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The victim was a morbidly obese and bull-necked woman in her twenties. She had the disorders, due to Down's syndrome, including severe mental retardation, advanced hearing loss, congenital cataract surgery, and amblyopia at postoperative glaucoma. She was deeply sedated for rest with an intravenous drip infusion of 350 mg of thiopental (TP) for 5 minutes during an intraocular pressure examination with secondary glaucoma at a hospital. The examination was finished within 10 minutes after the TP injection, but her respiratory condition deteriorated rapidly when the doctor left the patient. Although immediate artificial respiration was carried out, she was declared dead about 20 hours after the examination. Medical malpractice was suspected for her death. At autopsy, no fatal disease or injury was observed in the victim. The serum TP level was 0.80 µg /ml. TP is an ultra-short-acting intravenous anesthetic, and usually only the smallest amount should be administered by frequent additions after pre-anesthesia administration while maintaining contact with patients. Although contact with patients with a disability can be difficult, it was diagnosed that the death was caused by both respiratory arrest due to a single dose of TP and delay in resuscitation due to the absence of a doctor.

At present, there are a variety of guidelines for psychiatric and other departments. In general, guidelines are positioned as specific documents of reference suggested for clinical settings that state appropriate health care services to be provided. However, since many types of guidelines with varying characteristics are often published by academic societies and organiza- tions, it is difficult to assess clinical guidelines unambiguously. The Medical Information Net- work Distribution Service, operated by the Japan Council for Quality Health Care with the support of a Grant-in-Aid for Scientific Research from the Ministry of Health, Labour, and Welfare, collects, assesses, and selects clinical guidelines published in Japan. On the other hand, in medical lawsuits filed to determine whether malpractice has occurred, guidelines serve as evidence that provides reference standards for principally judging faults or negligence. When courts make decisions regarding duties of care imposed on physicians and their violations, they tend to emphasize clinical guidelines developed by medical societies and other organizations, and establish the norm of conduct of "these guidelines". This is significantly different from the medical community's view of clinical guidelines. The medical and judicial communities are cur- rently being advised to deepen mutual understanding of these guidelines.

Among recent court cases involving medical treatment (medical litigation), civil proceedings focused on compensation claims began clearly trending upward around 1999. This trend peaked in 2004, after which the number of cases declined slightly and remained mostly flat. Over the past year or two, however, cases seem to be on the rise once again. Fluctuations in the volume of medical litigation have been attributed to various factors, but there is little doubt that careless medical errors and incidents of serious medical malpractice, as well as media coverage, are major factors in the recent increase. Although there has been no significant change in the actual number of lawsuits involving psychiatric care, it is possible to identify risk resulting from circumstances unique to psychiatry (prejudice surrounding psychiatric care, etc.). In this paper, the author will illustrate current trends in medical litigation and important aspects of judicial decisions related to health care. Furthermore, based on his many years of experience acting for the defense in psychiatric care litigation, the author will offer suggestions for promoting mutual understanding between psychiatry and the law that will, in turn, contribute to both "advocacy for legitimate psychiatric care" and "the quest for ideal psychiatric care".

The aim of this study was to explore effective ways to prevent conflicts between patients and healthcare professionals by analyzing 836 malpractice cases. The analysis revealed two points that especially influence court decisions: disease prognosis and inadequate informed consent. Regarding prognosis, decisions are more in favor of the defendant (medical institution) in diseases with poor prognoses, such as sepsis and anaphylaxis, than in diseases with typically good prognoses, such as acute epiglottitis and strangulation ileus. Regarding insufficient informed consent, the cases fell into two groups, emergency and non-emergency. The non-emergency group consisted of cases such as preventative treatments for brain aneurysms and acute pancreatitis-related endoscopic retrograde cholangiopancreatography (ERCP), where essential information to consent to treatment, especially the prognosis with no treatment, was not given, despite sufficient time. The emergency group consisted of cases, such as acute coronary syndrome, especially treated by percutaneous coronary intervention (PCI), where there was not sufficient time to provide to patients information about treatments. This is the most difficult type of case and a subject for future efforts at clinical sites.

In medical malpractice law suits, the notion of informed consent is often relevant in assessing whether negligence can be attributed to the medical practitioner who has caused injury to a patient. Furthermore, it is not rare that courts award damages for a lack of appropriate informed consent alone. In this study, two results were arrived at from a statistical analysis of medical malpractice law suits. One, unexpectedly, was that the severity of a patient's illness made no significant difference to whether damages were awarded. The other was that cases of typical medical treatment that national medical insurance does not cover were involved significantly more often than insured treatment cases. In cases where damages were awarded, the courts required more disclosure and written documents of information by medical practitioners, especially about complications and adverse effects that the patient might suffer.

The Ibaraki Medical Association established the Committee for Alternative Dispute Resolution called the Neutral Medical Claim Management Committee in 2006. Among 64 claims presented to the committee, 29 were settled through mediation or consultation. Patients were generally satisfied that their claims were considered fairly by the committee and that they were able to talk directly with healthcare professionals. However, some did not consider the committee to be completely neutral. The healthcare professionals involved rated the committee highly because they felt that the processes were neutral and no emotional aspects were involved.

A model project to determine the cause of deaths related to medical practice began in 2005. Since 2010, it has been managed by the Japan Medical Safety Research Organization (JMSRO), which is supported financially by the government and a majority of medical societies and organizations. There is a central office in Tokyo and nine local offices nationwide. When the JMSRO accepts a case, it makes a report on the cause of death and measures to prevent recurrence after detailed autopsy and clinical evaluation. So far, 180 cases have been accepted, of which 156 have been completed. A system to achieve the goals of the project has been established. About 80% of families of the deceased and medical organizations stated that they were satisfied with the results. Four families have initiated civil actions, and another four could potentially do so. No criminal charges have been filed. A new concept to establish an official third-party organization to analyze causes of medical practice-related deaths has been proposed by a committee under the JMSRO, and efforts should be made to put that proposal into practice.

This article aims to highlight current trends in medical professional liability insurance. We present two cases of the lawsuit associated with regional anesthesia. Case 1: Cardiac arrest during femoral neck fracture surgery under combined general anesthesia and epidural anesthesia. Case 2: Neurologic complications following cystectomy under combined general anesthesia and epidural anesthesia. To avoid malpractice risks, it is important to fully understand the risks of this clinical role and how to protect yourself from potential lawsuits. Every anesthesiologist should feel obliged to pay attention to legal questions concerning medical subjects, though judgments on the contents and the extent of the informationthat must be given to patients are complex and difficult to understand for anybody not experienced in law.