JANUARY 22, 2001 VOL. 157 NO. 3

Very Questionable Care
The nurse may have done it—but the country's health care system could also be to blame
By TIM LARIMER Tokyo

On halloween night last year, an 11-year-old girl in Sendai, 350 km north of Tokyo, complained of a tummy ache. A doctor at a private clinic diagnosed appendicitis and admitted her. Just 25 minutes later, the girl's condition deteriorated rapidly to the point where she had trouble breathing and lost consciousness. Her doctor, Ikuko Handa, panicked. What was wrong with the little girl?

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The answer stunned Japan, and provided the latest graphic evidence that a sickened health care system needs a prescription—and fast. If police allegations are true, a male nurse at the clinic, Daisuke Mori, attempted to kill the girl by mixing a muscle relaxant into her intravenous saline and antibiotic solution. While such a deed is clearly criminal, the possibility that a nurse was able to administer drugs without monitoring highlights once again the lack of transparency and accountability of Japan's medical establishment.

Doctors, nurses and hospitals have been rocked by charges of malpractice recently—there were a record 638 such suits filed against medical institutions in 1999—unusual in a country where patients traditionally haven't been allowed to see their own medical records. Terminally ill patients typically aren't given accurate diagnoses, and even after they die, their families aren't informed fully about the cause of death. In 1999, a Yokohama hospital performed a heart operation on a lung patient and a lung operation on a heart patient. Last year, at least three patients died when given the wrong medicine or improper dosages. A survey of nurses in 2000 found that one in six admitted they had mixed up patients when administering drugs. Previous attempts at legislative reforms have been blocked by the powerful Japan Medical Association. But patients are slowly demanding to know what's wrong with them and what's in the medicine they are taking. "Paternalism in medicine hasn't changed a bit," says Naoki Fukuchi, a lawyer who specializes in medical malpractice. "People, and doctors themselves, have a fantasy that doctors are infallible. And doctors are eager to hide their mistakes."

Nurse Mori has been using this institutionalized unaccountability to hide a sadistic pattern of murder by drip, according to police. After the 29-year-old nurse began working at the 18-bed Hokuryo Clinic in March 1999, at least eight patients died under peculiar circumstances, including a five-year-old boy with asthma who expired in the clinic while his mother had returned home to collect clean clothes for him. And newspapers report that police suspect 11 other patients worsened after Mori handled their intravenous drips. "This is the most atrocious crime I've ever experienced," Miyagi prefecture police chief of criminal investigations Hideo Kuramoto said at a press conference on Jan. 6, after arresting Mori on suspicion of attempted murder.

If Mori is found guilty, he would join a pantheon of sociopath killers masking as caregivers, including Britain's notorious "Dr. Death," Harold Shipman, linked this month to nearly 300 patient deaths. What's all the more tragic about Mori's case is that he had aroused suspicions among his colleagues, who nicknamed him "Fast-Change Mori" because the condition of his patients often reversed course quickly, and dramatically, without a reasonable explanation. "I thought it happened too much to be a coincidence," a nurse at the clinic told the daily Asahi Shimbun. Sloppy record-keeping of drug supplies also prevented the clinic from discovering Mori's alleged misdeeds earlier. Clinics of this size are required by law to employ a full-time pharmacist, but Hokuryo didn't have one on staff for the past two years. When Dr. Handa, the clinic's deputy director, inspected the pharmacy cabinet in November, she discovered a dwindling inventory of the muscle relaxant. That was odd, because the clinic had used it in just 10 surgeries that year. But despite Handa's suspicions, she continued to let Mori work at the clinic. More than two weeks went by before the police were informed. "It was so terrifying that I couldn't ask him about it," Handa said at a press conference. Her clinic, covered in a blanket of snow, was closed last week.

The little girl in Sendai remains in a coma today. Last week, her parents posted a note on their front door, begging to be left alone. "Please understand," it read. "She's still unconscious. Looking back at the past just makes us cry." The chilling reality is that more victims may emerge: before joining the Hokuryo Clinic, Mori had worked at four other health clinics in Miyagi prefecture.

With reporting by Hiroko Tashiro/Tokyo

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