Huh: Should it be a trigger to establish a medical regulatory body in Korea?: A case of hepatitis C epidemic due to reuse of disposable syringes in a local clinic in Seoul
A case of hepatitis C epidemic was reported at a local clinic in Seoul, Korea, according to official reports by the Korea Centers for Disease Control and Prevention (KCDC) on November 22 and December 4, 2015 [1]. Prior to December 4, 2015, 78 anti-hepatitis C virus seropositive visitors (7.8%) out of 1,055 examined were found. Seropositive visitors all received infusion treatment at the local clinic. Of the 78 positive visitors, hepatitis C virus DNA was detected in 55, meaning infection was present, although there were no cases of severe complication. This situation was first reported to KCDC on November 19, 2015. KCDC dispatched epidemiology officers to the local clinic, where they interviewed related persons and searched the medical records. They concluded that the hepatitis C epidemic originated from reuse of disposable syringes during fluid infusion, enabling transmission of the hepatitis C virus through contaminated blood. The seropositive rate of hepatitis C viral infection in Korean adults was reported to be 0.7% in 2012-2014 (https://knhanes.cdc.go.kr); therefore, the 7.8% positive rate could not be explained as community acquired infection. The hepatitis C virus genotype 1a, the genotype of the positive visitors, was also detected in the clinic’s environmental samples. The local clinic was shut down immediately and visitors received follow-up screening for blood-borne infectious diseases. A physician from the local clinic confessed that he had been disabled due to cerebral hemorrhage since 2012, resulting specifically in cerebral and language disabilities. He also stated that the reuse of disposable syringes occurred after his cerebral illness.
After a briefing of the above case, the Ministry of Health and Welfare announced follow-up measures to prevent future instances of this unbelievable accident. First, enforcement of medical regulation is to be processed after organizing an “Ad hoc committee for improvement of medical license registration” in December 2015; a new policy proposal will be completed by February 2016. The health status criteria concerning physicians who should not practice will be discussed in the committee. Second, continuing medical education is to be enforced. Third, medical personnel associations such as the Korean Medical Association (KMA) are to be provided with authority to report unethical practice by members to the government after investigation by the ethics committee.
I was interviewed following this event on December 3, 2015 by Mr. Alex Jensen, host of the current affairs program “This Morning” on tbs eFM (101.3 MHz), the first all-English radio station in Seoul. The interview content is available from: https://itunes.apple.com/kr/podcast/tbs-efm-this-morning/id1038822609?l=en&mt=2 [cited 2015 Dec 27]. Although I discussed a variety of issues with him, some topics remained unaddressed due to time limitations. I would like to address some questions in addition to the interview content so people might better understand the situation.
How are medical licenses being regulated in Korea? Medical licenses are issued by the Ministry of Health and Welfare. Medical school graduates must pass a medical licensing examination to get their license, sponsored by the National Health Personnel Licensing Examination of Korea. Recently, the Korean government asked all physicians in Korea to report their license from April 2012 to April 2013, and to re-report their license every three years. To re-report their license, they must or training. The number of medical license holders in Korea was 106,670 as of 2012. Of these, 97,235 (91.2%) were registered through KMA. The number of physicians working in medical facilities in 2014 was 92,927.
Was it a lifetime license from the beginning? Nope, a physician’s license does not automatically renew after it is given.
Why has there been little or no training or assessment required for license renewal? Of course, eight hours is not enough; this requirement is based on current medical law.
Why is it important to have a regulatory system that requires doctors to keep up with certain qualifications? How is this related to people’s safety and health? A regulatory body has three major goals, as suggested by the International Association of Medical Regulatory Authorities (http://www.iamra.com/): first, to provide medical licenses or practice permits to eligible individuals; second, to ensure physicians’ professionalism through continuous education and training for people’s health and safety; and third, to resolve conflicts or complaints about physicians. In Korea, the licensing examination is sponsored by the National Health Personnel Licensing Examination Board of Korea. Physician professionalism has been promoted through continuing medical education sponsored by KMA. Conflicts or complaints have been resolved by the Korea Medical Dispute Mediation and Arbitration Agency (https://www.k-medi.or.kr/). If we establish a regulatory body, the second and third roles may be merged with it, and their activities can be enforced by professionals from each field. Additionally, the regulatory body can be supported according to new regulation by the Korean government. The regulatory body can screen physicians’ activities, and if misconduct or violation of professionalism is found, the physician’s activities should be limited and they should be required to enroll in a training course. This is an essential process to protect patients’ safety and people’s health.
Why is training of medical professionals important, even after they complete the education and training to get the license? This training increases the quality of patient safety and communication. Usually, training is focused on new technology and knowledge. Therefore, continuous professional development should be implemented into continuing medical education.
Why is the KMA not enough to serve as a regulatory institution? Why do we need an independent body consisting of both medical experts and non-medical experts? KMA cannot act with greater authority for a few reasons: first, there is no concrete legal background; second, while the KMA ethics committee can manage physicians to ensure proper medical practice, its members are all volunteers, and reports by the general public or peer physicians usually do not reach the committee; and third, the Korean government has not entrusted KMA with the role of physician regulation. In Korea, if conflict arises between physicians and patients, cases go to the Korea Medical Dispute Mediation and Arbitration Agency or to court. If a regulatory body were formed, more advanced training and screening could be done, and physicians’ behavior and practice could be supervised by peers. If the Korean government were to entrust KMA with that role, KMA could of course manage the job excellently. To ensure the more reliable action and decisiveness, participation is required of not only physicians but also lawyers, medical educators, ethicists, and the general public.
The subject of establishing a medical regulatory system in Korea was raised in 2013 [2]; however, there was no reaction from the government or KMA at that time. Because physicians in Korea are top-notch in patient care, it was believed that there was no urgent need to control medical licensing or medical practice. This case of hepatitis C epidemic due to reuse of disposable syringes might be a trigger event for pursuit of the regulatory system. Because the Korean government has promised to discuss the medical regulatory body until February 2016, I anticipate that a more rigorous system of medical regulation will soon appear. Now is the time for physicians in Korea to actively participate in the “Ad hoc committee for improvement of medical license registration” in order to establish a stable medical regulatory system that ensures patient safety and the health of all people.

Notes

No potential conflict of interest relevant to this article was reported.

REFERENCES

1. Korea Centers for Disease Control and Prevention. Epidemiologic investigation of local clinic, Seoul and following direction [Internet]. Korea Centers for Diseases Control and Prevention;Osong (KR): 2015. [cited 2015 Dec 27]. Available from: http://www.cdc.go.kr/.
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2. Huh S, Chung MH. Can a medical regulatory system be implemented in Korea? J Korean Med Assoc. 2013; 56:158–163. http://dx.doi.org/10.5124/jkma.2013.56.3.158.
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