A Seoul court acquitted medical staffs at Ewha Womans University Hospital of criminal charges over the deaths of four newborns by bacterial infection at the hospital in December 2017.

The Seoul Southern District Court said on Thursday it found not guilty for four physicians and three nurses at the neonatal intensive care unit (NICU) who were indicted on charges of professional negligence over the deaths of the four babies.

Although the court recognized partial negligence of the medical staffs, it was difficult to judge that the negligence had a direct causal relationship with the death of the newborns, the court said.

Cho Soo-jin, a pediatric professor in charge of the Ewha Womans University Hospital’s intensive care unit for newborns, and one of the seven indicted in the case, attends the trial of the Seoul Southern District Court on Thursday.

The court noted that the hospital practice of dividing a nutritional injection, SMOFlipid, from one bottle and giving them to multiple newborns at the NICU could not be justified.

“Dividing the injection raises the risk of infection from medical staffs. Therefore, such a practice should not be permitted,” the court said.

The court recognized thee professors and a head nurse’s violation of the obligation to pay attention, except for a trainee doctor and two other nurses. A professor was found guilty of belatedly checking the result of a rotavirus test of a newborn.

However, the court said it could not find a direct causal link between such medical mistakes and the deaths of the four newborns.

To recognize a causal relationship between the wrongdoing of the accused and the death of the victims, the court needed to recognize that the nutritional injections administered to the victims on Dec. 15, 2017, had been contaminated, that the contamination with the Citrobacter freundii bacteria led to sepsis, and that the infants died of the sepsis, the court said.

“Although the victims seem to have died of sepsis and may have died of sepsis due to the same cause, the SMOFlipid syringes were collected from medical waste containers along with diapers used by hospitalized children at the time of the epidemiological investigation,” the court said.

The court went on to say that it was difficult to determine the exact time of sepsis infection by medical records and that infants’ symptoms such as decreased food intake and apnea occurred 15 days before the incident. “The epidemiological study also had limitations in recognizing the causal relationship due to the wide confidence interval,” it said.

The court also said that the evidence submitted by the prosecutor alone did not prove the contamination routes and causes of SMOFlipid infection. Unless the cause of the contamination from Citrobacter freundii bacteria is demonstrated, there was no causal link to prove that sepsis from the bacteria led to the deaths of the newborns, it said.

Skipping all proving procedures for other negligence, the court declared not guilty on all the seven defendants.

Choi Dae-zip, president of the Korean Medical Association, welcomed the court’s decision but regretted the partial recognition of negligence by the physicians.

“We welcome the court’s acquittal verdict made under the principle of evidential justice but regret that it recognized the violation of the obligation to pay attention and negligence,” Choi said. “Only serious or intentional medical acts that are not medically recognized should be subject to criminal punishment. Other medical acts should not be subject to criminal punishment.”

Choi explained that he did not mean that physicians would not take responsibility for a medical error. Medical mishaps should be handled in civil compensations or mediations instead, he said.

The KMA will demand the government enact a law to exclude medical practices from criminal punishment in principle, Choi added.

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