Tallying cost of botched operations

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Tallying cost of botched operations

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Sarah Shechner, 33, a musician and a professor teaching in Korea, explains a court ruling in her favor after a botched “arm lift” procedure at a clinic in Seoul three years ago. She shows the stages of the infected wound under her right armpit, which was eventually repaired with a skin graft at another hospital, at the Korea JoongAng Daily headquarters in central Seoul on Wednesday. Shechner has permanent nerve damage to her right hand. By Park Sang-moon

Sarah Shechner, an aspiring recording artist and actress from New Jersey, was trying to build a career in Korea. She was told by friends in the industry - insiders - that a slimmer silhouette would help. She thought her arms looked a little too full.

In May 2012, Shechner, then 29, went to a reputable Korean cosmetic surgery clinic for an auxiliary brachioplasty, an “arm lift,” a weight reduction procedure on both her arms. Healing was supposed to take two weeks.

But Shechner’s arms did not heal. She experienced persistent pain and open wounds under her armpits that leaked puss. The wound under her right armpit was 6 centimeters (2 inches) by 5 centimeters, the one on her left arm slightly smaller.

Three weeks after the surgery, she sought out her surgeon, Dr. Kang Se-hoon, director of Seoul Sky Hospital, and said she was worried. Dr. Kang told her not to make a fuss, stapled the wounds and sent her off.

That didn’t help. At the brink of deliriousness, Shechner sought help at a large hospital, Seoul St. Mary’s Hospital.

There, Shechner learned she had a staph infection. In addition, doctors said she had permanent nerve damage to her right arm - a devastating diagnosis for a classically trained musician skilled at the piano.

Shechner, now 33 and currently a professor of global education at a university in Gyeonggi, embarked on a long quest for justice in Korean courts. From the start, she knew it wasn’t going to be easy.

“I was doing everything I could,” she recalls of the months to come. “I was writing letters to the judges. I was going online, warning people. I went to the Korean Medical Association. At the time, Kang was a very popular doctor. He was on TV.

“Basically, Korean society was telling me, ‘You can’t win. It doesn’t matter if he made a mistake. You can’t win because he’s a doctor.’”


Industry on the rise

Korea has worked hard to build and promote its medical tourism industry, boasting high-quality healthcare services for a fairly decent price. Cosmetic surgery is its most famous offering, but it is hardly the whole story. Almost anything can be done here, from LASIK eye treatments to cancer operations.

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Chinese women who had botched plastic surgery operations in Korea take to the streets of Myeong-dong in central Seoul to share their horror stories and protest against the clinics on Oct. 3. Provided by the protesters

The number of foreigners receiving medical treatment in the country has steadily increased over recent years, with an average yearly growth of 34.7 percent over the past six years.

According to the Ministry of Health and Welfare, 266,501 foreign patients received medical treatment in Korea in 2014 compared to 60,201 in 2009. The Korean health industry earned 556.9 billion won ($479.5 million) last year from foreigners flying in for medical treatment, 10 times higher than 2009’s 54.7 billion won.

Medical tourism is a kind of dream industry for Korea, the pot of gold at the end of its industrialization journey. Korea started industrializing as many countries do: by employing hungry laborers to make cheap manufactured goods like wigs, T-shirts, sneakers and toys, which were sent on huge container ships to prosperous consumers overseas. Fast forward half a century later, and now those rich consumers from the United States and Europe are flying to Korea to take advantage of the advanced skills Korea has developed, like surgery and cancer treatment.

At the same time they get treated, the visitors spend money on lodging, meals and shopping, a multiplier effect in terms of how much Korea earns from each patient.

And some patients choose Korea for medical treatment because they have fallen in love with the country through its cultural exports, its pop groups, movies and television series. Medical tourists from China want surgery to look more Korean to resemble their favorite actress or singer, the ultimate customer compliment. Medical tourism shows Korea at the very top of its economic and cultural game, a destination to which people make pilgrimages for health and glamor, an Asian Baden-Baden or Monaco.

But it’s an industry that must be able to deal with its mistakes and malpractices - or it could gain a bad reputation that scares potential patients away.

The Korean government is working on cracking down on illegal medical brokers and centralizing information in a consultation center on health services for foreigners.


Complaints by Chinese

At the beginning of this month, a group of Chinese women who suffered botched plastic surgery operations in Korea took to the streets of Myeong-dong, a popular shopping and eating area of central Seoul, to protest shady cosmetic surgery clinics and the intermediaries who steer patients their way.

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The number of foreigners seeking mediation or arbitration in relation to medical disputes has also increased in recent years.

Up until several years ago, medical arbitration for foreigners was not even considered a viable option. No longer.

According to the Korea Medical Dispute Mediation and Arbitration Agency, there were 131 cases of foreigners who sought counseling for medical issues last year, of which 30 applied for mediation. Of these, 14 started the mediation process, and those who went through requested an average award of 32.9 million won.

This is up from 59 cases of foreigners seeking consultations with the agency in 2012, of which nine filed applications and five went through with mediation.

As of August this year, 17 foreigners have filed for mediation with the agency in 2015.

These numbers also reflect the general trend in Korean society, as the agency offered a total of 45,096 cases of consultations in 2014, up from 26,831 in 2012.

In the case of medical accidents due to malpractice, victims have three options in Korea: contact the hospital or doctor directly, apply for mediation or arbitration, or file a lawsuit against the hospital or medical specialist.

The mediation and arbitration agency offers counseling on medical disputes over the phone, Internet and in person.

A report released by the Korea Medical Dispute Mediation and Arbitration Agency last June titled “Medical Dispute Mediation and Arbitration Statistical Yearbook 2014” gives a breakdown of the foreigners who sought its services over the past three years.

Of the total 281 counseling sessions it gave between 2012 and 2014, 194 were for Chinese patients, 25 for Vietnamese and 21 for Americans.

That was expected, given that the number of Chinese coming to Korea for medical services reached 79,481 people last year, up 17-fold from 2009.

In terms of age group, 11.5 percent of a total 131 cases last year were in their 20s, 35.9 percent were in their 30s and 32.8 percent in their 40s.

In 2012, the gender breakdown was split 50.8 percent male and 49.2 percent female, but in 2014, it was 43.5 percent male and 56.5 percent female.

Last year, the highest number of consultations by the agency with foreigners was over plastic surgery complaints, as expected. However, those consultations amounted to just 28.2 percent of the total, followed by 12.2 percent for orthopedic surgery problems, 5.3 percent for dental surgery and 4.6 percent for obstetrics and gynecology cases.

In the same year, 50.4 percent of consultations came in the middle of treatment, 5.3 percent came after the end of treatment and 5.3 percent followed some disability. One case came after the death of a patient.

The reasons for mediation applications last year included 16.7 percent for aggravation of symptoms, 16.7 percent for infections, 10 percent for misdiagnoses and 10 percent for nerve damage.

One case involved a Russian orchestra performer who took six weeks off to come to Korea in 2014 to receive several plastic surgery procedures, including chin reduction and fat reduction from under her eyes and neck, and rhinoplasty.

After she experienced infections, she demanded 120 million won from the hospital. After arbitration, she was awarded 30 million won when it was determined the infections had not been related to the surgery.

“The patient was Russian, but the doctors explained the procedure in English and then made her sign a Korean-language agreement,” Yu Sun-kyung, education and research team leader at the agency, pointed out. “They had the responsibility to have an interpreter and documents translated into her native language.

“There are many issues related to the explanation process, especially for foreigners,” Yu continued. “The key point is that even if there is no medical malpractice, the doctor has the duty to explain clearly the procedure, symptoms and side effects.”

The agency offers advice for mediation and arbitration but does not provide services for lawsuits. It suggests the Korea Legal Aid Corporation for more information regarding how to file a lawsuit.

“We do not know how many of the disputes that are not resolved lead to actual lawsuits,” Yu said.

A Health Ministry official said the number of medical-related lawsuits involving foreigners was not large, but couldn’t offer a precise figure.


Other options

A medical lawsuit is fraught with hassles and risk, but for Shechner, there wasn’t much of a choice in 2012.

“Arbitration wasn’t readily available back then as it is now,” she says. “When I went to my [first] lawyer, it was so new that I was told it wasn’t trustworthy.”

The Korea JoongAng Daily covered her story in a Nov. 22, 2012, article, “Some foreigners regret their plastic surgery in Korea.” At that time, she asked that only her first name be used and for Dr. Kang not to be identified.

Shechner almost died before she went to Seoul St. Mary’s Hospital three years ago as the staph infection spread through her body.

“My Korean ‘mother’ went to [Kang’s] hospital and said that a mistake was made,” she says, “and asked for him to cover my hospital bills.”

Dr. Kang asked her to bring medical documents from Seoul St. Mary’s Hospital. Shechner concluded that she would be compensated.

To her shock, Dr. Kang sued Shechner and the doctor who treated her at the hospital.

“When I first started [the lawsuit], everybody was very skeptical,” she recalls. “But I was forced into litigation because he sued me first to protect himself. He was the plaintiff and I was the defendant!”

Shechner filed a countersuit in August 2012 that gained little momentum. Dr. Kang was clearly not going to back down and admit fault, and her chances at any kind of victory looked miniscule.

Until fate stepped in.

Turning point

On Oct. 17, 2014, the 46-year-old rock icon Shin Hae-chul underwent abdominal surgery for adhesions at Seoul Sky Hospital. Five years earlier, Shin had gone through gastric bypass surgery at that clinic, and his large and small intestines had become attached to one another, which is called adhesion. Surgery was required to reverse the condition, and it was performed by Dr. Kang.

It was later discovered that Dr. Kang performed a procedure to shrink Shin’s stomach without his permission, leading to an infection. Shin died from cardiac arrest 10 days later at another hospital. Dr. Kang was indicted by prosecutors on Aug. 24 this year and charged with conducting additional stomach surgery without Shin’s consent.

He was also charged with failing to take proper measures after the singer complained of continued pain after the surgery. His trial has not begun yet.

After Shin Hae-chul’s death shined a spotlight on Dr. Kang’s practices, Shechner finally made headway in her lawsuit. Last autumn, law firm Shin & Partners took her case pro bono and agreed to receive a fee only if she wins her case.

“Medical lawsuits are in general very difficult to predict,” said Shin Hyun-ho, Shechner’s attorney, who specializes in medical disputes.

“Depending on the judge, the results can be very different. Regular cases are appealed 30 to 40 percent of the time. In comparison, medical lawsuits are appealed 60 to 70 percent of the time.”

Against the odds, the Anyang Branch of the Suwon District Court ruled in favor of Shechner on Aug. 21, recognizing the medical errors committed by Dr. Kang, and ordered the doctor to pay her 109.9 million won.

“The doctor has the duty to take the best possible measures to prevent any dangers regarding the patient’s specific symptoms or situation,” the court ruled.

The court determined that Dr. Kang held 70 percent of the responsibility for the medical accident, compared to 30 percent for Shechner. In medical cases, a court determines how much liability each side has. The 70 percent liability for Dr. Kang is considered a relatively high ratio for a case involving plastic surgery.

Scarred for life

“Dr. Kang holding 70 percent of the responsibility was considered very high,” attorney Shin says, “and compared to other plastic surgery lawsuits, Ms. Shechner’s liability was low.”

For Shechner, the scars from the botched surgery three years ago will haunt her for life.

The court found that she had numbness in three of her fingers and muscular weakness in her right thumb, scars under her armpits and on her left hip, where skin was removed to graft over the holes under her armpits.

The nerve damage to her right hand was devastating for Shechner as a pianist and would have an effect on her career.

“I was very concerned that the judges weren’t going to be fair,” Shechner admits, whose hands have healed enough that she can play on an electronic keyboard, which requires less pressure than a piano. “But they did what they could do. Based on the proof they had, I believe they gave a very fair trial.

“But honestly in America, the amount of money, with the amount of nerve damage and considering it was my livelihood, would not be enough to live on.”

However, on the day of the interview with this newspaper, Shechner came from a meeting with her attorney bearing news that Dr. Kang had appealed.

The appeal will be made at Seoul High Court and could take another year and a half.

Government hears complaints

The Korean government is becoming more aware of the need to be able to cope with medical treatments that go wrong.

The issue has become pressing as Chinese women who aspire to look like their favorite Korean actress or singer have undergone surgeries that leave their faces disfigured or paralyzed and have reached out to the press back home.

Ruling Saenuri Party lawmaker Rep. Rhee In-je told the JoongAng Ilbo in a report Tuesday that the Korean Embassy in China has reported to the Health Ministry: “If the side effects of plastic surgery in Korea continue to be reported, it will have a negative impact on relations between the two countries, so it is urgent to prepare a countermeasure.”

The Korean government announced on Aug. 31 a plan to attract 300,000 foreign patients to the country by increasing the transparency of Korea’s medical service industry.

This includes opening up a Health Ministry-affiliated center that specializes in multilingual support for patients involved in medical disputes.

It is also considering making medical accident insurance mandatory for foreign patients.

“We also plan to conduct a screening of doctors starting at the end of the year to come up with a more reliable list of hospitals and clinics that can treat foreign patients,” said Hwang Seung-hyun, director of the Health Ministry’s division of health industry policy. “This could be based on facilities, offering of interpreters, specialties and so on.”

Healing and seeking justice

Shechner says that what started off as a “surgery of vanity” changed her life forever.

“I almost died,” she says. “Realizing how precious life is, you want to help others who have problems.”

Shechner has picked up the pieces of her life. She is teaching, and the singer-songwriter signed a record deal and released an album online at the end of last month under the stage name Amayah Ma. She says the damage to her body has pushed her career into a new direction, for which she says she is actually somewhat grateful.

Horses have been instrumental in her healing, and Shechner runs Grace Stables, a charity enabling “horse healing” for disabled and autistic children. She says the compensation awarded to her from the lawsuit would go to that charity.

Shechner fought three years to see justice. But all she wanted at first was an apology and for Dr. Kang to take responsibility.

“Doctors make mistakes,” she says. “It’s to be expected.” Shechner’s own grandfather was a doctor.

“If Dr. Kang made an honest mistake with me, and he just said, ‘Sarah, I’m sorry, I take responsibility,’ if he went and worked on himself to be a good doctor, that would have made all the difference.”

But Korea needs to clean up its act, Shechner believes.

“The power lies in the Korea Medical Association, and they can be the ones that can make a difference,” she says. “They could filter out the bad doctors that give a bad name to the great doctors. They need to change rules. General surgeons should not be permitted to practice any other form of surgery other than general surgery. Plastic surgeons should only practice plastic surgery.”

She found out in her second hospital that Dr. Kang was a general surgeon, not a licensed plastic surgeon.

While Shechner has not met in person with singer Shin Hae-chul’s family, her lawyer has been in contact with its legal team.

Her victory in court was bittersweet. If someone had listened to her, Shin may never have died.

“If I were to meet [Shin’s wife], I would start crying,” she says, choking up. “Why did it take so long? Why didn’t they investigate earlier?

“It was me,” she says. “It was the exact same thing. Shin was told, ‘You’re fine, go home.’ Then he had to go another hospital. Shin had an infection that stopped his heart. I was blessed that I was young and it was in my arms, not my intestines, in an organ that the infection spreads so fast.

“If I waited a couple more days, it would have killed me, too.”

BY SARAH KIM [kim.sarah@joongang.co.kr]
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