Why You May Be Refused Medical Treatment In Japan

Many countries, including Japan, have adopted the Good Samaritan doctrine. It is used by rescuers to avoid civil liability for injuries arising from their negligence and cannot be charged if the rescuer attempts to help the injured party, provided the attempt is not made recklessly and no reward is exchanged. The purpose is to encourage emergency assistance by removing the threat of liability for damage done by helping.

The key points of this law are:

1. The care rendered was performed as the result of the emergency.
2. The initial emergency or injury was not caused by the person invoking the defense.
3. The emergency care was not given in a grossly negligent or reckless manner.
4. The rescuer cannot benefit from the Good Samaritan law.

Despite Japan having such a law, one keeps reading or hearing horror stories about the Japanese healthcare system or may even be unfortunate enough to have experienced being refused medical attention for whatever reasons.

In Japan, a doctor who helps a person on the street can be sued for malpractice which is dealt with under criminal not civil law in Japan should the outcome be dire. This is a a direct contradiction to the Good Samaritan doctrine but  it has happened before.

As far as the emergency departments are concerned, if the paramedics accept the patient only to find out later that the ER is not fully equipped to care for the patient, the accepting doctor can be held liable in a criminal suit. They have to be totally sure that they can take care of anything that might go wrong, otherwise these doctors might end up in jail. This could explain why ERs or doctors in Japan are so reluctant to accept patients especially during the low periods (ie. Weekends, holiday season or after hours). Many of the ERs in Japan are small, and/or are ill equipped and have very limited number of doctors at any one time (probably 1-3 doctors at most).

A widely publicized case in point:

A high risk pregnancy woman refused to be transferred to a larger hospital. She ended up dying during emergency surgery. The doctor was publicly (this was shown on TV) arrested for murder and was handed a  6 month jail sentence. In this case, the it was the opinion of the presiding judge that doctors cannot “try” to care for patients; doctors must be 100% sure. This case set the precedent for other hospitals who began to refuse pregnant women in ambulances if they don’t have all the available resources (eg. Medical personnel, equipment etc). The message that the Japanese court sent out was that if doctors accept patients “inappropriately”, it is a criminal matter.

Given these possibilities for doctors and healthcare institutions in Japan, unlike elsewhere in the world, it is not surprising that medical personnel in Japan do refuse medical treatment.

There are many other cases in Japan where people have died because they were refused medical treatment by hospitals or doctors. Below are some if you are interested to read more.

4th February 2009: Traffic accident victim dies after being refused admission by 14 hospitals

16th February 2009: Are Japan’s Emergency Rooms in Trouble?

28th April 2009: No Room for the Critically Ill In Japan’s Crowded Hospitals

It is to my understanding and experience that hospitals in many other countries do sometimes reject ambulances or patients but only on grounds that the hospital is full and never because they don’t have the right equipment or don’t speak the same language as the patient. I know for a fact that some hospitals in other countries even provide interpreters in situations where necessary. This service is available to everyone, even patients who are subsidized by the government or have no medical insurance and is not reserved for only the wealthy.

So know that the next time you are refused admission to a hospital or medical treatment by a doctor in Japan, these are all possible reasons why you were told what you were told. I am not saying that these reasons are acceptable. I am saying the Japanese healthcare system and criminal laws need to change because something is very wrong here.

* Parts of the information provided in this post courtesy of Dr J. Lea, FAMS, MBBS, MMed (Surgery) Consultant, Trauma Surgery.

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