[Emergency Care on the Brink] ③ Doctors Leave Amid Legal Risks: "Once You're Caught Up in a Lawsuit, It Takes at Least Several Years"

More specialists are working at clinics, while fewer residents are applying
"Doctors are held responsible whether they accept or refuse patients"
"Questions over the effectiveness of the immunity clause"

Editor's NoteAn amendment to the Emergency Medical Service Act, dubbed the "Emergency Room Ping-Pong Prevention Act," will strengthen designated hospitals' duty to accept critically ill emergency patients. It passed a Cabinet meeting and will take effect next April. The government says it based the amendment on results from a three-month pilot program. However, the pilot program had flaws in its structure and evaluation criteria, and the amendment does little to address the underlying injustices, leaving concerns among emergency medical professionals unresolved. This series examines what the amendment overlooks and what issues require deeper consideration before it takes effect.

1. Pilot Program Behind "Emergency Room Ping-Pong Prevention Act" Found to Be Full of Gaps

2. Duty to Accept Patients Imposed, but No Doctors Willing to Take Them and No Means to Assess the Situation

3. Doctors Leave the Front Lines: "One Misstep Can Mean Years of Legal Proceedings Before a First-Instance Ruling"

4. "The Law Should Not Force Hospitals to Accept Every Patient; It Should Create a System That Enables Them to Do So"

"I never thought that a respected senior colleague and mentor, who I believed would devote his life to emergency medicine, would leave the field so disheartened." A doctor at an emergency medical center in Seoul recently spoke to a reporter about a former center director, a specialist who left the center a while ago and opened a clinic treating colds and providing cosmetic dermatology services. "Those of us who came after him, myself included, also wonder how much longer we can stay in our positions," the doctor said.

Legal risks are widely cited as the most important reason emergency room doctors are leaving the front lines. The so-called "Emergency Room Ping-Pong Prevention Act," an amendment to the Emergency Medical Service Act, was approved for promulgation at a Cabinet meeting on October 13 and will take effect six months after promulgation. Although it includes provisions to reduce the criminal liability of emergency medical personnel to some extent, many in the field remain skeptical that it will make any real difference. In a survey of emergency medicine specialists conducted by the Korean Society of Emergency Physicians in September, 86% said the amendment's immunity clause would not reduce the risks they face.

On November 10, the government said that the current Emergency Medical Service Act stipulates that when a patient dies or is injured during emergency medical treatment, a penalty "may" be reduced or waived if the treatment was unavoidable and there was no gross negligence. The amendment changes "may" to "shall." It also adds a new provision exempting medical staff at designated hospitals from criminal punishment when they accept critically ill emergency patients. However, investigative authorities and courts ultimately decide whether to reduce or waive a penalty. They also determine whether gross negligence occurred. Until then, doctors must undergo investigations and trials as suspects or defendants.

Jo Seokju, a professor of emergency medicine at Pusan National University Hospital, recounted the case of a resident at a university hospital emergency room who was indicted after refusing an admission request from a 119 ambulance crew, following which the patient suffered complications. The resident endured six years of legal proceedings before receiving a first-instance ruling last year. "Whether immunity applies must ultimately be determined through litigation, and, as in this case, it is not unusual for years to pass before a first-instance ruling," Professor Jo said. "How painful must that process be for a doctor and, more broadly, for any working professional?"

Wang Sunju, a professor of emergency medicine at Hallym University Dongtan Sacred Heart Hospital, said, "In other departments, treatment begins when doctors see a patient in person. In emergency medicine, however, treatment begins the moment a doctor answers a call from a 119 ambulance crew, and doctors must take responsibility for patients they have not even seen." He added, "If a doctor refuses to accept a patient and the patient dies after failing to find a hospital, the doctor who took the call may end up in court. If the doctor accepts the patient but cannot provide definitive treatment, they may be held responsible and asked why they accepted the patient." Regardless of the extent of civil or criminal liability they may ultimately face, the prospect of litigation itself creates immense pressure. Professor Wang believes it will be difficult to ease that pressure unless the system that leaves doctors vulnerable to lawsuits at any moment is changed.

In July, when the Ministry of Health and Welfare gave advance notice of the amendment, it said that measures to reduce civil liability, such as expanding support for malpractice insurance premiums in essential medical care, should be pursued. In practice, however, no such measures to improve or supplement the system have been introduced, beyond a formal, partial reduction in criminal liability. Meanwhile, the number of medical disputes continues to rise. According to the Korea Medical Dispute Mediation and Arbitration Agency, 2,605 cases were filed for mediation or arbitration last year, the highest number in the past five years and up 24.7% from the previous year.

Emergency medical professionals consistently say that these burdens directly affect doctors' decisions about whether to accept patients. "When we receive a critically ill patient, we first worry about whether the case could harm the hospital and whether we might be drawn into a lawsuit two or three years later," said Choi Seokjae, a professor of emergency medicine at Yeouido St. Mary's Hospital. "As a result, doctors tend to avoid accepting patients unless they can be treated fully at our hospital." He stressed that other departments asked to provide consultations also feel the pressure and may practice defensive medicine. Lengthy testing procedures can, in turn, have an adverse effect on patients.

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