Hospital bed shortages leading to ambulance handover delays in Japan

The Yomiuri Shimbun: Nurses attend to a coronavirus patient at the intensive-care unit in Chiba University Hospital in Chiba, on Tuesday.

TOKYO, Feb. 6, 2021:Ambulance crews are increasingly finding it difficult to find medical institutions to receive patients for emergency treatment, particularly in Tokyo and 10 other prefectures where a state of emergency has been declared due to the coronavirus crisis. According to a Yomiuri Shimbun tally of 15 emergency services departments in those prefectures, including the Tokyo Fire Department, the number of such incidents in January increased by 2.3 times compared to the same period last year, due to such reasons as a lack of available medical personnel and beds at medical institutions designated to treat novel coronavirus patients

If a hospital refuses requests from emergency crews to treat patients at least three times and an ambulance is left waiting for more than half an hour, the Fire and Disaster Management Agency of the Internal Affairs and Communications Ministry defines the incident as an “emergency patient transfer problem. The number of such cases recorded by the 15 local emergency services departments totaled 9,865 from Jan. 4 to 31, an increase of 5,676 from the corresponding period last year. The highest number of such cases was recorded in Tokyo at 5,720, or 2.5 times more than last year, while cases in Osaka reached 1,048, or 1.7 times more, and Yokohama reported 885 cases, or 3.5 times more. The highest year-on-year rate of increase was registered in Kawasaki, which recorded 4 times as many cases.

In early January, an emergency crew transporting a man in his 70s who had fallen at his home in Chiba was rejected by as many as 27 hospitals. The crew arrived at the hospital that finally admitted the man 3 hours and 9 minutes after the first call for the ambulance was made. The man was not infected with the coronavirus. At the intensive-care unit of Chiba University Hospital in Chuo Ward, Chiba Prefecture, coma patients including severe coronavirus cases and others were being treated in two depressurized rooms on Tuesday, with two to three nurses attending to each patient. Patients were arriving in waves and the situation at the hospital became dysfunctional pretty quickly. There was nothing we could do, said a doctor who supervises the emergency unit at the hospital, recalling chaotic scenes at the hospital last month.

Its nine-patient emergency ward filled to capacity soon after the New Year, and beds in the 18-patient intensive care unit to which seriously ill patients are transferred also became fully occupied. The hospital said it had to reject requests to admit acute patients while taking into consideration degrees of urgency. The hospital took the unusual step of closing one of its 20 wards closed and assigning 22 nurses to deal mainly with coronavirus patients. But in late January, it was forced to cut the number of personnel in some of its clinical departments and it stopped accepting coronavirus patients after a cluster broke out in a general ward that affected hospital staff members and inpatients.

Tokai University Hospital in Isehara, Kanagawa Prefecture, accepted coronavirus patients from outside its service area, including patients from Yokohama and Kawasaki. Its 20 beds reserved for seriously ill patients and 10 for moderate cases have remained full. To increase its capacity to treat coronavirus patients, the hospital took such measures as reducing the number of beds in general wards and putting off surgical operations with relatively low urgency.

Although the number of patients the hospital admitted has been declining gradually since late January, many seriously ill patients have been hospitalized for several weeks, and beds are not readily available. Seiji Morita, director of the emergency and critical care center of the hospital, said: “We have been carrying out our work with a sense of mission. But feelings of hopelessness and signs of mental pressure are becoming more apparent.

S. Korean court orders Japan to compensate former comfort women

SEOUL, Jan 8, 2021: The Seoul Central District Court on Friday ordered the Japanese government to pay damages in full to 12 former comfort women, the first such ruling that has been reached in a lawsuit filed by former comfort women in South Korea against Japan. The women are each claiming 100 million won (about Â¥9.5 million) in compensation. The court decision contradicts Japan stance that postwar compensation issues between the two countries wereœsettled finally and irreversibly under the 1965 Agreement on the Settlement of Problems Concerning Property and Claims and on Economic Cooperation.

The latest court decision will inevitably further rupture the bilateral relationship which is already said to be the worst it has been since the end of World War II due to a series of issues including those involving former requisitioned workers from the Korean Peninsula. The Japanese government has refused to participate in the trial because of the principle of sovereign immunity under international law, which holds that a sovereign state cannot be sued before the courts of another sovereign state without its consent.

Whether a South Korean court would accept the principle of sovereign immunity was the main focus of the trial. The comfort women issue involved systematic and inhumane criminal acts carried out by the Japanese government, according to the district court ruling, which also stated that sovereign immunity cannot be applied. The court ordered the full compensation out of consideration for the unimaginable mental and physical suffering suffered by the plaintiffs. The lawsuit was triggered in 2013 when former comfort women filed for mediation. At that time, Japan did not accept the mediation on the grounds of the 1965 agreement, and the case moved to litigation in 2016.

Seven of the plaintiffs have already died. On Wednesday, another ruling filed by 20 people, including former comfort women, is scheduled to be handed down against the Japanese government, leaving open the possibility that there will be a series of court decisions granting compensation. In 2015, the Japanese government reached an agreement with the conservative administration of then South Korean President Park Geun-hye, confirming that the issue of comfort women had been finally and irreversibly resolved.

However, the left-wing administration of President Moon Jae-in, which was inaugurated in 2017, effectively scrapped the agreement, claiming it did not reflect the will of the victims. A Japanese company lost a lawsuit filed by requisitioned workers in South Korea, and plaintiffs are proceeding with the seizure and sale of assets held by the company in the country. The Moon administration, claiming it respects justice, has not responded proactively, causing a further deterioration in the Japan-Korea relationship.Speech

 How Much Does Japan Actually Pay to Host U.S. Forces?

OSAKA, Dec 17, 2020:: As 2020 draws to a close, it appears likely that Japan and the United States will not reach an agreement by the end of this fiscal year March 31, when the current deal expires on how much Tokyo will spend over the next five years to host American troops. The coronavirus delayed discussions, and Japan wants to continue long-term negotiations with U.S. President-elect Joe Biden’s administration after he takes office in January. In the interim, the Japanese government will likely approve a one year budget, roughly the same as this year’s amount.

What is host nation support and why is it needed?

In January 1960, Japan and the U.S. signed a security treaty that committed the U.S. to defending Japan in case of attack but did not obligate Japan to come to the defense of the U.S. The two sides also signed a Status of Forces Agreement that spelled out Japan’s responsibilities for hosting U.S. military bases. At the time, that meant merely providing facilities and land areas for use.

However, in later decades, the yen’s rise against the dollar meant it became more expensive for the U.S. to maintain forces in Japan and pressure was placed on Tokyo to help out. In 1978, Japan agreed to provide more money, especially for social welfare costs related to Japanese employees working at U.S. military facilities. Senior Japanese officials referred to the funds as a “sympathy budget” provided in response to U.S. government requests for more funding. The U.S. did not like the term, and though it is still used by some today, it is officially known as host nation support.

Before 1987, host nation support was essentially provided on an ad hoc basis. In 1987, it was agreed to formally establish the support through a series of special measure agreements (SMAs). These established longer-term precedents for the kind of expenses that Japan would undertake and expanded Japanese support.

What have past host nation support SMAs looked like?

The current and previous agreement, which ran from fiscal 2011 to fiscal 2015, were for five-year periods. They listed categories of expenses the Japanese government would take care of, including an expansion in areas such as labor and welfare costs for Japanese people employed by the U.S. armed forces. The current fiscal 2016-20 agreement calls on Japan to pay hourly and daily wages, as well as different kinds of allowances to Japanese employees depending on the nature of their work. Under the agreement, Japan is paying 100% of the salaries of Japanese workers on U.S. bases, with an upper limit of about 23,178 employees to be covered.

What is the state of current negotiations?

Under the fiscal 2011-2015 agreement, Japan paid ¥188 billion annually, and under the fiscal 2016-2020 agreement, that amount increased to about ¥200 billion annually. In the fiscal 2020 budget, ¥199 billion will be spent on host nation support. This includes ¥128.7 billion on civilian labor costs and ¥22.3 billion on utility costs for U.S. bases, family housing and recreational facilities. Another ¥26 billion goes for social security payments, and about ¥21 billion will be spent on facility maintenance.

For fiscal 2021, the Defense Ministry’s proposed budget includes a host nation support request for just under ¥203 billion. However, it appears unlikely that the current round of negotiations will produce another five-year agreement before the end of this year, when the next fiscal year budget proposal needs to be finalized. This is because the U.S. has pushed Japan to increase the amount of money it spends on hosting U.S. troops. Pressure by President Donald Trump to pay more had been particularly strong. According to former U.S. National Security Advisor John Bolton’s memoirs, Trump considered asking Japan to pay four times that annual amount beginning next year, and suggested withdrawing U.S. troops as a negotiating ploy.

But with Trump having lost the election and time running out to strike a deal, the Japanese government is looking at a one-year extension of the current ¥200 billion per year agreement. Faced with rising social security costs due to a graying, declining population and the economic damage due to the coronavirus, Japan’s negotiation strategy has been to try to convince the U.S. it doesn’t need to drastically increase the host nation support budget because it is contributing elsewhere, including paying some of the costs to relocate 4,000 U.S. Marines from Okinawa Prefecture to Guam. Last month, Foreign Minister Toshimitsu Motegi touched on Japan’s cooperation with the U.S. in space, cybersecurity and regional security. In terms of a possible longer-term host nation support agreement for specific annual amounts, however, Japan’s strategy is to negotiate that after Biden takes office.