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.

They accept Japanese National Health Insurance as well as private patients. House call services are provided also.

More information can be found here.

A note to readers out there:

The actual name of the doctor has been replaced in this post and in the accompanying comments from those who have been following this discussion. I would like to state that none of the concerned parties in relation to this post have contacted me regarding this move.

By highlighting this situation, it is in the interest of concerned parents to know that such an occurrence is not unlikely in Japan (or anywhere else in the world for that matter). Hopefully, by bringing this incident to your attention, parents can learn from the pitfalls, form opinions and set expectations about what is required from healthcare professionals (doctors and hospitals alike) before finding yourselves in a similar situation.

To set the record straight, our experiences so far with the clinic staff and the other doctors whom we had seen previously were always satisfactory without any glitches. It is in our opinion that the clinic is still one of the best choices for foreigners in Tokyo.

I would like to thank everyone who has responded and left a comment so far, especially Woodrow Martin who got the discussion ball rolling.

Mini Me
(23 March 2010)

Our experience with Dr XXX from Tokyo Medical & Surgical Clinic over the weekend left such a bad taste in our mouths that i feel other parents should know this.

Our 2 year old daughter fell and hit her head with great force on a sharp edge of a stone corner along a pavement yesterday. As it was Sunday, we called the clinic’s emergency telephone number to obtain the on-call doctor’s contact number and this was how the phone conversation went (thanks to the history list on my mobile phone, i could get the exact times and durations of the phone calls!):

At 12.00pm, i contacted the on-call doctor, Dr XXX, and was asked the questions below (my answers follow the questions):

I was told to observe her and Dr XXX then spent the next half of the conversation emphasizing several times that the clinic was currently closed  and made it very clear that she could not see us. Obviously she felt it unnecessary for further medical attention.

The entire call lasted 4 minutes.

6 minutes later at 12.10pm, Dr XXX called back but i was not able to answer the call. We were busy trying to arrange for our daughter to receive further medical attention. At 12.29pm, I returned her call only to be told that she could see my child and that she was already in the clinic. She had a 1pm appointment with another patient so therefore, she could see us at the clinic before or after the 1pm patient. Somehow, between 12.04pm and 12.10pm, she apparently changed her mind and suddenly could see us at the clinic. Why else would she called me back? For obvious reasons, we did not take up her offer.

The next morning, the clinic called up to inform us that we would be billed for the “phone consult”. I was disgusted. It was not the fact that we had to pay (our insurance company pays for it anyway), but more so the fact that after spending half the time trying to convince us that the clinic was closed and that we could not see her, Dr XXX apparently changed her mind barely a few minutes later and offered us the opportunity to bring our child to her. If she did not have another patient to see at 1pm, would she have offered to see us at the clinic?

I have worked with trauma doctors for several years before. No one (especially doctors!) needs to be told that serious head injuries may involve injuries to the brain. The only way to assess the extent of seriousness is to do so with a face-to-face examination before any respectable conclusion can be made. Difficulty breathing, shock, spinal injuries, and severe bleeding are all life-threatening injuries that may occur along with a head injury and require immediate medical attention. Injuries to the spine, especially the neck, must be considered when a head injury has occurred. It is impossible to assess all these things through a phone call.

On the bright side, we managed to get our daughter to appropriate medical attention at Daikanyama Medical Clinic in Daikanyama Plaza on that Sunday (It’s in the same building as Daikanyama Dental Clinic and Hillsideview Orthodontic Office directly opposite Daikanyama Tokyu Apartment) . By this time, our daughter was already complaining of a headache, the bleeding did not stop and the swelling had spread to her nose. The clinic was equipped with an x-ray machine and a CT scan. There, our child received a proper medical assessment, a CT scan to confirm for any internal bleeding or skull fracture, and had her wound attended to. The receptionist there spoke very limited English but Dr Yasuyuki Ueki was able to communicate well in English.

Parents may want to note also that The American Academy of Pediatrics recommends that parents contact their child’s healthcare provider for advice for anything more than a light bump on the head.

This being said, most head injuries are usually mild and not associated with brain injury or long-term complications. Very rarely, children with more significant injuries may develop serious complications (eg, brain injury or bleeding around the brain).

However, as a parent, would you take the chance and rather downplay your child’s head injury instead of getting it physically assessed? Well, Dr XXX was certainly more than willing and very quick to take this chance with our child.