Supreme Court: "Causal Link to Death May Be Presumed if Medical Staff Negligently Delay Tests"

Same Doctor Acquitted in Criminal Trial

The Supreme Court has ruled that if a medical team’s failure to conduct tests in a timely manner was one of the causes of a patient’s deteriorating condition, the connection to the patient’s death must be recognized unless the medical team proves otherwise.

The Supreme Court in Seocho-gu, Seoul. Yonhap News Agency.

According to legal sources on Oct. 19, the Supreme Court’s Third Division, with Justice Eom Sang-pil presiding, overturned a lower court ruling against the plaintiffs in an appeal filed by the family of A, who recently died, against School Foundation B and Doctors C and D at the foundation’s hospital. The case was remanded to the Busan District Court.

A, who had a history of lung cancer surgery and suffered from chronic obstructive pulmonary disease (COPD), was admitted to the hospital on Feb. 19, 2018, with swelling. When A’s oxygen saturation was found to be around 80% at most on the night of Feb. 23, the on-duty physician, C, increased the oxygen flow. In the early hours of Feb. 24, C switched A to an oxygen mask and increased the flow to as much as 10 liters per minute.

A’s consciousness deteriorated to a confused state at around 9 a.m. on Feb. 24. An arterial blood gas test was not performed until 4:09 p.m., about 12 hours and 20 minutes after high-flow oxygen therapy began. The test found an excessive buildup of carbon dioxide in A’s body. A went into cardiac arrest later that day and died on March 12.

The first trial found both negligence and a causal link, but limited the defendants’ liability to 20% in light of A’s preexisting conditions. The second trial overturned the portion of the ruling against the defendants and dismissed all of the plaintiffs’ claims. It found that the clinical guidelines were recommendations and that the improvement in A’s oxygen saturation to 95% did not provide sufficient grounds to find negligence. It also said that, even if there had been negligence, a causal link would be difficult to establish given A’s advanced age and severe underlying conditions.

The Supreme Court rejected that conclusion. The justices said, “There does not appear to be evidence sufficient to find that the death did not result from the negligence of the defendants named above.” They found negligence, noting that COPD treatment guidelines call for an arterial blood gas test 30 to 60 minutes after oxygen therapy begins, and that the medical expert who evaluated the case said this was not an unreasonable standard.

As for causation, the court said it was appropriate to presume a causal link and ease the burden of proof if the patient’s side establishes negligence in treatment and the likelihood that the negligence caused the harm. The medical expert considered hypercapnia the most likely cause of A’s worsening consciousness and also said that, if arterial blood gas tests had been performed more frequently, noninvasive ventilation could have been attempted.

Meanwhile, Doctor D, the attending physician, was indicted on a charge of occupational negligence resulting in death in connection with the same case, but the acquittal became final.

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