On August 17th, Japanese media reported the ruling of a medical resident’s suicide last May as a work accident and a case of karoshi (過労死), or death by overwork.
Senior resident Takashima Shingo (高島晨伍) worked more than 207 hours of overtime in the one month prior to his death, according to the Labor Standards Inspection Office. He had no days off work since February.
Konan Medical Center in Kobe City where Takashima worked denies overworking him.
Content Warning: the following article discusses topics of suicide. If you are sensitive to the topic, please do not read further. If you need help, call the phone numbers listed at the end of the article.
207 hours of overtime
Medical resident Takashima Shingo, then-26, was discovered dead in his Kobe City home on May 17th, 2022. Hyogo Prefecture Police ruled the case a suicide.
The following September, Takashima’s family filed for his suicide to be recognized as a “work accident,” or rosai (労災) in Japanese.
An investigation revealed hospital records that show Takashima had more than 207 hours of overtime work in his last month at Konan Medical Center. He had averaged 185 hours of overtime work during his last three months.
Takashima’s overtime far exceeded the Japanese government’s criteria for a case to qualify as a workplace accident. According to law, an individual with overtime work of 160 hours or more in a month, or an average of 100 hours or more in a three-month period, is eligible for recognition.
“(Takashima was) allocated the same workload as veteran doctors because he was just promoted to senior resident and this coincided with preparing for a conference presentation which resulted in overtime work,” said Nishinomiya Labor Standards Inspection Office.
Hospital denies fault
On June 5th this year, the Nishinomiya Labor Standards Inspection Office approved the family’s claim and officially recognized Takashima’s suicide as a work accident. Recognition of suicide as a work accident allows the surviving family to receive compensation and claim damages.
Konan Medical Center compensated the Takashima family by paying them the amount of money Takashima would have received for working 207 hours and 50 minutes of overtime in the one month prior to his death.
The hospital denies that it made Takashima work overtime in its comment to The Yomiuri Shimbun.
“(Takashima’s) time at the hospital did not consist only of worktime but also (his) ‘personal studying hours.’ The hospital did not order him to work on the conference presentation. The workload our hospital gave him was within appropriate limits.”
According to witness statements, Takashima’s workload increased in May as he prepared documents to present at an upcoming medical conference.
“It is true that Mr. Takashima worked hard. (The hospital) let the doctor self-report and was unable to manage (his) working conditions enough.”
The hospital has said that it now has doctors check in with their superiors.
Technically not overtime work?
Konan Medical Center distinguishes between “working hours” and “personal studying hours,” each of which the hospital mandates that doctors self-report.
The Japanese government outlines “working hours” for doctors to include time spent consulting with patients, reviewing surgeries, and attending medical conferences that are essential for career advancement. Time spent voluntarily writing medical papers does not count as “working hours.”
The hospital’s claim that it did not directly order Takashima to prepare for a medical conference may uphold its denial of overworking him, as time spent voluntarily working legally does not count as “working hours.”
Additionally, the hospital says that Takashima did not self-report overtime work.
Pushed over the edge
Takashima graduated from Kobe University in March 2020 and began his residency at Konan Medical Center the following month. Entering his senior year as a resident, Takashima chose gastroenterology as his specialization–––the same field of medicine his own father practiced medicine in.
Inspired by his father’s job as a doctor, Takashima decided in middle school to pursue the same profession.
Takashima woke up at 5:30 AM every morning to take a taxi to work where he would chase that dream. The chase was long and exhausting every day. He usually returned home at 11 PM.
Junko noticed that something was off in April. Her son’s home was beginning to fill with trash. He communicated less.
Junko reports that her son’s schedule got even busier in May last year when he began preparing presentation documents for a medical conference.
Junko went to go pick up her son at work on May 15th, two days prior to his suicide. When Takashima saw her, he broke down in tears.
Junko remembers Takashima saying, ” I can’t meet my deadline this week for the conference documents. This is bad, this is bad.”
The next day, Junko suggested that Takashima takes time off work but he refused.
” I can’t go back if I take leave.”
On May 17th, Takashima messaged his mother around noon, “I won’t do anything stupid.”
Afterward, Takashima stopped responding to messages and calls. His mother was the one who found him.
“My son was being pushed over the edge and I couldn’t save him. I don’t know what to say to apologize to my son,” says Junko.
Pressured to work?
Despite the hospital’s claims, Junko is convinced that her son was forced to work overtime.
She also suspects that the work culture made it difficult for employees to report their overtime work hours.
“My son’s colleague(s) told me that the atmosphere made it difficult to report overtime work. He wouldn’t have felt so pushed to the edge if he hadn’t been under orders.”
Change starts, in 2024
Japan revised its labor laws in 2018 and applied penalties in 2019 for overtime work–––but only in the private sector.
Suddenly imposing legal limits on overtime work in the medical field raised concerns that it would cause a shortage of sufficient healthcare services. Therefore, the government decided to impose legal penalties after a five-year delay in the medical sphere. That starts next year in 2024.
The movement is called ” The Revolution for Doctor’s Work” and will set the limit for overtime work at 960 hours per year and 80 hours on average per month. This limit is higher than that of the private sector which caps overtime work at 720 hours per year. For medical students undergoing special training, the limit is higher–––1860 hours per year, 155 hours per month on average.
When is a suicide a case of karoshi?
According to Japanese law, for suicide to qualify as a work accident or a case of karoshi, the following order of events must take place.
1. The subject incurs mental stress due to work duties
2. The subject develops mental disabilities due to work duties
3. The subject loses mental self-control over suicidal thoughts
4. The subject commits suicide
5. The subject’s case undergoes inspection for work accident recognition
Japan recognizes cases of karoshi to help reduce incidents and protect workers. However, some cases of karoshi – such as housework performed by stay-at-home moms – continue to go unrecognized.
If you are in Japan and need help, you can call the following numbers:
0570-064-556 for kokoro-no-kenkou-soudan (こころの健康相談) operated by prefectorial and city organizations.
0570-783-556 for inochi-no-denwa (いのちの電話) operated by Federation of Inochi No Denwa.
0120-061-338 for #inochi-SOS (＃いのちSOS) operated by jisatsu-taisaku-shien-sentā (自殺対策支援センター), or suicide prevention support center.
0120-0-78310 for Children’s SOS Support Desk operated by the Ministry of Education, Culture, Sports, Science, and Technology.
If you are in the US call 911 for emergencies and 988 for the suicide hotline.
If you want to know your country’s suicide hotline, click the link here.
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