Clinic-level anesthesia cases up 44% in four years

Gaps in emergency equipment and response systems exposed

A medical sedative used for anesthesia. This image is unrelated to the article. [Ministry of Food and Drug Safety]
A medical sedative used for anesthesia. This image is unrelated to the article. [Ministry of Food and Drug Safety]

About 85 percent of clinics that frequently perform sedation procedures lack defibrillators, a new survey has found. Of the 440 facilities examined, only two had ventilators on hand.

According to data obtained from the Health Insurance Review and Assessment Service by Rep. So Byeong-hun of the Democratic Party of Korea, a member of the National Assembly's Health and Welfare Committee, the number of anesthesia billing claims filed by clinic-level medical institutions jumped 43.6 percent — from 298,375 in 2021 to 428,425 last year. In the first half of this year alone, 236,043 claims were filed, already surpassing half of last year's total.

The use of "visiting anesthesia" — in which an outside anesthesiologist is brought in because no in-house specialist is on staff — jumped 69.1 percent, from 51,291 cases in 2021 to 86,732 last year.

Emergency resuscitation infrastructure, however, was found to be severely lacking. A comprehensive survey of 440 clinic-level institutions that administered 600 or more doses of sedation drugs — including propofol, midazolam and ketamine — in the first half of this year, based on national health insurance billing records, found that only two clinics (0.5 percent) had reported owning a ventilator. The share with a defibrillator — critical for securing the "golden hour" window in cardiac arrest cases — was limited to 15 percent, or 66 facilities.

According to the Korean Society of Anesthesiologists, the greatest risk of sedation anesthesia stems from respiratory depression. Without prompt intervention, patients can die.

The root cause lies in a legislative blind spot. Current enforcement regulations under the Medical Service Act require ventilators in operating rooms and intensive care units, and defibrillators in ICUs. The vast majority of clinics that administer sedation in endoscopy rooms and similar settings face no legal sanctions for failing to keep either device on site.

According to the National Fire Agency, emergency services responded to 474,634 calls at medical facilities — including clinics and long-term care hospitals — between 2021 and August of this year. Broken down by reason, the top causes were respiratory distress (58,768 cases), impaired consciousness (29,382 cases) and cardiac arrest (15,509 cases). The agency confirmed, however, that no coordination system exists to notify the Ministry of Health and Welfare or local public health centers after emergency patients are transported from clinic-level facilities.

Surveillance of patient safety incidents at clinics is also incomplete. Data submitted by the Korea Institute for Healthcare Accreditation show that of 33,606 patient safety incidents reported at clinic-level institutions between 2021 and May of this year, only one was classified as a serious case. Some 97 percent of all reports were cases in which pharmacists at the dispensing stage caught and flagged prescription errors before they reached patients.

Under the Patient Safety Act, mandatory reporting of serious incidents applies only to hospitals and general hospitals with 200 or more beds, meaning clinics are under no legal obligation to report deaths.

The issue has drawn renewed attention after two patients died following sedation procedures at a dental clinic in Gangnam, Seoul, within an eight-month span, among a string of similar incidents. "The fact that anesthesia-related deaths at clinics go undetected by the national surveillance system simply because they have fewer than 200 beds, and that roughly 85 percent of clinics are anesthetizing patients without even a defibrillator, amounts to a clear dereliction of duty by the state," So said. He added that he would press the Ministry of Health and Welfare to take action and push for amendments to the Medical Service Act and the Patient Safety Act to close the legislative gaps.


soho0902@heraldcorp.com