In the latest case, a 49-year-old man injured in a car accident in Higashi-Osaka city in Osaka prefecture died on Jan 2 after he was turned away by five emergency medical centres.

Four of the centres said that their two doctors on duty were busy performing operations and therefore unable to attend to the man.

Doctors at two of the centres were not even able to answer their emergency phones.

As Japan was in the midst of the traditional New Year holidays ending on Jan 4, the centres were operating on a holiday roster, which meant that only two doctors were on duty.

The fifth centre said it had a policy of not accepting patients who had sustained external injuries in car accidents.

On Dec 26, an 89-year-old woman died in Tondabayashi city, also in Osaka prefecture, after 30 hospitals refused to admit her.

She suffered a heart attack just before ambulance staff finally found a hospital that would take her.

The staff had not contacted emergency medical centres in her case as her condition had initially been stable.

Similar cases of rejection by hospitals leading to death are not uncommon in the country.

In November last year, a woman hit by a car in Fukushima prefecture died after being refused treatment by four hospitals, and in December, a man in Hyogo prefecture met the same fate after 19 hospitals turned him away.

But such cases often do not come under the media spotlight unless they set new 'records', such as being turned away by 30 hospitals.

Doctors said it was unfortunate that the two latest cases should have taken place in Osaka, which is one of the Japanese prefectures with the most hospitals.

But the number of emergency medical centres in Osaka has dwindled, from 298 in 2005 to 270 in 2006.

In addition, many hospitals are experiencing a chronic shortage of doctors, especially specialists, which keeps them from dealing adequately with emergency patients.

Dr Hisashi Sugimoto, of the Osaka University Hospital Emergency Centre, was quoted by the Mainichi Shimbun daily as saying: 'Because of a doctor shortage, we cannot operate at night or on holidays.'

And as it is becoming increasingly difficult to find a hospital with empty beds, the 13 emergency medical centres in the prefecture are swamped with patients.

The Health Ministry has ordered local government authorities to survey the situation and put up reports by the end of this month.

The inability of Japanese hospitals to respond to emergency cases was spotlighted last year after thousands of pregnant women reportedly had difficulty finding a hospital that would accept them.

Some cases have proved fatal.

In August 2006, a pregnant woman in Nara prefecture died after 20 hospitals turned her away.

Another woman died in an ambulance during childbirth in Nara in August last year after nine hospitals rejected her, underlining the fact that the problem had not been rectified a year later.

A government survey released last October said that in 2006, nearly 2,700 pregnant women were turned away by more than one hospital.

About one-quarter of the hospitals that refused admission said they were unable to treat the women due to the seriousness of their condition. Another one-quarter gave no specific reason.

Many said that they were understaffed.

wengkin@sph.com.sg