Malpractice and coverups

医療ミスで医師逮捕

It is the first time in Japan that doctors have been arrested on charges of malpractice. The patient, who was born with a hole in her heart, underwent surgery at the hospital in March last year. Investigations have revealed that she suffered fatal brain damage as a result of the failure of a mechanical blood and oxygen pump.

The doctors' arrests last week seem justified not only by the gravity of the malpractice but also by the alleged attempt to destroy evidence. Covering up a medical error can be as serious a crime as the error itself. At stake is the general standard of medical ethics. The immediate task for the university hospital is to re-establish its code of conduct and safety rules for the medical staff.

During the operation, conducted by a team of 14 doctors and nurses, the heart-lung system malfunctioned for more than 10 minutes, according to investigators, disrupting the blood flow to the patient's brain. The girl fell into a coma and died three days later. The hospital claimed that she had died of heart failure.

What's more, the incident came to light only after the girl's parents received a letter from a would-be whistle blower. And only after they filed a criminal complaint did the hospital begin a probe. However, much remains unknown about exactly what happened and why.

What is clear, as the hospital itself has acknowledged, is that the failure of the pump led to the patient's death. It is also clear that members of the operating team tried to hide the truth. One wonders how such things could have happened at a prestigious heart surgery center. Was the team trying to protect the university's reputation, with little regard for the victim and her relatives?

The problem here, aside from the operating blunder, is the lack of transparency. The coverup is seen by many as a symptom of a deep disease that is said to plague the medical profession: a propensity toward secrecy. Such a tendency goes against efforts to prevent medical accidents, including the government's recent action plan to promote medical safety.

It may be impossible to eliminate all accidents, but transparency, or honesty, helps to minimize their consequences. If anything went wrong, the doctor in charge should inform the patient and family about exactly what happened and apologize for it. If professional negligence is suspected, it should be reported immediately to the police.

It has been pointed out that investigative authorities in Japan — police and prosecutors — have tended to be lenient in cases of medical malpractice. This, combined with the lack of transparency, has left many cases unresolved. With malpractice suits rapidly increasing, however, investigators are beginning to get tough. The latest case indicates that people involved in serious coverups are also subject to arrest.

It is imperative that the medical world make itself more open. In particular, people in the forefront of medical care — doctors, nurses and others — must abide strictly by the rules of accurate reporting. Self-reform, however, needs to be supported by institutional reform, such as creating a third-party body to investigate malpractice cases and help victims.

University hospitals, as leading medical institutions, can set examples. Tokyo Women's Medical University Hospital, reputed for its high level of heart surgery, bears grave responsibility; as a government-designated center for heart transplants, it receives special financial incentives. Needless to say, it must reflect seriously on what occurred and take the necessary steps to prevent the recurrence of accidents and coverups.

Medical safety programs in Japan have a short history. They started in earnest as recently as 1999 when patients were mixed up at Yokohama City University Hospital. The results so far are anything but encouraging. Accidents have also occurred at other university hospitals throughout the nation, despite, or perhaps because of, their pioneering role in high-tech medicine.

Improving medical safety is an urgent priority for all hospitals and clinics, not just for these medical centers. That must be the most important lesson of the malpractice at Tokyo Women's Medical University Hospital. It is a wake-up call to a world of medicine long accustomed to botched operations and frequent coverups.

The Japan Times: July 5, 2002
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      医師と看護師14人のチームで行われた手術中、心肺装置のトラブルで患者の脳への血液の流れが10分以上妨げられたという。少女は意識不明に陥り3日後に死亡したが、病院側は死因を心不全とした。事件が明るみに出たのは少女の両親が内部告発者の手紙を受け取った後のことで、病院は両親の刑事告発を受けて初めて調査に乗り出した。事件の全容はまだ明らかになっていない。

      明らかなのは、心肺装置のポンプが少女の死につながるトラブルを起こしたこと、手術チームが真実を隠そうとしたことだ。

      隠ぺい行為は医療現場を蝕む秘密主義の現れで、医療事故防止の取り組みを阻むものだ。事故をなくすことはできないにしても、透明性がその後の影響を最小限に抑える助けになる。事故が起きたら担当医が患者と家族に事実を説明し、謝罪すべきで、業務上過失の疑いがあれば警察に届けるべきだ。

      医療過誤に対する警察と検察の甘さと透明性の欠如のため、多くの事件が未解決に終わっている。しかし医療過誤訴訟の急増で、当局の捜査も厳しくなっている。医学界は秘密主義をやめ、医療スタッフは正確な報告を行う義務を全うしなくてはならない。現場だけでなく制度の改革が必要だ。

      日本の医療安全対策は1999年に始まったばかりだが、成果は上がっていない。事故は他の大学病院でも起こっている。医療における安全性の向上はすべての病院や診療所にとって緊急の優先課題だ。今回の事件は手術ミスや隠ぺい行為に慣れてしまった医学界への警鐘といえよう。

The Japan Times Weekly
July 13, 2002
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