[Forensic Medicine Life] Blaming Neonatal Medical Accidents on Premature Births

The couple had long hoped for a pregnancy and regarded the fetus as a blessing from heaven once they conceived. Before the due date, the mother experienced severe abdominal pain, and it was diagnosed that both the fetus and the mother’s lives were at risk. A cesarean section was performed at the hospital where prenatal checkups were being conducted. The university hospital was renowned and trustworthy, especially its obstetrics and gynecology department. The doctor was an expert among experts. The doctor handed the baby, taken out from the mother’s womb, to a resident assisting with the surgery. The resident, who was about 1 meter away from the operating table, stumbled forward while rushing to the neonatal care station. The baby in the resident’s arms hit the operating room floor. It was an unfortunate accident that no one had anticipated.

The medical staff confirmed through emergency ultrasound that the baby had a fracture in the parietal bone located on the top of the skull and an epidural hemorrhage inside the head caused by the fracture. The baby died on the same day. The cause of death on the death certificate was recorded as neonatal hemorrhagic disease due to premature birth. The type of death was listed as natural death. There was no record of head injury anywhere on the death certificate. The medical staff informed the baby’s parents that the baby died from respiratory distress syndrome and hemorrhagic disease, which can occur in premature infants, and expressed their condolences but did not mention the accident that occurred in the operating room. The baby’s parents had no choice but to swallow their grief over the sad fate of their premature child in tears. The baby was cremated and forever buried in the hearts of the parents.

One day, after performing three autopsies in the morning and feeling too tired even to eat, a detective visited and placed a thick file on the desk. Upon reviewing the materials, it was found that the head injury caused by the baby’s fall was not severe enough to cause immediate death. However, considering the baby was premature, the injury was judged to be a damage that could not be completely ruled out as unrelated to the death. When asked who had reported this previously unknown fact, the detective replied, "I heard that an employee resigned because of this case. There are no secrets in this world, are there?" I promised to write an opinion letter on the impact of the head injury on the cause of the baby’s death.

The courtroom was packed. In the defendant’s seat sat the hospital’s executives and the obstetrics and pediatrics doctors who had been indicted, and the defense seats were full. The lawyers intensely questioned me, a forensic pathologist, focusing on the argument that the head injury was not severe enough to cause death. They also bombarded me with questions about whether the death certificate was problematic. I calmly concluded my testimony by stating the principle that when an external cause (head injury) influences an internal cause (prematurity), the death should be regarded as caused by the external factor.

I saw news articles reporting that as a result of the first trial, appeals, and the Supreme Court, some medical staff were ordered to be detained in court for evidence tampering, violation of medical law, and negligent homicide. Medical accidents are unfortunate but inevitable, and legal disputes will increase. When negligence occurs, it is important to offer a sincere apology, which may ultimately seek forgiveness. This applies not only to medical accidents but to all matters in life. Lastly, I hope people do not forget that the doctors who always work alongside me are mostly those who care deeply about their patients’ well-being and do their best. There are also innocent people who reduce their sleep to worry about patients and take their recovery and healing as the joy of their lives.

Yoo Seong-ho, Forensic Pathologist