It was on February 23 when Yoo So-yeon, professor of Nursing at Gachon University, and Han Su-Ha, professor of Nursing at Soon Chun Hyang University, first entered a psychiatric closed ward on the 5th floor of Cheongdo Daenam hospital. It has been five days since this hospital reported the country’s first COVID-19 death case (Feb 19).
The scene astounded the two specialists. In a bedless ondol floor-heated room, six or seven patients were either lying on or sitting by their sleeping mats. “May psychiatric hospitals or nursing homes use the ondol floor-heated rooms rather than using beds, in fear that the patient may fall off the bed. But this is not a desirable condition in terms of controlling an infectious situation. People could get exposed to the virus by surroundings such as floors. In a room like this, distancing between patients is difficult and they become vulnerable to droplet infection (via saliva droplets from sneezing or coughing) in comparison with other hospital rooms where they have beds and curtains. The Daenam ward was not even equipped with an appropriate air circulation system.” said Professor Yoo.
Infection control had been poorly executed in the hospital. Medical wastes and leftovers food were lying around everywhere making it seem that the hospital staff did not care to clean up. This was when confirmed cases were reported among the medical personnel and the authorities there used this as ‘the reason why the ward management system has temporarily suspended.’ However, many scenes highly implied the hospital’s poor management condition. A patient was touching food wastes. Other patients were seen attempting to sweep their bodily fluids into a dustpan after relieving themselves on the floor. Professor Han sighed, stating “the hospital’s infection containment room usually becomes a control tower in the case of an infectious disease. The control tower was nowhere to be seen at Cheongdo Daenam Hospital.” The reality of Cheongdo Daenam Hospital was exposed to the nation when the ‘ondol ward’ photo was made public at the National Medical Center’s briefing. The hospital, where the first COVID-19 complicated death was reported, also was reported to have 101 confirmed COVID19 cases out of the 103 hospitalized patients in the psychiatric ward. After just six days from the first confirmed cases, seven more people died.
Lim Dae-Ryun, an activist at Antica― Art and Creation Organization for the Mentally Ill― was taken back when he saw the photo of the closed wards at Cheongdo Daenam Hospital. He said that the closed wards there are drastically different from that of hospitals in Seoul where Mr. Lim was once hospitalized. Mr. Lim was hospitalized in a 6-bed room, where the beds and curtains were spaced a meter apart.
A nurse, who chose to be named Kim, now working at a psychiatric closed ward in a hospital in the region of Busan, has experienced both the ondol rooms and the rooms furnished with beds. For her, the difference between the two was the composition of the patients. “While the rooms with patients with health insurance are neat and have beds, the rooms with patients on medical aid are usually ondol rooms. Health insurance patients who pay deductibles and medical aid recipients for whom the government pays a flat rate are treated differently. It is because this is directly related to the hospital’s revenue.
True, ondol-floored wards can prevent patients from falling and group activities are easier. However, it is also true that they can cram together more so-called ‘not profitable’ medical aid recipients as possible. Most of the hospitalized patients at the psychiatric closed wards of Cheongdo Daenam hospital are medical aid recipients. Lee Jae-Gap, professor of infectious disease at Gangnam Sacred Heart Hospital of Hallym University, said “Cheongdo Daenam Hospital had a ward with a size that could accommodate 50 patients at most. At Daenam, there were 100 patients in the ward.”
But the story doesn’t end there. A closer look into it will expose the backward social welfare, health care system, and a network of the administrators (운영자들의 네트워크?) that expand to other regions beyond Cheongdo.
“There were no rooms with beds at the department of psychiatry in Guduk Hospital. Because they have renovated the rooms to the ondol-floored type. At most 20~30 patients were accommodated in a room. More than 10 patients were “crowded” on 6~7 mattresses in each room,” said Jeon Gyu-Hong, former Field Representative of the Gudukwon Trade Union on-site Committee who joined Guduk Silver Center in 2008 and continued union activities until 2012. He is currently a chairperson at Busan General Union under Korean Federation of Trade Unions.
The relationship between Busan Gudukwon and the Cheongdo Daenam Hospital
‘Guduk Hospital’ he mentioned was a hospital run by the social welfare foundation, Gudukwon, in Busan. Gudukwon was the largest social welfare foundation in Busan, running Guduk Hospital, Guduk Silver Center, the Senior Nursing Facility, and Busan Senior Health Center. Kim Hyun-Sook, former CEO of Gudukwon, was sentenced to 3 years in prison, 4 years of probation, and was fined 378 million won on charges of embezzlement and other charges from the Busan District Court in January 2011.
Guduk Hospital is linked with the Cheongdo Daenam Hospital through a human network. Kim Hyun-Sook, former chairperson of the board at Gudukwon, is at the core of this network. Oh Han-Young, her son, is the chairperson of the board of Daenam Medical Care Foundation (operating the Cheongdo Daenam Hospital). Other members of the board at Daenam Medical Care Foundation include her younger siblings, mother, and acquaintances.
Rep. Jeon Gyu-Hong claims that Gudukwon was funded by amassing corrupt money to establish Cheongdo Daenam Hospital. “There was a senior care department and a psychiatric department at Guduk Hospital also. Because the operators were embezzling government assistance money, the food quality was poor and the hospital fell short of personnel. The patients’ nutritive conditions and the insufficiency of medical ‘care’ were apparent even to the visitors’ eyes.” After it was made known that the first fatality at Cheongdo Daenam Hospital only weighed 42kg(92.6 lbs), human rights organizations for the disabled are demanding an investigation of all the facilities.
The Cheongdo county cannot evade its part of the responsibility. Because it is the job of the county public center to supervise medical facilities in the country, if there are any wrongdoings found in the operation of Daenam Hospital, it must also bear the brunt.
On the left side of the Cheongdo County public clinic building stand both the Cheongdo County Senior Nursing hospital and Daenam Hospital. To the right is the Hyo Sarang Silver Center. These buildings are not merely adjacent to each other. Each facility is also connected through passages. It is a very unusual structure where a public health facility and a private hospital are attached as one.
The Cheongdo Daenam Hospital operates as a trustee of the National Cheongdo Elderly Care Center which is on the left side of the public health center. The Hyosarang Silver Center (for which billions of won at the national and local level went into the construction) on the right side of the public health center is a nursing home operated by Eden One, a social welfare corporation. The CEO of Eden One is Hanyoung Oh, Chairman of Daenam Medical Foundation.
On top of that, it seems that the Cheongdo County Public Health Center , Cheongdo Daenam Hospital, Cheongdo County Senior Nursing Hospital have shared part of the personnel, facilities and equipment such as septic tanks, heating equipment necessary for operation and medical care, and also the cafeteria. Oh Seong-Hwan, former chairman of the board of Daenam Medical Care Foundation and father of current chairman, Oh Han-Yeong, argued, in a column he wrote for the Journal of the Korean Hospital Association, that “the related medical facilities are seeking efficiency by promoting common use of personnel, equipment, and facilities, newly constructing a complex building through the connection of health clinics, hospitals, and social welfare facilities.” He claimed that this arrangement would save 1.9 billion won of land and construction cost, and 300 million won of yearly operating expenses
Given this situation, it is highly questionable whether the Cheongdo County Public Health Center even bothered to execute a proper supervisory or managerial role of Daenam Hospital. Jeong Hyeong-Jun, chairman of policy at the Korean Federation Medical Activist Groups, said “the role of the local public health centers is to manage medical licenses or drugs as well as hospital licensing. It is hard to understand that this regulatory organization shares the same building with a private hospital. To put it into context, it is like a private bank sharing the same building with the financial supervisory service. This shows no distinction between the private and the public, and it seems like an extreme case of the privatization of health care.”
Risk diversification was also poorly executed. When a mass infection in Cheongdo Daenam Hospital broke out, the entire clinic personnel through whom the staff and equipment would have come and gone had to go under self quarantine. Regional prevention functions had been virtually paralyzed. One of the medical personnel who visited Cheongdo Daenam Hospital said, “there was not a single employee from the public center to be seen.” This bizarre ‘onestop’ structure where the private and public were not separated could have affected the hospital’s initial response to the spread of the coronavirus in the facilities.
It was old mentally ill patients with underlying medical problems who were infected primarily and died under the facility’s poor conditions. Lee So-Hee, dean of the department of neuropsychiatry of National Medical Center, who treated 10 patients with critical conditions transferred from Cheongdo Daenam Hospital’s psychiatric closed wards, said “there are a number of patients who had been hospitalized for 10 to 20 years. They have repeatedly been hospitalized and discharged until they were recently put back in the hospital. Most of the patients have schizophrenia, which shows how chronic the mental disorders are, and how serious their conditions are. They are not only unable to take care of themselves, but also have a hard time receiving care from others. It is no wonder that they were in poor nutritive conditions and had very weak immune systems. Many portions of patients have underlying diseases such as chronic obstructive pulmonary disease or anemia, and low amounts of muscle in their bodies make them much weaker and more aged than their ages.”
The first fatality had been hospitalized at Cheongdo Daenam Hospital for over 20 years and had no family or friends. The second one passed away in the middle of being transferred from this closed ward to Busan University Hospital. That was his first time going out in 15 years.
Some 30 of the patients with mild cases at Cheongdo Daenam Hospital’s psychiatric closed wards were transferred to the National Center for Mental Health. Jeon Jin-Yong, neuropsychiatry specialist of NCMH, who treated the patients heard some unexpected stories from them. “There are some patients who missed Cheongdo Hospital, even though our facilities are much cleaner and safer. This is probably because they have been hospitalized there for too long.”
After the Cheongdo Daenam Hospital case, an alternative is being suggested: deinstitutionalization, discharging patients from the psychiatric hospital and letting them get treatment at their local communities. This won’t materialize right away. A specialist, Jeon Jin-Yong, said, “the removal of prejudices and the construction of infrastructures are necessary for the mentally ill to live together in their communities. This is costly.“ Choi Jeong-Hwa, a nurse who worked at the only psychiatric closed wards in the region of Gangwon·Sokcho·Goseong·Yangyang until August 2019, is now working at a general ward after the closed wards disappeared. She stressed, “the patients have been dispersed to other regions because closed wards were closed down when proper infrastructures are nonexistent. An alcoholic patient broke his head drinking after getting out of the closed ward but didn’t get proper treatment. Deinstitutionalization without infrastructure is not easy.”
The problems of Psychiatric Closed Wards in Korea
The mass infection at Cheongdo Daenam Hospital clearly reveals the problems of psychiatric closed wards in Korea. The fact that there were several people who showed symptoms before and after February 15, when confirmed Covid-19 cases began to emerge, and it took the first death on February 19 for anyone to look into the situation at Cheongdo Daenam, clear means that proper medical services had not been provided in a timely fashion. In the midst of this, there have been other similar facilities in other parts of the country where the infection had been spreading but not attention was given. In Gyeong-Gi Province which is said to be taking ‘preventive quarantine’ like not allowing patients as well as workers and guardians to enter such facilities, it is doubtful if the measure is sustainable. There is no guarantee that infections will not happen after the quarantine measure is lifted.
Lim Seung-Gwan, president of An-Seong Hospital of Gyeong-Gi Provincial Medical Center, said “given the fact that the higher frequency, time, and density of contacts, the more vulnerable to the infection, an array of open nursing spaces (psychiatric closed wards, sanatoriums, mass residential facilities for the disabled) is vulnerable to the infection. It is not a matter of deviation of one hospital. Those facilities themselves eventually need to take control of dangers. They need to take more hygienical care than usual, and take more aggressive responses for people who show symptoms even if they are not ShinCheonJi people or visitors from Daegu.”
translated by Woong An
translation supervised by Beckhee Cho