[The Editors' Verdict] A Doctor’s Guide for Judges and Prosecutors

Since 1997, several major upheavals in our medical community were triggered not by the Ministry of Health and Welfare but by judges and prosecutors. This year, two such incidents caused by judges and prosecutors have occurred consecutively, shaking the medical landscape once again.

Rewinding the clock to December 1997, the Seoul Southern District Court sentenced a doctor to prison for aiding and abetting murder after he discharged a husband with cerebral hemorrhage from the Boramae Hospital ICU at his wife’s request and removed his ventilator. The custom of doctors removing meaningless ventilators vanished instantly and permanently from all hospitals nationwide that day. As a side effect, patients deemed irrecoverable could no longer leave the ICU before death. Until the Supreme Court ruling in 2008 ordering the removal of the ventilator for Grandma Kim at Severance Hospital, who had become a vegetative state, doctors had steadfastly refused such requests.

In December 2017, when four newborns suddenly died at Ewha Mokdong Hospital, prosecutors arrested three people including a professor of pediatrics. Although all were later acquitted, young doctors who witnessed the handcuffed professor began to avoid pediatrics from that day forward. The nationwide pediatric residency application rate, which was 113% in 2018, plummeted to 25% this year. The number of pediatric specialists produced will shrink starting this year, after the four-year training period.

When medically sound practices are provoked into judicial punishment, doctors either abandon those medical practices (as in Boramae Hospital ICU) or completely avoid the specialty (as in Ewha Mokdong Hospital Pediatrics). Medical practices are standardized, and doctors fear that “if I were in that situation, that hospital’s ruling would apply to me too.” For high-risk essential specialty doctors who are frightened, there is a comfortable escape in the form of high-profit non-insurance treatments. This is why the judicial prosecution of an intern at Boramae Hospital and a pediatrics professor at Ewha Mokdong Hospital caused a tsunami throughout the entire medical community.

Turning the clock back to this year, when a 17-year-old trauma patient in Daegu was subjected to an “emergency room carousel” incident in March and a Daegu Fatima Hospital emergency medicine resident was booked as a suspect, a flight from the profession is occurring again. The Korean Society of Emergency Medicine reports that there are cases of residents quitting midway, amid backlash calling it a “witch hunt criminalizing medical judgment not to accept patients who cannot be treated.”

Recently, the Pyeongtaek branch of the Suwon District Court ruled a 1.2 billion KRW damage compensation against an obstetrics and gynecology department where a newborn cerebral palsy occurred. The ruling stated that the attending physician ordered emergency tests to a nurse when a pregnant woman who sensed something wrong arrived at the hospital at 11:30 PM, but only arrived at 1:12 AM when the accident happened, thus holding the doctor responsible. Until 2021, the highest damage compensation related to childbirth in Korea was 550 million KRW (according to the Korean Society of Obstetricians and Gynecologists), but it instantly doubled to 1.2 billion KRW. This ruling will accelerate the closure of delivery obstetrics departments.

The Daegu and Pyeongtaek cases have not yet been finalized. The former is still under investigation, and the latter is pending appeal. Due to information asymmetry in medical lawsuits, doctors are overwhelmingly favored. Investigative agencies and the judiciary must strictly punish doctors if there is negligence to relieve the grievances of powerless patients. At the same time, they are urged to consider that individual punishments can cause ripple effects that change the entire medical system.