Five staff at a Kaohsiung hospital have been charged with letting unqualified sales reps take part in operations, a serious blow to the hospital's reputation and to patient trust.

• Prosecutors in Taiwan charged the head of Botian International Hospital and four colleagues with illegally practicing medicine.
• During a spinal disc operation, a device company rep stood at the operating table and measured hardware, prosecutors said.
• In a knee replacement, an engineer without a medical licence handled a robotic arm positioner and touched surgical tools.
• In a separate case, a sales engineer opened and mixed bone cement inside the operating room.
• The hospital chief was already fined and released on bail; he insists he handled all the difficult parts of the surgery himself.

Outlook: The case goes to court, and regulators are likely to tighten rules on how device company staff behave inside operating rooms.