A few things I can imagine:
Officially, the
derailment occurred because the driver, Ryūjirō Takami, attempted the turn at 116 kmph, when it was shown that derailment was assured at 106 kmph. But his blatant speeding was on account of missing a Red Light Signal (which forcibly activated the train's Emergency Brakes), and overshooting a station by 2-3 Car lengths, forcing him to reverse it back into position. Combined, this made him about 90-100 seconds behind schedule when the train left
Itami Station . On a schedule that allowed at best, 28 seconds of error.
The JR West Policy meant he had two reportable (and reported) offences early in the day, enough to secure him time at
ikkin kyōiku, a system of harsh, humiliating penalisation for such errors and lateness - which at JR West in 2005, were especially brutal, even by the standards of the time. Which the driver involved had faced some months before for a 100 meter overshoot.
A fact that would have been on his mind at the reportable offences racked up, which would likely have placed him in a panicked state, essentially making him unfit to drive the train safely. Hence why he only used the Service Brake and not the Emergency Brake when he (finally) realised he was going far too fast for the tight turn.
The faults with the harsh regime of
ikkin kyōiku, and how it imapcted on those who suffered it, only really came to light as a consequence of this disaster, and only after it, were improvements made. Improvements such as the inclusion of safety systems on such turns to slow a train down to a safe speed, along with a reduction in the Speed Limits.
It would not be unfair to say, that had this accident not occurred, then, sooner or later, a different one would have, and the lessons learned would have come later.
