A hospital sued for 700 million won ($523,500) for medical negligence resulting in cerebral infarction has been released from liability. The court found that the medical staff did their best under the circumstances.

The Seoul Central District Court recently dismissed all of the patient's claims for damages against the hospital's management.

That was five years after the lawsuit was filed.

The plaintiff underwent heart surgery for aortic valve stenosis at the hospital on March 13, 2017. Physicians at the hospital recommended that the patient be treated as soon as possible, as he was suffering from heart failure and possible aortic rupture, and there was no other option but surgery.

The patient underwent an ascending aorta and aortic valve replacement using a mechanical valve at around 8 a.m. that day. However, he began to bleed profusely after the ventilator was removed. The medical team restarted the CPR, applied hemostasis, and transferred the patient to the intensive care unit at 2:30 a.m. the following day.

The patient woke up on the afternoon of March 14 and complained of weakness on the left side of his body, and the medical staff conducted a brain CT scan on March 18, but no lesions were observed. The following day, the patient showed unclear consciousness, developed delirium, was transferred to the Department of Critical Care on March 22, and monitored. On March 27, the patient developed symptoms of generalized tonic-clonic seizures, and a brain MRI scan showed acute cerebral infarction.

The patient experiences aftereffects, including consciousness degradation, quadriplegia, and cognitive decline due to brain lesion disorders.

Accordingly, the patient sued the medical corporation that operates the hospital for 729,889,890 won in damages and delayed interest. He claimed that he suffered a cerebral infarction due to the negligence of the medical staff during the surgery and that they did not properly diagnose and take measures.

"It was necessary to avoid damaging the valve tissue and clean the remaining tissue at the surgical site sufficiently, but they neglected to do so," the patient claimed. "They did not stop the operation even though the aortic wall was weakened by atherosclerosis, and neglected to use the ventilator minimally."

The plaintiff added that even though the patient complained of weakness in the left side of his body immediately after the surgery, the medical staff delayed CT-MRI and reperfusion treatment, aggravating the cerebral infarction."

However, the court did not accept the patient's argument.

It ruled that the mere fact of a causal link between the patient’s disability and the surgery he received at the hospital could not determine medical negligence. Instead, the medical staff at the hospital did their best to check the condition of the patient’s surgical site, the court said.

"Cerebral infarction is a possible complication of the patient's surgery. Therefore, it cannot be inferred that the medical staff was negligent in the surgical procedure based on the observation of acute cerebral infarction," it said.

It was also pointed out that in a situation where the patient’s aortic valve was already severely calcified, and the valve tissue was "fragmented and unrecognizable except around the peripherals," the medical staff "carefully removed the valve given the possibility of the valve tissue falling off and causing a systemic embolism, and performed several cleaning and checking procedures to ensure that there was no remaining tissue."

Immediately after the operation, blood pressure increased, and bleeding occurred at the suture site. Still, the team decided that "if the surgeon operated with the utmost care, it was unavoidable that the weakened aortic wall would bleed after the operation."

Regarding the claim that the surgeon caused brain damage by restarting the ventilator to provide hemostasis, the court found that it was reasonable to conclude that "it would have been difficult to provide hemostasis other than restarting the ventilator and stopping the heart in a situation where massive bleeding occurred."

The court said that the claim that the medical staff delayed a CT-MRI scan of the brain, resulting in a late diagnosis of cerebral infarction, was also unfounded.

“The patient complained of weakness only on the left side of his body immediately after surgery, and the onset of neurological symptoms was around 18 days after the brain CT examination. The medical staff continuously observed the patient and administered renal replacement therapy and anticoagulants, considering the possibility of cerebral infarction," it said. "The patient was in a situation where he could not receive reperfusion treatment due to aortic surgery, so it cannot be said that it was negligent to continue only anticoagulant treatment."

Within 24 hours of the onset of cerebral infarction, the lesion cannot be observed on a brain CT scan, and the diagnosis of a cerebral infarction does not change the treatment method, the court went on to say. Since the patient’s cerebral infarction may have been triggered by a convulsive seizure that occurred on March 27, it is difficult to conclude that the results would have been different if a brain MRI scan had been performed on March 20.

The tribunal also rejected the claim that the medical staff failed to fulfill their preoperative explanation and postoperative guidance and explanation duty.

Accordingly, the court dismissed all of the patient’s claims as being without merit and ordered him also to bear the costs of the case.