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Cases of emergency patient refusal by hospitals rise to over 16,000

28 Comments

More than 16,000 emergency patients brought by ambulances to hospitals last year were refused admission by at least three hospitals, the Fire and Disaster Management Agency said in a report released to media on Friday.

In 2010, the number of emergency patients refused by at least three hospitals -- a parctice which has been dubbed "ambulance passing" by the Japanese media -- was up by more than 3,000 cases compared to 2009.

The agency, which is a branch of the Ministry of Internal Affairs and Communications, said in the report that last year represented the highest refusal statistics on record. The agency also recorded 727 cases in which emergency patients were turned away from more than 10 hospitals. In one case, an emergency patient was refused by 41 different hospitals.

Reasons given for the refusals included doctors were busy in surgery or consultation, lack of available beds and equipment, and no specialist on duty able to treat the specific condition.

© Japan Today

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28 Comments
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This should be list under CRIME!

7 ( +9 / -2 )

hidoi

-1 ( +0 / -1 )

My youngest daughter almost died because of that

-2 ( +2 / -4 )

Are there not enough Hospitals in Japan ? Especially in the Cities There should be more than a few as Large as Roppongi Hills even. I never heard of someone being turned away from a Hospital emergency room, maybe i just does not happen in the US.

0 ( +1 / -1 )

There are lots of hospitals, but too many of them are small and privately owned, minimally staffed--though there is a lot of consolidation going on, finally, as owners retire and the "business" of running a hospital is finally beginning to be treated as a business.

The U.S. has the Emergency Medical Treatment and Active Labor Act, which requires all hospitals with emergency departments who also accept Medicare to accept all patients transported for emergency care. Unfortunately, this altruistic piece of legislation, while cutting down significantly on admissions refusals, has in many case also resulted in astonishing waiting times and so-called "boarding" (essentially, parking patients in the hallways); in some cases, treatment is delayed so long that the patient doesn't survive.

So it's not really as simple as accepting everyone that comes in the door, by ambulance or otherwise.

Still, it's surprising that, given the system of public insurance here, no laws are in place to require at least public hospitals to accept all emergency patients. At the same time, the definition of "emergency patient" in the article above is vague--does it mean true medical emergencies, or anyone who happened to be transported in an ambulance, regardless of condition??

(The U.S. EMTALA does not require emergency rooms to accept non-emergency patients, but as the name implies, they cannot under any circumstances turn down a woman in labor.)

2 ( +3 / -1 )

Yes, it's as bad as it seems. And it makes me wonder where all this money we pay into the health care system goes.

-2 ( +1 / -3 )

So much for socialized medicine.

-1 ( +1 / -2 )

Hippo, I'm sorry to hear this practice affected you, but it looks like everything worked out in the end. Thankfully I've never had a bad experience with Japanese hospitals, but it sounds like this is enough of a problem that something should be done about it.

0 ( +1 / -1 )

too much complaining, too many excuses

0 ( +2 / -2 )

Japan has the most hospitals per square mile that I've seen anywhere in the world. The problem here isn't an absolute lack of space, but rather a lack of organisation and co-ordination. This situation could be solved by simply implementing legislation to require each prefecture to maintain a database that records the equipment and staff (by speciality) on duty at each hospital and beds available. Then when an emergency call comes in the dispatcher can simply cross-reference the paramedics' initial assessment of the specialist and equipment required with the nearest hospital that had beds, then dispatcher routes the ambulance to that hospital and reserves a bed provisionally for the patient. Ideally I see this sort of system as not requiring a dispatcher at all, but rather the paramedic ticking boxes on a 1-page form on a 3G enabled device like an iPad, and then the device returning the closest hospital and communicating that information to the driver's GPS immediately.

If this system was implemented then it would drastically reduce the time taken for patients to receive the correct care (those familiar with the "golden hour" concept would realise that this would also increase the patients' chance of survival). It would also firmly place the responsibility on hospitals to maintain their records correctly and remove any possibility of hospitals refusing patients for extraneous reasons (reluctance to accept patients who are highly likely to die, who have infectious conditions, or will require additional attention like foreign patients). If hospitals failed to accept a patient in accordance with their recorded capacity and expertise then it would also provide a legal basis for the hospital to be sued.

Honestly this system isn't simple, but it isn't rocket science either, and the fact that there isn't already a system like this in place is frankly a complete disgrace.

1 ( +2 / -1 )

Frungy.

Such a system is in place and has been for years. A few years back they did a report on it on TV.

They found that many of the Hospitals and Doctors don't update the stats/data on it and thus the ambulance drivers have to call each Hospital on their keitai's to check about status.

Like the system is supposed to show when a Doctor is doing a surgery, etc some places hadn't entered ANY data for months. At that time they were looking into automating a lot of that data entry.

2 ( +3 / -1 )

Zenny11

I don't know whether to hit "good" for your informed reply, or "bad" at such a pitiful state of affairs in the 21st century with Japan's population paying good money for so-called healthcare. Either way, thanks for the info.

0 ( +1 / -1 )

I suspect the Hospitals do not want to change their system, and are doing all they can to stymie any attempt to modernize or change. See it before in the work place.

-2 ( +1 / -3 )

Ask a doctor in Japan if they are aware of the Hippocratic oath.

Ask one if they ever took an ethics class at university.

They ask the knob why the JMA does not allow non-Japanese to practice medicine in Japan.

Chances are you will get empty stares and pathetic excuses.

If you want to get admitted, do what we did when my mother-in-law had cardiac arrest: get a taxi to the hospital and do the CPR yourself. They can't radio you with a lame excuse.

-1 ( +2 / -3 )

Japan: the safety country indeed...

-1 ( +0 / -1 )

I have no idea of other rich countries comparable to Japan, but this is inhumane. Much as I love Japan, this is cannot be accepted. I know doctors overwork here, true, but you can never ever refuse to attend a sick person whose life is at risk, you are less than human if you do so.

-1 ( +2 / -3 )

Its not right, but It is inevitable. And its only going to get worse with the shortage of doctors, the aging population, and the fact that the people in charge of admissions are not those who actually deal with the patients.

We all know that the doctors are not sitting round twiddling their thumbs though. We need more doctors working in big hospitals, instead of working there for a while, and then moving on to their own, very well paying, clinic.

But yea ... it does suck for those who need emergency help. HOWEVER ... are these statistics including all the ba-chans who phone an ambulance for a spilt cup of tea too? We have to look at both ends of the scale, IMO?

-1 ( +1 / -2 )

People here are so into going to the doctor when they do not need to go. It is a paranoia situation. The masks, and the scrubbing of hands is just crazy. Little Yu-kun gets a sniffle, and mama drags him to the doctor. They put the humidifier on his face, write a prescription for 6 or 7 kinds of drugs, and take the kid home and wrap him up in lots of blankets. If the doctors office is closed, they do the next best thing. Go to any emergency room. Most patients are not emergency cases.

-1 ( +2 / -3 )

Someone please tell me again: how wonderful the Japanese health system is; how Japanese respect the sanctity of life; and, about the legendary Japanese ability to plan/organize/focus on details. All three are horribly missing here, and people are dying asa result.

0 ( +2 / -2 )

Agreed with the above. For whatever reason patients often stay in the hospital much longer than they need to so that Japan has one of the longest hospital stays in the world, if not the longest. First order of business is to kick out the minor cases when the problem is one of space.

0 ( +1 / -1 )

Zenny11Jul. 23, 2011 - 07:53PM JST Such a system is in place and has been for years. A few years back they did a report on it on TV. They found that many of the Hospitals and Doctors don't update the stats/data on it and thus the ambulance drivers have to call each Hospital on their keitai's to check about status. Like the system is supposed to show when a Doctor is doing a surgery, etc some places hadn't entered ANY data for months. At that time they were looking into automating a lot of that data entry.

Thanks for the information. I'd say then that anyone that's turned away from these hospitals because of poor record keeping should be suing the hospital. Doctors all know that time is critical in emergency care, and failing to update their records is costing lives, so this is malpractice, plain and simple. I know that if I'm every turned away from a hospital if I survive my first step will be to contact my lawyer, have him look into whether the hospital I was turned away from kept their records up to date, and if not then I'll sue them for every last yen they have.

Sadly this is probably the only way to make them sit up, pay attention and hire some minimum wage clerk to update the doctors' statuses, because seriously that's all it would really take.

0 ( +1 / -1 )

Japan has clinics and hospitals. Doctors who work in hospitals earn low pay and work long hours. In many hospitals, they are required to do night duty. The hospital must have a certain number of doctors on duty. It is not important about the speciality of the doctors, just the number on duty. This means that, if you have five doctors; 2 are new graduates, one is a foot specialist, one nutrition and one African skin diseases. So impossible to treat A&E emergencies. They have to send them on....

-1 ( +0 / -1 )

I think Japanese health care is great. But as I mentioned above, the hypochondriacs bog down the whole system at times...especially in the evening hours.

-2 ( +0 / -2 )

No system in the world is perfect. It's all in a matter of degrees of how much crap we're already used to or are willing to take. I've had good experiences in Japanese hospitals, and I've had bad ones.

Preventative medicine in Japan is a wonderful thing. Care for minor ailments is excessive to a fault. But when it comes to emergency care, U.S. hospitals beat Japan's without question.

Just last week I had a really severe asthma attack at 2AM and had to go to the emergency room. Like a fool, I decided to call ahead to the university hospital, thinking because I had been treated there in the past for asthma, it would be a safe bet. Imagine my surprise when the person on duty told me that they couldn't provide emergency treatment right away because they were busy. He recommended I call another hospital.

I called the other hospital and the person in charge was noticably inconvenienced by my request for emergency care, asking me (and I'm not exaggerating), "You don't seem to want an ambulance, so can't it wait until morning?" When I said it couldn't, she gave a deep sigh, and said, "Fine. Come in," then hung up on me.

Gee. Should I head on over to that warm welcome. I decided to go back to my original plan and just head straight over to the much closer university hospital. I get there and hacve to wait in the reception area for about an hour. No problem. I was warned as much, but I figured, I'm not moving. I can rest.

Turns out what I was waiting for was the staff of two doctors, three med school interns, and four nurses to finish taking care of the two -- two -- patients that were ahead of me, one an elderly woman who had sprained her wrist and said goodnight to me on her way out.

It turns out that this emergency room, the biggest and most modern in the city, has only two exam rooms to handle emergencies.

Meanwhile, do I get a specialist? No. Do I get a doctor? No. Do I get a trained nurse? No.

I get a med student learning how to treat his first asthma attack, with a mentor standing by coaching this kid on how to do a blood gas drawing, even though it was established by the nurses immediately upon entering the exam room via a piece of proven tech that's been around for 20 years that my blood oxygen saturation level was 90% and that I was indeed having an asthma attack, as if my blue lips and fingertips weren't a dead giveaway.

But no, this kid spends time trying -- and failing -- to find out my blood sat levels the old-fashioned way. He fails three times over the course of 40 minutes to find an artery, digging around in my arms and legs. I still can't breathe. I can't really draw enough breath to talk either. And my head's on the desk they have me sitting at while the med student tries to figure out what to do next. I still haven't received a drop of medication to open up my airways. And the mentor is standing by the entire while, smiling patiently as his student gets frustrated at being unable to complete a redundant task.

Then the student doctor decides to give me lsome medication in a nebulizer. But for some reason, he decides to lowball the dosage. Why? Because he's a med students. When it becomes clear after the entirely-too-short 5-minute nubulizer treatment that it's not working, he orders another 5-minute session at the same low medication dosage. Imagine his surpirse when it still doesn't work.

At this point, I'm angry, and I tell him I need a shot of epinephrine and a 45-minute nebulizer treatment. He looks at me with surprise and asks, "Epinephrine? You don7t mind if we give you that?"

At this point I want to strangle the moron. Emergency Asthma Attack Treatment Basics: Administer epinephrine immediately to open op the airways and stabilize patient.

He apparently was worried that I'd be adverse to this course of treatment. No, I'm not joking.

So, he gives me the epinephrine at 5AM. My airways open up. But wouldn't you know it? He lowballs the epinephrine dose as well. And I'm flat on my back again in 15 minutes. He scratches his head and tells me, "You should take a nap," and leaves the room. I don't see anyone for an hour.

Then at 6AM, the morning staff rotation begins and an actual honest-to-goodness doctor shows up. He glances at my chart, checks my blood sat level with the gizmo, sees that it's at 91%, asks me how I feel. I say, "Not to good." And he tells me, "Okay, you can go home now."

I'm simply stunned at this point. I'm no better than when I came in, and in fact worse, all things considered. As I stagger out of the emergency room, I apparently look rocky enough for the receptionist to run out and ask if I 'm okay. I told him I'm not, but that I was sent home. He just shakes his head and tells me to take care, before heading back to his desk.

The result of this wonderful emergency care? I spent the next two days hospitalized with an oxygen mask and an IV drip of anti-inflammatory steroids at a hospital across town, with the doctors asking me why I was sent home from the university hospital in the first place. To which I had no answer.

God help us if there's ever a natural disaster, because this, the largest hospital in a city of 160,000, can only handle two emergency cases at a time, and the other hospitals don’t seem to want to be bothered with the inconvenience of emergencies.

Like I said, I've had good experiences here -- when it wasn't an emergency. This most recent experience, however, has put the system in a whole new light for me. Emergency health care here is abysmally inadequate.

1 ( +3 / -2 )

LFRAgain - your story blows my mind, for the story itself and the fact that this is happening every night and people are dying asa result.

I agree - on the one hand trips to the doctor here are far easier than in the UK (at least here you can actually SEE a doctor) but people in general and Mothers of young kids in particular seem to vastly overmedicate, all of which is of course encouraged by the clinics as they make more money from people paranoia. But emergency medicine - its shocking.

the paramedics' initial assessment of the specialist and equipment required

Are the "paramedics" here actually paramedics, trained to make that kind of assessment? The crew that came to pick my husband up when he was knocked down by a car were clueless and racist to boot - they marched up to me - the only foreigner on the scene - immediately on arrival to yell at me for my "bad driving", totally ignoring the actual driver and my husband bleeding on the floor.

Then without any neck/back/vital signs/shock etc assessment whatsoever they tried to pull him to his feet (spinal injury?).

I took my son in in the early hours of the morning a few weeks ago with intense stomach pains. I was getting a bit concerned about appendicitis as it wasnt letting up. The first thing the doc said - without even touching my son - was that it couldnt be appendicitis because that was rare in children. Besides which, if it was appendicitis he would also have intense stomach pain. I pointedly looked at him writhing around in agony clutching his stomach, and pointed out that it is notoriously difficult to diagnose because it can present with all sorts of funny symptoms that mimic other conditions (dry mouth, vomiting, fever, referred pain etc) but a simple examination and/or eco will reveal potential inflammation and if in doubt, whip it out. He just stared at me open-mouthed with wonder at how someone as apparently clueless and stupid as a Mother could possibly KNOW such complicated medical procedures as basic diagnostics, and switched tacks to berate me for having given him acetaminophen for the pain because "it doesnt work on this kind of pain" -yeah, well, no sh#$ sherlock, THATS WHY I BROUGHT HIM HERE!!!!

British preventative medicine is virtually non-existent, access to GP`s woeful, but our ER medicine is really good. Japan seems to be the other way around. Until this gets fixed I just hope and pray we never need real ER treatment.

0 ( +0 / -0 )

LFRAgain - thanks for sharing your story. Sorry to say, but not shocking as I have heard this kind of tale time and again. I sincerely hope you never have to experience that again!

As for the hospitals refusing patients, it is always interesting to talk about the movie "Sicko" with people in Japan. They see Michael Moore's portrayal of the healthcare system in America and thank their lucky stars they were born in Japan. But I wonder which is better? Being refused treatment in a system where you are asked about your insurance status or one where everyone is evidently covered and yet still refused treatment in an emergency situation?

0 ( +0 / -0 )

We brought a Japanese man who was sufferingfrom a reaction to a wasp sting to Onna clinic in Okinawa. He had lost consciousness abd stopped breathing due to swelling in the throat, he was sweating and his skin looked gray. Our medic was not trained or equipped to open his windpipe with an airway or tracheotomy, nor to administer oxygen or epinephrin. We called ahead to the clinic and they started refusing us, but the nearest hospital was over 30 minutes away and as the victim had already stopped breathing during our evacuation from the worksite I believed we had no time. We continued to the clinic and the man at the reception continued to refuse to allow us to speak to the doctor. I had to scream out loud so the doctor who was in a treatment room down the hallway could hear us. Once he heard my description of the sting and the signs he ran out and he treated the victim in our vehicle, as there was obviously no time to bring him inside. After receiving epinephrin by IV he started breathing again and regained consciousness. The doctor himself said the man almost died. Because of later events I believe he may have had lasting effects as it is, and I wonder if a slightly quicker treatment would have made the difference. I was especially disappointed because they advertise they operate an ambulance and I had visited this clinic earlier while preparing our safety plan, and had received their assurance that I could rely on them for emergency treatment during business hours.

1 ( +1 / -0 )

@ Liz Many hospitals are paid by the national health insurance system for the number of days a patient occupies a bed, whether that's needed or not, obviously if the patient is not very sick he/she won't be much trouble, nor require expensive other measures or staff time. The patient pays bout 20 percent of what the insurance pays I believe. I suspect that may have something to do with this Japan having "one of the longest hospital stays in the world" issue- almost (social-) insurance fraud?

1 ( +1 / -0 )

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