Medical blunders in the nation’s hospitals invariably make headlines — when they are discovered and acknowledged. The patient’s right to informed consent has been severely tested by reports that two patients at a municipal hospital in Osaka Prefecture were recently operated on for a second time without being told the real reasons they were put through the ordeal. In both cases, foreign objects were inadvertently left inside the patient — an 8 cm-long plastic cover from a surgical cleaning pipe in a 70-year-old woman and a handkerchief-size piece of gauze in an 80-year-old man. To avoid “shocking” the patients, they were told only that further surgery was required.
With little attendant publicity, the Health and Welfare Ministry has just warned all national hospitals to take immediate steps to prevent these kinds of medical blunders. In view of the rash of recent hospital errors that prompted the step, a great deal more attention should be directed to the ministry’s sudden insistence on the need for patient-monitoring systems and its reminders to nursing staff to double-check that essential devices are in working order or have been switched on again after being temporarily shut down.
Why have such basic safety procedures not been followed as a matter of hospital routine? The lives of patients are put at risk when such obvious precautions are not taken. Tragic proof is the death this month of a 12-year-old girl at a national hospital in Matsue because the artificial respirator allowing her to breathe was not switched back on after being briefly turned off while she was bathed. The girl, with a history of repeated hospitalizations, was quadriplegic and thus unable to summon help using the bedside call button. Hospital officials acknowledged that they had no guidelines for handling patients on respirators and the nurse involved reportedly “cannot remember” whether or not she turned the machine back on, and if not why not.
This incident differed only in kind from some other recent medical accidents. A 6-year-old girl born with a serious heart defect died in December one month after surgery at the prestigious National Cardiovascular Center in Osaka Prefecture. She was mistakenly given a transfusion of only distilled water during the operation instead of one that combined two protective chemicals with the water. The accident occurred because the technician who began preparation of the solution left the operating room on another task and the replacement thought the chemicals had already been added. A statement by a hospital official that they apologized to the patient’s family and did all they could is not satisfactory.
Surgical error is also suspected in the death of a patient with cancer of the esophagus at Juntendo University Hospital on the last day of 1999. The 66-year-old man died of massive, uncontrollable bleeding during what was supposed to be a routine operation to open his trachea so that a breathing device could be inserted. Extenuating circumstances — at least in the view of hospital officials and staff — may have played some part in all these recent cases. Taken together, however, they suggest a possible pattern partly resulting from the current severe shortage of medical professionals, doctors and nurses in the nation’s hospitals.
Recognizing the urgency, the Health and Welfare Ministry is submitting to the current session of the Diet a bill to revise the Medical Service Law so that the health minister can order hospitals enlarge their medical staffs. This is in keeping with recommendations made earlier this month by the Advisory Council on Medical Services Facilities. While the ratio of doctors and nurses to inpatients is stipulated by law, a 1997 ministry survey found that 42 percent of the hospitals checked had fewer than the prescribed number of professional medical personnel. Of even greater concern, 3 percent of the hospitals had only half the required number of doctors.
The situation may be even worse today. As important as they are, warnings to hospitals on what should be standard safety precautions are stopgap measures that do not go far enough. Real changes are needed, including in the way certain medical fees are determined. The health ministry should be able to do more than offer “guidance” to understaffed hospitals or reduce their health-insurance reimbursements. The proposed revisions in the law would give the ministry, and prefectural governors, the authority to order improvements at such institutions. That might at least begin to restore public trust in what critics consider Japan’s deteriorating health-care system.
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