Loyd Cummings tried to ignore his headache when it began on Aug. 7, 2003. But the electronic technician, who was working in Japan on U.S. Navy radars, eventually collapsed from an aneurysm — a bulge in a vein in his head.
He was transferred to the Yokohama Stroke and Brain Center after diagnosis in Yokosuka Naval Hospital. What happened next is disputed, but several doctors close to the case say that a combination of negligence and arrogance caused the death of the 53-year-old man on Aug. 9.
"If the doctors who operated on Mr. Cummings had been competent, he would be alive today," says one of the whistle-blowers (Doctor A), a medical adviser to the Ministry of Health and Welfare who wishes to remain anonymous. "Many doctors have paper licenses; they're literally not qualified to practice."
Doctor A's colleague goes further. Dr. Shizuko Matsuoka, who claims she was demoted after trying to expose the Cummings case, says "It is the tip of the iceberg of medical malpractice" in Japan. "I can't believe some of the things I've seen."
Matsuoka also claims that Yokohama Mayor Hiroshi Nakada agreed to set up an investigation into the malpractice claims but failed to do so and instead moved her. "He betrayed us," she says.
These are disturbing accusations: The critically ill man was treated in one of the country's top hospitals for brain disorders, in a country with one of the world's best reputations for advanced surgery.
But the whistle-blowers claim that the medical industry here is a mess; staffed by ambitious unscrupulous doctors, run by incompetent managers and protected by politicians.
"We are at war with hierarchical, old-fashioned Japanese society," says Doctor A. "But we are doctors so it is our responsibility to put the dignity of patients first."
Mr. Cummings was operated on by doctors using a relatively new neurosurgery procedure called endovascular coiling, which involves threading a catheter from a vein in the groin to the aneurysm and using aluminum coils to block the flow of blood and stop it rupturing.
It is a complicated operation, beyond the competence of the two surgeons who performed it, says Dr. Matsuoka. "They broke hospital procedures for this kind of treatment." The procedures state that a four-doctor team was supposed to be present, but the two less-experienced doctors went ahead without notifying their colleagues.
The surgeons made a number of critical errors, including failing to inject medicine to stop bleeding in Mr. Cummings' brain, claim hospital staff. During the seven-hour operation, his blood pressure fell disastrously and he went into a coma from which he never recovered.
The hospital management then allegedly covered up the incident with a series of lies and half-truths.
In a letter to Mr. Cummings' wife, Theresa, dated Nov. 9, 2005, for instance, hospital director Tsuneo Fukushima explained that the doctor who performed the operation on Mr. Cummings "had more than 200 experiences (sic) and he himself was supervisor of the endovascular team."
But documents seen by The Japan Times indicate that the doctor involved had performed just 12 of the endovascular operations, of which six ended in failure and two in death.
A success rate of just 33 percent sounds like poor odds on the operating table, but even more worrying, a 52-year-old patient called Tomiko Kameda was badly brain damaged in a similar procedure at the same hospital just 10 days previously.
Mrs. Kameda's husband, Hiroshi, brought his wife to the hospital on July 27 after she complained of feeling unwell. "The doctor told me she was bleeding in the brain and he recommended using this new procedure, which he asked me to sign for," says Mr. Kameda.
"She was conscious and able to talk normally when I left."
The operation started at 10 a.m. on July 28 and was supposed to last for 2-3 hours, but at 2:15 p.m., the hospital asked for permission to open Tomiko Kameda's skull. When his wife eventually came out of surgery at 8 p.m., Mr. Kameda was told that she was "critically ill."
"I asked if it wasn't strange that she was okay before the operation began, and the doctor just clammed up."
Today Mrs. Kameda is paralyzed on the right side of her body, wears a diaper and must be looked after like a baby. After a 20-month battle during which her husband says the hospital "lied and covered up" what had happened, medical managers accepted they had been negligent and offered compensation.
But Mr. Kameda, who is currently battling through the courts for a proper inquiry, is bitter at what he calls the arrogance of the medical profession.
"I'll never forgive them. I asked them if they would have done this procedure on their own family members and they said no. Later I found out that they had discovered a rash on my wife's genital area and sent pictures of it to doctors in another hospital without asking our permission. They just don't care about people."
How many other similar blunders have passed unnoticed? "Thousands," says Dr. Matsuoka, who says she has seen cases of astonishing incompetence, including a doctor who "cut the wrong artery, spraying blood everywhere."
"The doctor said, 'oh, that was bad luck.' "
The patient later died.
Dr. Matsuoka, who was a medical adviser to Mayor Nakada, believes she was moved from the hospital to the local city office because she stirred the pot.
Meanwhile, she says, the hospital has since spirited away many of the people involved in the negligence accusations.
Although the negligence cases have been brought to the attention of several news organizations, only the [local newspaper] Kanagawa Shimbun, which ran an article on Mr. Cummings in November 2004, has taken up the story.
"The media is running scared of the medical industry," says Dr. A.
The director of the Yokohama Stroke and Brain Center, Dr. Fukushima, said he could not comment on the Cummings case as it was part of an ongoing investigation. The U.S. Embassy also declined to comment.
Theresa Cummings recently called the embassy but they said they couldn't help, referring her instead to Japanese lawyers.
Did Loyd Cummings have to die? That is the question that haunts Theresa and their four children. "I truly believe that he became brain dead during surgery because of an error," says Theresa, who is now in Japan pursuing the case.
"This is not about being foreign or being Japanese," says Dr. Matsuoka. "It is about human lives."
Japan's national healthcare system, which for the average worker only covers 70% of medical charges in return for about eight percent of the previous year's salary, is frequently the subject of letters to newspapers. The following exchange between two Japan Times "Readers in Council" helps clarify what sets Japanese medical supervision apart from the norm in other advanced nations, and allows us to understand the above article in its wider context:
Get tougher on malpractice (8/25, 2005)
The number of medical mistakes in Japan seems to have increased recently, and the details are astonishing. For example, a nurse gave a patient a transfusion incorrectly. Another nurse provided the wrong medical drops to a patient. Both patients died. Many physicians also make mistakes, such as a wrong diagnosis or a judgment error during surgery. In Japan, though, there are no systems to crack down on medical malpractice. Doctors and nurses who have caused medical accidents don't have to quit their jobs afterward.
In America, medical doctors must take exams every few years after getting a license to practice, and authorities seem stricter with people who make medical mistakes. We should be able to undergo treatment without feeling uneasy. The Japanese government should be tougher on medical malpractice and the requirements for getting and keeping a doctor's license.
Nation's medical embarrassment (9/5, 2005)
RK is absolutely correct in her Aug. 25 letter about the need for Japanese authorities to "get tougher on malpractice," but the Health Ministry, the Japan Medical Association, the medical insurance society (Kenporen) and the Japan Hospital Association have not stated any intention to change.
As long as physicians are licensed for life, are not required to undergo continuing medical education, are not credentialed (qualifications and past performance verified), and are not privileged (limited to demonstrated competency) in the facilities where they work, and as long as facilities are not evaluated by an independent third-party accrediting entity, a prescription for trouble remains.
There is no national practitioners' database, no formal physician performance-evaluation system in most hospitals, no funding for research into medical errors and no law requiring physicians to disclose the contents of a patient's medical record. There is no mechanism to record complaints against healthcare providers at the prefectural or national level, and no data on the extent of medical errors in Japan.
Healthcare reform is resisted, and no real attempts to make it accountable, responsible and transparent have emerged. As a hospital employee in Japan, I view all this as a national embarrassment, yet the public remains rather passive.
Editor's note: David McNeill completed his PhD on the Japanese information society at Napier University, Edinburgh in 1998. He went on to teach at universities in Ireland, England and China before taking up his current position with Sophia University in Tokyo. I'd like to thank to Dr. McNeill for his kind permission to republish the above article here in Japan Perspectives.