Fellow Since 2008
Thai Medical Error Network-TMEN
This description of Preeyanan Lorsermvattana's work was prepared when Preeyanan Lorsermvattana was elected to the Ashoka Fellowship in 2008.
Preeyanan Lorsermvattana is mobilizing a broad coalition of health professionals, media, consumer rights activists, lawyers, and medical malpractice victims to change policy, change public attitudes, raise professional medical standards, and establish a clear system of legal redress for victims of medical malpractice in Thailand.
The New Idea
Preeyanan has organized Thailand’s first cross-sector network of medical malpractice victims, doctors, lawyers, media, and consumer activists into a collective force that is having a measurable impact on public health policy, the judicial system, public opinion, and the standards of the country’s healthcare institutions and medical profession. Herself the victim of an emotionally and financially devastating medical malpractice, Preeyanan endured a decade-long struggle against a legal system which favors medical institutions over individual patients. In response, she has pioneered a process for other victims to use in their battles for legal redress and is driving a movement for systemic change. In a society where doctors are held in high esteem and rarely challenged, and access to medical records and other fundamental patients’ rights are not guaranteed, Preeyanan’s Thai Medical Error Network (TMEN) connects victims to medical experts, legal advisors, and a support network of peers to help them gain access to justice. Preeyanan’s network is increasing the visibility of this once-hidden problem by leveraging the power of local print and broadcast media to spread the stories of victim struggles to the public, as well as lecturing about medical error to cadres of medical students. His goal is to create a more socially responsible medical profession that is held to account by an empowered populace. Expanding on the work of a successful Thai consumer rights movement initiated by Ashoka Fellow Saree Aongsomwang, Preeyanan has successfully advocated for the introduction of patients’ rights legislation in the Thai Parliament. This is a solid step towards achieving her vision of codifying a patients’ bill of rights into Thai law and establishing an independent and neutral body to monitor the medical profession.
Despite Thailand’s attempts to promote itself as a hub for international and world-class medical care, the country has yet to codify patients’ rights, and there are few external review processes to correct or account for medical error. No concrete statistics on malpractice cases exist in Thailand, underscoring one of the most fundamental problems surrounding the issue: Lack of visibility, and a tendency to cover up medical mistakes. Unofficial estimates, however, place the number between 10,000 and 50,000 cases a year. The lack of transparency in malpractice cases stems from a fundamental social phenomenon in Thailand: The extreme reverence given to members of the medical profession. As a result, the quality of medical care rarely comes into question by patients and rarely goes to the courts for suspected error. Doctors and hospitals are rarely held to account due to a lack of incentive to report error and no clear definition of what constitutes malpractice.Thailand’s current legal system widens this gap between patients and the medical profession, valuing the protection of doctors and hospitals at the expense of patients’ rights. This is clearly illustrated by the lack of enforcement of weak existing legislation establishing a patient’s right to access their own medical records. While patients are theoretically allowed to request such records, in practice, these requests are systematically denied, especially in cases where there is suspicion of medical error. If not denied, medical records are routinely claimed to be “lost” or even altered to cover what could be perceived as medical error. While Thailand was a signatory to a 2002 World Health Organization (WHO) agreement to make information on medical malpractice public, Thailand’s Ministry of Public Health has made little progress towards its implementation. Without accurate medical records to present as evidence, the cases of plaintiffs in medical malpractice lawsuits are greatly weakened.If victims do go to court, they endure the frustration of battling a judicial system skewed towards protecting doctors and medical institutions. Government and private hospital administrations, as well as doctors, may routinely refuse requests to provide evidence (including medical records). Without such evidence, cases become a patient’s word against that of the hospital. Given that many private hospitals are owned by high-profile political figures and protected by powerful legal teams, and that some enjoy the backing of government ministries, individual patients face an insurmountable legal struggle. Further complicating these issues is the widespread social opinion that those who sue for medical malpractice are greedy and capitalizing on their illness or disability. The few victims who enter the public spotlight through high-profile lawsuits suffer public stigma, are refused medical treatment by other doctors, and in some cases have been threatened. Adding to the legal hurdles faced by victims is a push in recent years towards legislation that would exclude medical error from criminal litigation—effectively placing doctors and hospitals above the law. Health Ministry officials argue that criminalizing medical error has no possible benefit and may scare doctors from carrying out more delicate and risky surgical procedures due to risk.
From the beginning, Preeyanan realized the importance of leveraging existing resources and networks to sustain an initiative to transform the healthcare system in Thailand. After an intense personal struggle to seek redress for an egregious medical error against a family member, she began a broader campaign for patients’ rights. It took her to the steps of hospitals, courts, government offices, and the boardrooms of a array of health care institutions, associations, and independent agencies. Throughout her endeavors, Preeyanan leveraged the popularity of Thai print and broadcast media to change public opinion and has steadily brought the long-hidden issue of medical malpractice and the cause of patients’ rights into the public arena. In the early 1990s, as attention to her efforts grew, other victims of medical malpractice began to reach out to Preeyanan in growing numbers. She knew she needed to organize her growing network into both a support network for victims and a unified voice to pressure the government for policy change. She identified an existing consumer rights organization, the Thai Consumer Protection Foundation, and reached out to its founder, Ashoka Fellow Saree Aongsomwang. Saree fostered Preeyanan’s entrepreneurial and organizational skills, and in 2002, Preeyanan formed TMEN to assist victims seek justice. Over the past six years TMEN has grown into a nationwide network of over 400 members, including victims, lawyers, and doctors serving as medical advisors, who have fought over ten successful cases and secured millions of baht in court-ordered compensation. As a support group, TMEN offers advice about how to prepare a case based on Preeyanan’s personal experience with the legal system. This includes how to ask for medical records; how to connect to lawyers and doctors who can provide medical testimony and assistance in interpreting medical records; how to negotiate with hospitals; and how to prepare the appropriate documents to file a strong legal case. In addition to support services, Preeyanan uses the group as a powerful voice to change public opinion, professional standards, and policy. TMEN has created a media campaign for its members to share their personal stories with the media, with the long-term goal of reducing public stigma against malpractice victims and leveraging growing public sympathy to impact policy. Preeyanan works with doctors and medical school professors to introduce her members in medical school classrooms and share their experiences. Her goal is to create a more socially responsible generation of medical doctors who recognize their role as safeguards of public health. She has also published a book describing her experiences and the work of her organization.But Preeyanan has also realized that to impact policy requires more than the voice of a few individuals. As such, she has broadened the TMEN coalition to include various institutions, both domestic and international, to help bring about change, including Thailand’s National Human Rights Commission (NHRC) and the influential Rural Doctors Association. TMEN achieved measurable success when the NHRC issued a resolution which, although not legally binding, recognized the fault of the hospital Preeyanan had been fighting and asked the Public Health Ministry to set better standards for medical treatment, especially in the maintenance of medical records. Preeyanan sees the Thai government’s recent efforts to promote Thailand as a global medical tourism hub as an opportunity to promote patients’ rights—leveraging existing momentum to upgrade Thailand’s medical system for the benefit of domestic patients as well. In terms of policy change, Preeyanan’s most promising achievement has been TMEN’s involvement with the Public Health Ministry committee to draft a bill, “Protection for Patients Damaged from Medical Malpractice.” The bill, under consideration by the newly elected Thai government, has been recognized as one of the new administration’s priority policies for the upcoming year. The bill would establish a policy framework to handle malpractice complaints, streamline the process, set a fixed time frame for consideration of complaints, and ultimately increase protection for patients. It would also provide a compensation fund to pay awards to victims. While the bill represents a compromise between the medical profession and TMEN’s patients’ rights movement, it would increase the visibility of malpractice victims and the cause of patients’ rights.One of TMEN’s main efforts to bring the cause to the global arena has been to leverage the existing WHO Patients for Patient Safety initiative, a global movement seeking to enshrine patient safety into public policy and use its force to further pressure the Thai government for policies that would allow patient access to medical records, recognize medical error, and establish an independent body to investigate medical errors. TMEN is attracting attention from similar bodies in the U.K., France, and the U.S. Preeyanan’s next step is to link these international bodies to fight for greater change worldwide, possibly through the WHO initiative.
Preeyanan was born in 1963 in the northern Thai province of Chiang Rai. Her father was a farmer and her mother a food vendor. Preeyanan began to recognize the power of organizing stakeholders into a single unified voice to speak out against systemic problems while still in secondary school. In her final year, she organized her fellow students to register a formal complaint against a teacher using student collected money for personal use. Preeyanan went on to enroll at Payap University in neighboring Chiang Mai province, electing to study business administration rather than education—the typical field of study for female students. Upon graduation, she moved to Bangkok to explore new career paths. She soon wanted to further her studies, particularly in English, which she saw as key to success in a newly globalizing Thailand. However, after briefly attending a Master’s program in England, Preeyanan was forced to exchange her full-time studies for work, to provide for her aging parents in her village.Returning to Thailand, Preeyanan married and took over the management of her husband’s guesthouse operation in Bangkok. Her management skills turned the once-failing business around, and soon it was bringing in substantial profits, which she later used to help open a successful photo processing shop. In 1991 Preeyanan gave birth to a son who fell ill shortly after birth due to an allegedly mishandled delivery and subsequent medical neglect. She began a decade-long legal struggle to bring about justice for her son, uncovering the many legal and policy hurdles which protect the medical profession at the expense of patients’ rights in Thailand. She formed TMEN in 2002 to use her personal experience to help other victims seek justice and create policy changes to enshrine patients’ rights into Thai law.