Among the series of events that happened in Kamagasaki between 1989 and 1991, there were two things that cannot be missed. One was the Daiwa Chuo Hospital Case in 1989 and another one was the@"riot" in 1990. The latter made headlines in news media, but the former was paid almost no attention. But both of them equally reflect how the workers of Kamagasaki today are feeling in their everyday life.

1. Emergency Medical Service that Doesn't Help

On April 27, 1992, the 10th hearing of the Daiwa Chuo Hospital Case was held at the Osaka District Court. The defense witness was Dr. Takashima, who was cross examined by the plaintiff side on that day. The court was packed with workers from Kamagasaki. They were crying out loud, "Are you really a doctor?," or "Don't tell a lie!" The judge ordered them to be quiet but could not stop them from laughing. And when the witness tried to evade his responsibilities by saying "I gave instructions over the telephone and a nurse, a veteran nurse, took care of it," there was a big burst of laughter, and the judge, apparently in sympathy with the workers, said, "Please don't speak up. But I cannot stop you from laughing. " The doctor' s testimony was that defiant.

In the end the judge himself asked the witness a question: "Daiwa Hospital is an emergency hospital, isn't it. Then, do you leave a patient for as much as 90 minutes before taking an electrocardiogram?" And the answer was: "After the patient has been hospitalized, then we take his or her electrocardiogram. That's the way it is at our hospital." A worker thought to have suffered a heart attack was rushed to the hospital, but he was left unattended for 90 minutes and died. He died right after an electrocardiogram was taken. What kind of doctor could tell the court this without feeling any shame at all. What does he think of the life of a worker? There are so many questions to be asked.

But that is how the emergency medical service is in Kamagasaki. This time, a charge was brought against the hospital, so the situation surfaced to some extent. But usually this type of incident never receives due attention. Yet medical fees are billed to the individual or relevant welfare office. They are making money by robbing people of their lives.

This is how the Daiwa Chuo Hospital Case happened. On Sunday, April 23, 1989, a worker, "M," was brought from his "Doya," a small inn, to Daiwa Chuo Hospital in an ambulance past 11 o'clock at night. "M" had complained of a chest pain. The part-time doctor in charge then, an anesthetist, examined "M," took an electrocardiogram, diagnosed "M" as having "intercostal neuralgia," and sent him home after administering some medicine.

But soon after that, "M" had a second attack. The next day on April 24, he was again rushed to Daiwa Chuo Hospital. His friend "S" who was with him, thought Daiwa Chuo Hospital was not an adequate emergency hospital, so he asked the driver of the ambulance to go to another hospital, but was refused. "Daiwa Chuo Hospital has the patient's chart as he was there yesterday. Since it is an emergency, he has to be taken to the nearest hospital," the driver said. The ambulance arrived at the hospital after 9 o'clock in the morning.

On that day, Dr. Takashima, the full-time staff physician in charge, examined "M." Many discussions took place and finally at 10:30 a.m. it was decided that "M" would be hospitalized. "S" left the hospital to buy things for "M," and when he returned he was told that "M" had died. He died at 12:05 p.m.

Later, "M" was diagnosed as having died of an unnatural cause somehow and was sent to the Osaka University Hospital for autopsy. Even though he died in the hospital, doctors could not identify the cause of the death. This is hard to believe. Also, during discussions at Daiwa Chuo Hospital held right after his death, the hospital admitted this kind of thing happens quite often.

As "S" still had questions over the death of his friend, he came to seek advice from the Medical Group at the Kamagasaki Day Workers' Union. He said, "I can't let this thing drop. I can only think that "M" died because of negligence on the part of the medical staff," and he explained to the group the whole process.

To find out the real cause of the death and where the responsibility lies, we asked Daiwa Chuo Hospital to answer our questions. On May 10, we had a talk with some hospital staff members for the first time and were asked to submit our proposal on paper. In June and July, we tried to confirm facts, but their answers differed every time we did so. Also, the doctor in charge refused to sit in a meeting to confirm facts.

The hospital broke the promise it made in the beginning and the@talks were suspended. They repeated statements which could be@taken as defiant, such as "There was nothing wrong with the diagnosis made on April 23" and "The patient could not have been saved even if an electrocardiogram had been taken earlier on April 24."

Then "S" started looking for a family members of "M" who would be the plaintiff in court. He took on this difficult task because he was a close friend of "M." With little information, he walked all over and finally found the younger brother of "M," who said he would be the plaintiff of the "malpractice" suit. It was 15 months after the death of "M." "S"'s efforts moved the heart of "M"'s brother.

The lawyer who represented the plaintiff was Ryutaro Nakakita. On December 13, 1990, we took the case to the Osaka District Court. A press conference was held later at the Osaka Judicial Press Club, and the case was reported in next day's newspapers. However, it was later ignored.

After the suit was filed, "M"'s brother received a telephone call from relatives to drop the case. Daiwa Chuo Hospital was putting pressure on them.

The time was in the middle of the "Getting Through the Winter" program, and so the Daiwa Chuo Hospital Case became widely known among workers and supporters participating in the program. There was a big reaction because many shared similar experiences with the hospital, and most of them complained of the carelessness at Daiwa Chuo Hospital.

Two years after "M"'s death, a steering committee to "Accuse the Discriminatory Killing at Daiwa Chuo Hospital" was formed to gather wider support for the court struggle. It was January 24, 1991. Since then, the workers of Kamagasaki have engaged in protest and publicizing activities on the 24th of every month.

As for the trial, the first six appearances were from January 28 to August 24, 1991 in which only papers were exchanged, but from the 7th, the defense witnesses appeared in court.

The highlight of the questioning of witnesses was the hearing held an April 27, 1992, stated earlier. The following is what happened on that day. This will show the negative side of the medical care not only in Kamagasaki but also of the medical care in general today.

First, here is what happened:

Dr. Takashima of Daiwa Chuo Hospital who knew that "M" was on the way having been notified earlier by telephone, examined "M" at 9:20, 12 to 13 minutes after his arrival at 9:07. After listening to the heartbeat, he gave instructions to have X-ray photos taken of the chest and abdomen of "M. " From the complaints, Dr. Takashima concluded that the patient was suffering from a cardiac infarction, and didn't suspect intercostal neuralgia because the pain had continued for over 12 hours. However, he did not take an electrocardiogram of "M," saying it would be taken after he was hospitalized. Also he did not ask "M" much about the pain. He did not bother to find out when the attack came, either. He also said he did not think it was necessary to ask him about the pain in the heart. It is very doubtful as to whether Dr. Takashima really thought it was cardiac infarction.

At 9:50, "M" was told that he would be hospitalized. Around 10:30, he was examined for the second time, and again at 11:20, when there was a sudden change in his condition.

It was 95 minutes after his arrival at the hospital that an electrocardiogram was finally taken. They did so in a flurry because "M" suddenly turned for the worse. Though they knew an electrocardiogram was necessary for those with chest pain, it was not done immediately. They also knew a blood test could determine the presence of a cardiac infarction, but it wasn't done either. The result of the electrocardiogram test was brought to Dr. Takashima at 11:20, two hours and 10 minutes after the patient came to the hospital. (The test began at 10:45 and ended at 10:50) The blood test was not taken either, for they thought it was something to be done after hospitalization. Dr. Takashima testified, saying it was only a hypothesis, that if a blood test had been taken, cardiac infarction could have been detected, and relevant measures could have been taken.

"M"'s blood pressure was quickly going down, but this was also judged within normal bounds. The first time it was 132 over 80, with a pulse of 100. The second time it was 110 over 82 with a pulse of 96. But still it was not thought of as becoming worse, and they had the patient walk to his room. Even though his condition was rapidly changing for the worse, the doctor only talked with the nurse over the phone and did not go to see "M" in person.

As stated before there is much doubt as to whether he really thought the patient was suffering from a cardiac infarction. One reason is the type of medicine administered to the patient in the form of an I.V. drip. There was nothing for a heart condition. The medications are known to have bad effect on the treatment of cardiac infarction. Medicine to stop inflammation or infection, medicine for the pancreas, and medicine to clear blood vessels in the brain, and medicine for stomach pain was given in two 500 cc bottles.

These medicines had nothing to do with the symptoms of "M." Especially, the medicine for the pancreas was given because it was assumed "Kamagasaki workers take much alcohol and thus, pancreatitis was suspected." The administration was based on a biased view. The same goes for the medicine for blood vessels in the brain. They determined "M" was suffering from arterial sclerosis without having taken any tests. Dr. Takashima also admitted in his testimony that he knew the pain-killer which he administered could aggravate cardiac infarction. This is equivalent to murder.

When the testimony was over, the judge asked the question stated earlier. But the problem that has surfaced is not just limited to "M"'s case. Every year, about 8000 workers are rushed to Daiwa Chuo Hospital in an ambulance, an average of 20 patients in a day. The hospital is crucial to medical care in Kamagasaki. But this is how the hospital really is. There are workers who refuse to be in the ambulance when they learn it is headed for Daiwa Chuo Hospital. They all know so well how terrible the hospital is.

The Steering Committee to Accuse the Discriminatory Killing at Daiwa Chuo Hospital began a petition campaign calling for the retraction of the title of "emergency hospital" for Daiwa Chuo Hospital. In the autumn of 1991, we brought the first collection of signatures to the Osaka Prefectural Medical Affairs Section. But what they told us was very irresponsible indeed: The title of emergency hospital is not subject to administrative authorization. A hospital only reports to the local government to be titled as an emergency hospital and that Osaka Prefecture cannot retract the title unless Daiwa Chuo Hospital voluntarily gives up the title.

No matter how many people are killed and how much of public fundsare spent on it, there is nothing the administration can do. Is this the way emergency medical service should be? But there 'aremany who want the title of "emergency hospital" to be removed from Daiwa Chuo Hospital. In turn, there is a question of what should be done if Daiwa Chuo Hospital is no longer considered an emergency hospital. To answer these calls, we are trying to find a better emergency hospital and establish a better system. In fact, there are hospitals that are cooperating with us.

Although a vast sum of public funds is being spent for medical care in Kamagasaki, as represented in Daiwa Chuo Hospital, it is not to the benefit to the life and health of the workers at all. However, the medical care administration cannot do anything about it. They are letting the workers die. I cannot help but wish our struggle against Daiwa Chuo Hospital will be a breakthrough in this situation. As this struggle was only possible with the effort of "S," a friend of "M." I admire him very much.