South Korea's Supreme Court has ruled that medical staff can be held negligent for failing to check whether carbon dioxide had built up in a patient with chronic obstructive pulmonary disease for more than 12 hours after administering high-concentration oxygen, a lapse that led to the patient's death.
The Supreme Court's Third Division, presided over by Justice Eom Sang-pil, overturned a lower court ruling that had dismissed a damages suit filed by the family of a patient identified as A against a school foundation identified as B and two doctors identified as C and D, and sent the case back to the Busan District Court, legal sources said on the 19th.
A visited the hospital on Feb. 19, 2018, for swelling and was admitted after being diagnosed with suspected pneumonia and pulmonary edema. The patient had previously undergone a partial lung resection for lung cancer and had COPD. At about 3:50 a.m. on Feb. 24, medical staff increased A's oxygen supply to 10 liters per minute. A became disoriented at around 9 a.m., but staff did not perform an arterial blood gas test until 4:09 p.m., when they confirmed that carbon dioxide had accumulated excessively in the body. That was about 12 hours and 20 minutes after the high-concentration oxygen was administered. A went into cardiac arrest and was revived through cardiopulmonary resuscitation but died on March 12.
The first-instance court sided with A's family. It recognized a causal link between the medical staff's negligence and the death, ordering about 30 million won ($21,000) in total damages.
The appeals court reached a different conclusion. It found it difficult to establish negligence, citing that clinical guidelines are only recommendations and that the patient's oxygen saturation had improved. "The deceased had a history of being given sedatives for symptoms of delirium, so it appears to have been difficult to distinguish whether the decline in consciousness at the time was caused by carbon dioxide accumulation or by the administration of those drugs, and the deceased had severe swelling throughout the body at the time, with the skin depressed along the tubing attached to the oxygen apparatus," the court said.
The Supreme Court reversed that finding. Because the technical nature of medical treatment makes it difficult for patients to prove negligence, the court held, a causal link between negligence and harm can be presumed once a breach of the duty of care and the likelihood of resulting harm are established. It cited an expert medical witness who assessed hypercapnia as the most likely cause of the deterioration in A's consciousness and said that a timely test would have allowed staff to attempt non-invasive ventilation. "The negligence described above can be seen as one of the causes that worsened the deceased's state of consciousness," the court said. "There does not appear to be proof sufficient to establish that the death did not result from the negligence of these defendants."
A Supreme Court official said the court "recognized negligence by considering the content of the clinical guidelines, the expert medical opinion and the circumstances under which no test was carried out for about 12 hours after the high-concentration oxygen was administered, and found that because this negligence can be seen as one of the causes of the worsening consciousness, causation is presumed and the medical side failed to produce proof sufficient to rebut it."