A patient who walked into a clinic perfectly fine on a Tuesday morning is brought home cold by the afternoon. The family cannot make sense of it.
So they begin a fight that seems nearly impossible to win. Savings are liquidated, homes are sold, and the money raised goes toward answering one question: why did their loved one die? But proving a medical institution's liability is extraordinarily difficult for patients and their families — because of the deep asymmetry of information between them and the providers.
In South Korea, medical disputes are handled primarily through two channels: mediation and arbitration requests filed with the Korea Medical Dispute Mediation and Arbitration Agency, which receives an average of about 2,100 cases a year, and civil litigation, which accounts for roughly 1,000 cases annually according to research by the Korea Insurance Research Institute. More than 3,000 medical disputes play out every year — each one a David-versus-Goliath struggle.
The Herald Business, in partnership with law firm O'Kims, has analyzed a range of medical dispute rulings to examine how David might defeat Goliath. This series, Medical Survival Game, runs twice a month — every other Tuesday — and is dedicated to helping patients and their families survive the fight. [Editor's note]
It seemed like nothing serious — just constipation. The hope that a single acupuncture session at a traditional Korean medicine clinic would fix it did not take long to become something far worse: a bowel resection.
On May 11, 2018, a patient identified as A visited a traditional Korean medicine clinic run by a practitioner identified as B, seeking treatment for irregular menstruation and constipation. B inserted acupuncture needles into A's lower abdomen. The next day, A was admitted to Yangsan Pusan National University Hospital.
The consequences of that single needle were devastating. On May 14, 2018, A underwent a small intestine resection — the first surgery — after being diagnosed with a mesenteric hematoma of the small intestine.
A mesenteric hematoma is a condition in which blood pools inside the mesentery — the membrane that holds the small and large intestines in place — forming a large blood pocket. In simple terms, it is bleeding that does not rupture outward but instead clots in place.
Mesenteric hematomas typically arise from abdominal trauma such as traffic accidents or physical assault, medical procedures such as abdominal surgery or endoscopy, or spontaneous bleeding caused by anticoagulant use.
When the hematoma expands, secondary complications can follow. A swollen hematoma pressing on the small or large intestine can cause a bowel obstruction; if it compresses a major blood vessel and cuts off circulation to the intestine, bowel necrosis can result; and if the hematoma ruptures, massive internal bleeding and shock are possible.
That is why the insurer covering practitioner B moved quickly to reach a settlement with A. In September 2018, A received 8.313 million won ($5,870) from B's insurer and 1.967 million won from B as a personal deductible — a combined total of 10.28 million won. In exchange, A signed an insurance receipt confirmation agreeing not to file any civil or criminal lawsuit or raise any objection in connection with the abdominal symptoms, under any circumstances. Practitioner B also signed and sealed the document.
That promise would become the shackle that bound A when a second surgery became unavoidable.
A and practitioner B face off again
The ripple effects of that single needle did not stop at the bowel resection. In April 2020, A was diagnosed at a university hospital with a bowel obstruction caused by intestinal adhesions.
There was no alternative. A returned to the operating table for a small intestine adhesiolysis — the second surgery — a procedure in which sections of the small intestine that have fused together are separated and restored to their normal positions.
The most common cause of intestinal adhesions is the wound-healing process following surgery or a procedure. As the body attempts to repair itself by secreting fibrin, sections of intestine can adhere to one another or to the abdominal wall.
That is what drove A to sue practitioner B even after settling with the insurer for 10.28 million won. A sought a total of 159.03 million won from B: 130.47 million won in lost future income, 8 million won in treatment and cosmetic surgery costs, 5.83 million won in prior medical expenses, 10.28 million won representing the original settlement amount, and 25 million won in consolation damages — all stemming from the mesenteric hematoma and the two surgeries it necessitated.
Practitioner B countered by invoking the September 2018 settlement between A and the insurer, arguing that the agreement — including its no-litigation clause — was binding on B as well.
A no-litigation agreement, in plain terms, is a pact in which the parties agree not to bring the matter before a court. That agreement became the central legal issue in the dispute between A and B.
B also denied any medical negligence in the procedure and argued there was no causal link between the acupuncture treatment and A's intestinal bleeding and necrosis, or the two surgeries that followed. It was the beginning of a protracted legal battle.
Court upholds agreement: both A and practitioner B signed the document
The Ulsan District Court, presided over by Judge Lee Dong-uk, upheld the no-litigation agreement that practitioner B had signed and sealed. Finding that the agreement was binding on B as well, the court dismissed A's lawsuit outright — without even reaching the question of fault.
The court said B had participated in drafting the insurance receipt confirmation, which stated that A would not file any civil or criminal lawsuit or raise any objection in connection with the procedure, after receiving the 10.28 million won settlement from B and the insurer. Because B's signature and seal appeared on that document, the court found the lawsuit A filed against B to be procedurally improper.
The court also rejected A's argument that the agreement had been reached solely between A and the insurer regarding insurance proceeds from the first surgery, and could not be construed as a no-litigation agreement with B personally.
"The insurance receipt confirmation shows that practitioner B participated as a party to the agreement and signed and sealed it," the court said. "It is reasonable to conclude that the effect of the agreement extends to B as the insured."
The court then ruled that "the lawsuit filed by A against practitioner B violates the no-litigation agreement" and that it "lacks the legal interest required for protection of rights and is therefore procedurally improper."
The court also declined to find medical negligence on B's part. It noted — as courts routinely do — the inherent difficulty for laypersons in establishing a breach of the duty of care in medical practice, while reiterating that there must be a sufficient degree of probability to infer that a physician's negligence caused the outcome in question, citing a Supreme Court ruling from Dec. 10, 2009.
The court also took into account the principle that negligence cannot be established if a physician's clinical conduct, assessed against the prevailing medical standards of the time, did not fall outside a reasonable range — citing a Supreme Court ruling from May 31, 2007.
In its detailed findings, the court said that based on the results of a medical records review commissioned from the head of Society D and the overall tenor of the proceedings, the evidence A submitted alone was insufficient to establish either negligence in B's procedure or a causal link to the adverse outcome A alleged.
The court considered five factors: the needle B used measured 0.4 mm by 6 cm and was not a long needle of 9 cm or more, and the procedure was performed in a manner consistent with current clinical standards; the hematoma that developed after the procedure was located 5 cm from the Gwanwon acupoint — meaning a 6 cm needle, excluding the handle, would reach only about 4 cm; A's mesenteric bleeding could have been caused by medication such as aspirin; nearly two years elapsed between the first and second surgeries; and complications such as bowel obstruction and adhesions following a small intestine resection are foreseeable.
Attorney Jo Jin-seok: second surgery was damage that could not have been anticipated
![Attorney Jo Jin-seok of law firm O'Kims [Provided by O'Kims]](https://wimg.heraldcorp.com/news/cms/2026/08/11/news-p.v1.20260810.4e9f8a46516c44bbb7b34f5714a32085_P1.jpg)
Attorney Jo Jin-seok of law firm O'Kims focused on a key point: even accepting the no-litigation agreement and B's signature on it, the second surgery represented damage that could not have been anticipated at the time of the settlement.
However, he cautioned that even in such cases pursuing additional claims is often not possible, and advised that the scope and content of any settlement must be clearly defined at the negotiation stage.
The starting point, he said, is the no-litigation agreement itself. According to Jo, such an agreement triggers procedural legal consequences — including the waiver of the constitutionally guaranteed right to seek a court ruling — for the parties to the litigation. This also means that even a no-litigation agreement concluded directly between the parties is valid only to the extent that the parties could have anticipated the circumstances at the time.
Courts do not automatically uphold no-litigation agreements in medical disputes. They weigh the agreement's content, the settlement amount, the scope of the agreement, the timing of the settlement, and the condition of the parties at the time before determining whether the agreement is enforceable.
Accordingly, courts have in some cases found that damages claims remain available regardless of a settlement agreement when factors such as the following are present: the settlement amount was unreasonably small; the settlement was reached immediately after the incident; the party lacked decision-making capacity at the time of settlement; or symptoms emerged that did not exist at the time of settlement.
"The court upheld the no-litigation agreement based on the status of the parties who signed the insurance receipt confirmation," Jo said. He added that the ruling also reflected the fact that the settlement was reached about four months after the procedure; that the court found the second surgery due to intestinal adhesions and bowel obstruction to fall within the scope of the settlement; and that the damages were deemed to fall within what the parties could reasonably have anticipated at the time.
"Where sequelae or damages that could not have been anticipated at the time of settlement emerge afterward, there is room to argue that the agreement does not extend to them," Jo went on to say. "A needed to argue or demonstrate that the second surgery for intestinal adhesions and bowel obstruction constituted damage that was not foreseeable at the time of the settlement."
He was more cautious, however, about cases in which victims seek additional damages after already receiving a settlement.
"Regardless of whether medical negligence exists, additional claims may be foreclosed by a no-litigation agreement depending on the content, amount, scope, timing, and circumstances of the settlement," Jo said. "It is advisable to define the content and scope clearly at the settlement stage, and to avoid wasting unnecessary legal costs and effort after a settlement has been reached."
ko@heraldcorp.com
