Case Study: Tick-borne Encephalitis in China
A Well-Publicized Tragedy Leads to Questions About Taking Reasonable Precautions Against Foreseeable Harms
Panshan, Tianjin, China
In 2007, a 15-year-old first-year high school student at a prestigious private school in the USA attended a summer program run by the school in China. Students hiked up Panshan, a mountain approximately 100 km from Tianjin in northeastern China, by a paved pathway.
Students and teachers split up on the descent, most taking a cable car down the mountain. The student, and a small group of others, decided to walk down the mountain by themselves, and were permitted to do so.
The student left the paved trail and began walking on narrow dirt paths surrounded by vegetation. The student received insect bites during this time.
Shortly thereafter, she began to experience symptoms, and was diagnosed with tick-borne encephalitis.
Two routes down Panshan: the trail or the cable car
The encephalitis had terrible effects. It reportedly gave the student permanent brain damage and left her unable to speak. She is only able to give soft, monosyllabic, childlike sounds. Her fingers have limited ability to bend, which makes activities like typing difficult.
She reportedly also has limited control of facial muscles, and drools, has difficulty swallowing, and exhibits socially inappropriate facial expressions. Her cognitive abilities are also diminished, particularly in complex problem-solving, and ability to comprehend math and reading.
This damage is expected to last her entire life.
Before the trip, the school advised students to visit a travel medicine clinic; the student did not do so. The school listed insect repellent on the packing list. The school warned students about several hazards, but not about the possibility of tick-borne disease in China, or steps to take to avoid tick-borne disease.
Insect repellent was brought to the site, but left on the bus. Students were advised to wear long pants but it was not required. The school did not ensure that the student took steps to avoid tick-borne disease such as conducting tick checks.
Hiking along the Panshan trail
The school argued that tick-borne encephalitis is rare—the student was the first American traveler to contract tick-borne encephalitis in China—and the risk of contracting the disease was not reasonably foreseeable.
The school also argued that it did not have a responsibility to warn against every single possible risk that a student might encounter, including rarely occurring risks.
In a lawsuit, the school’s release form was ruled to be invalid. A jury awarded the student USD $41.5 million in damages, which was upheld by the state Supreme Court.
Questions for outdoor program managers
A risk management system is not required to eliminate all risks, but only to reduce reasonably foreseeable risks to a level as low as reasonably practicable. Based on the information above, did the school’s risk management plan work as intended? Was this an example of a non-foreseeable risk and a reflection of inherent risks? Or should something different have been done?
Could your outdoor organization develop and implement risk management systems to keep something like this from occurring? If so, how?