"Can Assigning Hospitals Really Save Patients?"...Medical Community Protests the 'Prevention of Emergency Room Refusal Act'

Bill Mandating Designation and Mandatory Admission of Hospitals for Critically Ill Emergency Patients Passes Legislation Committee
Korean Society of Emergency Medicine: "Verification of Hospital Capacity Needed"
Korean Medical Association: "Seve

As the so-called "emergency room ping-pong" bill—which aims to prevent emergency patients from wasting time in ambulances because they cannot find a hospital for treatment—rapidly passes not only the National Assembly's standing committee but also the Legislation and Judiciary Committee, emergency medicine doctors and the broader medical community are expressing strong opposition. Their argument is that "determining which hospital will take in the patient" and "whether that hospital can actually provide final treatment" are two separate matters.

On September 28, the National Assembly Legislation and Judiciary Committee held a plenary session and approved 19 bills under the Health and Welfare Committee’s jurisdiction, including the "Partial Amendment to the Emergency Medical Services Act." Earlier, on September 17, the Welfare Committee’s standing committee had already passed the amendment to the Emergency Medical Services Act—also known as the "Emergency Room Non-Admission Prevention Act." This amendment allows the Central Emergency Medical Situation Room and the 119 Emergency Dispatch Control Center to designate a hospital for the transfer of critically ill emergency patients if a transfer institution is not selected swiftly. The designated medical institution is required to admit the patient unless there is a valid reason not to. With only the final approval by the National Assembly scheduled for early next month remaining, the bill is close to becoming law.

The main controversy surrounds the standard for whether an emergency room is "capable of accepting" a patient. Treating emergency patients requires not just available beds in the emergency room, but also the capability for surgeries or procedures, as well as the presence of relevant specialists, anesthesiology staff, and intensive care unit resources. The availability of these medical resources can change in real time depending on how many patients present at the hospital.

For example, even if a patient with cerebral hemorrhage is successfully admitted to the emergency room, the absence of an appropriate specialist or an available operating room means that final treatment cannot proceed. The medical community points out that if hospitals for patient admission are designated based solely on the number of available beds, patients may end up being offloaded at one hospital, only to have to be transferred again elsewhere in a repeated cycle.

Therefore, the medical community insists that procedures to verify a hospital's actual capacity to accept patients before transfer are essential. They criticize the bill for obliging hospitals to confirm whether they can accept patients, yet omitting any process for verifying acceptance capability before the transfer takes place, calling the logic inconsistent.

Concerns have also been raised about relying on on-site emergency paramedics to assess the severity of a patient’s condition. The Korean Medical Association cited cases in which patients who appeared to have mild symptoms were later found to have serious conditions such as cerebral hemorrhage, emphasizing that "determining a patient’s severity and allocating responsibility accordingly should not be left solely to paramedics and emergency room staff."

The bill also requires medical institutions to report reasons for being unable to accept patients to the Central Emergency Medical Situation Room and have this information shared in real time with the 119 Emergency Dispatch Control Center. However, the medical community insists that the reasons for being unable to accept patients provided by medical institutions must be faithfully reflected in actual transfer decisions. There are also calls for a unified system for managing patient transfer and admission, given uncertainties over who will coordinate in the event of conflicting judgments between the situation room and 119, or if designations are duplicated, as well as who will be responsible for secondary transfers if the designated hospital is unable to provide the necessary final treatment.

Minister of Health and Welfare Jeong Eun-kyeong explained, "A pilot project for the emergency medical transport system was run from March to May of this year, and based on those results, the amendment was drafted—meaning that the law was created with a certain level of field verification." She added, "All 16 regional governments created and began applying their own transfer guidelines by region, and rather than deleting the provision for pre-transfer capacity verification, these requirements have been incorporated into the regional transfer guidelines."

The issue of protecting medical staff from liability is also a major topic. The Korean Medical Association argues that while the amendment provides immunity from criminal responsibility for cases where the situation room or 119 designates and compels a hospital to accept a patient, it imposes only limited protection for ordinary emergency medical activities. If the structure compels hospitals to admit patients while providing doctors with only limited protection from liability, there is a higher risk that medical staff will resort to defensive medical practices.

The Korean Society of Emergency Medicine announced on September 29 that it would hold an emergency press conference in the afternoon to oppose the bill’s forced implementation. Lee Hyungmin, president of the Korean Society of Emergency Medicine, said, "Refusals to accept emergency patients are often due not to problems with the emergency room itself, but to a lack of resources for surgery, hospitalization, or intensive care. Forcing patients into an overcrowded emergency room does not guarantee that they will receive final treatment," adding, "The current legislative effort will not actually prevent non-admission of emergency patients."

This content was produced with the assistance of AI translation services.