New York Times
POSTED: 1:30 a.m. HST, Dec 27, 2013
NEW YORK » Whenever the endless shifts at the day spa in Flushing, Queens, where Myung Hwa Jang worked got to be too draining, Jang's colleagues would head down the street for some refreshment. And so on a brisk day in February, feeling run down, Jang found herself in a storefront clinic, a needle in her arm and a bag of solution she knows as "Ringer" sliding into her veins.
On a recent afternoon, she gestured with her thumb to the spot where the fluid, which was probably dextrose, a form of glucose, or sugar, was inserted. It is the only digit Jang, 61, has left. Doctors amputated most of her hands and both her legs below the knee after she was taken by ambulance from the clinic to New York Hospital Queens, racked with septic shock.
And although it is not certain that the infection resulted from her procedure at the clinic, Jang's fate sent a scare through the Korean and Chinese hubs of New York City, where the use of intravenous solutions to combat even mild illnesses is something of a norm, a practice imported from home.
Though the zip glucose imparts is similar to that from consuming a sports drink, according to doctors, in China, IV solutions are dispensed so freely to healthy people that there have been calls by the government to halt the practice and stark warnings of IV overuse there from international health organizations.
In New York, some pharmacies sell IV bags illegally over the counter with whispers not to tell any "Westerners," off-duty nurses go door-to-door offering IV pick-me-ups, and there are private walk-in clinics where, patients say, for less than $100 they get a drip hooked up on request, no questions asked. Patients and staff at clinics and pharmacies described the drips and how they are given, but on a visit to the clinic where Jang said she received her IV, a reporter was forbidden from seeing the room beyond the drawn curtain where, a receptionist said, the drips were administered.
When Jia Ling had a persistent cough this summer, she sought out IV treatment.
"I took medicine, American medicine — it didn't work," said Ling, 28, a former kindergarten assistant who emigrated from China four years ago.
At the Flushing clinic a friend recommended, she paid $80 for the treatment, sitting beside several other people on a couch, each hooked up to an IV drip. She does not know what the solution was.
"They are professionals, I trust them," she said.
Beyond improper sale and administration of the solution, there are other inherent dangers, said Ray Macioci, the chairman of the New York City Pharmacists Society, including that it may mean a patient doesn't seek "good professional help to see what is actually the problem."
Many who turn to IVs are uninsured, drawn by the relatively low price for a treatment. And while intravenous infusions are regularly prescribed by doctors and performed by medical professionals in the United States, because of the risk of infection they are used with reserve, for patients suffering from dehydration or who are unable to eat, for example.
Doctors have leeway to decide when a drip should be used, but prescribing it to, say, take the edge off jet lag is not medically indicated, said Dr. Perry Pong, the chief medical officer of the Charles B. Wang Community Health Center, a nonprofit facility based primarily in Manhattan's Chinatown.
Fielding and refusing requests for IV infusion at the Wang center is routine, according to the medical staff.
In China, however, drips are so commonly prescribed that the country's national health organization started public awareness campaigns to try to limit the practice. According to the World Health Organization, China is among the countries that use the most intravenous treatments; in 2010, the last year for which data is available, the region averaged 4.18 injections per person per year; the world average is just 2.88. The WHO estimates that more than a half-million new cases of hepatitis B were contracted there that year because of unsafe injection practices, and more than 6,000 new cases of HIV.
Intravenous solutions are prevalent in Asia in part because many doctors receive a modest base salary, and rely on fees from performing expensive procedures, meaning they have an incentive to order those procedures rather than, say, pills, said Peter A. Muennig, an associate professor of health policy and management at the Mailman School of Public Health at Columbia.
Jack Wu, 30, who works at a clinic in Flushing, said when doctors there denied patients a drip, they faced a medical culture clash: The patients' perception, Wu said, is that "you're basically telling them: 'I'm not treating you at all; go home and die.'"
And when Wu himself had a sore throat and chills, he chose to get his antibiotics via an IV, not pills.
"It was faster," he said.
Doctors who serve this population often fight a losing battle.
"Even though I explain to them I cannot give them IV," said Dr. Yunhee Chung, the president of the Korean American Physicians Independent Practitioners Association, who runs a clinic in Flushing, "they come back and say they've gotten it from somewhere."
Where to get it is passed through word of mouth and on the expat message board on HeyKorean.com.
At the clinic in Flushing where Jang said she and her friends went regularly for treatments, three beds lie behind a blue curtain in an alcove where, a receptionist explained, patients relax while IV treatments are administered. Dr. Weining Liang, who runs the clinic, said he only performs IV treatments when a patient is very ill. As he spoke in his office, a few steps away attendants escorted patients into the alcove and drew the curtains around them.
Liang said he could not recall Jang being a patient, nor her being taken by ambulance from his clinic. He denied that the clinic provided IVs on demand.
"It's not true," Liang said, before telling a reporter to leave his clinic immediately.
Jang is suing the clinic and a doctor there, Dr. George Mang, on grounds that the care she received was negligent and deviated from standard medical practice.
The suit, filed in state Supreme Court in Queens, says that Jang was a victim of malpractice, and claims that no one asked her why she was sick, that the clinic merely took her cash and gave her an intravenous solution.
"They need to explain what happened," said Jeffrey Kim, a lawyer for Jang. "People don't normally go into a clinic and come out with symptoms that result in amputation. These clinics that are in the Korean community, they need to diagnose patients properly, and not take a patient's word that that's what they need and just administer this stuff to make a quick buck."
Reached by phone, Mang declined to comment.
Jungeun Park, 72, a friend of Jang's, said that when she had a nasty cold, a nurse who attended her church administered a drip at her home. Treatments were perfunctory: "She put a needle in my arm" and left, Park said. "I just took it off when it was done."
Since Jang's amputations, Park has forsworn drips, as has much of the parish, she said.
On Jan. 3, after 11 months at New York Hospital Queens, Jang will be taken by a medical transport vehicle to Kennedy Airport, and will head home to Seoul, South Korea, where her husband lives, she said. Her lawyer said her hospital bill, which she cannot afford, has not yet been paid. The hospital declined to comment, citing privacy rules.
On Northern Boulevard in Queens, at Smile Pharmacy, a clerk said the bags of solution ran about $20. But when asked later about selling them without a prescription, Tae Lee, the pharmacy owner, said the clerk misunderstood the request.
"Most of the time we ask 'Do you have a nurse coming home?'" Lee said, referring to a visiting nurse who would be licensed to perform the infusion, and have the patient's prescription.
At Center Pharmacy on Main Street in Fort Lee, N.J., where there is a large community of Korean immigrants, a man who identified himself as the owner in a telephone interview but would not give his name because he is selling prescription medication over the counter, said: "Giving it out without prescriptions is illegal, I know. But many times it's hard for me, saying no. People from Korea who are used to doing it, and also seniors, they blame me if I say no to them."
Why, when the treatment is illegal and potentially hazardous, do people continue to get the infusions?
"I don't know how to explain, but you gain power," said Jang, tugging her hospital gown self-consciously to hide the place where her lower legs end in angry red lines.
That is why, she said, back in South Korea, her husband and daughter have not stopped.