A medical travesty in Nara
(From The Japan Times Sept. 4 issue)

妊婦救急搬送の問題点

In late August, a woman from Kashihara, Nara Prefecture, miscarried after nine hospitals refused to admit her. In August 2006, 19 hospitals refused to admit a woman, also from Nara, who had lost consciousness during delivery. She died eight days after she gave birth in the 20th hospital. These two incidents highlight the shortage of maternity clinics and obstetricians, and the Nara Prefectural Government's slowness in improving its ability to transport pregnant women in critical condition to hospitals that can admit them.

The Kashihara woman was picked up by an ambulance shortly before 3 a.m. Aug. 29 after complaining of a stomach pain and bleeding. Her water broke at around 5 a.m. on her way to the 10th hospital. Approximately 10 minutes later the ambulance collided with a minivan. She arrived at the hospital in another ambulance around 5:50 a.m. and the fetus was pronounced dead.

The number of childbirth facilities in the nation declined from 4,200 in 1993 to 3,000 in 2005. In 2004, obstetricians and gynecologists nationwide numbered about 10,600, a 7 percent drop from 1994. The government must take urgent measures to increase the number of obstetricians and improve their working conditions.

It is possible that miscommunication also contributed to the tragedy. If the paramedics had better explained the urgency of the situation to doctors, the woman may have been admitted earlier. The collision between the ambulance and the minivan also serves as a reminder that the police must work harder to make drivers aware that they must give way to emergency vehicles.

Nara Prefecture has a computerized network of hospitals to help those in an emergency find a suitable and available hospital. To do this, however, the patient's doctor must make a request to a member hospital. Since the woman did not have a regular doctor to make the request, the ambulance team could not use the system. The prefectural government must quickly rectify this system's absurd inflexibility.

8月末、奈良県橿原市の妊婦が救急搬送途中に、9 ヶ所の病院で受け入れてもらえず、救急車内で胎児は死産した。昨年8月には、出産途中に意識不明になった奈良県の女性が19ヶ所の病院に転送を断られ、20ヶ所目で出産したが、8日後に死亡した。

これらの事例は、産婦人科医の不足と、危険な状態の妊婦を搬送するシステムの改善を怠った奈良県に問題があることを示している。

奈良県には、危険な状態の妊婦を高度の機能を持つ病院に転送するために、各病院のベッドの空き状況や医師の態勢を確認できる情報検索システムがあるが、このシステムを利用するためには、妊婦のかかりつけの医師が関係病院に依頼する必要がある。問題の妊婦はかかりつけの医師がいなかった。県当局はシステムの硬直した運用規則を早急に改めねばならない。