Dr. Hirofumi Kawakita's plan to use the government's newly created special structural reform zones to launch a pediatric emergency medical service in Tokyo soon led him into a Kafkaesque nightmare.

Kawakita proposed to officials on two separate occasions last year his plan to establish Suginami ER in Suginami Ward, Tokyo. But he was soon exhausted by the bureaucratic red tape involved in the application process for the much-touted special zone system, initiated by the administration of Prime Minister Junichiro Koizumi.

"There's no use working with bureaucrats," he said. "It's a waste of time."