A system to support children with severe cerebral palsy and theirfamilies as well as aim to improve the quality of obstetric care

The Japan ObstetricCompensation System
for Cerebral Palsy- Looking back over 10 years after System was launched -Overview of System
Background and Objectives of the System
The Japan Obstetric Compensation System for Cerebral Palsy (referred to as “this System”, hereafter) was
launched in 2009 for the following objectives, as part of building the environment in which obstetric care canbe smoothly delivered and also as a Japan's first no-fault compensation system in the medical field with thebackground to improve the shortage of obstetricians and ensure the obstetric care provision system.

Objective 1
Objective 2
Objective 3

Quickly compensating for the economic burden on the families and children with severe
cerebral palsy developed related with delivery.
Analyzing the cause of cerebral palsy and providing information that will help prevent therecurrence of similar cases
Prevention and early settlement of conflicts and improvement of quality in obstetric care

Overview of This System
As the sole operating organization of this System, the Japan Council for Quality Health Care (referred toas “JQ”, hereafter) performs operations such as encouragement for childbirth facilities to participate in this
System, collection of insurance premiums, approval of eligible cases for compensation, long-term payment forcompensation (insurance claim procedure), cause analysis and recurrence prevention, and others.

••Compensation
The childbirth facilities participating in this System make a contract with expectant mothers under their control
for all eligible cases to be compensated. The childbirth facilities participate in casualty insurance under which
the operating organization is the contractor and pay the insurance premiums accordingly.
If a delivery is approved to be eligible for compensation by the operating organization, insurance money will be
paid to the expectant mother (child) as compensation payment from the insurance company.
Insurance premiums for compensation of this System are paid by healthcare insurers through childbirthfacilities, but for deliveries (limited to deliveries after the 22nd weeks) in participated childbirth facilities, anamount corresponding to the insurance premiums is added to the insurer’s lump-sum payment for delivery
and nursing, and this total amount (approximately 420,000 yen) is paid to the childbirth facilities as part of thedelivery cost. So, practically, there is no burden on the childbirth facilities.
Structure of Compensation in This System
Contract ofCompensation *1

Healthcare
Insurers

Lump-sumallowancefor delivery

Expectantmothers(each child)

Registration
Certificate
DeliveryexpensesChildbirthfacilities
Insurance
premium

Contractor[JapanCouncil for
Quality HealthCare (JQ)]
OperatingInsurance
Organization
premium

Casualty
insurancecompany

Compensation payment (Insurance money) *2*1 Compensation is promised under the standard compensation agreements stipulated by the operating organization.
*2 If approved eligible for compensation by the operating organization, the operating organization will apply to the insurance company for payment as
a deputy of the participated childbirth facility. Also, the insurance company will pay the compensation.

Eligibility for compensation is judged according to the eligibility standard by the JQ as the operating organization.
Specifically, it is judged by the “Review Committee” consisting of pediatricians, rehabilitation doctors, obstetricians
and academic experts. Based on the judgment, the JQ approves the eligibility for compensation.

1

If judged as eligible, a total amount of 30 million yen is paid for compensation. Of that amount, a lump-sum
payment of 6 million yen is paid for preparation for nursing care and another total compensation amount of
24 million yen (installment compensation payment) is paid every year as nursing care expenses (annual amountof 1.2 million, 20 times).
To provide the foundation expenses for nursing care

To provide nursing care expenses
Installment compensation payment:

Lump-sum payment for preparation:

6 million yen

Total

24 million yen(1.2 million yen, 20 time-installments in a year)••Cause Analysis and Recurrence Prevention
For all the cases approved to be eligible for compensation, the operating organization analyzes the cause frommedical point of view based on the information described in the medical records and other documents submitted
from the childbirth facilities and information from parents. Specifically, the “Cause Analysis Committee/Cause
Analysis Committee Sub-committee” composed of obstetricians, pediatricians, midwives, lawyers, experts, etc.,
analyzes the cause, prepares a Cause Analysis Report for each case, and deliver it to the relevant childbirthfacility and the child and his/her parents.
Also, the JQ systematically organizes and accumulates individual case information, and the “Recurrence
Prevention Committee” compiles the recurrence prevention measures and other information found from multiple
cases in the “Recurrence Prevention Report”. By providing these information to citizens, childbirth facilities,
relative academic societies/organizations, administrative agencies, etc., the JQ is trying to prevent recurrenceof similar cases and improve the quality of obstetric care.
Flow of Cause Analysis and Recurrence Prevention in This System

Recurrence Prevention Committee

Cause Analysis Committee<Analysis on a “collective cases” basis><Analysis on “Individual Case” basis>from epidemiological point of view

from medical point of view

Cause Analysis Report

Recurrence Prevention Report
Recommendations from Recurrence
Prevention Committee(Leaflet, poster), etc.

Cause Analysis Report

Recurrence Prevention Report

Recommends
recurrence
prevention
measures fromanalysis ofmultiple cases

Offer to citizens,participated childbirthfacilities, relative academic
societies/organizations,administrative agencies,etc.
• Publication on the website• Distribution of report, etc.

Recommendations from Recurrence
Prevention Committee (Leaflet)

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産科医療補償制度
再発防止に関する報告書―産科医療の質の向上に向けて

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Operation Records of The Japan Obstetric Compensation System for Cerebral Palsy
1. Number of participated childbirth facilities(As at the end of June 2018)

Number of childbirth facilities

Number of participated childbirth facilities

Participation (%)

3,239

3,236

99.9%

Number of childbirth facilities is counted by cooperation of the Japan Association of Obstetricians and Gynecologists and the Japanese Midwives Association.

2. Review(As at the end of June 2018)
Not Eligible
Number of cases
processed

Eligible2009 *3561

2010 *3

Birth year

*1

Cases in process

Application deadline

00Application acceptance ended.

141

0

0

ditto

355

147

0

0

ditto

516

361

155

0

0

ditto

2013

410

308

94

7

1

Until 5-years-old birthday in 2018

2014

311

233

59

15

4

Until 5-years-old birthday in 2019

2015

246

211

15

18

2

Until 5-years-old birthday in 2020

2016

130

120

7

3

0

Until 5-years-old birthday in 2021

2017

15

15

0

0

0

Until 5-years-old birthday in 2022

Total

3,214

2,404

760

43

7

-

Not Eligible

Reapplication
possible *2

419

142

523

382

2011 *3502

2012 *3*1 “Eligible” includes the cases that become eligible after reapplication and the cases approved eligible by the Opposition Review Committee.
*2 “Not Eligible (Reapplication possible)” is for the cases that are “Not Eligible” at the time of review for compensation but should be reviewed again whenreapplication is submitted with specified requirements met in the future.
*3 For the children born in the years from 2009 to 2012, the review results were confirmed.

3. Cause Analysis
At launch of this System, the Cause Analysis Committee started with 6 sub-committees, reviewing one case foreach per month. After that, along with an increase in the number of preparation, the Committee now has grown to asystem to review 6 cases per month in 7 sub-committees and prepare Cause Analysis Reports on 500 cases a year.
By June 2018, a total of 1,962 Cause Analysis Reports were sent to children, their parents and childbirth facilities.
In order to ensure the transparency of the System as well as prevent the recurrence of similar cases and improve
the quality of obstetric care, the “summary version” of the Cause Analysis Reports have been posted on thewebsite of this System after obtaining the consents of the childbirth facilities and parents of the children and also
the “full-text version (masking version)” has been published through specified procedures for research purposes.

4. Recurrence Prevention
By the end of March 2018, a total of eight times, the “Recurrence Prevention Reports” have been published andsent to the affiliated childbirth facilities, relevant academic societies/organizations, administrative agencies, etc.,
as well as posted on the website of this System.
In addition, the JQ has provided tools to prevent recurrence, such as leaflets and posters on “Premature
separation of normally implanted placenta” and “Early skin-to-skin contact for mothers and newborn infants”.

3What We Have Found during 10 Years Since Launch in January 2009
 What we have found in review and compensation
Situation of nursing care for children with cerebral palsy who were eligible for compensation
The JQ summarized and published as follows about the children with cerebral palsy who were approved eligible
for compensation in February 2017.

Main living place
0%

20%

40%

60%

80%

0%

100%

Home

89.7%

Hospital

5.9%

Nursing home

5.1%

OthersWay of nutritional intake

Approx. 90% stay at home.

0.4%

Oral ingestion
Gastrostomy
Nasogastric tube
Oral ingestion/Intravenous nutrition
Other tube feeding
Intravenous nutrition

Use of oxygen and artificial respirator
0%

10%

20%

0%

Approx. 20% use
oxygen and artificial
respirator.

21.4%

Use of artificial respirator

19.5%

20%

40%

60%

80%

Wheelchair/buggy

OthersOthers5.9%
5.4%

Walker

4.0%

Walking stick

0.6%

15.0%
6.2%
“Gastrostomy” and “Nasogastric
1.9%
tube” are 40% in total.
0.1%

20%

40%

60%

8.0%

80%

100%

Approx. 90% use diapers.

0.7%

Aid to washing face and changing clothes

100%

0%

20%

Total assistance

90.4%

Lower limb orthosis

55.2%

91.1%

Diaper unnecessary

Means of transport
0%

60%

29.4%

Use of diaper

24.3%

Intratracheal intubation,
tracheotomy

40%

Diaper usage

30%

Use of oxygen

20%

General assistance

40%

60%

80%

100%
90.4%

7.6%

Approx. 90% use “wheelchair or buggy”.

Approx. 90% require total assistance.
Assistance unnecessary

1.2%• This data is a summary of the items listed in the medical certificates attached to the compensation installment applications of 1,282 cases, whose
diagnosis date is in the period from January 2016 to December 2016, submitted by the end of December 2016.
• When there are answers in two or more options, the percentage may not be 100% because each item has to be calculated.
• If there is no answer, it is included in 1,282 target cases, but it is not included in the number of each item.

Number of compensation applications by age of child after delivery(Case)
500

400
236

300
9

130

2

•• The number of compensation applications has two
peaks. One is “1 year to 1 year 6 months” and theother is “4 years and elder” after delivery.
•• A high proportion of eligible children is observed in
the former group, while a low proportion of eligibility
is seen in the latter group.

200
15

100

230

53

246

20

70
250

32

159
99

91

2 years
2 years
6 months

2 years
6 months
3 years

192
131

119

3 years
3 years
6 months

3 years
6 months
4 years0
6 months
1 year

1 year
1 year6 months

1 year6 months
2 years

 Eligible  Not Eligible

4 years
4 years
6 months

4 years
6 months
5 years•• For compensation application, a medical certificate (special
medical certificate for compensation application) has to besubmitted.
•• This data was calculated for the children who were bornfrom 2009 to 2012 out of the cases for which compensation
applications was submitted.
•• The period for compensation application is from the 1st birthday
to the 5th birthday of a child. However, if medical condition isextremely serious and diagnosis is possible, compensation
application can be submitted from 6 months after birth.

4 What we have found through Cause Analysis
Cause Analysis Report
In this System, JQ performs Cause Analysis for all the cases approved as “Eligible” for compensation and prepare“Cause Analysis Reports”.

What is Cause Analysis Report?
The Cause Analysis Report is a report in which Cause Analysis is done by the “Cause Analysis Committee/
Cause Analysis Sub-committee” composed of obstetricians, midwives, pediatricians (including neonatologists),
lawyers, experts, etc. from a medical viewpoint based on the medical record, maternity record, clinicalexamination data, and information on medical treatment system, etc. submitted from the relevant childbirthfacility, information from parents, and so on.
The prepared Cause Analysis Reports are delivered to children, their parents and childbirth facilities.
Major contents of the report•• Outline of the case
Describes the information on pregnancy, delivery, course of neonatal period, etc.
•• Cause of cerebral palsy
Lists up everything at the present time as the causes of cerebral palsy onset.
•• Medical evaluation on clinical course
Medically evaluates pregnancy, delivery management, and medical treatment.
•• Items to consider for improving obstetric care in the future
Recommends possible measures to prevent the onset of cerebral palsy to childbirth facilities, relative
academic societies/organizations, administrative agencies, etc.

In order to ensure the transparency of the System as well as prevent the recurrence of similar cases and improve
the quality of obstetric care, the “summary version” (not involving information such that individuals and childbirthfacilities can be identified) of the Cause Analysis Reports have been posted on the website of this System after
obtaining the consents of the childbirth facilities and parents of the children and also the “full-text version (maskingversion)” (masking (blackening) the information such that individuals and childbirth facilities can be identified) has
been published through specified procedures for research purposes.

Possible causes of cerebral palsy
In the 8th Recurrence Prevention Reportpublished in March 2018, 968 cases(60.3%) out of 1,606 analyzed cases havestated pathological conditions as the maincause of the onset of cerebral palsy.
Out of these cases, 773 cases (48.1%)
noted a single pathological condition,and 195 cases (12.1%) noted multiple
pathological conditions.
On the other hand, no cause was
identified in 638 cases (39.7%). In thesecases, even experts were unable toidentify the cause.

Pathological condition

Numberof cases%

Pathological conditions are noted as the major causes of theonset of cerebral palsy.

968

60.3

773

48.1

Separation of placenta or bleeding from placenta

272

16.9

Umbilical factors

214

13.3

Infection

57

3.5

Uterine rupture

34

2.1

Fetomaternal transfusion syndrome

31

1.9

Others

165

10.3

195

12.1

638

39.7

1,606

100.0

Single pathological condition is noted.

Two or more pathological conditions are noted.
Main cause is not clear or hard to identify
Total

5

Evaluation of Cause Analysis Report from parents/childbirth facilities
The JQ conducted questionnaires on “Evaluation of Cause Analysis Report” for the parents and childbirth facilities
to whom or to which Cause Analysis Reports were delivered four times by 2017. The results of each questionnaire
were as follows.
The best reason for having answered “Very good” or “Fairly good” was “Analysis was done by a third party” for boththe parents and childbirth facilities.

[Evaluation from Parents][Evaluation from Childbirth facilities]

Poor
8 cases (2.0%)Poor
6 cases (1.7%)

Not so good
59 cases (14.5%)

Not so good
10 cases (2.8%)
Very good
126 cases (31.0%)

Yes and No
75 cases (18.4%)

Very good
113 cases (31.5%)

Yes and No
74 cases (20.6%)

Fairly good139 cases (34.2%)

Fairly good
156 cases (43.5%)

Number of responses: 407

50

Reasons for“Very good” and “Fairly good”

0

150

200

Analysis was done
by a third party(Case)
250
226

Lead to improvementof obstetric care

121

Cause was identified

Relieve sense of distrust
against delivery facilities
and doctors

Others24

Others

Cause was not
identified after all

58

150

200

(Case)
250(Case)
250

83

48

12

50

0
Doubtful about fairness
or neutrality in evaluation

12

41

Never Lead to
improvement ofobstetric care

11

Never Lead to
improvement ofobstetric care

36

Cause was not
identified after all

9

Doubtful about fairness
or neutrality in evaluation

31

Increased sense of
distrust against delivery
facilities and doctors

9

Others

4

10

200

127

Increased sense of
distrust against delivery
facilities and doctors

Others150

242

Cause was identified

29

100

100

Analysis was done
by a third party

Relieve sense of distrust
against delivery facilities
and doctors

50

50

0

Lead to improvementof obstetric care

1350Reasons for“Not so good” and “Poor”

100

Number of responses: 359

100

150

200

(Case)
250

This data is a summary of the responded cases out of 659 cases for which the Cause Analysis Report was delivered by May 2015. (With duplicate answers)
6 Provision of Recurrence Prevention Information
Recurrence Prevention Report
The JQ systematically organizes and accumulates individual case information, and the “Recurrence Prevention
Committee” compiles and publishes the recurrence prevention measures and other information found from multiple
cases in the “Recurrence Prevention Report”.
The main themes discussed up to March 2018 on causes of cerebral palsy and its background factors are as follows.
(As at the end of March 2018)

Main theme

Report involving main theme on left

Monitoring fetal heart rate during delivery

1st report, 3rd report

Reading of cardiotocogram (CTG)

8th report

Umbilical cord prolapse

1st report, 3rd report

Premature separation of normally implanted
placenta

3rd report, 6th report

Health guidance for premature separation of
normally implanted placenta

2nd report

Uterine contraction drug

1st report, 3rd report

Neonatal resuscitation

1st report, 3rd report, 5th report

Record of medical records, etc.

2nd report

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産科医療補償制度
再発防止に関する報告書―産科医療の質の向上に向けて

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Recurrence Prevention Report

Monitoring/reading cardiotocogram (CTG)
In the current obstetric care, monitoring fetal heart rate is one of the useful methods to infer the conditions of the fetus.
For this reason, it is said that reading of cardiotocogram (CTG) is important for grasping the conditions of the fetus in thecourse of delivery.
In order to correctly evaluate the conditions of the fetus in the course of pregnancy/delivery and lead to subsequent
responses, this System has analyzed monitoring/reading of the cardiotocogram (CTG) over three times in the past.
Proficiency is necessary to accurately read the cardiotocogram (CTG) since it shows various waveforms depending on thesituation during delivery. So, the JQ makes recommendations and prepares teaching materials for obstetric medical personnel
based on the actual cardiotocograms (CTG) of the children with cerebral palsy who were approved eligible for compensation.

Recommendations to obstetric medical
personnel (partially excerpted.)•• Participate in-hospital study sessions in eachfacility and out-of-hospital workshops so as toenhance the ability to read cardiotocograms(CTG).
•• Understand the physiological meaning of theemergence of the waveform pattern of the fetal
heart rate and master the skills to infer the fetal
conditions from the cardiotocogram (CTG).
•• Evaluate the cardiotocogram (CTG) according
to the “Guideline for Gynecological Practice”
and note the findings from reading in the
medical record regardless of whether theevaluation results are normal or abnormal.
7

Preparation of teaching materials
for obstetric medical personnel
Based on the specific cardiotocograms (CTG) of thechildren with cerebral palsy, points for reading are
explained concretely.
Japanese version: Published in January 2014.
English version: Published in September 2014.

Cardiotocogram (CTG) in cerebral palsy cases

In the “8th Recurrence Prevention Report”, the JQ has made recommendations to the obstetric medical personnel
so that he/she can properly judge as to the reading of the cardiotocogram (CTG) in the course of delivery.

Differentiation between late transient bradycardia and variable transient bradycardia
Differentiation between late transient bradycardia and variable transient bradycardia.
[bpm]

3 cm/min.

Fetal heart rate

[bpm]

200

200

180

180

160

160

140

140

120

120

100

100

80

80

60

60

[mmHg][mmHg]

100

100

75

75

50

50

25
0

25
0

Uterine contraction

Lowest point of fetal heart rate of transient bradycardia is indicated by a blue arrow “Strongest point of uterine contraction is indicated by a red arrow “”.

”.

Time from start of lowering fetal heart rate to its lowest point is indicated by a green arrow “”.

•• Comments from Recurrence Prevention Committee• The fetal heart rate has slowly decreased with the contraction of the uterus and gradually recovered, so it can be judged as alate transient bradycardia.
• The lowest points of the fetal heart rate of the transient bradycardia occurred repeatedly behind the strongest points of uterine
contraction.
• If it is difficult to visually distinguish whether the decline in the fetal heart rate is rapid or gentle, check whether the time from thestart of declining fetal heart rate to the lowest point is less than or more than 30 seconds. It is more than 30 seconds from thestart of declining fetal heart rate to the lowest point, which indicates a gentle waveform.
[Reference]
Late transient bradycardia: Observed when the fetal oxygen is deficient.
Variable transient bradycardia: Observed when umbilical cord is pressed.

Efforts to “Recommendations from Recurrence Prevention Committee”
We conducted questionnaires for childbirth facilities twice by 2017 as to utilization of “Recommendations
from Recurrence Prevention Committee” in the clinical practices. The results of the questionnaires were as
follows. The most utilized recommendation is about “Monitoring fetal heart rate during delivery”.

N/A
80 cases(8.4%)

No plan to do
25 cases(2.6%)
Not yet136 cases(14.4%)

Most
294 cases(31.0%)

A little
412 cases(43.5%)

Situation of efforts by theme of people who answered“Most” and “A little” (for top 5 items with duplicate answers)
0%

20%

40%

60%

80%

Monitoring fetal heart rate during delivery

100%
90.4%

Uterine contraction drug

82.9%

Neonatal resuscitation

82.0%

Health guidance for premature separation of
normally implanted placenta
Premature separation of
normally implanted placenta
Pregnancy hypertension syndrome

68.8%

65.9%

8

Transition of Japan Obstetric Compensation System for Cerebral Palsy
TopicsUp to 2008

Efforts to make System known

Feb. 2007 1st Operating Organization Preparation Committee
meeting held.
Jan. 2008 “Preparatory Committee Report” summarized.
July 2008 1st Operating Committee meeting held.
Participation procedure of childbirth facilities started.
Oct. 2008 Registration of expectant mother information started.

July 2008

Operation of dedicated call center started.

Jan.

The Japan Obstetric Compensation System for
Cerebral Palsy launched.
1st Cause Analysis Committee meeting held.
1st Review Committee meeting held.
Acceptance of applications for compensation
started.
Cause Analysis Report on virtual case created.
2nd Review Committee meeting held. (Case review
started.)June“Guideline for preparation of medical certificate”(special medical certificate for compensation
application) prepared.

Jan.

“Cause Analysis Report Preparation Manual (How to
prepare Cause Analysis Report)” prepared.
“Explanation of Cause Analysis” for childbirth facilities
prepared.
“Guide to Cause Analysis” for parents of children who
were approved eligible for compensation prepared.

July

12th Cause Analysis Committee meeting held
(Review of Cause Analysis Report started) anddelivery of Cause Analysis Reports started.
Cause Analysis Reports “summary version”
published (posted on this System website.)
Disclosure of Cause Analysis Reports “full text
version (masking version)” started.
1st Recurrence Prevention Committee meeting held.

Feb.

1st Opposition Review Committee meeting held.

2013

Aug.

Emergency Countermeasure meeting for promoting
compensation application held.

Aug.
Dec.

“Reference cases approved eligible” prepared.
“Reference cases on severity of cerebral palsy” prepared.
Special medical certificate for compensation application
revised to a checkbox type.

2014

Jan.

System revision implemented (how to analyze
causes, how to coordinate compensation anddamage compensation, efforts toward prevention of
conflicts and early resolution, etc.)
1st Recurrence Prevention Working Group meeting
held.
Cases approved eligible for compensation exceeded
1,000 in total.

Sep.

“Explanation of criteria for cerebral palsy eligible forcompensation” prepared.
“Examples of reference cases on eligibility forcompensation” prepared.

System revision (criteria for cerebral palsy eligible
for compensation, insurance premiums, etc.)
implemented.
Disclosure of Cause Analysis Report by a new
disclosure method based on “Ethical guidelines on
medical research targeting people” “full-text version(masking version)” started.

Oct.

2009

Feb.
June
July
Sep.
Nov.

2010

Feb.
Mar.
Apr.

2011

May
July

2012

May
Sep.

2015

Jan.
Nov.

2016

July
Nov.

9

Nov.

Nov.

“The Japan Obstetric Compensation System for
Cerebral Palsy News” first-issued.
“Compensation Application Review Guidebook”
prepared.

Total number of delivering Cause Analysis Reports
exceeded 1,000 cases.
100th Review Committee meeting held.

2017

May

Cases eligible for compensation exceeded 2,000 in
total.

2018

Jan.

10th anniversary of System launchedJan.

“Cause Analysis Report summary version searchfunction” added to this System website.

Events around System

Approach to recurrence prevention

Oct. 2004 “Midwife Business Guidelines 2004” first-issued.
Apr. 2008 “Obstetrics and Gynecology Practice Guidelines Obstetrics
volume 2008” first-issued.

Dec.

“Midwife Business Guidelines 2009” issued.

Mar.

“Obstetrics and Gynecology Practice Guidelines Obstetrics
volume 2011” issued.

Aug.

“1st Recurrence Prevention Report” first-issued.

May
Dec.

“2nd Recurrence Prevention Report” issued.
Leaflet on “Premature separation of normally implanted placenta”
prepared.

May“3rd Recurrence Prevention Report” issued.

July

Meaning of this System mentioned in the “Report on
verification concerning speedup of trials (Social Factors
edition)” issued by the General Secretary of the Supreme
Court.

Jan.

“Reading and cautions of cardiotocogram (CTG) waveform
pattern of cerebral palsy cases” (Japanese version) prepared.
Leaflet on “Importance of informed consent when using uterine
contraction drug” prepared.
Posters on the flow chart of “Use of Metreurynter” and“Implementation of Artificial Rupture” prepared.
“4th Recurrence Prevention Report” issued.
“Reading and cautions of cardiotocogram (CTG) waveform
pattern of cerebral palsy cases” (English version) prepared.

Mar.
Apr.

“Midwife Business Guidelines 2014” issued.
“Obstetrics and Gynecology Practice Guidelines Obstetrics
volume 2014” issued.

“5th Recurrence Prevention Report” issued and “Recommendations
from Recurrence Prevention Committee” prepared.

July

A pharmaceutical company announced “Request for properuse of uterine contraction drug”, and the Pharmaceuticals
and Medical Devices Agency posted this document on its
website.
In response to the recommendations of “Recurrence
Prevention Report”, four societies such as Japan Society
for Neonatal Health and Development requested release of
adrenaline at the concentration recommended by Neonatal
Resuscitation Guidelines 2010 (Japanese version).

Feb.

Apr.
Sep.
Mar.

Nov.

“A Paper on Comparative Study between Cases of Cerebral
Palsy Approved for Compensation of This System and Perinatal
Registration Database of Japan Society of Obstetrics andGynecology” posted in open access journal “PLOSONE”.
“6th Recurrence Prevention Report” issued.
Leaflet on “Early skin-to-skin contact for mothers and newborn
infants” prepared.

Jan.

Mar.

“7th Recurrence Prevention Report” issued.

Apr.

Jan.

“A paper on Perinatal Factors in Delivery Period of Children with
Cerebral Palsy Birthed from Mothers of Pregnancy Hypertensive
Syndrome” posted in open access journal “Wiley”.
“8th Recurrence Prevention Report” issued.

Jan.

Mar.
July

Mar.

July

An article on “Adjustment, etc. of the compensationand damage compensation of the obstetric medical
compensation system” posted in the “HANREI TIMES”
widely read by legal personnel.
In response to the recommendations of “Recurrence
Prevention Report”, Japan Society of Perinatal andNeonatal Medicine launched “Working Group to Consider‘Points to remember to improve rooming-in safety’”.
“Obstetrics and Gynecology Practice Guidelines Obstetrics
volume 2017” issued.

10The Japan Obstetric Compensation System for Cerebral Palsy and Its Guidelines
Use of “Recurrence Prevention Report” in Guidelines
In the “Obstetrics and Gynecology Guidelines Obstetrics volume” prepared by Japan Society of Obstetrics and Gynecology
and the Japan Association of Obstetricians and Gynecologists and “Midwife Business Guidelines” prepared by theJapanese Midwives Association, the “Recurrence Prevention Report” of this System used as a cited reference.

The Japan Obstetric Compensation
System for Cerebral Palsy

Guidelines of society
and association
When preparing a Cause
Analysis Report, “medical
evaluation” is carried out
based on the guidelines.

第
9
回
産
科
医
療
補
償
制
度

産科医療補償制度
再発防止に関する報告書

再
発
防
止
に
関
す
る
報
告
書

―産科医療の質の向上に向けてWhen preparing a guideline,
the Recurrence Prevention
Report of this System isquoted.

公
益
財
団
法
人
日
本
医
療
機
能
評
価
機
構

Recurrence
Prevention Report

Cause Analysis
ReportName of guidelines

Obstetrics and Gynecology
Practice Guidelines
Obstetrics volume

Midwife Business
Guidelines

Quoted item of guidelines

Obstetrics and Gynecology Practice Guidelines
Obstetrics volume

Midwife Business Guidelines

2014“CQ412 How to induce childbirth and its cautions?” and 1 other item

2017

“CQ308 What is the diagnosis and management of Premature separation of
normally implanted placenta?” and other 4 items

2014

IV. Matters to be Noted for Medical Safety
1. Midwife and record
4. Health guidance for premature separation of normally implanted placenta
8. Neonatal resuscitation

Trends in lawsuit cases in obstetrics and gynecology
Obstetrics & Gynecology(Case)
200

Whole medical specialties

Whole medical specialties(Case)
1200

1000

157

1043

149
1085

Obstetrics & Gynecology

161

Launch of System

150

1120
1007

800

955

922

99

896
770

108
600

84

89

821

779

764

100

751

750

753

50

52

54

2015

2016

0
2017 (Year)

82

400
59

56

60

50

200

0

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

* Preliminary report value is shown for 2017.

Quoted from “Number of medical lawsuit cases in each medical department” of the Supreme Court
Medical Affairs Litigation Committee.

References

The Japan Obstetric Compensation System for
Cerebral Palsy, although the target is limited toobstetrics, has an important significance in the
points that a mechanism was launched in which a
public third party organization analyzes the causeof an accident and that a no-fault compensation
system was introduced from the viewpoint ofsocially burdening this risk on the premise thatrisks are involved in medical treatment (especiallyobstetric medical treatment). So, it is also noticed
that no-fault compensation system may develop to
fields other than obstetrics.
The Japan Obstetric Compensation System for
Cerebral Palsy has dealt with a considerable
number of cases after its enforcement, and it isthought that a certain influence is also given to thenumber of the medical-related lawsuit cases.
Excerpt from "Report on verification concerning speedup of trials (Social Factors
edition) in July, 2013" issued by the General Secretary of the Supreme Court.

•• Website of The Japan Obstetric Compensation System for Cerebral Palsy <http:/www.sanka-hp.jcqhc.or.jp/documents/english/index.html>•• Japan Obstetric Compensation System for Cerebral Palsy : Strategic system of data aggregation, investigation, amelioration and no-fault compensation
Shin Ushiro, Hideaki Suzuki, Shigeru Ueda. 2019. <https://doi.org/10.1111/jog.13906>•• Global Patient Safety
John H. Tingle, Clayton Ó Néill, Morgan Shimwell. 2019 – Routledge
Chapter 17:
The Japanese Obstetric Compensation System for Cerebral Palsy – A Case Study of a No-Fault Compensation System
11