Japan, Taiwan, and Patient Safety: Reforms Attempted and Reforms Undermined

Medical error is estimated to be a cause of > 200,000 deaths annually in the US. Similarly, blunders at some of Japan’s famous hospitals led to a national uproar there in the early 21st century, and reports of iatrogenic injury have directed attention to legal reforms in Taiwan as well. The speaker’s interviews with Japanese, American, and Taiwanese patients and families, doctors, judges, lawyers, prosecutors, journalists, academics, and health policy officials form the background for this analysis of the politics of medical injury review and compensation systems in the three countries. There is a little-known recent reform of Japan’s dysfunctional system of peer review of medical errors – a reform engaging the national political parties in surprising ways, leading to 2014 legislation setting out the framework for a new structure for peer review nationwide. The speaker also examined the different approach taken in Taiwan.

The speaker noted the legal, medical, and political developments leading up to the Japanese law of 2014, including the health ministry's "Model Project for the Investigation and Analysis of Medical Practice-Associated Deaths." This seminar offered a critical analysis of the 2014 law, its ambiguities, and the health ministry's struggles to implement the new system, and contrasted that system with US approaches to obtaining and reacting to information about iatrogenic injuries. The speaker suggested that the new system’s reporting mechanisms, as well as health ministry statistics, may seriously underestimate Japanese hospital mortality rates, with adverse consequences for public and political attention to the problems of medical error.

Rob Leflar is a professor at the University of Arkansas School of Law, University of Arkansas for Medical Sciences, a Visiting Scholar at the University of Tokyo Faculty of Law, and a Visiting Scholar at the Ntional taiwan University.