Is there a statement in the law that says a public hospital may not turn a patient away? And how does one determine if a hospital is public or private?
What I’ve always heard is that if you feel you need to see a medical professional urgently, you should call an ambulance because it’s part of their job to find a place that can treat you. If you walk into an ER (or a clinic, etc) you can be turned away.
It’s not clear to me if there’s a duty to care for life threatening situations, but maybe someone that understands the regulations can weigh in on that.
Article 19, Paragraph 1 of the Medical Practitioners Act stipulates that “a physician engaged in medical treatment shall not refuse medical treatment without just cause when requested to do so. The Dentist Act has a similar provision, and the obligation of a physician not to refuse medical treatment is generally referred to as the “duty to respond (to call)” or “duty to treat.
The legal interpretation of the duty to attend is that it is not a duty to the patient, but a duty under public law in relation to the state. Under the Medical Practitioners Law, there are no criminal penalties for violations of the duty to attend to patients. In the event of a violation of the duty, administrative penalties such as a warning may be imposed, but no actual cases of administrative penalties have been confirmed.
The duty to attend to patients is exempted only when there is a “justifiable reason” for the exemption. In the September 10, 1949 notice of the Director-General of the Medical Affairs Bureau of the Ministry of Health and Welfare, it is stated that “the duty to attend to a specific case should be based on a moral judgment that is socially accepted as sound in each specific case.
What constitutes a “justifiable reason” for refusing medical treatment? According to the Ministry of Health, Labor and Welfare’s “Appropriate Response to Requests for Medical Treatment, Including the Obligation to Attend Medical Services” (December 25, 2048, hereafter “the Notice”), there are three major factors to consider.
The first is “whether or not an emergency response is necessary (severity of the condition). Since the purpose of the duty to respond is to protect the life and body of the patient, the presence or absence of urgency is a factor to be considered.
The second factor is “whether the medical treatment was requested during or after office hours. Doctors are human beings and need rest and leisure time. Basically, it can be said that if it is outside of working hours (outside of examination hours), doctors do not have a duty to attend to patients.
The third reason is “relationship of trust with the patient. If the patient has a problematic behavior, it is not reasonable for the doctor to assume the duty to attend to the patient.
Individual cases where “justifiable cause” is recognized Let’s take a look at specific cases in which “justifiable reasons” for not being obligated to attend to medical treatment are recognized under the said Notice, case by case.
Cases in which medical treatment is requested outside of office hours or working hours When medical treatment is requested during office hours, unless there is an exception such as a medical condition that cannot be handled by the medical institution, the patient is obliged to attend to the request in principle. However, when medical treatment is requested outside of medical or working hours, it is desirable to take emergency measures, but as a general rule, the duty to attend to medical treatment is not assumed.
When emergency treatment is not required If an emergency response is unnecessary outside of medical or working hours, as a general rule, the duty of care is not owed. However, even if an emergency response is not required, if medical treatment is requested during office hours or working hours, the duty to attend medical treatment is assumed in principle unless there is an exception, such as a medical condition that cannot be treated at the relevant medical institution.
Other individual cases Patient’s nuisance If a patient repeatedly makes complaints that have nothing to do with the content of the medical treatment, there is no need to provide a new medical treatment because there is no relationship of trust between the patient and the medical institution.
Nonpayment of medical fees Even if there has been nonpayment of medical fees in the past, immediate refusal of medical treatment on the basis of nonpayment is not justified. However, if there is a repeated nonpayment of co-payments for insured medical treatment, the refusal of medical treatment may be justified.
Discharge of an inpatient or transfer to another medical institution The obligation to discharge a patient when there is no need for continued hospitalization or to transfer a patient to another medical institution even if there is a need for continued hospitalization is not contrary to patient protection, and therefore, the patient is not obliged to comply with the obligation.
Discriminatory Treatment Refusal to treat a patient solely on the basis of age, gender, race, nationality, or religion is not justified. However, refusal of medical treatment may be justified if the patient is unable to receive appropriate medical treatment due to language barriers or religious or other reasons.
There was that [case](https://www.asahi.com/sp/ajw/articles/14421133) a couple years ago where a pregnant woman with covid ended up having to give birth at home because she couldn’t find a hospital that would admit her, resulting in the death of the newborn. So yeah, if they can refuse a woman in labor, I think they can refuse anybody
I’ve presented to the ER of a small public hospital in Sapporo holding my sliced hand together and bleeding through a makeshift bandage, that was <2mins walk just around the corner from where I was staying, but been told to call an ambulance to go somewhere else. They refused to even help stem the bleeding. Ended up finally being accepted at a hospital >30mins drive away and lost a not insignificant amount of blood by the time I was treated, well over an hour after the injury that bled continuously throughout the ordeal. I’m not sure who would be liable if someone dies, but they can and do refuse even if you’re literally bleeding on them. Interested to see if anyone knows the real legal answers to this question.
There are a few Thousand People who died because the Hospitals did not accepted them, there are hundreds of “mentally challenged” (+750) People that died because no Hospital wanted the extra Work!
(COVID Crisis)
Shame there isn’t a Hippocratic Oath or similar here.
6 comments
What I’ve always heard is that if you feel you need to see a medical professional urgently, you should call an ambulance because it’s part of their job to find a place that can treat you. If you walk into an ER (or a clinic, etc) you can be turned away.
It’s not clear to me if there’s a duty to care for life threatening situations, but maybe someone that understands the regulations can weigh in on that.
I don’t think public or private matters.
https://www.phchd.com/jp/medicom/park/idea/management-medicalact
Machine translation.
Article 19, Paragraph 1 of the Medical Practitioners Act stipulates that “a physician engaged in medical treatment shall not refuse medical treatment without just cause when requested to do so. The Dentist Act has a similar provision, and the obligation of a physician not to refuse medical treatment is generally referred to as the “duty to respond (to call)” or “duty to treat.
The legal interpretation of the duty to attend is that it is not a duty to the patient, but a duty under public law in relation to the state. Under the Medical Practitioners Law, there are no criminal penalties for violations of the duty to attend to patients. In the event of a violation of the duty, administrative penalties such as a warning may be imposed, but no actual cases of administrative penalties have been confirmed.
The duty to attend to patients is exempted only when there is a “justifiable reason” for the exemption. In the September 10, 1949 notice of the Director-General of the Medical Affairs Bureau of the Ministry of Health and Welfare, it is stated that “the duty to attend to a specific case should be based on a moral judgment that is socially accepted as sound in each specific case.
What constitutes a “justifiable reason” for refusing medical treatment? According to the Ministry of Health, Labor and Welfare’s “Appropriate Response to Requests for Medical Treatment, Including the Obligation to Attend Medical Services” (December 25, 2048, hereafter “the Notice”), there are three major factors to consider.
The first is “whether or not an emergency response is necessary (severity of the condition). Since the purpose of the duty to respond is to protect the life and body of the patient, the presence or absence of urgency is a factor to be considered.
The second factor is “whether the medical treatment was requested during or after office hours. Doctors are human beings and need rest and leisure time. Basically, it can be said that if it is outside of working hours (outside of examination hours), doctors do not have a duty to attend to patients.
The third reason is “relationship of trust with the patient. If the patient has a problematic behavior, it is not reasonable for the doctor to assume the duty to attend to the patient.
Individual cases where “justifiable cause” is recognized
Let’s take a look at specific cases in which “justifiable reasons” for not being obligated to attend to medical treatment are recognized under the said Notice, case by case.
Cases in which medical treatment is requested outside of office hours or working hours
When medical treatment is requested during office hours, unless there is an exception such as a medical condition that cannot be handled by the medical institution, the patient is obliged to attend to the request in principle. However, when medical treatment is requested outside of medical or working hours, it is desirable to take emergency measures, but as a general rule, the duty to attend to medical treatment is not assumed.
When emergency treatment is not required
If an emergency response is unnecessary outside of medical or working hours, as a general rule, the duty of care is not owed. However, even if an emergency response is not required, if medical treatment is requested during office hours or working hours, the duty to attend medical treatment is assumed in principle unless there is an exception, such as a medical condition that cannot be treated at the relevant medical institution.
Other individual cases
Patient’s nuisance
If a patient repeatedly makes complaints that have nothing to do with the content of the medical treatment, there is no need to provide a new medical treatment because there is no relationship of trust between the patient and the medical institution.
Nonpayment of medical fees
Even if there has been nonpayment of medical fees in the past, immediate refusal of medical treatment on the basis of nonpayment is not justified. However, if there is a repeated nonpayment of co-payments for insured medical treatment, the refusal of medical treatment may be justified.
Discharge of an inpatient or transfer to another medical institution
The obligation to discharge a patient when there is no need for continued hospitalization or to transfer a patient to another medical institution even if there is a need for continued hospitalization is not contrary to patient protection, and therefore, the patient is not obliged to comply with the obligation.
Discriminatory Treatment
Refusal to treat a patient solely on the basis of age, gender, race, nationality, or religion is not justified. However, refusal of medical treatment may be justified if the patient is unable to receive appropriate medical treatment due to language barriers or religious or other reasons.
There was that [case](https://www.asahi.com/sp/ajw/articles/14421133) a couple years ago where a pregnant woman with covid ended up having to give birth at home because she couldn’t find a hospital that would admit her, resulting in the death of the newborn. So yeah, if they can refuse a woman in labor, I think they can refuse anybody
I’ve presented to the ER of a small public hospital in Sapporo holding my sliced hand together and bleeding through a makeshift bandage, that was <2mins walk just around the corner from where I was staying, but been told to call an ambulance to go somewhere else. They refused to even help stem the bleeding. Ended up finally being accepted at a hospital >30mins drive away and lost a not insignificant amount of blood by the time I was treated, well over an hour after the injury that bled continuously throughout the ordeal. I’m not sure who would be liable if someone dies, but they can and do refuse even if you’re literally bleeding on them. Interested to see if anyone knows the real legal answers to this question.
There are a few Thousand People who died because the Hospitals did not accepted them, there are hundreds of “mentally challenged” (+750) People that died because no Hospital wanted the extra Work!
(COVID Crisis)
Shame there isn’t a Hippocratic Oath or similar here.