The trial of an obstetrician of a Fukushima prefectural hospital, where a 29-year-old woman died of blood loss during a Caesarean operation in December 2004, serves as a reminder that doctors' efforts to save lives sometimes lead to death. As the level of medical treatment advances and becomes more complex, the risk of medical accidents is rising.

The Fukushima District Court ruled in August that the doctor, who is with the prefectural Ono Hospital in the town of Okuma, was not guilty of professional negligence leading to death. The doctor had discovered that the placenta was firmly attached to the uterus — an extremely rare case that occurs in about one of every 10,000 deliveries. The blood loss resulted when he tried to detach the placenta from the uterus. The court acquitted him, saying he followed standard procedure. The prosecution eventually decided not to appeal the ruling probably because it believed it could not support its arguments with enough clinical data.

During the trial, the prosecution had argued that the obstetrician should have removed the uterus, instead of detaching the placenta from it. The indictment caused fear among doctors that interference by investigators in doctors' actions during medical treatment might increase nationwide. At the same time, doctors were angered by the fact that the obstetrician apparently had not erred.

Regardless of personal reactions to the ruling, doctors have a duty to take all necessary precautions during operations, and hospitals must provide adequate explanations to patients and their families when medical accidents occur.

A criminal investigation and trial may not be able to unravel the whole truth behind a medical accident because the focus tends to be only on determining the culpability of medical personnel directly involved. As a result, information coming out of such trials may not fully satisfy patients and their families. It is a welcome development that both the health ministry and the Democratic Party of Japan have prepared bills to facilitate noncriminal investigations into medical accidents.

Both bills envisage establishing specialized investigative bodies whose ultimate purpose is to prevent the recurrence of medical accidents. The findings in these investigations will take precedence over police action. It is estimated that about 2,000 unexpected deaths related to medical treatment occur at hospitals nationwide every year.

Under the health ministry proposal, medical institutions will have to report to a Medical Safety Investigation Commission — or a Medical Accidents Investigation Commission — any death resulting from malpractice or suspected malpractice and any death that has occurred unexpectedly after treatment. Medical institutions that file reports with the commission will be exempt from having to report an unusual death to police under the Medical Practitioners Law.

Bereaved families may also ask the commission to launch an investigation. The commission will be composed of medical and legal experts as well as representatives of patients' organizations and hospital associations. The commission will use such means as autopsies and medical records for their investigation. It will not only make public the investigation results but also make proposals on how to prevent the recurrence of an incident that has been investigated.

If the commission determines that the medical treatment under investigation greatly deviated from standard medical practice, it will report the case to police. A number of medical societies, including the Japanese Association for Acute Medicine, oppose the health ministry's proposal, fearing that an investigation by the commission will easily lead to a criminal investigations of doctors. The association says the concept of a "great deviation from standard medical practice" is ambiguous.

Another problem with the health ministry's proposal is the danger that medical specialists will become so busy conducting autopsies for the purpose of responding to the demands of investigations that they will not have enough time to treat patients. As a way out, the ministry has proposed using computed tomography and magnetic resonance imaging machines to examine the bodies of dead patients.

The DPJ proposes to make it obligatory to establish an investigation commission in each hospital. Although priority is given to the commission's investigation, patients and bereaved families may also file complaints with a prefectural Medical Safety Support Center. A high rate of disabilities following a medical treatment as well as deaths will be investigated. Reports will not be forwarded to police.

Since both the health ministry and the DPJ agree on the importance of setting up a neutral investigation entity, they should join hands and make efforts to create the best possible entity. Transparency and sufficient expertise are the most important criteria for such an entity.