expensive.” He recalled to 8:00 Jianwen.

Infectious complications are a common problem after lung transplantation. Zhang Ailin is infected with drug-resistant bacteria, and his daily medication includes a special antibiotic—Fengweiling(generic name “colistin sulfate for injection”), also known as “antienemyin (colistin sulfate)” or “polymyxin sulfate E”. The drug is produced by Shanghai Shangyao Xinya Pharmaceutical Co., Ltd. and was launched in China in January 2019.

“5 ml of (500,000 units) costs 2,200 yuan.” Zhang Peishuang was impressed by such expensive antibiotics. He said that they were hospitalized twice in 2019 and 2020. They were on the first floor of the hospital.Kangda Pharmacy purchased the drug at its own expense and spent nearly 300,000 yuan.

After that, he showed the doctor’s prescriptions and a large number of receipts and invoices issued by Kangda Pharmacy in Wuxi City to Jianwen at 8:00, each with a value ranging from more than one thousand to tens of thousands.

In addition to Feng Weiling, during 2019 and 2020 when his father was hospitalized, the drugs he and his family purchased at Kangda Pharmacy at their own expense also included albumin, amphotericin B, and gamma globulin(Intravenous human immunoglobulin) etc. These expenses were later confirmed as 524,955 yuan in court.

A secret discovered by accident

It was purely accidental to discover that self-paid medicines were in the medical insurance catalog.

One day in mid-March 2020, Zhang Peishhuang suddenly wondered whether his father’s expensive self-paid drugs would be cheaper to buy online?

He found an online store, which indicated that polymyxin E(Fengweiling) can be purchased from Germany. After contacting, the shopkeeper asked him if he was in Wuxi People’s Hospital. He said that a few years ago, many patients went to Germany through him to buy goods. They have not had them in the past two years, but he was still willing to help.

Zhang Peishhuang asked the doctor whether he could purchase the medicine on his behalf. The attending doctor clearly told him that since Fengweiling was launched in China, the hospital forbids patients to buy the antibiotic on his behalf. “He said that the patients themselves bought generic drugs. If the doctor asked them to buy them, they would go to jail.”

Be cautious, he followed the doctor’s advice, did not find a purchasing agent, and continued to get the medicine at his own expense in the pharmacy.

But then, he had another thought, to check if the medicine was in the medical insurance catalog, “Actually, I didn’t have much hope, I just took a look.”

He discovered: Feng Weiling is in the National Medical Insurance Directory and also in the Jiangsu Provincial Medical Insurance Directory. He checked the albumin that he had spent tens of thousands of dollars to buy at his own expense last year and found that it was also in the Jiangsu Medical Insurance Catalog.

Continuing the investigation, he found that during the two hospitalizations of his father, several other self-financed medicines that the doctor asked to buy at Kangda Pharmacy were all in the Jiangsu Medical Insurance Catalog.

A huge cloud of suspicion rose in his mind: Why are these medical insurance directoriesOf medicine, the doctor asks to buy it at his own expense?

On March 15th, Zhang Peishhuang began to ask around: the doctor on duty, the attending doctor, the medical insurance department, the pharmacy department, and the Jiangsu Provincial Medical Insurance Bureau… After sorting out the statements of various parties, he became more confused.

Zhang Ailin handled the direct settlement of medical insurance for hospitalization in a different place. According to regulations, the scope of medical insurance reimbursement should be implemented in accordance with the regulations of the place of medical treatment. In other words, in Zhang Ailin’s situation, whether a drug is paid for by himself or by medical insurance is determined by the medical insurance catalog of Jiangsu Province.

For Fengweiling and albumin, the attending doctor said: Although these two drugs are covered by medical insurance, the hospital has not introduced them, so they can only pay at their own expense, and “it seems that other hospitals in Jiangsu have not introduced them.” Zhang Peishhuang asked whether the hospital could introduce it, but the doctor said it could not.

The news that Zhang Peishang got from the Department of Pharmacy and Medical Insurance is that if the condition requires it and meets the relevant national conditions, the doctor can apply for special medication.

In addition, the medical insurance department also told him: medical insurance limited the scope of application of albumin and several other drugs. If the patient’s illness is not within the applicable scope, it cannot be reimbursed. Among them, the scope of application of albumin includes human albumin less than 30g/L. Zhang Peishuang found that when his father’s index was lower than this value in 2019, he still had no reimbursement.

He felt that several statements were contradictory.

What adds to his distrust is that the Kangda pharmacy, which has repeatedly purchased drugs at his own expense, is wholly owned by Wuxi People’s Hospital. This pharmacy is located on the first floor of the outpatient building of Wuxi People’s Hospital. Checking the industrial and commercial registration data shows that the pharmacy is a wholly-owned enterprise owned by the people of Wuxi People’s Hospital.

Zhang Peishuang questioned the relationship between the hospital and Kangda Pharmacy to the Medical Insurance Department of Wuxi People’s Hospital, and the other party replied: “Kangda Pharmacy is independent and does not belong to the hospital.” However, he later obtained a certificate from Kangda Pharmacy that it was sponsored by the hospital.

“Why does the hospital’s own pharmacy have medicines that are not available in the public pharmacy?” He was full of doubts.

Report

It hasn’t been a few years since Zhang Peishuang graduated from university. Except for his father’s illness, he rarely dealt with the hospital. He didn’t fully understand the operation of the medical insurance system. After several negotiations with the hospital, his voice seemed a little weak. In order not to affect his father’s continued medical treatment, he decided to solve the problem in a way that avoids direct conflict.

2020On the afternoon of March 17, 2005, Zhang Peishuang posted a message on the website of the Jiangsu Provincial Health Commission, reporting that Wuxi People’s Hospital “allows patients to purchase drugs in the medical insurance drug catalog at their own expense.” For the purpose of doing so, he just said, “I hope the hospital can act according to the regulations.”

But the subsequent development surprised him a bit.

He recalled that on March 19, his mother told him anxiously: his father’s human albumin concentration had dropped to 28g/L, and his mental state was not very good. Based on previous experience, Zhang Peishuang thought that the drug albumin should be injected at this time.

When my father was hospitalized in 2019, he and his family bought this medicine at their own expense many times, and the effect was remarkable.

So he called the attending doctor and asked for a solution.

The doctor said, “(albumin) will rise faster if used, and will rise slowly if not used.” It is recommended to eat more , Such as eating egg whites.

He felt that this was not insured, and he took the initiative to express that he understood that medical insurance was not available, and that he still hoped that the medication would “be better for treating diseases”. The doctor said, “I think so too, but sometimes do bad things with good intentions”, “It’s good for everyone if you don’t use it,” and other explanations did not agree with the medication.

In those few days, his father went from bad to worse, and the patients in the same ward all noticed that he was “not as good as every day.”

On March 20, Zhang Peishuang asked again how his father’s albumin was too low and how he should be treated. The doctor’s advice is to strengthen nutrition.

He made another request for albumin. The doctor responded, “(albumin) is certainly better to use,” and “but also consider an economic reason.” The doctor told him that Zhang’s mother had reported that the expenses were too high, and he was helping Zhang’s family save money, “it is best to reduce your burden as much as possible when the condition can be controlled”.

Zhang Peishhuang continued to insist, saying that regardless of the cost, he must first follow the medication that is beneficial to the condition.

The attending doctor said that the treatment plan was not decided by himself, and promised to discuss with the director and the doctors of the entire treatment team to reselect the treatment plan.

Zhang Peishhuang recalled that his father finally used albumin that afternoon.

After the twists and turns caused by albumin, Zhang Peishuang distrusted the doctor moreUp. From March 16th, the doctor changed the treatment plan. Instead of using the special antibiotic Fengweiling, it replaced it with common antibiotics such as amoxicillin. He began to feel that something was wrong. Everyone who had used antibiotics knew that because of the existence of drug resistance, the replacement of antibiotics is generally a special effect instead of broad-spectrum antibiotics. Otherwise, the infection may not be controlled and the condition may worsen.

Before, Zhang Peishang had always believed that the dressing change was “a need for treatment”, but at this time, he began to suspect that the dressing change was the cause of his father’s worsening condition.

He urgently contacted two other major hospitals, intending to transfer his father. He recalled to Jianwen at 8 o’clock that in those few days, the doctor said that Fengweiling could be used again, so his father continued to live.

Daily medication records show that ten days later, on March 26, Zhang Ailin used Feng Weiling again.

Zhang Peishhuang said that he later learned that after the report was reported to the Provincial Health Commission, someone came to ask his mother to sign a consent form stating that all self-paid medicines were self-paid. “After my mom signed, the medication resumed.”

In the consent form he provided to 8:00 Jianwen, the signing date was March 16. However, Zhang Peishhuang said that this date is false, and the mother’s signature was actually a few days after that, and the hospital “advanced” the time to before he reported it.

The website of the Jiangsu Provincial Health Commission showed that on March 18, Zhang Peishhuang’s report and complaint were withdrawn on the grounds that “the petitioner understood that the drug was used for lung transplantation, and expressed understanding through communication with the party concerned and voluntarily withdrew the complaint”.

But according to the Zhang family, they did not withdraw the complaint.

During that time, Zhang Ailin’s body gradually weakened. On March 28, he was admitted to the intensive care unit.

On April 10, he was discharged from the hospital under the doctor’s recommendation and transferred to Taikang Xianlin Drum Tower Hospital for palliative care. He died there the next day.

My father is gone.

Looking for the hospital to negotiate, complaining and reporting to the Provincial Health Commission did not bring the results Zhang Peishuang hoped. All of the above made him start contacting a lawyer to bring Wuxi People’s Hospital