93% of Emergency Medicine Specialists Oppose "Turnaway Prevention Act" ... "Forcing Hospitals to Accept Patients Without Doctors to Treat Them"

95% Oppose Elimination of Pre-Acceptance Confirmation
92% Against Hospital Designation and Mandatory Acceptance
96% Say "Real-Time Notification Obligation Is Impossible"

It has been found that 9 out of 10 emergency medicine specialists oppose the revision of the Emergency Medical Services Act, also known as the "Emergency Room Turnaway Prevention Act." According to a survey of 301 specialists conducted by the Korean Society of Emergency Medicine (hereinafter referred to as the Society), 93% of respondents opposed the revision, and 92% said that overcrowding and the inability to accommodate patients in emergency rooms would not improve even if the law were amended. The Society claimed that the amendment imposes an obligation on hospitals to accept emergency patients without addressing the root causes that prevent hospitals from accommodating them.

On the 29th, the Society released the results of this survey, which reflected these concerns, during an emergency press conference at the Korean Medical Association Auditorium in Yongsan-gu, Seoul. The survey was conducted on 301 emergency medicine specialists from the 25th to the 28th. Of the respondents, 50% were in their 40s, 54% were employed doctors (not private practice), and 50% were affiliated with regional emergency medical centers. 57% of respondents worked in Seoul, Gyeonggi, and Incheon.

Lee Hyungmin, president of the Korean Society of Emergency Medicine, is speaking at an emergency press conference held on the 29th at the auditorium of the Korea Medical Association in Yongsan-gu, Seoul. Korean Society of Emergency Medicine

According to the survey results, 93% of respondents opposed the amendment; only eight specialists (3%) were in favor. The specialists were against all the key provisions of the proposed amendment. 96% replied that it is impossible for hospitals to report "inability to accept" situations in real-time. 95% opposed eliminating the procedure by which the 119 emergency response team checks a hospital’s ability to accept patients before transport. 92% were against having the emergency situation room designate a receiving hospital and mandating that hospital to accept the patient. 86% believed that a clause exempting individuals from criminal punishment as long as there is no gross negligence does not sufficiently reduce legal risk. 91% responded that even if regional transport protocols are strengthened, emergency patient transport would not improve.

In the free-response section, most specialists pointed to problems in the legislative process. There were 79 mentions of "lack of field input and desk-bound policymaking," making it the most cited issue. This was followed by 52 mentions of concerns over "medical staff leaving and the collapse of emergency care," 45 comments regarding "shifting legal responsibility and insufficient exoneration," and 42 responses concerning "insufficient backup care and lack of final treatment capacity." One respondent stated, "Even if patients are accommodated in the ER, without definitive treatment available from backup departments, surgery rooms, or intensive care units, it merely shifts the problem inside the ER."

The Society’s main objection to the amendment is that there is no way to prove, on-site, the "legitimate reasons" for which a hospital may refuse to accept a patient. The Society argued, "It is impossible to objectively and in real-time certify situations such as lack of facilities, staff, equipment, or definitive treatment personnel. If hospitals are punished for failing to prove this, the on-site reality is that hospitals will be forced to accept all patients unconditionally."

The Society also argued that the obligation for hospitals to report their inability to accept patients in real time is unrealistic. Emergency room conditions change from moment to moment, making it impossible for hospitals to check and report their status every time. The Society expressed concern that in practice, frontline medical staff would end up bearing all legal responsibility if the reported information turned out to be inaccurate. They criticized the real-time notification system, warning that—like the underutilized “ER in Your Hand” program—it would only waste budget without being effectively used on-site.

The Society emphasized that eliminating the procedure for the 119 emergency team to confirm acceptance in advance and designating hospitals through a control room would put patients at greater risk. "Forcing hospitals without the capacity for definitive treatment to accept patients endangers both existing and newly transferred patients," the Society said. They argued that the issue is not that hospitals "do not want to" accept patients, but that they "cannot"—yet the amendment shifts all responsibility onto individual medical staff. The Society stated, "The moment the obligation to accept patients is written into law, it is tantamount to stating that refusal will be punished."

They further argued that the amendment will not be effective unless emergency room overcrowding is resolved. As all patients, from minor to critical cases, freely visit ERs and over half of patients transported by the 119 emergency team are non-severe cases, hospitals cannot secure enough resources to treat severe cases. The Society pointed out, "Renaming regional emergency centers as ‘severe emergency centers’ does not improve their actual capacity."

The Society also raised criticisms regarding the legislative process. "For the past five years, we have consistently raised issues and voiced opposition, but the government and National Assembly have never had proper discussions with the field," the Society argued. "Despite the overwhelming opposition from specialists, some agreement was manufactured based on limited support, and the bill was presented as if a consensus had been reached and passed through the relevant committee."

As an alternative, the Society proposed that decisions on whether to accept patients should be made by on-site specialists, not administrative agencies. The Society suggested adopting specific and objective civil and criminal indemnification criteria as in the U.S. Emergency Medical Treatment and Labor Act (EMTALA), introducing paid 119 emergency transport to reduce overcrowding, and creating more flexible staffing plans in medically underserved areas. They also called on the government and National Assembly to involve field experts in the amendment, subsequent implementation rule revisions, and the development of plans for advancing emergency medical care. Lee Hyungmin, President of the Korean Society of Emergency Medicine, stated, "The issue of ER non-acceptance can never be resolved without first addressing the underlying problems of legal risk, overcrowding, and infrastructure expansion. The compulsory obligation without indemnification should be immediately halted."

This amendment is an integration of eight different bills intended to address ER turnaways. It stipulates in the law the "legitimate reasons" under which hospitals may refuse emergency patients. These include situations where all facilities, equipment, or staff are in use, when staff for definitive treatment are care for other critical patients, or in disasters where it is impossible to accept patients. Hospitals must promptly report to the Central Emergency Medical Situation Room whenever such reasons arise or are resolved. If a hospital for a severe emergency patient is not quickly selected, the Central Emergency Medical Situation Room and the 119 Emergency Transport Situation Center may designate a receiving hospital, which must accept the patient. The prior procedure, whereby the 119 emergency service checked the hospital's ability to accept a patient before transfer, will be abolished. The amendment also includes a clause exempting medical staff from criminal liability in the absence of gross negligence in the course of providing emergency medical care.

The revision passed the National Assembly's Health and Welfare Committee on the 17th of this month and the Legislation and Judiciary Committee on the 28th. The National Assembly is scheduled to vote on the amendment at its plenary session on October 2. If adopted, the amendment will take effect six months after its passage in plenary session.

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