The clinics that can kill(2)

Another reason some elect to go to these clinics is privacy. "Especially if they have a venereal disease, people are too embarrassed to go to public hospitals. They are afraid their friends and relatives will learn about this while the small clinics will be more discreet."

Fu explained that in the past, power poles around the city were plastered with small advertisements claiming cures for venereal diseases - often the cures were "secret prescriptions handed down from ancestors" and able to end the embarrassing diseases forever. This sort of advertising is not as common these days.

"There are also many gynecological clinics equipped with ultrasound machines which can tell pregnant women if their embryo is male or female. If it turns out to be a girl, a woman could seek an abortion," Fu said.

Cosmetic marketing

Unlike the usual illegal medical clinics, the new wave of cosmetic treatment clinics target young well-paid women. "In hair and beauty salons, staff will often suggest that customers undergo simple beauty treatments like eyebrow tattoos or laser hair removal," Fu said. "But all of these treatments are illegal if the clinics involved are not licensed as medical institutions." 

Most illegal clinics don't have sterilizers and are hotbeds for the transmission of infectious diseases like hepatitis. To cut costs, some clinics buy substandard medical materials or out-of-date medicines. 

Fu said these bargain basement clinics could be highly profitable. "They only need to rent an apartment. Their instruments and drugs are cheap if they buy recycled stuff. And they don't bother with disinfecting. The amounts they charge are a lot less than legal clinics or hospitals do and this is their big appeal."

Chen Shouping is a dentist who runs a private clinic in Pudong New Area. He told the Global Times: "The problem is also, to some extent, the fault of medical instrument and medicine manufacturers who don't check licenses when they sell their equipment and medicines. Anyone with cash can buy directly from a manufacturer."

Most of the tragic outcomes of these illegal clinics are the result of malpractice and the harm, when not fatal, can last a lifetime. Sometimes the illegal clinics come in unexpected forms.

A head dentist with a city hospital was given an administrative penalty in 2007 after performing restorative work on a patient's teeth in his own home, rather than at the hospital, the Shanghai Evening Post reported.

The patient, a 36-year-old woman, wanted to have three teeth fixed before she traveled to the US in 2003. She went to see Zhang Qiang, who was the head dentist at a hospital and a former classmate of her husband. Although the woman only wanted three decayed teeth repaired, Zhang talked her into a comprehensive restoration work and offered to do this at his home, telling her it would save her time and money.

She paid 45,000 yuan for the dental work but after a month she was suffering agonizing pain and swelling in her jaw. She was unable to chew and could only eat noodles or rice soup. She and her husband tried to meet Zhang (he had promised to fix the problem) when they returned from the US but he refused to see them. They then took him to court, asking for 700,000 yuan in compensation.

The court sided with the woman, saying a third party evaluation showed that she did not need the extensive restorative work that had been carried out and that Zhang had performed this at his home which was not licensed as a medical institution. He was ordered to pay her 230,000 yuan in compensation. But the damage the woman suffered has meant she has had to undergo a series of operations and her teeth will need expensive and constant care for the rest of her life.

Not uncommon

Treating people at home is not uncommon. One dentist surnamed Zhou said, "This is a common practice and it is what the market demands." Zhou works in a public hospital in Jiaxing, Zhejiang Province, but outside her work hours she sees patients in her apartment's garage - essentially another illegal clinic.

In her 8-square-meter garage, Zhou acts as dentist, receptionist, and assistant. But her patient list continues to grow. Some people often have to wait for an hour to see her. "People choose my garage clinic because it's convenient and cheap. Just to register at a hospital now costs 10 yuan for every visit, not to mention having to wait for hours. Normally a ceramic tooth replacement costs 700 yuan at my hospital. Here I only charge 500 yuan."

She doesn't think private clinics are necessarily unsafe and said that patients can also receive bad treatment at public hospitals. Her garage clinic opens every night from 6 pm, and runs during the day on weekends. "I don't have any spare time - there are too many patients," she said.

She said that often in public hospitals doctors will run several tests before wanting to make a diagnosis - in these small clinics there is more efficiency.

"It's actually quite easy to learn how to fix teeth or carry out an abortion. A beginner can learn what to do in a month. But without proper treatment, there might be complications. Even in major hospitals, things go wrong because doctors get careless. The difference is that hospitals can be held responsible for this," she said.

In 2008, China introduced new laws to crack down on illegal clinics. Anyone caught running a clinic without a proper license or qualification will be fined 8,000 yuan and the clinic and staff will be placed on a blacklist to ensure they cannot do this again.

If an offender is caught for a third time, he or she will be charged and can face three years in jail for offering diagnoses or treatments illegally. If the clinic has caused serious harm, they can be imprisoned for between three and 10 years. If their actions cause a death, they face a 10-year sentence.

The garage dentist Zhou said the problem was that in her hospital the government required that the hospital was responsible for its profits or losses, so doctors were encouraged to prescribe expensive medicines or order more tests on patients, otherwise they would find themselves trying to live on a very basic wage.

"If the costs of medicine and treatment were less, there wouldn't be so many patients coming to my garage."