Many Japanese die in ambulances because of strange policy

A 69-year old Tokyo man died two weeks ago because of a huge glitch in the Japanese ambulatory system. Somebody was just telling me about this recently. In Japan, if you call an ambulance, they then in turn have to call around to neighboring hospitals to see if the doctors in the emergency room have time to see another patient. As it goes, emergency rooms are often pretty busy and a lot of them say no. On this particular night, 14 hospitals said they were too busy and refused to take the ambulance in. The guy died 90 minutes after he was hit by a motorcycle. Most of those 90 minutes were spent in the ambulance, even though paramedics were at his side within minutes. He had severe head and back injuries and lost too much blood.

More than 14,000 emergency patients were rejected from hospitals three or more times in 2007. The record is a woman in her 70s who was having trouble breathing. She was denied entry by 49 hospitals. WTF?? One pregnant woman died in 2006 from a brain hemorrhage during childbirth because she was rejected by 19 hospitals.

Note to self: If ever in an emergency situation in Japan, don't call an ambulance. Call a cab instead, because if you show up at the door instead of succumbing to the courtesy system of the ambulances, they'll have to see you.

Link (Thanks, Walter!)

Comments

[ender]

so my wife is (was) an ER doctor in Japan. She has "escaped" to the US due to the issues facing Japanese doctors.

There are several problems - firstly, Japan does not have a good samaritan law. In the US, if a doctor sees a person on the street needing help, the doctor can help that person, and will not be held liable if something bad happens (*as long as no payment is accepted by the doctor). In Japan, the doctor who helps the person on the street can then be sued (as a criminal and for a civil suit for money). This has happened.

Secondly, as far as the ER goes, apparently, if the patient in the ambulance is accepted by the ER of a hospital, and that ER then turns out to not be fully equipped to care for the patient, the accepting doctor can be (and have been) held liable in a criminal suit. Most ER's in Japan are small, and have only 1-3 doctors present at a time. Therefore, if you want to accept a patient, you have to be sure that you can take care of anything that might crop up, or else you may be dragged to jail. Example (true story): An opthamologist working in the ER accepted a guy punched in the face, took care of his face, then told him to come back the next day; the patient was sent to the police station, and ended up dying shortly after (allegedly of a "lung injury"). The doctor was arrested 12 hours after the patient died, and the guy who beat the patient was not. Another true story: A pregnant woman who was diagnosed with a high risk pregnancy, who refused to be transferred to a larger hospital, ended up dying in emergency surgery. The OB doctor was publicly (on TV)arrested for murder, and after spending 6months in jail (!!!) ended up settling his case for 10000yen. The judge said (I paraphrase) - "you doctors can't try to care for patients. you have to be 100% sure you can". After that case, all small local hospitals began refusing pregnant women in ambulances if they don't have all available backup (emergency surgeons, interventional radiology backup, available OR's, etc).

To sum it up, the Japanese supreme court has ruled that "inappropriately" accepting a patient that your ER cannot take care of, is a criminal matter. Doing your best as a doctor is not enough to stay out of jail in Japan.

In response to the cases described in the blog posting, the motorcycle guy obviously needed 1) neurosurgery, 2) trauma surgery, and 3) luck. The 14 hospitals who refused him weren't too busy, but probably didn't have 1) AND 2), and those doctors probably did not want to be arrested when the guy died. Similarly, the 70's year old woman (I'm guessing) was probably about to die, and noone wanted to accept her and then have her die. As for the pregnant woman, well, she needed 1) neurosurgery 2) high-risk OB surgery 3) pediatrics; I'm sure that combination would be hard to find.

As a US trained doctor, I know that ambulances can be refused from US hospitals, but pretty much only if the hospital is full. The idea of refusing ambulances based on the patient's condition is strange. I am accustomed to the constant threat of civil medical liability (and that's why we have medical malpractice insurance). However, the idea of criminal liability while practicing medicine appropriately is outrageous. Also, the doctors in Japan are paid a (small) fraction of what US doctors are paid, and work much harder. To saddle them with criminal risk, as they are now, is straining a system already on edge. From my personal experience, more and more Japanese doctors are trying to escape the system in Japan, and come to the US where they are better paid, have less stress at work, and aren't afraid of being sent to jail at a moment's notice.

[alexanderpink]

Thanks for your comment ender, very informative. I am a 3rd year medical student here in the US, and have a friend who is a CVTS surgeon in Japan. Your thoughts echo what he told me in response to this article. Though he didn't give as many details as you, he said that in the past Japanese doctors would dedicate many hours to their patients for little pay, but had low risk of lawsuit. Now he feels they dedicate long hours for low pay, but have increased legal liability risks. It is sad that physicians in Japan make only a fraction of what physicians here make, especially when you consider that surgeons are paid roughly the same as dermatologists, family practice docs, etc. It is quite an interesting healthcare system they have. I have only heard about patients being turned away from US hospitals when the hospital was full, and even then if there was no alternative they would likely be accepted. Of course my experience is very limited, and I go to school in a major city that has many large hospitals to accept patients, as well as a very busy county hospital (Parkland) that is well staffed to handle patients.

[Malcolm Burgess]

Wow, that is incredible.
I can only imagine such things must originate from somewhere in Japan's history?
Or is it really that cold there...? @_@

[Ed3]

Hmm.. I will be in Japan in my. I hope nothing happens, but if it does I will remember this tip!

http://www.almost-otaku.blogspot.com

[Jeff]

Before people go nuts indicting the Japanese health care system, realize that we have the exact same problem here, it's just that instead of waiting to die in an ambulance, you wait to die in an emergency room.

ER's in the United States generally do not refuse patients unless the ER has no physical space to put a patient (including stretchers in the hallway). That means ER's will fill up to the point that a doctor can't see you for hours. The motorcycle guy died after 90 minutes? He would have likely died in the United States too, unless he was by chance taken to a large hospital in a well-served area with a well-staffed ER. It happens literally every single day in the United States, multiple times. People die in ER's all the time, without ever seeing a doctor.

It's six of one, half a dozen of the other. Which is worse, waiting in an ambulance for a couple of hours, or waiting in an ER for a couple of hours? In both cases you have access to trained health care workers, but in neither case do you have access to a doctor who can provide advanced care using advanced equipment or techniques.