- Email: [email protected]
Will accident reports filed in hospitals in Japan be used in the future as evidence in malpractice lawsuits?
International Notes
Will Accident Reports Filed in Hospitals in Japan be Used in the Future as Evidence in Malpractice Lawsuits? TAKASHI YOKOTA, MD, YASUO KUNII, MD, SHU KIKUCHI, MD, YASUO YAMADA, MD, AND HIDEMI YAMAUCHI, MD A major drawback of submission of so-called incident reports for medical institutions is that such reports may be able to be obtained on request by patients and to be used as evidence in malpractice lawsuits. In Japan, there are no established rules concerning the use of accident reports in medical lawsuits. More debate is needed for voluntary report systems to become established in medical institutions throughout Japan. (Am J Emerg Med 2001;19:597. Copyright ©2001 by W.B. Saunders Company)
Medical accidents are becoming increasingly more frequent in Japan, with reports of such accidents appearing almost every day in newspapers. This increasing frequency of medical accidents may be attributable to the recent advances made in disclosure of medical information and/or to the recent decline in the status of doctors in Japan. Recently, there has been an increasing awareness in Japan of the importance of collection and analysis of information concerning medical accidents, and the establishment of voluntary report systems has been recommended by medical organizations and related groups to help prevent medical accidents. These systems are designed to contribute to the prevention of medical accidents by requiring submission of so-called incident reports on accidents and incidents that almost resulted in accidents by those involved. However, a major drawback of such systems for medical institutions is that such reports may be able to be obtained on request by patients and to be used as evidence in malpractice lawsuits. In fact, in September 1999, the decision to proceed with a malpractice lawsuit in Japan was made after, in addition to the acquisition of copies of medical records from the hospital, a claim for perpetuation of an accident report that had been kept in the hospital had been filed with the court. 1 In Japan, there are different views among legal specialists as to the correct interpretation of the law concerning the obliga-
From the Department of Surgery, Sendai National Hospital, Sendai, Japan. Manuscript received and accepted June 2, 2001. Address reprint requests to Takashi Yokota, MD, Department of Surgery, Sendai National Hospital, Miyagino-ku, Sendai 983-8520, Japan. E-maih [email protected] Key Words: Accident reports, malpractice, accidents, lawsuits. Copyright © 2001 by W.B. Saunders Company 0735-6757/01/1907-0013535.00/0 doi:10.1053/ajem.2001.28035
tion to submit an accident report in a malpractice lawsuit. This has very much depended on the decision of the court in past cases. In the US, submission of hospital records concerning peer reviews is generally not required in civil lawsuits. This is based on the view that protection against legal disclosure should be used as an incentive to encourage medical staff to submit accident reports to the hospital. In Japan, on the other hand, there are no established rules concerning the use of accident reports in medical lawsuits. There has not even been any debate yet in Japan over whether medical institutions should be obligated to disclose information in such accident reports. In Tokyo, the local government has taken measures to deal with this problem. A municipal ordinance was passed in July 1999 excluding Tokyo municipal hospitals from obligation to disclose information in medical accident reports l. However, this ordinance is only valid for municipal hospitals in Tokyo, and other medical institutions must make efforts to establish their own regulations concerning disclosure of such information. Some hospitals in Japan do not require the name of the patient to be included in reports on cases of incidents that almost resulted in accidents but had no effect on the patient. The reasoning for this is that the purpose of reports on such cases is to clarify what exactly happened in the hospital and should serve as a means for preventing future accidents. Because the information in such reports do not include names of patients, it can not be subjected to disclosure obligation. There is undoubtedly a reluctance by medical staff in Japan to write accident reports because of the lack of legal protection for medical staff. If the problem of information disclosure is in fact preventing progress in the establishment of preventative measures in Japan to deal with medical accidents, there must be many unfortunate victims in Japan of "avoidable" medical accidents. More debate, including debate to resolve the issue of whether the main purpose of medical accident reports is to provide information to patients or to hospitals, is needed in Japan for voluntary report systems to become established in medical institutions throughout Japan. REFERENCE 1. Shoji h A special report about incident reports. Nikkei Medical 2000;397:78-80 597
Will Accident Reports Filed in Hospitals in Japan be Used in the Future as Evidence in Malpractice Lawsuits? TAKASHI YOKOTA, MD, YASUO KUNII, MD, SHU KIKUCHI, MD, YASUO YAMADA, MD, AND HIDEMI YAMAUCHI, MD A major drawback of submission of so-called incident reports for medical institutions is that such reports may be able to be obtained on request by patients and to be used as evidence in malpractice lawsuits. In Japan, there are no established rules concerning the use of accident reports in medical lawsuits. More debate is needed for voluntary report systems to become established in medical institutions throughout Japan. (Am J Emerg Med 2001;19:597. Copyright ©2001 by W.B. Saunders Company)
Medical accidents are becoming increasingly more frequent in Japan, with reports of such accidents appearing almost every day in newspapers. This increasing frequency of medical accidents may be attributable to the recent advances made in disclosure of medical information and/or to the recent decline in the status of doctors in Japan. Recently, there has been an increasing awareness in Japan of the importance of collection and analysis of information concerning medical accidents, and the establishment of voluntary report systems has been recommended by medical organizations and related groups to help prevent medical accidents. These systems are designed to contribute to the prevention of medical accidents by requiring submission of so-called incident reports on accidents and incidents that almost resulted in accidents by those involved. However, a major drawback of such systems for medical institutions is that such reports may be able to be obtained on request by patients and to be used as evidence in malpractice lawsuits. In fact, in September 1999, the decision to proceed with a malpractice lawsuit in Japan was made after, in addition to the acquisition of copies of medical records from the hospital, a claim for perpetuation of an accident report that had been kept in the hospital had been filed with the court. 1 In Japan, there are different views among legal specialists as to the correct interpretation of the law concerning the obliga-
From the Department of Surgery, Sendai National Hospital, Sendai, Japan. Manuscript received and accepted June 2, 2001. Address reprint requests to Takashi Yokota, MD, Department of Surgery, Sendai National Hospital, Miyagino-ku, Sendai 983-8520, Japan. E-maih [email protected] Key Words: Accident reports, malpractice, accidents, lawsuits. Copyright © 2001 by W.B. Saunders Company 0735-6757/01/1907-0013535.00/0 doi:10.1053/ajem.2001.28035
tion to submit an accident report in a malpractice lawsuit. This has very much depended on the decision of the court in past cases. In the US, submission of hospital records concerning peer reviews is generally not required in civil lawsuits. This is based on the view that protection against legal disclosure should be used as an incentive to encourage medical staff to submit accident reports to the hospital. In Japan, on the other hand, there are no established rules concerning the use of accident reports in medical lawsuits. There has not even been any debate yet in Japan over whether medical institutions should be obligated to disclose information in such accident reports. In Tokyo, the local government has taken measures to deal with this problem. A municipal ordinance was passed in July 1999 excluding Tokyo municipal hospitals from obligation to disclose information in medical accident reports l. However, this ordinance is only valid for municipal hospitals in Tokyo, and other medical institutions must make efforts to establish their own regulations concerning disclosure of such information. Some hospitals in Japan do not require the name of the patient to be included in reports on cases of incidents that almost resulted in accidents but had no effect on the patient. The reasoning for this is that the purpose of reports on such cases is to clarify what exactly happened in the hospital and should serve as a means for preventing future accidents. Because the information in such reports do not include names of patients, it can not be subjected to disclosure obligation. There is undoubtedly a reluctance by medical staff in Japan to write accident reports because of the lack of legal protection for medical staff. If the problem of information disclosure is in fact preventing progress in the establishment of preventative measures in Japan to deal with medical accidents, there must be many unfortunate victims in Japan of "avoidable" medical accidents. More debate, including debate to resolve the issue of whether the main purpose of medical accident reports is to provide information to patients or to hospitals, is needed in Japan for voluntary report systems to become established in medical institutions throughout Japan. REFERENCE 1. Shoji h A special report about incident reports. Nikkei Medical 2000;397:78-80 597