A court ruling that cleared a hospital of liability in a medical negligence lawsuit involving cauda equina syndrome (CES) has been overturned on appeal.

The Cheongju Division of the Daejeon High Court recently overturned the original trial that dismissed the patient's claim in a damages lawsuit against a medical corporation, initialized as A, and ordered the hospital to pay damages.

The patient, identified as Mr. B, underwent percutaneous endoscopic neuroplasty for a herniated disc and disc bulge at a hospital, initialized as C, under the medical corporation, in March 2020. As the pain continued after the procedure, he underwent a laminectomy and discectomy a week later. On a subsequent MRI scan, the doctors found a hematoma at the site of the disc removal, and the hematoma was removed the next day. However, Mr. B's symptoms did not improve, and he was transferred to another hospital, where he was diagnosed with CES.

In response, Ms. B claimed that the medical staff at hospital C failed to treat him properly and delayed treatment, which caused him to develop CES, and demanded damages of 447.49 million won ($322,980) and delayed interest from hospital C's operator, medical corporation A.

On March 9, 2023, the Jecheon Branch of the Cheongju District Court, which conducted the original trial, dismissed all damages claims, saying there was no reason for Mr. B's claim. The court reasoned that there was insufficient evidence to show that the medical staff of hospital C committed negligence or delayed treatment during the procedure or surgery. It was challenging to say that the medical staff's negligence caused CES. Therefore, the breach of the duty of explanation was not established.

However, in Mr. B's appeal, the appeals court found medical negligence and breach of the duty of explanation.

"Mr. B. was advised to undergo a microscopic discectomy of the fourth and fifth lumbar vertebrae of the left lumbar spine, but he agreed to undergo surgery if his pain did not improve after the procedure. However, the medical staff should have opted for a laminectomy from the outset,” the appeals court said. “The medical staff of hospital C committed medical malpractice by recommending and performing conservative treatment aimed solely at reducing pervasive pain without sufficiently considering the progression of the patient's condition."

Moreover, the left foot symptoms Mr. B experienced after the procedure were likely due to an aggravation of her herniated disc, and “the medical staff had a duty to foresee that consequences such as CES could occur if immediate nerve decompression was not performed and to take steps to avoid them, the tribunal noted.

“Even if the patient's pre-existing condition contributed to CES, the medical staff did not make sufficient efforts to identify the cause of the left foot symptoms after the procedure and select the appropriate treatment method,” the court said. “There is a causal relationship between the occurrence of CES and the treatment by the medical staff of hospital C.”

The court's finding of negligence also upheld the claim that the medical staff breached their duty of care.

“The consent form, which was signed in a face-to-face meeting with the medical staff before the procedure, did not list CES, hematoma, and foot drop as possible risks or complications,” it said. “It is difficult to say that it was sufficiently explained that surgical treatment was more suitable than conservative treatment in cases where the patient had already reached stage 3 of the herniated disc or that it may be difficult to cure the underlying disease with the procedure alone.”

Accordingly, the court ordered her to pay 231,169,275 won, including 30 million won in alimony, plus prejudgment interest.