Objective

Iwaki Hospital, as psychiatry hospital, and Dr Watanabe, as superintendent of the hospital and psychiatry specialist, have practiced extremely low quality psychiatry clinical medicine in psychiatric open therapy to voluntary admitted Mr Junichi Nozu who was a chronic schizophrenia patient for more than 20 years.

The doctor in charge, Dr Watanabe, was serious mistaken in the prescription of plural number of psychotropic agents, however, he performed far from enough follow up observation and even refused patient request of examination, and the patient self injured inside hospital but they failed to find out injury at the patient face, and let him go out to the shopping center under their permission and the patient bought a kitchen knife and stabbed to death an unknown young man named Makito Yano. The hospital was first and finally known abnormal situation of the patient after he was arrested on the next day when patient visited place of homicide.

If such poorest level of psychiatry open therapy were allowed and accepted as common practice in Japan, then it is serious in human right to both of psychiatric patients and citizen who accept psychiatry and community integration of psychiatry patients. However, the situation was excused and explained as common psychiatrist and psychiatry in Japan and free from fault responsibility to the common practice by the expert reporter professor in psychiatry. For the purpose to expect the improvement in the clinical psychiatry of Iwaki Hospital the victim family and offender family, based on the sorrow feelings of each sides, cooperated at the Local Court as plaintiff in the litigation. However, judgment accepted Iwaki Hospital psychiatry as free from fault responsibility based on many mistakes in fact acknowledgements.

Currently, both of plaintiffs are keeping victim-offender cooperation and are appealing the case to the High Court. But despite outcome of the litigation at the judicial court, we wish the case to be known widely by the people in the world, especially by psychiatry experts and by people with common sense in human right in the world including who are in WHO and international organizations. We hope psychiatry and judiciary in Japan to get lessons from sorrow experiences and they are motivated to initiate reformations and innovations for the psychiatry in respect and practice of universal human right.

It is the reason why we have compiled this report and make it open to the world.

Wisdom from Psychiatry Homicide

The death of Makito Yano was the serious regret to us as parents to him, and we learned Makito Yano was killed by a mentally disabled in schizophrenia, who was under community integration program in psychiatric open therapy at Iwaki Hospital in Takamatsu City, Kagawa Prefecture Japan.

To our question "Why Makito Yano have to die?" We were told "It was under the normalization program of mentally disabled who has already been punished for he was born a mentally disabled, and being a mentally disabled was not his responsibility. And nobody can stand against but should accept the reality and must understand the situation that Makito Yano lost his life for the patient might consider him in about to assault against the patient and the patient was in no way but to exert his right of self defense". But Makito Yano has never imagined injury against others and it was irrational and mistaken to put the logic of born punishment and tell as if mentally disabled got born right of homicide against unknown others.

So called expert professional said, "Wait psychiatrists and lawyers to start study about such cases, it is the careful job of the professionals for the sensitivity in human right of mentally disabled". But it was very clear that psychiatry academy and hospitals in Japan, even judicial circle do not expect to learn from sorrow accidents. And as parents of Makito Yano, we made up our minds to speak "the needs of our society to get wisdom from unhappy experiences." And we are under the litigation since 23rd June 2006 against Iwaki Hospital and Dr Watanabe, of their idleness, mal practice, and non-performance in psychiatry medicine to Mr Junichi Nozu as combined plaintiff with his parents Mr and Mrs Nozu. It is to tell what is a real problem in the human right.

Looking back history of psychiatry medical and legal system of Japan, we found past innovation in human right was initiated by external pressure, but not by the self made efforts and wisdom. Psychiatry in Japan has been helping human right violation as a tool in social security policy, but they pretended as if human right infringement was small and minor. However the violation was common and widespread, and Japanese psychiatry was forced to change into respect of human right and accept psychiatry open therapy, and it turned out the reason of Makito Yano death.

We wish Psychiatry of Japan to develop and promote social integration of psychiatric patients based on wider community supports. And for the purpose we have made up our minds to let the information be known. However, this report is not designed to exert influence on the litigation, but we expect jurisdiction and psychiatry societies in Japan to move forward in respect of universal human right to everybody.

Iwaki Hospital Case & How Happened

1, Makito Yano a Citizen of Britain and Japan

Makito Yano was born in 20th August 1977 in Liverpool UK and under Japanese citizen Mrs Chie Yano and Mr Keiji Yano. By birth he was a citizen of the United Kingdom. His parents also confirmed him Japanese citizenship. He stayed in New Delhi India from 1982 to 1985 for three years for his father was a first secretary at the Embassy of Japan in India and he started his education at the British School in New Delhi. When he was 20 years old, legally grown up, he was asked to confirm whether to keep dual citizenship or not, and with his intention he kept British as well as Japanese. And then he studied for one year at the University of Liverpool under Professor Peter N Davies from 1998.

Makito Yano was stabbed to death at 12:25 on 6th December 2005 at the car parking of the shopping center in Takamatsu city in Japan, when Makito Yano was about to get into his car after taking lunch at a restaurant. The offender was named Junichi Nozu (36), a schizophrenia patient admitted at nearby Iwaki Hospital and he was under community integration program in open psychiatric treatment. It was their first encounter and Makito Yano died immediately by the massive blood loss for he was stabbed his right chest by a kitchen knife found next to his body.

Soon later Junichi Nozu went back to Iwaki Hospital and got into his room, and washed his blooded hands at the sink in his room and sulk in bed. He did not take supper, very unusual for he was always good in appetite, and was advised by a care taker to take supper but answered "Is police coming to catch me?" however, Iwaki Hospital understood nothing strange, although evening TV news covered widely the bloodshed death of a young man at the Iwaki Hospital neighborhood. On the next day on 7th he did not take breakfast and lunch and he went out at about 14 o'clock and visited the place of homicide and was arrested. Junichi Nozu was identified for he was injured at his left cheek and the injury was seen by a cashier at the shopping center who sold kitchen knife few minutes before the homicide. And Junichi Nozu was putting same blooded costume with the day before. Picture of police arrest of the criminal was taken by the TV and was broad casted nationwide. And after the arrest Junichi Nozu explained to the police scars at his left cheek were self burnt by tobacco fire and he called the injury as Konjyo-yaki.

2, Schizophrenia Patient and Crime

The Criminal Law of Japan says that a man with insanity of minds should not be punished, and with diminished responsibility criminal shall be decreased the term of punishment. And majority of the case in Japan, schizophrenia patient are considered insanity automatically, and prosecutors are likely not to prosecute for they are difficult to be judged as criminal.

Parents of Makito Yano soon after the case made up their minds to tell to the public the reality of Makito Yano death. Shown their face on the TV and in the news paper, and published a book titled Kyojin: Insanity Sword, ant tried the case be kept in a fresh memory as the public notion. Thus Junichi Nozu was prosecuted, and Takamatsu Local Criminal Court judged him 25 years and it was confirmed.

Parents of Junichi Nozu, Mr and Mrs Nozu visited parents of Makito Yano after one month of the homicide, and Mr and Mrs Yano asked them to offer evidence of Iwaki Hospital treatments to Junichi Nozu. And Yano asked them to accept criminal court procedure and jail punishment. Also Yano proposed Mr and Mrs Nozu to start civil litigation as plaintiff against Iwaki Hospital. Yano kept contact with Mr and Mrs Nozu and they agreed to put the matter to the civil court before the criminal court judgment. And also they accepted Junichi Nozu long years of punishment as a mentally disabled.

When Junichi Nozu will be finishing the term of punishment Mr and Mrs Nozu will be over 90 years old, and Junichi Nozu at 61 years old will no way to stay but compulsory admission at psychiatry or if he will be good at mental condition may be accepted in community houses. But ordeals of Mr and Mrs Nozu at home by Junichi Nozu domestic violence has been finished. And although Junichi Nozu dissatisfied with the situation in Kita-Kyusyu Psychiatry Prison for he was not allowed to go out free and his room is locked, it is the good psychiatry hospital without any necessity in family financial supports. Junichi Nozu was looked better and good and was not suffering any more from Akathisia at his interrogation practice on 25th January 2010, four years after the homicide. At the interrogation, Junichi Nozu appeared with clear and clean left cheek and no remaining scars were found.

3, Civil Court Litigation against Iwaki Hospital

Soon after death of Makito Yano, we, parents of Makito Yano, started to learn the real cause of the incident and concluded that Iwaki Hospital and Dr Tomoyuki Watanabe was most responsible and we tried to find out the logic and method how to let them stand at the judicial court. First we asked prosecutor to put them into the criminal court, but they said, not possible. We looked for lawyers to work as representative of Yano in the judicial court, but all the lawyer, including whom we considered our good friend, said no, and said "most likely and certainly Yano shall lose the case". Yano tried to find out court representative throughout Japan, and were refused by many of lawyers even who claim himself professional and expertise in the medical litigation.

One lawyer, although he refused, gave Yano a good idea. Before the visit to the lawyer, Yano were considering "Junichi Nozu is better judged at the criminal court non-guilty. For it means Iwaki Hospital permitted insanity man the free outside activity for the purpose in community integration." However, the lawyer said, "in such case, Yano are impossible to get police investigation evidence and medical record at Iwaki Hospital for they are regarded as private record of an innocent man and no way even victim family to get and read public authority collected evidence."

Thus we made up our minds to put Junichi Nozu under criminal punishment. For the purpose we tried best efforts to keep the case under public notion kept alive and active. And we tried to persuade Mr and Mrs Nozu to accept the criminal judgment and work for the unhappy mentally disabled represented by Mr Junichi Nozu. Even though, Mr and Mrs Nozu took 2 years to join in the litigation against Iwaki Hospital as plaintiff. And Mr and Mrs Nozu were criticized by psychiatrists more badly than Yano and were said as if they the ingratitude against psychiatry medical treatment. And we, Yano, are very grateful to Mr and Mrs Nozu to keep the combined plaintiff status against Iwaki Hospital with us.

The court representative of Yano was said a lawyer noble in medical litigation, however, the lawyer did not respect what Yano wished to say, and what Yano expected in many ways. When the litigation was started, Yano met Mr Matsumoto a young lawyer and kept contact with him for years and waited him get experienced. After six years, the litigation was started, Yano exchanged lawyer to Attorney Matsumoto. Mr and Mrs Nozu asked a lawyer who was the criminal court appointed defense lawyer to Junichi Nozu for the civil litigation. However, the lawyer was stopped his qualification at the final stage of the local court civil litigation, for his mal practice in adult guardian ship. Thus Nozu representative was also changed to Attorney Kusunose at the final stage. And the judgment was victory to Iwaki Hospital. However, Yano believes both of Yano and Nozu have achieved the better judicial representative to the Takamatsu High Court and successive process.

4, Iwaki Hospital and Dr Watanabe Psychiatry

Iwaki Hospital was established by the father of Dr Tomoyuki Watanabe in 1974 as a geriatric hospital. However, the reputation of Iwaki Hospital was not good in the local people and they say "Elderly easy to die in the hospital soon after admission" and said "They put elderly on the bed with nappy and with small cares and they do not practice enough rehabilitation".

Dr Tomoyuki Watanabe after he got medical doctor license eventually with elongated years, he inherited Iwaki Hospital by the death of his father as a junior psychiatrist and transformed the hospital into psychiatry. And he is said to wish in getting Iwaki Hospital reputation as an excellent hospital, and introduced psychiatric open therapy. He accepted outpatient doctor side job at Kagawa University Hospital psychiatry department in one afternoon in a week, and it was considered he wished high reputation as a university hospital doctor and greater number of patient intake and transfer from the university hospital. Dr Watanabe is also the board member of the Japanese Society of Social Skills Training (SST), which promote psychiatry open therapy. Dr Watanabe loves superficial name and fames and he was a member of Takamatsu Family Court advisory committee.

Japanese age structure is rapidly going in to elderly and geriatric medicine is the sector of medicine with increasing high needs. Thus, Iwaki Hospital at current stage is expanding the elderly medicine. When Dr Watanabe inherited the superintendence duty at Iwaki Hospital he wished get reputation at the academy forum and he spoke positively and said "Schizophrenia and Elderly Impairment are the same kind of syndrome for both of them are effective in same antipsychotic drug". When Yano pointed the ward function of the Ward Two and mixture of mentally disabled with elderly, he replied "Plaintiff Yano do not understand the fact that both of them are psychiatric patients classified by the ICD-10 and DSM-IV." In addition to the expression Dr Watanabe accused Yano as if demanded Junichi Nozu to place in the closed wards without psychiatric medical understandings. And the latter part of the Dr Watanabe opinion was accepted by the judges but the former part was dismissed.

In Japan psychiatry are increasing elderly care department for elderly population are increasing but mentally disabled admitted in psychiatry hospital are forced to decrease by the policy. And health administration is considered to prefer psychiatry to accept elderly in need of medical treatment for it is cheaper in public medical support because of psychiatry special scheme, and it is economy and require smaller input of doctor and nursing as compared with other sector of medicine.

5, Dr Watanabe Psychiatry to Mr Junichi Nozu

Mr Junichi Nozu was voluntary admitted to Iwaki Hospital on 1st November 2004 at Annex building of Ward Two. Prior to and on admission Mr Junichi Nozu parents explained psychiatrist and psychiatric social worker about his past history of fire-setting and violence. And Mr Junichi Nozu himself assaulted a male nurse at morning on 21st November 2004 for he mistook the nurse was washing injection tube at the sink and considered it was unhygienic. By the behavior Mr Junichi Nozu was temporary isolated but when he was finished his isolation and was advised to join in other schizophrenic patients in a common room, he rejected the cohabitation with other patients and by his will he went into isolation room and stayed in solitude in the room without locked.

On 14th February 2005, Dr Watanabe exchanged doctor in charge, and it was reasoned from Hospital income point of views, since Mr Junichi Nozu voluntary admission in Iwaki Hospital and was becoming longer in period over 4 months, superintendent and owner of the Iwaki Hospital wished expedited discharge of the patient. At the first and second interview by Dr Watanabe on 14th and 15th February, Mr Junichi Nozu started to explain about his past violence and other harming history, however, the new doctor in charge did not ask into the detail. And said in the court that "Junichi did not speak in detail and it was impossible to understand fully about his violence nature, it was not Dr Watanabe fault but it was Junichi who was uncooperative with the doctor". Mr Junichi Nozu was "stable" when he was changed doctor in charge to Dr Watanabe, but Dr Watanabe changed an antipsychotic drug from Risperdal (Risperidone) to Toloperone (Timiperone) and Mr Junichi Nozu worsened his condition. Although Dr Watanabe was unable to treat him back, but Dr S supported and Mr Junichi Nozu was recovered. Dr S on 23rd February 2005 diagnosed him Akathisia (+), and returned Toloperone to Risperdal and Mr Junichi Nozu get recovered. And on 25th February, Dr Watanabe wrote in medical record "Policy: CPK value is too low to diagnose Akathisia." However, it seemed Dr Watanabe did not wish to accept an antipsychotic drug prescription by his employee psychiatrist, he changed again an antipsychotic drug and Mr Junichi Nozu discharge was delayed and delayed.

On 23rd November Dr Watanabe started drastic prescription changes and withdrew an antipsychotic drug (Propitan) and abrupt withdrew antidepressant (Paroxetine) and increased anti Parkinson's agent Dops (droxidopa). Mr Junichi Nozu looked well for one week and Dr Watanabe practiced the follow up examination at night after taking sleeping pills on 30th November and it was only once he examined and wrote medical record after large scale prescription changes. Ironically, from the night on, Mr Junichi Nozu started suffering from Akathisia irritation and annoys in crawly feelings at his arms and legs. Iwaki Hospital started injection of saline water as placebo test and replaced Akyneton (biperiden) at 21:30 on 1st December. On 2nd December Mr Junichi Nozu got second placebo injection at 11:00 and nurse recorded "Placebo effective" at 12:00. Although Mr Junichi Nozu started to suffer from Akathisia from 15:30 and thereafter Mr Junichi Nozu suffering went even greater, Iwaki Hospital insisted to say placebo effect was confirmed and judgment was acknowledged the nurse report but it was without psychiatrist confirmation as medical fact.

Dr Watanabe said that he examined Junichi for 30 minutes at his outpatient examination room from 19:00 on 3rd December (Sat), but strange enough no medical record was written, but the judgment acknowledged medical contents of 30th November record as that of 3rd December. And also, judgment acknowledged 4th December (Sun) at saline water injection was done by Dr Watanabe, however, Mr Junichi Nozu suspected the injection whether it was Akyneton or not and if Dr Watanabe did not evaluated the placebo test at the time, then, it was outrageous. Dr Watanabe did not write any medical records from 1st December and Mr Junichi Nozu requested Dr Watanabe for examination but he was refused. Dr Watanabe after large scale prescription changes in withdrawals of an antipsychotic drug (Propitan) and Paroxetine, and under placebo test, observed and examined Mr Junichi Nozu once on 30th November only, and no other medical records exists.

Dr Watanabe deposed at the court that Junichi was not different from previously in his psychiatric condition and he was not screaming nor behaving in violence and no way for psychiatrist to pre-recognize symptom of abnormal signs. However, after the large scale prescription changes, Dr Watanabe examined Mr Junichi Nozu only once on 30th (Wed) November and at the time, he was stable for it was immediately after the withdrawals on 23rd (Wed). If Dr Watanabe maintains to say he was keeping scheduled examination of once a week interval, then next examination date was 7th (Wed) at night and Mr Junichi Nozu was arrested at 14:30 on the day, so the schedule was not broken, Dr Watanabe as psychiatrist in charge of Mr Junichi Nozu, did not consider the importance duty of him to daily observe and examine patient with the psychiatric morbid conditional changes after withdrawals of psychotropic agents of an antipsychotic drug Propitan and antidepressant Paroxetine and placebo test against Akathisia treatment Akyneton. Dr Watanabe opinion was idle and dishonest but judgment accepted his opinion as proper as a psychiatrist opinion. If such kinds of judgment were to be confirmed, psychiatrists in Japan are free to be idle and do not have to worry about fault responsibility by non-performance, and will sure to result in the demolition of psychiatry.

6, Team Psychiatry of Dr Watanabe Superintendence

Dr Watanabe instructed Pharmacist F of her observation about Mr Junichi Nozu of his pharmaceutics manner of taking which the pharmacist understood to keep schedule and good in compliance, however the doctor considered Junichi was obsessional in his demands. They disagreed also in the policy of "Propitan to change and Dops to increase" and the pharmacist wrote last pharmacist instruction report on 2nd December and thereafter she stopped her duty. Dr Watanabe introduced large scale prescription change on 23rd December 2005 but with no pharmacist cooperation and supports. And it may be one of reasons that Dr Watanabe did not know serious important danger information about abrupt withdrawal of Paroxetine. By any means, Dr Watanabe was far from practicing team psychiatry for he was without support by pharmacist while in large scale prescription changes.

Head nurse of Ward Two Ns O spoke in her interrogation on 9th August 2010 that she was known the big scale prescription change when she read Mr Junichi Nozu medical record and said, she was not told from Dr Watanabe and was not instructed special point of nursing to Mr Junichi Nozu after the psychotropic agents withdrawals. And in medical and nurse records of Mr Junichi Nozu, nothing was written about case conference and Dr Watanabe instruction on special point of care after the prescription changes.

Mr Junichi Nozu self injured Konjyo-yaki (tobacco burns) at his left cheek from the harsh Akathisia annoyance in few days before the homicide. Konjyo-yaki was found by a cashier at shopping center few minutes before when Mr Junichi Nozu bought a kitchen knife used in the homicide on 6th December. Mrs Nozu also found at Mr Junichi Nozu face on 6th afternoon inside Iwaki Hospital. Based on Police taken photo, immediately after his arrest on 7th December red, black scars was found, but two days later black scar was removed, and on 7th , it must have passed few days after Mr Junichi Nozu injured black scar at his face.

【Junichi Nozu and his Konjyo-yaki】
at 15:35 7th December 2005	at 16:00 9th December 2005

Iwaki Hospital denied any kinds of fresh scars at Mr Junichi Nozu face while he was in Iwaki Hospital. Even they said, Mr Junichi Nozu, when he was going out from Iwaki Hospital in the afternoon an outpatient nurse saw his face direct from the front but she did not saw any scars at his face. And Iwaki Hospital said, Junichi must have injured at his face in order to disguise his face after he left Iwaki Hospital and before he was arrested. And Iwaki Hospital said, professional nurse in psychiatry should not miss to find out abnormal features at patient face. And judgment excused Iwaki Hospital for it may not be difficult to see clearly.

However, shopping center cashier found abnormal scars at a glance. And it was evident that Mr Junichi Nozu was inside Iwaki Hospital after 13:00 on 6th to about 14:00 on 7th in Iwaki Hospital but nobody found Konjyo-yaki scars at his face. Thus, it was very clear that Iwaki Hospital psychiatry nursing did not look into the face at the patient. And judgment was mistaken for they based on absence of witness as the evidence that Mr Junichi Nozu Konjyo-yaki was the minor matter not to show abnormal sign of his psychiatry conditional symptoms.

Iwaki Hospital maintained their position that since they employed required number of medical and nursing staffs, and specialty of professionals, their team psychiatry was functioned well. But it was mistaken, Nurse were not told and instructed important notice of psychotropic agents withdrawals and they did not know what to keep eye on, and serious and important pharmacy prescription change was not coordinated with pharmacist. Thus reality of Iwaki Hospital was far away from team psychiatry.

7, Psychiatry Open Therapy with Neglect and Irresponsibility

Iwaki Hospital open therapy psychiatry to Mr Junichi Nozu was neglect and irresponsibility. Iwaki Hospital permitted outside activity to Mr Junichi Nozu every day within two hours. By the regulation, Mr Junichi Nozu was supposed to get permission from psychiatrist or from nurse and then he was required to fill his name in out and back note placed in front of the nurse station. However, in reality, nobody was watching him to go out from the ward. He was known key code of elevator. And within Iwaki Hospital, he was free to move around, and it was not possible for the nurse to identify whether he was going out from hospital or he intended to stay inside the hospital. Iwaki Hospital proposed the court of their permission record of attached outing to prove perfect safety of Junichi outside permission for two hours but the Iwaki Hospital presented record failed to prove Mr Junichi Nozu outside activity. It was clear that Makito Yano was killed in the other type of permission, without doctor sign, and Iwaki Hospital was in failure to propose the full record in Mr Junichi Nozu daily activity outside the hospital.

Iwaki Hospital did not observe and confirm every day of psychiatric condition of voluntary admitted patient with permission to gout within two hours. And such kinds of daily confirmation records do not exist. As the result, whatever worsens the patient condition, voluntary admitted open therapy patients are all free to go out from the hospital. Of course everybody is to join in the community and when in community they are all free, but even voluntary accepted patients are in hospital treatment for they are with psychiatric morbid condition in need of treatment. And psychiatry is required to confirm best possible prescription for patient to keep favorable condition for the patients to maintain community integration. As psychiatry hospital, it should be the duty to confirm daily changes in the symptom.

Iwaki Hospital psychiatry open therapy was the neglect of observation to the patient of their daily changes in condition. Even if Mr Junichi Nozu was self injuring Konjyo-yaki tobacco burns, they did not notice, for they did not observe the patient at the face. And Iwaki Hospital was irresponsible in the treatment of schizophrenia of Mr Junichi Nozu who was a chronic schizophrenia patient, for he was withdrawn an antipsychotic drug without explain and his consent. Iwaki Hospital was irresponsible for they did not protected him at the worsen situation of his schizophrenia by the interruption of an antipsychotic drug.

8, Iwaki Hospital a Model of Common Psychiatry

Iwaki Hospital and Prof A accused Plaintiff Yano and said Yano was to destroy psychiatry of Japan through the litigation. According to them, Iwaki Hospital is a common psychiatry in Japan. Dr Watanabe is a common psychiatrist not at the level of university hospital sophistication in psychiatry. And if common psychiatrist and common psychiatry are found fault responsible, then, thousands of common psychiatrists in hundreds of common psychiatry may face to the risk of fault responsibility throughout in Japan. Thus, psychiatry in Japan shall be paralyzed from the fear to be accused.

In reality, it was the specific problem of the poor, idle and neglect psychiatry by Dr Watanabe at Iwaki Hospital, who concurrently take responsibility of outpatient doctor at Kagawa University Hospital. However Plaintiff Yano was surprised by the supports to Iwaki Hospital from psychiatry hospitals in Japan and by supports to Dr Watanabe from psychiatrists in Japan on the logic of common psychiatry and common psychiatrist.

Plaintiff Yano wish to say, if it is the common problem of the common psychiatrist at common psychiatry in Japan, then, it prove the common task in psychiatry of Japan.