Reader TH: Refused treatment at neurological hospital by setting overly-high hurdles for J-translation services

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Hi Blog. Submitted for your approval (cue Twilight Zone theme):

/////////////////////////////////////////
Date: September 3, 2015
From: TH

Hi Dr Debito, I thought you might be interested in my experience of trying to get an appointment at the top hospital for neurology in Japan. Basically they refuse to see me unless I pay for a specialist medical interpreter – they won’t even see me with a third party volunteer hospital interpreter.

I have a problem with a nerve at the base of my spine. It may or may not be caused by an accident I had early last year in which a taxi hit me when I was riding my bicycle.

I got a referral to the 国立精神・神経センター from my clinic because my research said they were the best in Japan for neurology.

I called them up to organize an appointment. My Japanese isn’t great so they told me in Japanese that I need a Japanese speaker to call on my behalf to make an appointment. I guess this is because they couldn’t get all the info needed to set up the appointment.

I had my Japanese teacher call during a lesson of mine and set up the appointment for me. They told her that I couldn’t come alone because of my language level. If I did come without a Japanese speaker they would cancel my appointment on the spot and not see me. I was surprised at this and as I was put on the spot, I said that’s ok, I’ll get a friend to come with me.

I thought about it and as the appointment time is this Monday at 9:45 am none of my friends could come with me. I searched out a group that organizes a free medical interpretation service telephone line staffed by trained professionals. They were a great help. They have to be engaged from the hospital side so I called the hospital and said in Japanese that I couldn’t get a friend to come so I will need to use this volunteer service.

The lady from the hospital called the volunteer service. The lady from the volunteer service called me back and said that the hospital refused to allow telephone based interpretation during my appointment. I must have a person come with me. I said ok. The lady from the volunteer service organized a volunteer to go with me and then called the hospital to confirm.

The hospital said they would not accept a layperson as a volunteer to accompany me. The hospital said that I must engage a professional medical interpreter. I thought this strange – they initially said that I need to come with a friend. A friend would undoubtedly be a layperson as well, so their refusal of a lay volunteer seems contradictory and petulant.

At this point it is too much hassle and will become prohibitively expensive to go to this hospital.

Is it legal to treat me like this?

Kind regards, TH
/////////////////////////////////////////

COMMENT: It is NOT illegal in Japan, and that is the problem. We have discussed numerous times on Debito.org about awful NJ hospital treatment (such as saying aloud that your NJ client should die; see here too) and outright NJ refusals (see here, here, and here, for example).  They call into question how well-regarded (or even enforced) the Hippocratic Oath is in Japan.

Moreover, claiming a language barrier as grounds of refusal is a common tactic amongst discriminators in Japan (it adds more plausible deniability than an overt “Japanese Only” sign), and it looks like that is happening in this event too.  But in the case of medical treatment, it is a much more serious issue, as it can be a matter of life and death.

Comments and assistance from Debito.org Readers is welcome below, and TH can respond with more details there as he sees best. Dr. ARUDOU Debito

28 comments on “Reader TH: Refused treatment at neurological hospital by setting overly-high hurdles for J-translation services

  • This is f’ing inexcusable… It angers and deeply worries me that this sort of practice is allowed, especially when lives are on the line at hospital. I wonder about the ability to sue privately.

  • Unfortunately, I am not shocked to hear this story.

    Japan is a country that has been ruled throughout it’s post-war period by unapologetic descendants of war-criminals, with an overt agenda of restoring imperial era social norms, virtually unchallenged.

    Japan is a country that has a post-war Ministry of Education that was initially staffed with de-mobilized kempeitai with the expressed goal of ensuring that Japanese post-war education continued to brainwash Japan’s youth with imperial era racist world-views (‘We Japanese….’, ‘Japan has four seasons’ at it’s most harmless, at it’s worst ‘I can’t believe I killed a foreigner’- poor Nepalese guy in Osaka, and unlawful police questioning on the street, snitch sites).

    Japan is a country that has a post-war medical establishment overseen by a former leader of the lethal human experiment conducting Unit 731, ‘Doctor’ Takeo Tamiya, who held the highest positions in the post-war Japanese medical community, and was in a position to propagate and spread as a ‘social norm’ his own value system (that saw NJ as disposable ‘objects’) into every hospital, university hospital, medical school classroom, and clinic, in the country.

    http://www.forbes.com/sites/eamonnfingleton/2014/03/03/forget-the-comfort-women-row-heres-postwar-japans-biggest-abomination-and-it-is-still-unresolved/

    — Fine. But this doesn’t help TH get treatment. Let’s also try to be helpful, shall we?

  • My strong suggestion would be to take a deep breath and go back to steps.

    Right now TH has essentially a 3rd hand account, so before trying to rally the troops, I would actually try to find a friend that is willing to help and have them call the hospital to find out why they require a professional medical translator (to the best of my knowledge that is unusual) and if there are other ways to fulfil the requirement. E.g. an example would be that the hospital does not want the legal burden of any mistranslation fall no either the hospital or the volunteer and a simple written acceptance of that risk by TH might resolve that issue.

    Also – despite sounding defeatist – it might be worth also checking in with the number two hospital on his list. On the one hand it might be just worth it for a second opinion and on the other – if another hospital does not have such a requirement it would give another argument to bring up.

  • Perhaps TH’s Japanese friend should contact the hospital again but this time claim to be calling on behalf of a deaf person. Ask them if it’s OK if the deaf person brings along a sign language interpreter. If they say yes, ask if the sign language interpreter can just be a friend or relative. If they say yes (which I’m sure they will!), ask them to explain the precise difference between not being able to understand what the doctor is saying because you are deaf vs. not being able to understand because you don’t speak Japanese. Also, record the conversation.

    I also find the ‘famous’ specialist hospitals are the worst to deal with.

  • @ Dr. Debito #3

    I would like very much to be helpful, but I haven’t got anything to work with.
    A healthcare system that permits refusal of treatment to foreigners. I’d like to suggest legal action, but Japan has a legal system that permits refusal of human rights to foreigners.
    Where to go from there? I really don’t know.

  • Unbelievable, just unbelievable. Foreigners in Japan now can’t even get medical treatment, they are only for Japanese blooded people. Why aren’t any Western press covering these issues in Japan, and let the world know that if you get sick in Japan, they will deny you of treatment with the flimsies excuse that they can find? Why does Japan get a free pass? If this had happened in UK or US, the press from all over the world would be descending down on the story. But not in Japan who gets a free pass all the time!

  • OnceAGaijinAlwaysAGaijin says:

    It sounds a bit thick of me, but shouldn’t the hospital be interested in helping the patient first instead of putting up roadblocks to treatment. They sound like a bunch of assholes. How about if one of their children was refused help in the U.S. or Europe because they couldn’t speak English well enough.

    Surely this treatment (well, lack of treatment) fails a basic humanitarian and professional test on top of other considerations.

  • There is no licensing for medical interpreters, so it is entirely possible to simply have a friend come along and tell them to say, if asked, that they are a professional medical interpreter (ironically enough, a trilingual friend does this job and has no qualifications).

    I’ve found that most hospitals have numerous doctors who speak really, really good English, but then you get stuff like this. My regular doctor usually wants me to stay more so he can practice his English.

  • Loverilakkuma says:

    Not all front desk staff share the same opinions or understanding on the visitation of patients who don’t speak Japanese. I don’t think they have any written rule in this case. That is exactly the problem.

    Since the hospital is national medical institution, they have no excuse for refusing medical treatment based on cultural/language barrier.

    As some posters mention above, I would suggest TH’s Japanese friend(s) call the hospital first, explain the detail, ask the head or manager for meeting, visit the hospital with TH to discuss the issue with the head of hospital in a lengthy conversation. Also, make sure to present TH’s medical records (would be great if accompanied with Japanese translation) that indicate the need for his treatment at the time of meeting.

    If it doesn’t work, then, they should consult for legal assistance.

  • I’ve been rejected by two small neighborhood hospitals because they said that the doctors did not want to deal with me because they were not comfortable with dealing with a foreigner. They don’t speak English, either. One visit was for work related health check. They just told me to go to another hospital. Even though I spoke some Japanese. So I had to find other hospitals to get my work health check done.

    I was going to write a letter to the city council but I just gave up. And this was in Tokyo.

  • Thanks for the thoughts.
    I think it would work to go along with a friend without saying anything beforehand.
    It is this one hospital making it difficult to see them, others have been much better.
    Honestly, I don’t want to the hassle of going to this place now, or associate myself with people who treat me like this. I’ll have to settle for other options.
    It would be good to see them taking responsibility for this kind of behavior, however. It is nothing to be proud of, especially for the National Center for Neurology and Psychiatry!
    I agree that it is strange that Japan gets a free pass for behavior like this.

  • I’ve been asked for my Alien Registration ID at a hospital, and my precise visa status and expiration date to be entered into their system. And whenever I renewed my visa at Immigration, the hospital would require me to update it in their system as well. It only happened at that one hospital, and that’s why I don’t go there anymore. Isn’t there a different hospital you could go to that’s just as good?

    — Which hospital was this?

  • Okay, here is the question I feel is important to ask, “How, and under what grounds, does one go about suing these hospitals?” Has it been done? How much damages can be claimed and how can these places be shown up for their horrible failure to uphold basic medical practices… of simply accepting a patient!

  • Furthermore, if it IS NTT Medical Center Tokyo, how can we get this on the news, trending on Twitter, or make sure that they know this is unacceptable?

  • Ive had to endure this mickey mouse treatment as well on many occasions. needed a flu shot and was told I needed a J speaker. I asked why, and they said maybe I had allergies. I said your telling me this in English, and Ive had many flu shots in japan before so whats the big deal? Stuff can really rattle you and long term I dont think its good for your health. You go to get treated, and end up feeling worse. Nonsense.

  • It is quite standard procedure to ask for immigration status in Japanese hospitals:

    http://www.kameda.com/us/information/attention/index.html

    “If you have been in Japan continuously for more than 90 days and do not have a valid Alien Registration Card and/or a valid unexpired visa in your passport, the clinic or hospital may report you to the police and/or immigration authorities.
    Even if there is a stamp indicating that the bearer has overstayed the authorized stay, many clinics and hospitals will still report this to the police/immigration authorities.”

    This would be quite unthinkable in European hospitals, where the prevalent thought is that it is better to treat illegal migrants than to let them die or propagate epidemics. Even illegal pregnant women are never reported to the police as it would go against medical ethics and unborn babies also deserve proper care.

  • Piglet #18

    They may ask but under the current law, as i understand it, unless the hospital has been given special permission/authorisation by the police/immigration dept to ask and expect, you are under no obligation to present/show your visa status. You must ask them for proof of being able to ask/demand your visa status. Downside is, they’ll just simply refuse you on the grounds that they’ll be unable to continue, for the aforementioned reasons.

    Thus the whole evil eye of Japan is on you and you must comply, regardless what the law says. Those dam pesky foreigners slipping through these darn “rules”…I get this all the time when obtaining travel insurance at the airports and some travel agencies. They tell me it is in their policy document. Errr yes…but it is not legal to do so…goes over their heads…they keep saying it’s in their policy agreement!!…endless circles.

    So yes..this really needs to be brought to the publication attention pronto.

  • Loverilakkuma says:

    @Piglet, #18

    “If you have been in Japan continuously for more than 90 days and do not have a valid Alien Registration Card and/or a valid unexpired visa in your passport, the clinic or hospital may report you to the police and/or immigration authorities. Even if there is a stamp indicating that the bearer has overstayed the authorized stay, many clinics and hospitals will still report this to the police/immigration authorities.”

    That just sounds like a language stolen from state immigration authority through cut-and-paste (I would probably dock points for plagiarism.) Technically, hospitals have no rights to refuse NJ visitors except for ID verification. New Resident Card is not one and the only ID for NJ. They still have several options to show their IDs–such as driver’s license, certificate of residency, without showing immigration status to unknown strangers. It’s kind of creepy if local hospitals are deliberately asking NJ visitors ID for policing instead of authority.

  • Are you talking about the NTT hospital that’s near Gotanda station? If so, I’ve used them and found their care to be largely excellent (and I’ve spent more time there than I want to talk about), but they did ask for my residence card when I went there by myself.

    I asked why they needed it, and they said for ID purposes, so I told them they can accept my driver license. The girl at the counter talked to someone of (presumably) higher authority behind the counter, and they accepted my license without further issue.

    Now, this was almost two years ago, so I don’t remember exactly what I said at the counter (or if I specifically mentioned discrimination), but I did immediately after complain to the healthcare professional I was scheduled to see that day, and there I specifically mentioned being upset at such discriminatory behavior. She made a note of my complaint (I saw her write it down on actual paper) and said she’d contact the appropriate parties. Since I wasn’t asked for my card again after that, I had assumed they adjusted their training, but obviously not.

    I guess my advice would be to have an alternative form of photo ID and insist on using that, if you go to NTT.

    . o O (Not trying to be an apologist. I’m going to continue using NTT, but I will also bring this issue up again the next time I have a chance when I go there.)

  • Hi TH,

    this seems totally illegal to my understanding. They are basically denying medical services to you. The fact that you don’t understand japanese language shall not be an impediment to your medical treatment. They can (and they did) suggest and interpreter, but that is for your own benefit. The main reason for the interpreter is to translate the physician’s explanation/recommendation to you. Not the other way around, since the physician can obtain most information he needs for treatment by conducting medical exams.

    Requesting the translator to be a medical professional interpreter is nothing more than an excuse not to take you as patient. The interpreter is there to cover the japanese language gap only. Professional medical knowledge shall not be required from the interpreter and it is not requested from any japanese citizen who is treated at the very same hospital.

  • This is reality in Japan.
    There is the written law, then there is the reality on the ground.
    Someone at the hospital is arbitrarily impeding access, most likely with permission from their superiors.
    Further investigation will reveal no such policy exits, and the person(s) requiring (in this case) a medical translator will be revealed as having mis-quoted hospital policy. no harm, no apology. shucks. it’s all ok now, isn’t it?

    First they try to turn you away.
    Then they try to discourage you with silly requirements.
    If you really persist, you may actually get access.

    I have seen this across many industries in Japan – not just medical. It has always (in my experience) turned out to be individuals “mis-interpreting” policy. If you go away, problem (for them) solved. If you really want/need their service/treatment, don’t back down.

    Good luck!

  • So after this experience, as well as others, I’m voting with my feet and leaving Japan for good.
    The change that we’d all like for Japan – change that would be positive for Japan’s future – won’t come from expats. Others may disagree, but I think that to be the case.

  • TH (OP) – of course it won’t come from “expats”, “visitors” or “long term residents”.
    Japan does not respect minorities. It certainly does not accommodate or listen to them.
    In Japan, you join the dominant group, or get shit on. This is Japan, and always has been.
    Japan does not even pretend to offer a level playing field.
    It does not offer NJ human rights, or other protections that are considered standard in most countries.
    I think more people will see their options in Japan are limited, and leave.
    Japan’s loss.

  • It’s things like this that annoy me about Japan. They want foreigners to praise and admire their country yet they keep coming up with slick, underhanded ways to undermine the very rights of foreigners if not deny them basic service. You can’t have it both ways Japan.

  • From my experience this sounds more like a liabilty issue than a discrimination issue.
    Perhaps you should try to see if offering to sign up a release form would do the trick, if not try to complain to the bucyou or whoever else is in charge.
    Personally i am very sensitive to that issue and I complain even when the doctor has a bad attitude or they start using eccessive katakana.

  • @ Giuseppe #27

    I certainly wouldn’t want to potentialy discriminatory doctor a release form for any bad treatment he might like to give me!

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