NationStates Jolt Archive

Man injured in traffic accident dies after being rejected by 5 emergency centers

Sunday, January 6, 2008 at 03:52 EST

OSAKA — A 49-year-old man who sustained injuries in a traffic accident died after being rejected by five hospital emergency centers in Osaka, police and ambulance staff said Friday. Masao Nishimura collided with a car while riding a motorcycle at around 10:20 p.m. Wednesday in Higashiosaka. He was still conscious when the ambulance crew arrived at the accident scene at 10:33 p.m., they said.


They asked five medical emergency centers in Higashiosaka and the vicinity via phone to accept him, but all of them rejected the request, saying their doctors were busy or that all of their beds were occupied. Nishimura was finally accepted at a hospital in Suita, Osaka Prefecture, some 15 kilometers away from the accident site at around 11:25 p.m., but died of damage to a main artery at 1:45 a.m. Thursday.
http://www.japantoday.com/jp/news/424276/all

This is a relatively common occurance in Japan.
Some recent examples: http://ap.google.com/article/ALeqM5gj51sFlY0uvQOGTQ9NLqbVgPhcCAD8TQBL0O1
http://articlestash.blogspot.com/2007/09/16-hospitals-rejected-pregnant-chiba.html

At least 2,780 pregnant women were rejected by at least one hospital, 191 of whom were rejected by at least five, between 2003 and 2006.
http://articlestash.blogspot.com/2007/09/191-multiple-refusals-of-pregnant-women.html
The news site that had the original

The site with the first story had this question:
"Should hospitals that refuse to admit emergency patients be subject to criminal prosecution?" (Poll question.)

What say you all?

Only if they could have actually provided emergency treatment without endangering existing patients.

I used to work in a hospital for a while doing dispatch in the wee hours of the morning, there would be a point where we would go "lock down" which basically meant we didn't have the room/beds/doctors for any more trauma patients. It would be worse for the patients to show up than if they just went to another hospital.

I don't know squat about hospitals, but that sounds tragic.
i'm glad i don't work in a hospital (purely, because of the long hours, and crap they get, well that i hear of).
go nurses, and doctors and paramedics, and secretaries, and those emercency call receiving people.
Did you know, that in one case in UK, a man was jailed for calling emergency services too much, his excuse? "i liked the woman's voice", i mean come on how can you get turned on by "hello what service do you require?"(by the way if you don't like me saying these little Did you know things, just tell me, i won't mind honest.:)

I know crap all about japanese law, and only slightly more about US health care law, but to hazard a guess, I would say it would not be illegal to turn him away if they were literally incapable of providing any service to him.

The general standard is that you must do all you reasonably can. If there's nothing you can do, there's nothing you can do.

Only if they could have actually provided emergency treatment without endangering existing patients.

this, it's sad that they couldn't provide help though, they need more hospitals.

The general standard is that you must do all you reasonably can
It appears that the only reasonable thing they could do was send him to the next hospital....and so on...until he ran out of options.

http://www.japantoday.com/jp/news/424276/all

This is a relatively common occurance in Japan.
Some recent examples: http://ap.google.com/article/ALeqM5gj51sFlY0uvQOGTQ9NLqbVgPhcCAD8TQBL0O1
http://articlestash.blogspot.com/2007/09/16-hospitals-rejected-pregnant-chiba.html

At least 2,780 pregnant women were rejected by at least one hospital, 191 of whom were rejected by at least five, between 2003 and 2006.
http://articlestash.blogspot.com/2007/09/191-multiple-refusals-of-pregnant-women.html
The news site that had the original

The site with the first story had this question:
"Should hospitals that refuse to admit emergency patients be subject to criminal prosecution?" (Poll question.)

What say you all?
Does Japan have single payer national health care?

http://www.japantoday.com/jp/news/424276/all

This is a relatively common occurance in Japan.
Some recent examples: http://ap.google.com/article/ALeqM5gj51sFlY0uvQOGTQ9NLqbVgPhcCAD8TQBL0O1
http://articlestash.blogspot.com/2007/09/16-hospitals-rejected-pregnant-chiba.html

At least 2,780 pregnant women were rejected by at least one hospital, 191 of whom were rejected by at least five, between 2003 and 2006.
http://articlestash.blogspot.com/2007/09/191-multiple-refusals-of-pregnant-women.html
The news site that had the original

The site with the first story had this question:
"Should hospitals that refuse to admit emergency patients be subject to criminal prosecution?" (Poll question.)

What say you all?

Hospitals with ER's can reach "saturation", when this happens, there is no longer room for any more patients in the ER... No beds, no doctors, no nurses... All are occupied with emergency patients... And while it's sad, I do not think they should be held criminally responsible for simply no longer having any more resources available for new patients... It's far better that the emergency crews be notified so they can keep looking for a new hospital who may be able to provide assistance, that to deliver them to a saturated hospital where the patient would merely die before getting the help he/she needs.

I used to work in a hospital for a while doing dispatch in the wee hours of the morning, there would be a point where we would go "lock down" which basically meant we didn't have the room/beds/doctors for any more trauma patients. It would be worse for the patients to show up than if they just went to another hospital.

yep. I work at a hospital, and sometimes I go to the ER to work on some computer problem and... organized chaos is shown. every bed filled and some are waiting in the waiting room. sometimes a hospital is just overloaded and cannot take anymore without endangering the patients. at least they called around before trying to take him via ambulance to the hospitals.

It appears that the only reasonable thing they could do was send him to the next hospital....and so on...until he ran out of options.

and if that's the case, then there was, tragically, nothing different that could be done.

yep. I work at a hospital, and sometimes I go to the ER to work on some computer problem and... organized chaos is shown. every bed filled and some are waiting in the waiting room. sometimes a hospital is just overloaded and cannot take anymore without endangering the patients. at least they called around before trying to take him via ambulance to the hospitals.

isn't there any protocalls or something that are in place the hospitals can use? when it becomes overfilled, i dunno let go of the drunk ballasts, and send them to a mosque or something?
oh and good luck with the hospital thing, one of my friends is a nurse, and she's pretty tired most of the time we see her.

[side thread] I've heard that in some countries, it's not illegal to not get out of the way of emergency vehicles like Ambulances, Fire Truckes, etc... is this true? [\side thread]

isn't there any protocalls or something that are in place the hospitals can use?

Yes, it's called "when they reach critical mass, send the overflow to another hospital".

isn't there any protocalls or something that are in place the hospitals can use? when it becomes overfilled, i dunno let go of the drunk ballasts, and send them to a mosque or something?
oh and good luck with the hospital thing, one of my friends is a nurse, and she's pretty tired most of the time we see her.

They will discharge people as fast as they can, but a hospital has a limited number of monitored beds, if they fill up, they are full, there isn't anything they can do about it. There are maybe 10 hospitals within a 30 mile radius here, it's not a huge deal to go to another (4 of them are within a mile of each other). As far as trauma we only have one ER that is a level IV trauma center, if the trauma beds are full then people die, and it sucks, but I can't even begin to explain how to fix the problem without hijacking the thread.

isn't there any protocalls or something that are in place the hospitals can use? when it becomes overfilled, i dunno let go of the drunk ballasts, and send them to a mosque or something?
oh and good luck with the hospital thing, one of my friends is a nurse, and she's pretty tired most of the time we see her.Yes, it's called "when they reach critical mass, send the overflow to another hospital".

Hard to say who's there for a bed and who needs the care. especially if they guess/diagnose wrong, they are liable for damages.

so Neo Art's right. when the hosptial is saturated or full census (all beds filled) they tell EMS to go to next nearest hospital.

Does Japan have single payer national health care?

Why, yes, it does. (http://en.wikipedia.org/wiki/Health_care_in_Japan)

They will discharge people as fast as they can, but a hospital has a limited number of monitored beds, if they fill up, they are full, there isn't anything they can do about it. There are maybe 10 hospitals within a 30 mile radius here, it's not a huge deal to go to another (4 of them are within a mile of each other). As far as trauma we only have one ER that is a level IV trauma center, if the trauma beds are full then people die, and it sucks, but I can't even begin to explain how to fix the problem without hijacking the thread.

be my guest, it's what the internet was born for, to let out stress. i do it all the time.
i always have the utmost respect for people who work in hospitals, (not out of pity or anything, but because i could never hack it in them, you need to be a really caring person for them)

It appears that the only reasonable thing they could do was send him to the next hospital....and so on...until he ran out of options.
This is a terrible conclusion. It's what you expect in an overpopulated, third world country.

This is a terrible conclusion. It's what you expect in an overpopulated, third world country.

no, it's a situation that can happen in any country, third world or superpower. Don't believe me? go to your nearest ER and ask them.

Why, yes, it does. (http://en.wikipedia.org/wiki/Health_care_in_Japan)
Why then, the government has failed its citizens by not providing the facilities they need.

Yet another example of why single payer national health care is a very bad idea.

no, it's a situation that can happen in any country, third world or superpower. Don't believe me? go to your nearest ER and ask them.
I watch the news and I don't think I would categorize this as a 'common' problem in the U.S. In fact, I challenge you to find me one example of a similar 'mishap'. People don't die in American waiting rooms and they don't die on the way to the fifth or sixth hospital.

... sounds an aweful lot like home...

I watch the news and I don't think I would categorize this as a 'common' problem in the U.S. In fact, I challenge you to find me one example of a similar 'mishap'. People don't die in American waiting rooms and they don't die on the way to the fifth or sixth hospital.

So when ERs are full in America people can still somehow receive treatment there from staff that are occupied with other patients? Do you have doctors that can be in two places at once or something?

And am I the only one who remembers that news story a while back about a man who died because a veteran's hospital refused to give him emergency treatment on the grounds that he wasn't a veteran?


Oh, and 'St. Louis hospital liable for death in waiting room' (http://findarticles.com/p/articles/mi_qn4181/is_20051102/ai_n15829274)

I watch the news and I don't think I would categorize this as a 'common' problem in the U.S. In fact, I challenge you to find me one example of a similar 'mishap'. People don't die in American waiting rooms and they don't die on the way to the fifth or sixth hospital.

I don't have to, You can do this yourself. just go to your local ER and ask them if it ever happened to them or better yet, ask the EMS drivers.

Oh and read the article. their EMS didn't 'GO' to the hospitals and were turned away, they (EMS) called the hospitals and were told that the hospital couldn't recieve the patient.

it was the fifth or sixth hosptial CALLED that they were heading to.

if they cannot provide the care a person needs without endangering existing patients then fair dos, there's nothing they can do. i was ready for a "because he didn't have insurence" clause, now to my mind that would have been criminal. however, if a hospital with a particular catchment cannot provide A&E services for it's area on a regular basis, like more than once tbh, then they should face some sort of punishment. a fine would be counterproductive (as they always are) but some sort of imposition or other would be necessary.

to fix a publicly funded hospital i would imagine new management plus extra funds for expansion/improvement of infrastructure and equipment would be required. to fix a private hospital, well, fuck 'em. no money, maybe impose some admin support, otherwise if they can't deal with their market they deserve to fail. and in the health business (*shudder*) taking on a market you cannot provide for is tantamount to willful manslaughter through negligence, or whatever the legal phrasology is. so private hospitals that fail can have their administrators and shareholders incarcerated. seems fair to me.



incidentally, something i'm entirely clueless about regarding a privatised health service:

Do companies/consortiums/whatever who buy a hospital also "buy" responsibility for a catchment area? Or do they just buy the building and provide whatever service they feel like?

I watch the news and I don't think I would categorize this as a 'common' problem in the U.S. In fact, I challenge you to find me one example of a similar 'mishap'. People don't die in American waiting rooms and they don't die on the way to the fifth or sixth hospital.

http://www.msnbc.msn.com/id/20218016/
http://www.msnbc.msn.com/id/19207050/
http://www.latimes.com/news/science/la-me-olive28nov28,1,6872155.story?track=rss

The worst of these: An Iraq war vet left to die in his barracks bed in the US: http://www.veteransforcommonsense.org/articleid/9010

This is a terrible conclusion. It's what you expect in an overpopulated, third world country.Japan is a first world country. I think this another reason to be a little weary of single - payer national health care systems.

http://www.msnbc.msn.com/id/20218016/
http://www.msnbc.msn.com/id/19207050/
http://www.latimes.com/news/science/la-me-olive28nov28,1,6872155.story?track=rss

The worst of these: An Iraq war vet left to die in his barracks bed in the US: http://www.veteransforcommonsense.org/articleid/9010

sad. :(

Glad they're closing that center tho. one would've thought a 'mass firing and hiring of new personnel... management and otherwise' would've fixed it.

but I think (s)he was asking for people dying on the way to the hospital after being turned away by saturation.

http://www.msnbc.msn.com/id/20218016/
http://www.msnbc.msn.com/id/19207050/
http://www.latimes.com/news/science/la-me-olive28nov28,1,6872155.story?track=rss

The worst of these: An Iraq war vet left to die in his barracks bed in the US: http://www.veteransforcommonsense.org/articleid/9010
Tragic as these are, they are still exceptions and do not represent the "relatively common" condition that you state exists in Japan.

Actually, they illustrate another form of ineptitude all together... Caring for patients when the patient probably should have been transferred.

sad. :(

Glad they're closing that center tho. one would've thought a 'mass firing and hiring of new personnel... management and otherwise' would've fixed it.

but I think (s)he was asking for people dying on the way to the hospital after being turned away by saturation.
The county probably should have turned the hospital over to commercial interests. We had the same thing happen to our big, charity hospital. There was a lot of griping from the poor, who had lost a social center. But the hospital is still running and still provides the superior trauma care that it did before the hand-off.

Tragic as these are, they are still exceptions and do not represent the "relatively common" condition that you state exists in Japan. no one stated that it was a 'relatively common' condition in Japan or anywhere, only that it can and has happened that hospitals find themselves redirecting EMS to other hospitals.


The county probably should have turned the hospital over to commercial interests. We had the same thing happen to our big, charity hospital. There was a lot of griping from the poor, who had lost a social center. But the hospital is still running and still provides the superior trauma care that it did before the hand-off.
the LA hostpital focused in Daistallia 2104 post had many attempts at improving it. To turn it over to Commercial interests you would need
1) a financier. someone to buy the hospital and all it's baggage (that would include any and all debt and legal responsibilities.)
2) then pay for the improvements new staff and administrators.
3) pay money to regain public trust.
4) find an insurance carrier that won't charge an arm and a leg.

that's a lot of money spent before you start seeing any positive returns.

no one stated that it was a 'relatively common' condition in Japan or anywhere, only that it can and has happened that hospitals find themselves redirecting EMS to other hospitals.

Actually, someone did.

In the first post of the topic it was stated that, "This is a relatively common occurance in Japan.
Some recent examples: http://ap.google.com/article/ALeqM5g...PhcCAD8TQBL0O1
http://articlestash.blogspot.com/200...ant-chiba.html

At least 2,780 pregnant women were rejected by at least one hospital, 191 of whom were rejected by at least five, between 2003 and 2006.
http://articlestash.blogspot.com/200...ant-women.html"

And the examples went on to describe deaths that resulted from numerous hospitals refusing care. The first link is just unbelievable -- 30 hospitals turned down one woman and the ambulance drove around for 2-1/2 hours. That does NOT happen here.

the LA hostpital focused in Daistallia 2104 post had many attempts at improving it. To turn it over to Commercial interests you would need
1) a financier. someone to buy the hospital and all it's baggage (that would include any and all debt and legal responsibilities.)
2) then pay for the improvements new staff and administrators.
3) pay money to regain public trust.
4) find an insurance carrier that won't charge an arm and a leg.

that's a lot of money spent before you start seeing any positive returns.
All I'm saying is that it worked well for Grady in Atlanta. LA should have made the effort, rather than allow the hospital to close.

Actually, someone did.

In the first post of the topic it was stated that, "This is a relatively common occurance in Japan.
Some recent examples: http://ap.google.com/article/ALeqM5g...PhcCAD8TQBL0O1
http://articlestash.blogspot.com/200...ant-chiba.html

At least 2,780 pregnant women were rejected by at least one hospital, 191 of whom were rejected by at least five, between 2003 and 2006.
http://articlestash.blogspot.com/200...ant-women.html"

And the examples went on to describe deaths that resulted from numerous hospitals refusing care. The first link is just unbelievable -- 30 hospitals turned down one woman and the ambulance drove around for 2-1/2 hours. That does NOT happen here.
oops, missed that. ;)

the first article states that the hospitals said they were full.

the second didn't give a reason.

but the third might have given a clue.
ambulance crews forced to scramble by the dearth of obstetricians in the country.

In the first survey, most of the hospitals cited an inability to offer adequate care and a lack of specialized staff for refusing pregnant women for emergency treatment.

so a lack of proper care and staff could be a reason why some of those hospitals denied service.

All I'm saying is that it worked well for Grady in Atlanta. LA should have made the effort, rather than allow the hospital to close.

and it worked for one hospital here in Hawaii, but they had to struggle to find the buyer, then to get the necessary insurance coverage...

however, it sounds like the LA hospital is only closing it's long term care and keeping to only outpatient services.

Its really unfortunate but hospitals shouldn't be punished criminally because it'll just make the problem worse

The hospital was 15km away and the man died two hours after they were able to start moving towards it. I cannot imagine that it would take two hours to get to the hospital. Not with an ambulance.

This man did not die because hospitals refused him - he died because it wasn't possible to save him.

so a lack of proper care and staff could be a reason why some of those hospitals denied service.

Let's just say that there are definately a lot of things wrong with Japan's medical system, many of which are culturally and demographically related. Poor training is a big factor. And paramedics are basically non-existant.

The hospital was 15km away and the man died two hours after they were able to start moving towards it. I cannot imagine that it would take two hours to get to the hospital. Not with an ambulance.

This man did not die because hospitals refused him - he died because it wasn't possible to save him.

Are you familiar with the "golden hour".

"There is a golden hour between life and death. If you are critically injured you have less than 60 minutes to survive. You might not die right then; it may be three days or two weeks later -- but something has happened in your body that is irreparable."
http://www.umm.edu/shocktrauma/history.htm

The man was struck at 10:20. He arrived at the ER after the "golden hour" had passed. Yes, it is possible he would have died had he been taken in in time. However, it is statistically much more likely to have lived.

I doubt it. If a hospital is full. What can they do? At least they could call ahead.

[side thread] I've heard that in some countries, it's not illegal to not get out of the way of emergency vehicles like Ambulances, Fire Truckes, etc... is this true? [\side thread]

I have been to a lot of places and can never recall seeing people not move out of the way for police or fire.

Only if they could have actually provided emergency treatment without endangering existing patients.

Somehow the notion of calling up to make an appointment to provide care for an emergency car-accident victim strikes me as the brainchild of the most macabre and racist of stereotype sketch comedians.

Its really unfortunate but hospitals shouldn't be punished criminally because it'll just make the problem worse

Hospitals? No. But the people who make these decisions should be replaced when they screw up this bad.

http://www.japantoday.com/jp/news/424276/all

This is a relatively common occurance in Japan.
Some recent examples: http://ap.google.com/article/ALeqM5gj51sFlY0uvQOGTQ9NLqbVgPhcCAD8TQBL0O1
http://articlestash.blogspot.com/2007/09/16-hospitals-rejected-pregnant-chiba.html

At least 2,780 pregnant women were rejected by at least one hospital, 191 of whom were rejected by at least five, between 2003 and 2006.
http://articlestash.blogspot.com/2007/09/191-multiple-refusals-of-pregnant-women.html
The news site that had the original

The site with the first story had this question:
"Should hospitals that refuse to admit emergency patients be subject to criminal prosecution?" (Poll question.)

What say you all?

I say, this is a sign that Japan should BUILDS MORE HOSPITALS!

Sounds like hospital system is running on bare minimum with no capacity for expansion.

I think the people not getting proper hospital care should all move to Canada. Problem solved.

I say, this is a sign that Japan should BUILDS MORE HOSPITALS!

I agree but I think the real problem in many Asian cities is where to build them. Land is extremely expensive. The amount of land an average hospital occupies is fairly large.

I agree but I think the real problem in many Asian cities is where to build them. Land is extremely expensive. The amount of land an average hospital occupies is fairly large.

True and Japan is just a volcanic outcrop on the Rim of Fire

Are you familiar with the "golden hour".

"There is a golden hour between life and death. If you are critically injured you have less than 60 minutes to survive. You might not die right then; it may be three days or two weeks later -- but something has happened in your body that is irreparable."
http://www.umm.edu/shocktrauma/history.htm

The man was struck at 10:20. He arrived at the ER after the "golden hour" had passed. Yes, it is possible he would have died had he been taken in in time. However, it is statistically much more likely to have lived.

I am now at any rate, though I believe I have heard of it before.

I looked back at the article. It seems they spent roughly fifty minutes calling around. That makes ten minutes per hospital they called. That's a long time to spend calling. One wonders if perhaps the means by which they call the hospitals are streamlined enough?

I watch the news and I don't think I would categorize this as a 'common' problem in the U.S. In fact, I challenge you to find me one example of a similar 'mishap'. People don't die in American waiting rooms and they don't die on the way to the fifth or sixth hospital.

Yes, they do.

http://www.nbc4.com/health/13503186/detail.html

I watch the news and I don't think I would categorize this as a 'common' problem in the U.S. In fact, I challenge you to find me one example of a similar 'mishap'. People don't die in American waiting rooms and they don't die on the way to the fifth or sixth hospital.


Yes, they do.

http://www.nbc4.com/health/13503186/detail.html


http://abcnews.go.com/GMA/OnCall/story?id=2458644

Yes, they do.

http://www.nbc4.com/health/13503186/detail.html
That one poor woman in LA is getting a lot more notice here than she ever did at the hospital. It's still the same woman, over and over. Hardly a "relatively common" state of affairs.

http://abcnews.go.com/GMA/OnCall/story?id=2458644

Hmmm, one case was a Spanish woman and the other was a Black woman. I think the people there were racist and enjoyed watching them die a slow and horrible death. If that is the case I hope the ghosts of those who were victimized by this inhuman bigotry get haunted.

Let's just say that there are definately a lot of things wrong with Japan's medical system, many of which are culturally and demographically related. Poor training is a big factor. And paramedics are basically non-existant. poor training is the Bane of all countries. :(

as one friend told me. Right now, there are Doctors out there that barely passed their exams... and they are seeing patients right now.

I have been to a lot of places and can never recall seeing people not move out of the way for police or fire.police and fire...yeah, but what about ambulances?

and it's tough to try to not move when you know you got either 1) a big ass truck behind you or 2) someone with a gun behind you. :p

Somehow the notion of calling up to make an appointment to provide care for an emergency car-accident victim strikes me as the brainchild of the most macabre and racist of stereotype sketch comedians.
It's not so much as making an appointment but informing the ER what kind of patient, the type of injuries and vital information so that the ER will have the necessary equiptment ready and standing by for the patient's arrival. When they are wheeling the patient into the ER is not the time to ask "what happened?"

I've heard over the reciever in our ER "EMS ## coming in from [location] with [type of injury]" many times and they would give vital stats. The receiver will either get more information to prep a room for them or if unable to receive they would reply back "EMS ## this is [name of hospital] unable to receive patient, suggest you contact [give name of nearest hospital, and reason for inability to receive patient]"

Hmmm, one case was a Spanish woman and the other was a Black woman. I think the people there were racist and enjoyed watching them die a slow and horrible death. If that is the case I hope the ghosts of those who were victimized by this inhuman bigotry get haunted.

If anyone enjoyed watching people die like that need to sit in a prison somewhere.

Edit: At least the black woman's death was ruled a homicide.

Does Japan have single payer national health care?

Why, yes, it does. (http://en.wikipedia.org/wiki/Health_care_in_Japan)
Ummmm, apparently NOT (http://www.medhunters.com/articles/healthcareInJapan.html)?

The Japanese healthcare system is highly regulated by the government and, as described by the OECD, "combines a mainly private provision of services with mandatory health insurance. Service providers are paid directly by insurers (the third payer system). Payments for outpatient care are predominantly on a fee for service basis, and inpatient care is paid through a mixture of per diem and fee for service. Fees for different medical services are set out in the Fee Schedule announced by the government and revised every two years. Between 20 and 30% of the fees are born by patients as co-payments. But with a ceiling (see below) the effective co-payment rate is about 14%."

If they cannot treat the person, they should arrange a place for them to receive treatment.

If they cannot treat the person, they should arrange a place for them to receive treatment.... from... where exactly...

or are you suggesting that the HOSPITAL, calls other hospitals to see if there's any openings? so the ems would what? wait for a call back?

I've heard that if you're going to have a medical emergency in Japan, you should do it during business hours.

I doubt it. If a hospital is full. What can they do? At least they could call ahead.

That's exactly what they were doing.

They asked five medical emergency centers in Higashiosaka and the vicinity via phone to accept him, but all of them rejected the request, saying their doctors were busy or that all of their beds were occupied.

I say, this is a sign that Japan should BUILDS MORE HOSPITALS!
Sounds like hospital system is running on bare minimum with no capacity for expansion.
I agree but I think the real problem in many Asian cities is where to build them. Land is extremely expensive. The amount of land an average hospital occupies is fairly large.

As I understand it, rather than enough hospitals, the problem one of not enough staff. As I said earlier, part of that is due to demographics. For example, hospitals may not have an Ob/Gyn on emergency call, or may not have enough, because Japan's falling birthrate has resulted in fewer Ob/Gyns.


In addition to being understaffed they're overloaded. There was an article in the Daily Yomiuri (IIRC - can't seem to find it online) late last year regarding ERs in Japan and people abusing them - walking in with relatively minor non-emergency issues - colds and drunkenness for example - and taking up valuable ER time.

I am now at any rate, though I believe I have heard of it before.

:)

I looked back at the article. It seems they spent roughly fifty minutes calling around. That makes ten minutes per hospital they called. That's a long time to spend calling.

Indeed. The note above about contacting hospitals by phone was also troubling. That may have been a mistake in the aticle, or it may be a case of there not being proper communications equipment.

I am under the understanding that Japanese EMS is not as well trained and equiped as in the US.

One wonders if perhaps the means by which they call the hospitals are streamlined enough?

Some of my experiences with Japanese medicine can confirm this.

For some nice anecdotal horror stories re Japanese medicne:
http://www.stippy.com/japan-life/bad-bad-medicine-doctors-in-japan/
http://www.stippy.com/japan-life/calling-an-ambulance-in-japan/

Yes, they do.

http://www.nbc4.com/health/13503186/detail.html

I believe that's one of the same cases I linked above.

In any case, I did some more digging and it does happen in the US - it's called "ER Diversion".

Emergency room (ER) diversions—when ambulances are redirected from one hospital emergency room to another—are becoming common in communities across the country, raising concern that critically ill patients are increasingly confronting obstacles to timely medical care. Although hospitals have long diverted patients during the winter flu season, recent site visits conducted by the Center for Studying Health System Change (HSC) reveal that ER overflows are now a year-round problem. As this Issue Brief describes, difficulty obtaining emergency services may be just the most visible evidence of deeper problems facing many hospitals as they struggle to meet growing demand for services at a time of increasing capacity constraints.
http://www.hschange.com/CONTENT/312/

SUSAN DENTZER: Dr. Niels Rathlev, vice chair of the Emergency Department, or ED, says it's one of many Boston emergency rooms that frequently go on "diversion."

Niels RathlevDR. NIELS RATHLEV: Well, diversion means that all of our acute care bays are full and at that point we make a decision that we're unable to care for yet another sick patient that's brought in by the ambulance services. We then notify the City of Boston Emergency Medical Services and inform them that we cannot accept any more ambulances.

SUSAN DENTZER: The diversion problem is pervasive here in Massachusetts -- and it's getting worse. State figures show that the number of hours Massachusetts hospitals go on diversion has risen about 50 percent in the past two years. There have been no studies to demonstrate the effects. But officials think the problem is almost certainly bad for patients -- and could be causing avoidable deaths.
http://www.pbs.org/newshour/bb/health/jan-june05/er_6-07.html

The April, 2002 American Hospital Association (AHA) survey of emergency department and hospital capacity is the latest evidence of what the AHA calls “a growing crisis.” According to the survey, 62 percent of all hospital emergency departments perceive themselves to be at or over capacity. The overload is especially severe in large city hospitals. Over 75 percent of urban hospitals and 90 percent of hospitals with over 300 beds said they were at or over their operating capacity. The strain has become so acute that many hospitals experience times when they simply can not accept all, or certain types, of patients by ambulance. These individuals must then be “diverted” to another hospital. About one-third of all hospitals, and over half of urban hospitals, reported experiencing ER diversion in the AHA study. Diverting a patient to an available facility when another is overcrowded is often the only way to assure timely treatment but, as the AHA points out, ER diversion is a warning sign of capacity constraints even under normal conditions.
http://www.physiciansweekly.com/article.asp?issueid=30&articleid=241

Anywho, as the question of legal/criminal liability seems to be answered adequately, and I hope the above establish that it isn't just a Japanese problem, on to the next question - how to fix it?

For some nice anecdotal horror stories re Japanese medicne:
http://www.stippy.com/japan-life/bad-bad-medicine-doctors-in-japan/
http://www.stippy.com/japan-life/calling-an-ambulance-in-japan/ my friends Father-in-law ended up in a Hospital in Japan, he (my friend) and his wife begged her father to come to the US to recieve treatment. If I remember correctly, she ended up practically kidnapping him to get him treated here. :p

Anywho, as the question of legal/criminal liability seems to be answered adequately, and I hope the above establish that it isn't just a Japanese problem, on to the next question - how to fix it?

can't really. as long as ER's HAVE to treat anyone who comes in... the only thing they can do is create a hospital sized ER that does nothing but trauma and would transfer patients to actual Hospitals when they're stable.

this, it's sad that they couldn't provide help though, they need more hospitals.

If he needs emergency treatment, and is able to make it to five hospitals then they have enough hospitals, they need better staff.

poor training is the Bane of all countries. :(

as one friend told me. Right now, there are Doctors out there that barely passed their exams... and they are seeing patients right now.

Over regulation and slow adaptation are common as well here. A couple of examples: 1) Low doasage birth control pills were approved by the health ministry in 1999. 2) My current main asthma control med was approved by the states in 2000, but was only approved in Japan last July.

Also, there's no such thing as a GP in Japan. Eveyone is a specialist.

police and fire...yeah, but what about ambulances?

and it's tough to try to not move when you know you got either 1) a big ass truck behind you or 2) someone with a gun behind you. :p

That's a problem in Japan.

Ummmm, apparently NOT (http://www.medhunters.com/articles/healthcareInJapan.html)?

Good one. More from the same.

The roots of Japan's public health insurance go back to 1927. As stated above, services are covered by health insurance. Health insurers are required, by law, to offer a basic package of benefits (including medical consultation, drugs, and other materials; medical treatment, surgery, and other services; home care treatment and nursing; and hospitalization and nursing at medical institutions) and they may offer additional benefits (e.g., funeral benefits, maternity allowances) under the collective scheme.

People are assigned a health insurer according to their employment situation. Those who are employed at a company or office are insured by the Social Insurance System (SIS). This system is funded by the employers (who pay varyingly from 50 to 80% of the cost) and by premiums paid by the employees. Everyone else (the unemployed, elderly, and self-employed, including lawyers, doctors, etc.) is insured through the National Health Insurance (NHI) system. The NHI system is funded by the government and the employed members of the system.

About 63% of the population is covered by SIS plans, which is delivered by about 1,800 entities nationwide known as Health Insurance Societies. Premiums depend on the employee's annual income, but amount to approximately 8.5% of their salary. An insured person and their dependents must, in addition to contributing the cost of the premium, pay 20 to 30% of inpatient and outpatient costs and make an additional co-payment for prescription drugs.

The remaining 37% of the population is covered by NHI, which is delivered through about 3,400 regional plans. Premiums for those employed persons covered by NHI depend on income, assets, and benefit payments from the previous year. The NHI also require co-payments of 30% for beneficiaries and their dependents.

A third type of insurance, known as long-term care insurance, was started in April 2000 to help cope with the aging population. (This insurance is funded half by the government and half by individuals aged 40 or older.) Users are enrolled both in health insurance and the long-term care insurance. To qualify for this insurance, which covers 90% of inpatient and outpatient health costs, as well as prescription medication, patients must be certified as in need of long-term care by a regional review board. Users must be older than 65 (or between 40 and 64 but with one or more of a list of 15 specific conditions, e.g., pre-senile dementia, cerebrovascular disease).

However, social admissions (usually of the elderly), with patients often admitted for treatment that is regularly done on an outpatient basis in other countries (e.g., diagnostic testing, minor surgical procedures, rehab, follow-up services), continue to plague the system and drive up costs.

I've heard that if you're going to have a medical emergency in Japan, you should do it during business hours.

Indeed.

Some of my experiences with Japanese medicine can confirm this.

For some nice anecdotal horror stories re Japanese medicne:
http://www.stippy.com/japan-life/bad-bad-medicine-doctors-in-japan/
http://www.stippy.com/japan-life/calling-an-ambulance-in-japan/

Ya know, honestly I haven't had any problems with it. In fact, I just got done with a week and a half stay in a hospital to get my tonsils yanked and no complaints except for the quality of the (few) kinds of food I could eat (Tofu for breakfast/lunch/dinner for 5 days) and the nurses cheerfully chirping at me at 6 am.

Maybe Nagano is just better than Kansai? ;)

Also, there's no such thing as a GP in Japan. Eveyone is a specialist.
Oi! that would be a problem.

Ya know, honestly I haven't had any problems with it. In fact, I just got done with a week and a half stay in a hospital to get my tonsils yanked and no complaints except for the quality of the (few) kinds of food I could eat (Tofu for breakfast/lunch/dinner for 5 days) and the nurses cheerfully chirping at me at 6 am.

Maybe Nagano is just better than Kansai? ;)

Never had my tonsils removed... is it that long here in the US? and at least here, you get Ice Cream!

And here's a quick post script for this thread:

200 hospitals have ended emergency care over past two years

Wednesday, January 16, 2008 at 07:09 EST

TOKYO — More than 200 hospitals in Japan have ended emergency care in the past two years due to financial difficulties and a lack of doctors, a survey showed on Tuesday.


The Asahi Shimbun, which conducted a nationwide study of hospitals, said that doctors were increasingly unwilling to work overnight shifts and that operators were finding hospitals unprofitable, particularly in rural areas.

A total of 235 hospitals — or 5.6% of those offering immediate care — stopped accepting emergency patients in 2006 and 2007, with 20 hospitals closing completely, the newspaper said.

Japan has a system of universal health care provided through insurance by employers or through local governments, but many hospitals are privately operated.

Japanese media have reported a string of cases both in cities and in rural areas in which ambulances failed to find a hospital due to recent cutbacks.

A 77-year-old woman died in March last year in Osaka as ambulance staff spent more than 40 minutes looking for a hospital after 13 hospitals refused to accept her. She had apparently suffered a heart attack in the bathtub.

In 2006, Osaka reported 104 cases in which ambulance staff needed to ask more than 20 hospitals to accept one emergency patient.

The Fire and Disaster Management Agency has launched a nationwide study on the issue in a bid to improve the emergency medical care system.

The agency has also urged patients with minor injuries or illnesses to refrain from calling for ambulances in an effort to save them for serious patients in need of emergency help.

(AFP)
http://www.japantoday.com/jp/news/425091

Only if they could have actually provided emergency treatment without endangering existing patients.

that makes sense, but why shouldn't it be part of the requirement to be licenced to opperate a hospital to have or make some provision for doing so?

that or for governments themselves, this is the first i hear of this problem in another country then the u.s., but i suppose i shouldn't be surprised it exists in any country so completely under the influence, of america's bullying, to maintain some sort of perminent 24 hour everywhere triage, for when incidents like this, as they inevitably will untill population stops increasing, occur.

(perhase someone could introduce a n.s.u.n. resolution to that effect here?)

=^^=
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