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Hospital failed to heed kidney patient's pleas to restart dialysis: Tokyo gov't report

The Mainichi logo The Mainichi 20/3/2019 The Mainichi
an aerial view of a city: Fussa Hospital is seen in Fussa, western Tokyo, in this file photo taken from a Mainichi Shimbun helicopter. (Mainichi) © The Mainichi Fussa Hospital is seen in Fussa, western Tokyo, in this file photo taken from a Mainichi Shimbun helicopter. (Mainichi)

TOKYO -- Doctors at Fussa Hospital did not respond to a 44-year-old kidney patient's requests to restart dialysis treatment and "failed to sufficiently confirm her will" before her death, a Tokyo Metropolitan Government probe has concluded.

The report is based on an on-site inspection of the public hospital in western Tokyo by metro officials over the 44-year-old woman's death last year. The woman elected to cease dialysis treatments on Aug. 9 after being presented the option by a 50-year-old surgeon, who made it clear that stopping the therapy would be fatal. She went home but was readmitted to the hospital on Aug. 14. She passed away two days later.

However, the metro Tokyo investigation found that the woman had repeatedly suggested to medical staff that she had changed her mind in the days before she died -- pleas that went unheeded. The metro government believes the facility may have violated standards of appropriate care mandated by the Medical Care Act, and is likely to issue written guidance to the hospital.

The 50-year-old doctor has stressed that "patients undergoing dialysis treatment are in the 'final stage' of an illness," and that there was no duty to provide treatment (to the woman)" once she had elected to cease dialysis. The metro government report, however, defines a "final stage" condition as the last phase of an illness before death, and refuted the attending doctor's assertion by pointing out that the patient "would have lived another three to four years" had she continued therapy. It thus concluded that the doctor did indeed have a duty to provide treatment.

According to sources close to the case, Tokyo officials analyzed the woman's medical charts and other relevant materials, and took statements from the 50-year-old physician and other Fussa Hospital staff.

The investigators confirmed that the woman signed a document to halt dialysis on Aug. 9, but judged that she was not told that she could change her mind. The report furthermore found that, due to extreme pain, she had "repeatedly asked to restart the treatment" after being readmitted to the hospital on Aug. 14. However, the attending doctor did not put her back on dialysis. With doctor and patient deadlocked, the woman's 51-year-old husband demanded that the surgeon restart the treatment. However, his pleas went unheeded.

The metro Tokyo report noted that Fussa Hospital had made no effort to consult its outside ethics panel or other third-party bodies over the proper course of action, and found that the institution had violated Japanese Society for Dialysis Therapy (JSDT) guidelines on patient care.

According to the woman's husband, she had previously been diagnosed with suicidal depression and had attempted to take her own life three times. The Tokyo report concluded that apprehending the woman's psychiatric treatment history should have been easy for the attending doctor and the hospital, but that they had failed to do so. The investigators also pointed out that the woman's illness itself may have impacted her decision to halt dialysis.

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

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