USELESS BUREAUCRATIC OVERSIGHT OF PUBLIC HOSPITALS IN JAPAN

Pointless to expect openness in Japan, I suppose

Recent revelations of a failure to report several cases involving heart patients who died after surgery by the same doctor illustrate defects in the current system in which medical malpractice must be reported to the directors and other administrators of hospitals. Investigations at Tokyo Medical University Hospital following the deaths of a number of patients after heart valve operations were conducted only at departmental level, including that of a joint committee from the surgical and internal medicine departments. The department's investigations concluded the deaths were not caused by malpractice, a hospital insider said.

Because the four deaths were judged not to be the result of "incidents that caused actual harm due to improper medical practices," it was deemed unnecessary to report them to the hospital's director or an official responsible for safety management. However, it was abnormal for four patients to die in a short period after undergoing the same operation involving the same doctor, and the doctor in question was removed from the surgery roster for heart valve operations after the death of the third patient. With this in mind, it should have been natural for the hospital to have further examined the cases.

The system for internally reporting medical errors in hospitals was established in April 2000 by the Health, Labor and Welfare Ministry in the wake of a series of medical accidents. The system was imposed on university hospitals and other designated medical institutions providing advanced treatment, together with an order to improve guidelines on safety management.

The series of medical accidents caused by malpractice in university hospitals included a 1999 case at Yokohama City University Hospital, in which a mix-up caused two patients to undergo the wrong operations. It should be a matter of course in any organization that serious accidents are reported to senior officials. But in university hospitals, it is said that professors maintain a stranglehold over their departments and cannot be overruled by hospital directors. In the event of malpractice, it is not unusual for investigations to be handled entirely within the department responsible for the mistake. If a hospital's senior management does not know the details of an accident, it is impossible for the hospital to properly respond to the patients or their families, or take measures to prevent the mistake's recurrence.

The system of internal reporting is the first step to prevent malpractice, and has been obligatory for all hospitals since October 2002. The ministry is planning to introduce an experimental system whereby third-party organizations examine cases in which patients die during treatment. But the new system can work only if the internal reporting system is operated properly. If a hospital as a whole does not know of a malpractice case, it is impossible to bring it to the attention of a third-party organization.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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