An image for illustrative purposes [123RF]
An image for illustrative purposes [123RF]

The Supreme Court has ruled that medical staff can be held liable for a patient's death if they fail to conduct follow-up tests for more than 12 hours after administering high-concentration oxygen therapy.

The Supreme Court's Third Division, presided over by Justice Eom Sang-pil, recently overturned a lower court ruling that had dismissed a damages claim filed by the family of the deceased, identified only as A, against the hospital and its medical staff, and remanded the case to the Busan District Court.

A, a man in his 80s, was admitted to the hospital in February 2018 after being diagnosed with suspected pneumonia and pulmonary edema.

A had a history of hypertension and diabetes, had undergone a partial lung resection due to lung cancer in 2001, and had been discharged from the same hospital just two weeks earlier after treatment for pneumonia and an acute exacerbation of chronic obstructive pulmonary disease, or COPD.

When A's blood oxygen saturation dropped to around 80 percent, the on-call physician administered high-concentration oxygen therapy at around 3:50 a.m.

A's condition began to deteriorate around 9 a.m. as his consciousness became impaired.

The hospital conducted an arterial blood gas test at around 4 p.m., which revealed an excessive buildup of carbon dioxide in A's body.

A went into cardiac arrest at around 6 p.m. and ultimately died in March of that year.

The family filed for damages, arguing that the hospital had waited 12 hours and 20 minutes after starting oxygen therapy — and seven hours after A's condition had begun to deteriorate — before conducting the test.

COPD clinical guidelines call for an arterial blood gas test to be performed 30 to 60 minutes after the start of oxygen therapy.

The first-instance court found partial negligence on the part of the hospital and assigned 20 percent liability to the defendants, ordering them to pay the family approximately 30 million won ($21,700).

The appellate court, however, ruled in favor of the hospital, finding that clinical guidelines are recommendations and that the decision to conduct tests falls within a physician's discretion, and noting that the medical staff had continuously monitored A's condition.

The appellate court also found that even if the medical staff had been negligent in not conducting timely tests, A's advanced age and severe underlying conditions made it insufficient to establish a substantial causal link between the negligence and his death.

The Supreme Court reversed the lower court's ruling and sided with the family.

The court cited its existing precedent, which holds that "given the difficulty of proving medical negligence, it is reasonable to ease the burden of proving causation once the patient's side has demonstrated the existence of negligence in treatment and the probability that such negligence caused harm to the patient."

The court found that hospital negligence was established when considering the COPD clinical guidelines, the opinions of medical experts, and the circumstances under which no tests were conducted for approximately 12 hours after oxygen therapy began.

The court also said the medical staff's negligence could be considered one of the causes of A's deteriorating consciousness, and that the staff had failed to produce evidence sufficient to rebut that conclusion.

On remand, the Busan District Court will determine the scope of damages by weighing the medical staff's negligence against the contribution of A's medical history.


husn7@heraldcorp.com