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Obstacles to Reducing Human Injury and Death Due to Medical Error

s of self-critical analyses as part of the hospital accreditation process, and fear of civil litigation. Leflar found that although some Japanese hospitals are more frequently reporting medical errors on a voluntary basis, the absence of these accountability mechanisms means they are not compelled to do so.

'In Japan, the weakness of peer review and professional discipline structures, the lack of mandatory hospital accreditation and the absence of objective, hospital-by-hospital statistics on outcomes of medical treatment -- not to mention the relative infrequency of civil malpractice litigation -- enhances the social importance of criminal law as a way of increasing transparency in the medical world,' Leflar said.

Few Japanese officials would argue that police and prosecutors are ideally suited for the role of medical quality control, Leflar said, but the weakness of other structures has forced them into that role. As an alternative, Japan's health ministry has developed an innovative 'model project' in which independent and neutral groups of medical specialists investigate medical accidents. Their goal is to obtain facts and reach conclusions in a much more timely, less expensive and perhaps more accurate and objective fashion than the legal system allows.

'If the Japanese project succeeds,' Leflar said, 'American reformers seeking to link patient safety and improvement of the medicolegal dispute-resolution system may find the Japanese approach instructive.'

Other initiatives and practices in Japan could inform health practices and policies in the United States, Leflar found. Most American physicians, especially those in high-risk specialties such as obstetrics and neurosurgery, are keenly aware of the connection between medical liability insurance premiums and the volume of both insurance claims and medical malpractice lawsuits. American physicians argue that premiums have risen to unsustainable levels. In Japan,
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