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Friday, Jan. 25, 2008


Ambulance fiascoes become Osaka campaign issue

Staff writer

OSAKA — With just a few days to go until Osaka elects a new governor, the candidates are finding themselves facing an issue that is literally a life and death situation for all prefectural residents.

Earlier this month in Higashi Osaka, 49-year-old Masao Nishimura survived a car accident but died after the ambulance was turned away by five hospitals.

The city of Tondabayashi has seen a number of tragic cases. Only last month, an 89-year-old woman collapsed at home and died after being refused by 30 hospitals. In March, a 77-year-old woman died in an ambulance after being refused by 12 hospitals. That same month, an 85-year-old woman died after 40 minutes in the ambulance and being refused by 14 hospitals.

In Kanan last March, a 70-year-old man was turned away by 21 hospitals. He died 17 days later after his heart stopped while in intensive care at the 22nd hospital, which accepted him after initially refusing him.

"Osaka's emergency medical system needs a complete overhaul. There are not enough doctors or nurses on call and many emergency medical facilities, especially those for life-threatening injuries, are too small," said Osaka Dr. Shunichi Takeda, who used to work in the emergency ward of a local hospital.

Last week, the Osaka Medical Association, the prefecture's main association of medical experts, warned that a decrease in the number of hospitals over the past two decades has weakened the entire system.

It issued a statement saying: "The entire medical system now faces grave dangers. In 1991, there were 302 medical facilities that could accept emergency patients in Osaka Prefecture. That number had declined to 271 by 2005. At the same time, there is a shortage of medical personnel, while more and more doctors are specializing in certain types of medicine, and cannot treat cases outside their area of expertise."

The decline in the number of hospitals is due primarily to a combination of budget cuts since the early 1990s and the closure and consolidation of hospitals and other medical facilities.

There have also been reports of people in other areas, including Tokyo and Nara, dying while emergency medical personnel tried to find a hospital that would accept them. Last August, the Internal Affairs and Communications Ministry said it found 667 cases nationwide during fiscal 2006 where emergency patients had been refused by three hospitals or more.

The ministry said last month it would establish a task force to study ways to solve the problem by improving communications between hospitals and emergency personnel. The task force is expected to issue a report by the end of March.

In the city of Osaka alone, where ambulances are dispatched about 560 times a day, there were 104 cases in 2006 in which patients were refused by at least 20 hospitals due to insufficient staffing, according to a recent municipal survey.

Most of the cases occurred between 9 p.m. and 5 a.m. In at least one case, a patient was in an ambulance for nearly two hours.

Concern about the quality of Osaka's medical care has been growing for the past few years. In last year's annual survey by the prefectural government, ensuring proper medical care and reducing crime were at the top of what voters want most from their local government. Just four years earlier, only 18 percent of the respondents thought medical care was getting worse, but the figure rose to 37 percent last year.

The recent reports of patients in critical condition dying in ambulances have shocked and angered voters. Reform of Osaka's medical system has now emerged as a major issue in this Sunday's gubernatorial election.

The two front-running candidates have, within the past two weeks, announced their own plans for reform. Toru Hashimoto, backed by the prefectural chapter of the Liberal Democratic Party, said the solution is to make the dispatch of ambulances more efficient.

"This can be done by dividing the prefecture into eight districts, which would make it easier for ambulances, dispatch centers and hospitals within each district to share information with each other," Hashimoto told supporters last week.

Sadatoshi Kumagai, supported by the Democratic Party of Japan and other opposition parties, told reporters last week that the entire medical system needs restructuring, not just emergency care.

"We need a system where specialized doctors such as pediatricians and obstetricians are available 24 hours a day," Kumagai said. "In addition, a communications system that allows rescue workers to communicate more quickly and effectively with area hospitals, so they can reach the nearest hospital quickly, needs to be set up. And to reduce the time-consuming paperwork of doctors on call, I'll push for the hiring of more medical secretaries."

None of this will be easy, however. Both the municipal and prefectural governments are in dire financial straits. The question of how to pay for additional doctors and nurses, or a new, more efficient emergency communications system, has many wondering if the candidates can make good on their reform promises anytime soon.

Neither the city nor the prefecture has so far announced specific measures to address the problem.

Late last week, the mayor of Tondabayashi called on other towns and villages in the prefecture to join together to discuss ways to improve emergency responses services, but said that due to a shortage of medical personnel, it is imperative that the health ministry also take steps to address the problem.

Said Dr. Takeda: "Osaka, like the rest of the nation, faces a growing population of elderly, and so there will be a definite need for more emergency medical facilities in the coming years. But that will increase the local tax burden, and it's unclear how any of the candidates for governor plan to pay for their proposals."

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