[Report file] Despite the exposure of “treatment without consent”… 'Integrative care' a long way to go

Between the heart and the aorta, there is a valve that keeps blood from flowing backwards.

When this valve hardens, blood does not flow well, so even a short walk can cause shortness of breath or chest pain.

Patients with such stenosis have undergone a surgical operation to replace the valve after making an incision in the chest. About 10 years ago, transcatheter aortic valve implantation was performed in which a small hole was made in the thigh and then the artificial valve was pushed through the blood vessel to the heart. , the so-called 'TAVI' procedure is increasingly being chosen.

It is six times more expensive than surgery and only 20% of it is a conditional screening benefit that can be covered by health insurance.

In order to perform the TAVI procedure, strict procedures must be followed.

It's been a little over 10 years since the TAVI procedure was introduced in Korea, and when it's done on young patients, it's because the verification isn't over, such as whether the durability is sufficient after 15 or 20 years.

In its 2018 report, the Korea Institute of Health and Medical Sciences concluded that the TAVI procedure for severe patients who were difficult to operate was safe and effective from most domestic and international studies, but noted that more long-term follow-up studies for more than 5 years needed to be accumulated.

He also emphasized the importance of selecting the right patient for TAVI treatment.

For this reason, the Health Insurance Review and Assessment Service has created a kind of safety device that allows specialists such as cardiologists and thoracic surgeons to decide whether to perform the TAVI procedure after undergoing integrated cardiac treatment.

In the United States and Europe, experts gather to provide integrated cardiac care that assesses individual risk.

In order to find the optimal treatment method for the patient.

However, it is pointed out that the integrated treatment procedure is not being followed well in the field.

In the end, it was revealed that the medical records were forged as if the former and current thoracic surgeons at a large hospital in Seoul had unwittingly attended and agreed to an integrated cardiac treatment.

During 7 months, 53 TAVI procedures were performed with forged records, and this fact was reported to the hospital, but no action was taken.

▶ [Sell to the end] Telegram is issued after whistleblowing for “treatment without consent” (full video)

A hospital official said, "If you were unable to attend the integrated treatment, you could communicate by phone or record it on a chart afterwards." Says. Even after the report, it is the position that "we have to wait for the police investigation and the court judgment."

In response, the Korean Society of Cardiovascular and Thoracic Surgery issued a statement urging a thorough investigation, saying, "In the TAVI procedure, integrated treatment is the minimum device that protects the patient's safety and rational treatment." He mentioned the need for long-term follow-up of patients with existing procedures, saying that strict measures such as expulsion from the TAVI enforcement agency are required if the theft of signatures or forgery of records is found to be true.

A statement from the Korean Society of Cardiovascular and Thoracic Surgeons on SBS reports regarding the TAVI procedure "The TAVI procedure

is a high-risk procedure, and failure may result in loss of life or serious irreversible side effects."

"It is not a light act to eventually turn a minimal procedural device that protects the safety of patients and medical staff into a 'signature paper'."

"We urge a prompt and thorough legal investigation into the accused matter."

"If the theft of signatures and forgery of private documents exist during the Tabi procedure and harm the integrated medical care system, measures including expulsion from the Tabi enforcement agency should be implemented."

"Patients are a being that cannot be defined by the statistics of a few percent of the success rate of the procedure, and it is essential to strengthen the integrated medical system to protect these patients and perform appropriate procedures."

The reaction of the Korean Heart Association to which cardiologists are affiliated is the exact opposite.

Recently, as patients' preference for the TAVI procedure has increased, thoracic surgeons who want surgery often put the brakes on integrated treatment.

It is also true that there have been conflicts of opinion between thoracic surgeons and cardiologists over the introduction of the TAVI procedure.

Hyo-Soo Kim, President, Korean Heart Association |

Professor of Cardiovascular Internal Medicine, Seoul National University Hospital

"In the integrated treatment process, most of the opinions differ as the cardiologist insists that the cardiothoracic surgeon perform the procedure and the thoracic surgeon performs the operation. In the end, we leave it up to the patient's choice to respect the patient's convenience. Usually damage to the human body Because patients prefer TAVI procedure that requires less wear and tear, thoracic surgery often puts the brakes on integrated treatment. Depending on the patient's condition, there is no problem if there is a clear agreement of opinion, but if there is room for argument due to a different opinion, In line with the global guidelines, I think it is a good compromise to conclude a gentleman’s agreement in a way that divides the TAVI operation and the operation based on the age of about 75.”

The people watching the power struggle between the two expert groups is just frustrating.

This is because the fact that multiple specialists revealed that the attendance and consent of the integrated treatment was forged is proof that the integrated treatment procedure, which was created for the life and safety of the patient, is not working properly.

Apart from the police investigation that takes specific legal responsibility, it is pointed out that the hospital in question or the Health Insurance Review and Assessment Service, which is in charge of evaluating the adequacy of the paid benefits, should come forward to check whether the integrated treatment has been properly followed.