University hospitals across Japan reported 39 malpractice cases to the government in fiscal 2002, more than four times the number in the previous year, according to documents obtained by Kyodo News.

The tally for the year that ended in March includes cases that had relatively little effect on patients -- but also six that led to deaths, according to the Education, Culture, Sports, Science and Technology Ministry documents obtained under the access to information law.

Differences between the cases that were reported indicate the hospitals have no clear criteria for reporting malpractice cases. The Health, Labor and Welfare Ministry is planning to oblige hospitals to report malpractice from fiscal 2004.

The documents also show that some hospitals failed entirely to disclose serious incidents, despite guidelines requiring they be revealed.

Of the 42 national university hospitals, only 18 filed reports. The number of reported malpractice cases soared in fiscal 2002 following 14 in fiscal 2000 and nine in fiscal 2001.

These hospitals are currently not required to report such incidents to the government, but began to do so following a case in which two patients were mistakenly switched ahead of surgery at Yokohama City University Hospital in 1999, the ministry said.

They drew up a common guideline in 2001, calling for the disclosure of obvious malpractice incidents in an effort to learn from them and to restore public trust in Japanese health care.

But Ryukyu University, Kochi Medical School, Akita University and Osaka University failed to report any cases, according to the documents, even though there were clear malpractice incidents.

The Ryukyu hospital, in Okinawa, left a woman partially paralyzed after a tube in her nose to regulate breathing after surgery entered her brain in January. The hospital says it refrained from disclosing the case at the request of the patient's family.