Staff writer

Ikuo Kondo’s son has been bedridden for 20 years, suffering damage from a spinal anesthesia mishap during an appendectomy.

Kondo, 63, the founder of the Nagano-based Medical Malpractice Plaintiffs Association, and his son, 32, filed a civil suit against the hospital that treated him, and after 11 years of litigation accepted a Tokyo High Court mediation plan for the hospital to pay them about 50 million yen.

“We lost the first trial at the Nagano District Court although my son’s medical records were found to have been altered by the doctor in charge of him,” he said.

About 30 percent of the polled members of Kondo’s group said in 1997 that medical records used in their malpractice trials were altered by hospital staff.

“The public should know that we are often deceived by doctors and other medical workers,” said Kondo, who established the MMPA in October 1991 and has built the group up to about 380 members. Approximately 3,200 malpractice cases have been reported to the MMPA, including some 80 cases now in court, he said.

Kondo said that those cases represent only the tip of the iceberg.

A number of medical accidents have made for shocking headlines lately.

In January, two men received the wrong operations at Yokohama City University Hospital due to a mixup that occurred just before surgery.

On March 10, a surgical team at Yamanashi Prefectural Central Hospital in Kofu that removed a brain tumor from an 8-year-old boy left a 20-mm-long by 6-mm-wide fragment of a stainless steel surgical instrument in the boy’s head.

A 58-year-old woman with rheumatoid arthritis died at the Tokyo Metropolitan Hiroo Hospital in February soon after she was mistakenly given an intravenous drip of disinfectant instead of heparin, an anticoagulant. Similar mixups were reported Friday at Otaru City Hospital in Hokkaido and Izumisano Municipal Hospital in Osaka Prefecture.

On Saturday, it was revealed that a male patient in his 60s fell unconscious in January 1998 at Tarumizu City Hospital in Kagoshima Prefecture after being injected with a disinfectant. “I believe there have been more incidents of malpractice in which victims and their families silently put up with medical workers’ negligence and mistakes without claiming compensation, and many more medical accidents that have been hushed up,” Kondo said.

“In addition, the recently revealed cases all happened at public hospitals. It is believed such cases have been better covered up at private hospitals,” he said.

The great majority of doctors and medical workers usually do not admit negligence and try to cover up malpractice, said Yoshio Kato, the only lawyer in Japan devoted solely to representing plaintiffs in medical malpractice cases.

Kato alleges that the most extensive and insidious violation of human rights occur at medical institutions in Japan. “Around 600 medical malpractice suits are filed annually nationwide, but we have estimated, based on U.S. research, that there are around 100,000 malpractice cases across Japan every year,” Kato said, referring to the Harvard Medical Practice Study conducted in 1986, in which some 150,000 medical accidents were estimated to occur in a year in the United States.

According to Kato, plaintiffs win between 30 percent and 40 percent of malpractice suits in Japan, a success rate that he believes is reduced by the difficulty that patients or families, with scant access to medical information, have in proving malpractice that often occurs behind closed doors of operating rooms.

Medical records in Japan have long been regarded as doctors’ property, and patients have had no right to see them. Although the Health and Welfare Ministry is currently working on a bill to require doctors to open up medical records to patients, the Japan Medical Association has strongly opposed it and is lobbying the Liberal Democratic Party to kill it . JAMA has backed the LDP for decades.

Isao Mori, director of Ishinkai Yao General Hospital in Yao, Osaka Prefecture, said, “Incidents of malpractice have continued to occur, because the nation’s medical circles have not learned lessons from mistakes, because malpractices have been covered up.”

Mori also attributed medical accidents to the lack of a system to check the quality of medical care at hospitals. “There is no concept of risk management because medical care has been provided on the assumption that medical workers do not make mistakes,” Mori said. “Accordingly, there is no system to train medical staffers to prevent accidents from occurring.”

Mori stressed it is necessary to learn from other Western nations to improve the situation. “In the U.S., for example, doctors are required to take a variety of seminars including those related to risk management to renew their licenses every two years. It is appalling that doctors in Japan are not legally required to study medicine after they have once obtained their licenses, which are valid as long as they live,” Mori said.

Although Mori heads a doctors’ group formed to study the cause of medical accidents and work out measures to prevent them, he admits that the number of doctors who agree with the group is still not large.

Yutaka Tsutsumi, an associate professor of pathology at Tokai University School of Medicine in Isehara, Kanagawa Prefecture, said usually there is no opportunity for doctors at medical school hospitals to discuss and learn from mistakes. “I believe it would be almost impossible to conduct peer review not only at my hospital but also at other medical school hospitals,” he said. “Without changes at medical school hospitals, which play a central role in medical care in Japan, no change can be expected at smaller hospitals.”

Mori does not believe that the Health and Welfare Ministry or the Diet is capable of fomenting the institutional changes necessary to improve the situation, adding that the prospect for change in the near future is not good. “I think the only thing we can do now is to introduce gradual changes in local communities by fostering patients’ autonomy in medicine,” he said, adding that his hospital has given notebooks to patients to record their diagnoses, prescriptions, effects and side effects of medications, and what doctors have said about possible outcomes if they did not take the drugs. “By creating an environment in which patients are involved in the decision-making process of their own health, patients will become wiser, then medical workers will become more careful,” Mori said.

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