The earthquake and tsunami--observations by Japanese physicians since the 11 March catastrophe.

Japan was struck by a magnitude 9.0 earthquake and a tsunami on 11 March 2011. Although this catastrophe has caused the most devastating damage to Japan since World War II, we believe that our systematic preparation for disasters somewhat alleviated the damage. Learning lessons from the magnitude 7.3 Great Hanshin earthquake in 1995, the government organized approximately 700 medical teams specialized in disaster management. In this earthquake of 2011, hundreds of medical teams were successfully deployed and started operations within the first 72 hours. Furthermore, the internet, which was not commonly used in 1995, made significant contributions in communication among clinicians and enabled them to promptly identify the needs of the affected hospitals. In addition, medical professional societies took leadership in the logistics of transferring victims away from the disaster zone. We also observed that the spectrum of causes of death is distinct between the earthquakes of 1995 and 2011. In 1995, many victims died from trauma, including crash injury, and delays in providing hemodialysis contributed to additional deaths. In 2011, in contrast, many victims died from drowning in the tsunami, and most survivors did not have life-threatening injuries.

Healthcare safety committee in Japan: mandatory accountability reporting system and punishment.

PURPOSE OF REVIEW: The publication of To Err is Human by the Institute of Medicine highlighted the increased international concern about patient safety. Each country has developed its own medical adverse event reporting system. In 2007, the Japanese government attempted to establish a new accountability system in medicine, after an obstetrician was arrested for manslaughter. This paper reviews how this accountability system affected Japanese physicians' behavior, and describes different types of medical adverse event reporting systems. RECENT FINDINGS: In general, reporting of adverse event systems can be either mandatory or voluntary, with the purpose being either for learning or for accountability. The goal of a newly proposed mandatory accountability system from the Japanese government was to investigate the cause of death in medical cases in order to clarify liability. Reports generated by this system could potentially be cited in civil law suits, administrative sanctions, and criminal prosecutions. After announcement of this new system, Japanese physicians began to act defensively, fearing criminal prosecution. Refusing to see high-risk patients and 'bouncing' (sometimes referred to as 'turfing' or 'dumping') to other hospitals became national phenomena. In addition, medical school graduates began avoiding highly legally vulnerable specialties. Even though this new system is not yet legalized in Japan, at least 153 obstetrics hospitals and 3320 clinics have closed. SUMMARY: The new system of investigating medical adverse events in Japan allows for incident reports to be utilized in court. This has led to widespread fear of prosecution and defensive medicine. The lessons from Japan should be considered when other countries implement nationwide accountability systems.