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Tokyo hospital didn't get written consent from 21 patients who died without dialysis

Tokyo Metropolitan Government employees head to Fussa Hospital to conduct an on-site investigation, in the capital's suburban city of Fussa on March 6, 2019. (Mainichi/Yuki Miyatake)

TOKYO -- A public hospital here did not obtain written consent from 21 of 24 patients who died after they discontinued dialysis or never underwent such treatment from the beginning, the Tokyo Metropolitan Government has found.

The finding came after metropolitan officials conducted an on-site inspection on the Fussa Hospital in the Tokyo suburban city of Fussa. The metro government issued a written order to hospital director Takeshi Matsuyama based on the Medical Care Act on April 9, accusing the hospital of failing to sufficiently confirm the patients' intentions and demanding it submit a report on improving the facility.

The metropolitan government analyzed medical records and other related documents that were provided by the hospital and examined the cases of four patients who died after discontinuing dialysis and 20 others who died after not undergoing such treatment from the start. As a result, it turned out that the hospital had not obtained letters of consent from one patient in the first group and all 20 in the second group. The medical charts of three patients in the latter group showed no records of their agreement to never receiving dialysis.

In response to the findings, the metro government has instructed the hospital to gain understanding from patients after providing proper explanations, as well as to keep accurate medical and other records.

While hospitals are not legally obligated to acquire written consent from patients, Katsuhiko Kabuki, a lawyer versed in medical care and human rights issues, commented, "Consent in writing is absolutely necessary in performing medical care that could lead to death. The hospital's actions are outrageous as they were not based on informed consent."

With regard to a 44-year-old female patient who died in August last year after discontinuing dialysis, it emerged that a surgeon at the hospital had not explained to her that she could retract her decision to terminate dialysis. Her medical charts show that she had repeatedly requested to withdraw the decision since the day before her death.

It has also emerged that the hospital had earlier withheld from metropolitan government inspectors a portion of the documents concerning the 20 patients who died without ever receiving dialysis, and initially reported the figure to be 17. After inquiries by metropolitan officials the hospital reportedly said, "We had submitted the cases up until March 2017, instead of March 6 (this year) when the on-site inspection was conducted."

(Japanese original by Yoshihiko Saito and Hidenori Yazawa, Lifestyle News Department, and Akiyo Ichikawa, City News Department)

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