No fault compensation in perinatal medicine in Japan-from results for 8 years

Abstract

No fault compensation in perinatal medicine has been established to provide aid to patients in the event of disability due to a medical accident during delivery and to strive to resolve disputes quickly that contributes to reduce medical malpractice suit in the field of perinatal medicine. Furthermore, this system is aimed to establish a mechanism that achieves higher quality of obstetric care by analyzing the causes of accidents. This system is operated by Japan Council for Quality Health Care and 99.9% of childbirth facilities in Japan registered with this compensation system. Compensation system has two major functions including compensation and cause analysis and recurrence prevention based on cases. Compensation eligibility is reviewed in the Review Committee at the organization in Japan Council for Quality Health Care and currently 1,717 cases are judged as eligible cases out of 2,250 since 2009. The cause of each eligible case is analyzed in the Cause Analysis Committee one by one. The Cause Analysis Committee has 7 independent subcommittee and each subcommittee members are consistent of obstetricians, neonatologists, pediatricians, midwives and lawyers. Original cause analysis report is sent to childbirth facility and patient's family. Questionnaire survey demonstrated that 73% of childbirth facilities and 65% of patient family were satisfied with the cause analysis report. The number of medical lawsuit in obstetrics and gynecology is significantly decreased compared to those in all medical departments since the compensation system was introduced suggesting that these cause analysis reports may contribute the decrease in medical lawsuits. The major purpose of the Recurrence Prevention Committee is striving to prevent future cases of cerebral palsy and to improve the quality of obstetric care. To accomplish the purpose, the committee routinely collect information from individual cases and analyze quantitatively and epidemiologically. Furthermore the committee choose subject from cases to discuss for future prevention and provide wide public disclosure of the information with recommendation. The committee issued 6 reports until now and these reports have been distributed to childbirth facilities, perinatal medicine-related scientific society and administrative agencies.

What Ibero-American hospitals do when things go wrong? A cross-sectional international study

“…Probably, for the same reason, it is no coincidence that the hospitals in this study are located in countries where there are no no-fault compensation policies. However, sorry laws [25] seem to contribute to a greater involvement of professionals in safety [26,27]. This fact probably justifies some of the results obtained and represents one of the challenges that should probably be addressed as a priority.…”

Current Status of the Obstetric Compensation System for Cases of Cerebral Palsy at a General Hospital in Tochigi, Japan

“…US $280 000) were paid for each recipient of compensation. 3,4 In addition, after authorization of a recipient as being eligible for compensation, the causes of the cerebral palsy were analyzed from a clinical viewpoint. The analyses reports were provided to both the caregiver of the child and the childbirth facility.…”

“…4 Under these circumstances, the Japan Obstetric Compensation System for Cerebral Palsy (JOCSC) was established in January 2009, as the first nationwide no-fault compensation system. [3][4][5][6] No-fault compensation system in medicine was precedingly introduced in New Zealand, Norway, and Sweden et al, so the JOCSC referred to the system of these countries when it was established. 7,8 In our country, this system is managed by the Japan Council for Quality Health Care (JQ), which has major functions, including compensation for the economic burden faced by children with cerebral palsy and their families, analysis of the causes, and prevention of recurrence of similar cases.…”

“…In Japan, obstetrics and gynecology departments, among various clinical departments, often face medical lawsuits, and according to a few reports, the number of medical lawsuits per 1000 medical doctors was the highest in the departments of obstetrics and gynecology. 3,4 This is one of the reasons for the continuing fall in the number of obstetricians in our country. Therefore, nationwide security of the perinatal medical system is required.…”

Management of disseminated intravascular coagulation associated with placental abruption and measures to improve outcomes

“…Thus, placental abruption is a condition requiring an appropriate perinatal management. According to the analysis of the Japan Obstetric Compensation System for Cerebral Palsy [1213], which targets cerebral palsy cases delivered after a periviable period, occurring mostly before and during the delivery, and covering 99.9% of childbirth fatalities [12], 793 cases were diagnosed with cerebral palsy. Among them, 431 cases had cerebral palsy attributable to a single cause, and placental abruption accounted for 145 cases, ranking as the most common cause.…”