To enhance the quality and safety of medical care, the Ministry of Health, Labor and Welfare (MHLW) launched a model project in September 2005 for investigation and analysis of medical practice associated deaths in an attempt to move the existing system in a different direction. The project, initiated in Tokyo, Osaka, Nagoya, and Kobe, has now been implemented in nine prefectures. In the hope that the model project will lead to the nationwide development of medical safety investigating committees, the MHLW has submitted a provisional third plan. Based on our practical experience of the model project in Osaka, we present and discuss practical problems and legal issues involving surgeons' criminal punishment.