By staff reporter Sun Tao and intern reporter Tian Peng

On March 23, 17-year-old Li Mengnan attacked and stabbed several staff at The First Hospital of Harbin Medical University (HMU First Hospital) in the northeastern city of Harbin, leaving one intern doctor dead and three others severely injured.

Prior to the incident, Li and his grandpa Li Lu were forced to travel 623 kilometers from a small town in Hulunbuir city, Inner Mongolia, to Harbin, Heilongjiang Province, on five separate occasions to receive treatment for Li Mengnan's ankylosing ondylitis, a chronic condition that causes inflammation around the spinal vertebrae. However, during their sixth trip, a doctor at HMU First Hospital's Department of Rheumatology and Immunology refused to inject Li with Remicade, a drug that treats his condition, claiming that Li's tuberculosis had not yet healed. The doctor told Li to go home and recuperate for another three months.

Denied the medication he demanded and overwhelmed by pressure, Li returned to the hospital with a knife and began a murderous rampage.

Li Mengnan grew up with his grandparents. His father is in prison, while his mother left many years ago and has never been heard from. The whole family lives on his grandfather's pension payment of 1,300 yuan per month. Also, after applying for a government subsidy to residents living below the minimum living standard in 2008, Li Mengnan received an additional100 yuan every month.

Born in May 1994, Li dropped out of school in his first year of junior high. Employment opportunities are scarce in small town he grew up in, and most local youth go to large cities to work as migrant laborers. In 2009, Li went to Beijing with his aunt to find work. During this period, he began to feel pain in his legs; the pain became so intense that Li chose to return home.

Li's grandfather was diagnosed with stomach cancer in 2009. The surgery cost over 100,000 yuan, leaving the family tens of thousands yuan in debt.

Local hospitals lack the resources to treat Li, so he and his grandpa had little choice but to travel to Harbin six times to seek medical treatment from Sept. 2010 to March 2012. Each time, they opted for the cheapest seats (the ticket fare is 48 yuan) on the cheapest trains which left at around 10:00 p.m. and arrived at 8:20 a.m. the next day.

To treat Li Mengnan, the family incurred about 70,000 yuan in medical treatment costs, transportation, and accommodation over a period of about 18 months, of which more than 20,000 yuan was reimbursed through medical insurance while the remaining 50,000 yuan was to be borne by the family.

The treatment process was also filled with a series of twists and turns.

Li Mengnan was previously misdiagnosed with synovitis by HMU First Hospital's Department of Osteology and delayed treatment for seven months. In April 2011, Li began to be treated with the imported monoclonal antibody drug Remicade by HMU First Hospital's Department of Rheumatology and Immunology.

Remicade is an expensive drug that costs 6,240 yuan per vial, or 39,000 yuan for three injections. Eager to cure his grandson, Li Lu chose this medicine for Li Mengnan.

However, after taking the second injection of Remicade, Li Mengnan was diagnosed with tuberculosis.

Since then, Li Mengnan began running back and forth between a specialized tuberculosis hospital in his hometown and HMU First Hospital. On his fourth and fifth trips to HMU First Hospital, the hospital refused to administer him Remicade injections, contending that his tuberculosis had not yet healed.

The sixth time Li Mengnan traveled to HMU First Hospital, he was once again denied a Remicade injection due to lingering tuberculosis. The repeated refusals by the hospital sent Li into a rage and subsequent killing spree.

The current state of China's health care system is that grass-roots hospitals, lacking the resources to meet local residents' medical needs, are withering while patients are crowding into major hospitals in big cities. Doctors typically work long hours for low pay and often spend less time receiving each patient, leading to a lack of communication and intensified distrust between doctors and patients.

Under China's current health care system, the allocation of medical resources is dictated by administrative agencies, leading to scarcity and high prices for medical treatment.

Meanwhile, huge vested interests have made it difficult to promote market-oriented reforms on the supply side of medical resources.

1 yuan = 15 U.S. cents

Full story in Chinese: http://magazine.caijing.com.cn/2012-04-09/111804673.html