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Tuesday, June 18, 2002
SIDS diagnoses seen as malpractice cover
Parents suspect mystery syndrome is being used to sidestep liability
By TOMOKO OTAKE
In June 1999, Shinobu and Shinya Ishii took their 4-month-old son, Mahiro, to a municipally run hospital in the city of Funabashi, Chiba Prefecture, for treatment of bronchitis, and were told he would be released after a week or less of care.
Two days later, the hospital called the parents at 7:10 a.m. to say Mahiro's condition had changed. A doctor told the family the baby suffered cardiac arrest earlier that morning after he was found with his face down over a bag of ice.
He apparently rolled over and suffocated while the nurse was away, the doctor reportedly told the parents, adding, "It was negligence on our part."
However, the doctor also said the baby may have had congenital abnormalities that caused his death, the parents said.
Mahiro suffered severe brain damage and soon fell into a vegetative state. He was put on life-support and died 14 months later.
After the results of detailed examinations confirmed he had no congenital abnormalities, the hospital came up with a new cause of death: sudden infant death syndrome.
"Hospital staff kept apologizing to us privately, saying it was an accident," Shinobu Ishii, 29, said. "But officially, they claimed it was a case of SIDS and therefore they were not liable."
The family filed a 114 million yen damages suit against the Funabashi Municipal Government in June 2000. The suit is still pending before the Chiba District Court.
By definition, SIDS deaths are unexpected and remain a mystery after close scrutiny and autopsies. In 2000, SIDS was blamed for the deaths of 363 children in Japan, according to government statistics.
But recently, a growing number of parents like the Ishiis are raising questions about the SIDS diagnosis. They suspect hospitals and nurseries often resort to this diagnosis to cover up fatal accidents and abuses.
Doctors have apparently made SIDS diagnoses without really understanding the nature of the syndrome.
The government's SIDS definition states that it occurs most commonly between the ages of 2 months and 5 months, but can occur as late as at 2 years old. In the last six years, however, 84 children whose deaths were attributed to SIDS were over 2 years old, including an 8-year-old boy.
More than 50 lawsuits have been filed nationwide by parents who feel their children's deaths were misdiagnosed as SIDS, according to Fukumi Kushige of the citizens' group Infant Safety Alliance.
She said the biggest point of contention in most cases is whether the children died of suffocation, as parents claim, or from SIDS, in which case defendants are cleared of liability.
"If the baby died of suffocation, the institution (hospital or nursery) would be accused of negligence," she said. "If it's SIDS, it's considered a disease and no one is liable. But I suspect quite a number of SIDS cases have actually been suffocation deaths."
Kushige, who lost her daughter in 1993 at a Yokohama clinic one day after giving birth, has led a crusade against what she terms SIDS diagnoses abuses. Most recently, she helped two families who lost their babies at nurseries.
Ryosuke Hojo died in March 2001 at 4 months old at the Ikebukuro branch of Chibikko-En in Tokyo. The child had been rolled over by an older baby who had been placed in the same bed. The firm, a nationwide chain of facilities that care for babies, initially denied negligence and claimed Hojo had died of SIDS.
A few weeks after watching a barrage of media reports, Kushige's group contacted the parents and offered help. "I thought, if left alone, it would become another case that was swept under the rug," she said.
Kushige flew to the facility along with the baby's mother and interviewed care workers. Their investigation revealed that the facility was extremely understaffed at the time — for about one hour and 40 minutes before the death, 12 babies sharing nine beds were left unattended, as were some two dozen toddlers sharing a few tatami mats.
The probe helped the Hojo family win a 62 million yen settlement from the firm in July, as well as a promise that Chibikko-En would improve management to prevent future incidents.
Executives of the chain have been indicted for professional negligence resulting in death and are now on trial before the Tokyo District Court.
Parents united again in February when a family suffered the sudden loss of their son at a private nursery in the city of Kagawa.
When Hitoki Fujishima, 14 months old, died at the nursery, it was found that his body was bruised all over, suggesting possible physical abuse.
But Iwao Ijiri, a professor of forensic medicine at Kagawa Medical University who conducted an autopsy, wrote in his report that the cause of Fujishima's death was "suspected SIDS" — wording not as definitive, but enough to discourage police from probing further.
The baffled Fujishimas located Kushige's group via the Internet and asked for help, and they got a swift response.
Kushige said her group introduced Shoji Takamizawa, the lawyer who triumphed in the Hojo case. Kushige provided the Fujishimas with moral support as well as practical advice on how to confront the head of the nursery.
Katsuyo Tani, the nursery head, then admitted in a taped interview with the family that she had trampled on Hitoki because he wouldn't stop crying. Armed with this evidence, the family filed a criminal complaint against Tani with prefectural police in March.
The complaint, as well as the public outrage that followed, prompted police to resume their investigation, according to Takamizawa. Tani was indicted for murder in May.
While the families in these two cases have won justice, Takamizawa suspects there are many similar cases that are not prosecuted.
"Losing your baby is difficult enough for parents," he said. "What could be more agonizing than having to face a denial of responsibility after that?"