Medical Accident Investigation: Can the System Be Used to Prevent Recurrence?

Editorial

14:49 JST, November 26, 2025

Even if a patient dies during hospitalization, similar situations could arise repeatedly if the cause is swept under the rug. There is no end of problems between hospitals and bereaved families seeking the truth.

It is crucial to review the medical accident investigation system to ensure the causes of such accidents are thoroughly traced.

An expert panel of the Health, Labor and Welfare Ministry has compiled a draft report focused on improvements to the system. A key feature is the requirement for each medical institution to state in advance the criteria and procedures for determining which cases should be subject to investigation.

The draft plan also requires medical institutions to look into every instance of patient death. And it requires that the decision-making process for investigations be recorded and preserved.

The current investigation system, which comes under the Medical Care Law, was established in 2015 with the aim of preventing a recurrence of accidents. The system mandates that when a patient dies unexpectedly, the medical institution must report it to a third-party organization and conduct an internal investigation.

However, because it is left to the hospital director to decide which cases should be investigated, situations continue in which the number of investigations falls below the government’s projections. Some medical institutions are reluctant to use the system, leading to a spate of problems and the concealment of accidents.

Clarifying the criteria and procedures for such decisions may prevent cases from being handled differently depending on the director’s way of thinking. However, the draft report leaves the creation of these criteria and procedures up to each medical institution. Isn’t there a risk that medical institutions could excessively narrow the scope of cases that should be investigated?

The central and local governments must thoroughly monitor and guide medical institutions. They need to check whether the investigation criteria established by each medical institution are appropriate and whether there are problems with implementation, making use of such opportunities as on-site inspections by public health centers.

Even if a medical accident occurs, an earnest investigation and measures to prevent another accident are expected to improve the quality and safety of medical care, and they will also help restore relationships with bereaved families in some cases.

Last year, Iwate Medical University Hospital made public the findings of its investigation into a medical accident in which a teenager with severe disabilities died from asphyxiation during hospitalization. The hospital apologized to his bereaved family after his death, acknowledging that his phlegm was not adequately suctioned out.

The hospital has reviewed its nursing system and operations and is working to prevent a recurrence. The bereaved family reportedly views these efforts positively.

While there are some medical institutions that use the investigation system, more than a few medical institutions hesitate to conduct investigations. To what extent will the situation change with this review of the system? If problems remain, further improvements should be considered.

Fundamentally, limiting the scope of the investigation system to fatal cases is problematic. Investigating the causes when a patient is left with severe disabilities is worthy of consideration as well.

(From The Yomiuri Shimbun, Nov. 26, 2025)