Daegu emergency doctors referred to prosecutors over patient death, sparking legal debate

Emergency medicine specialists and paramedics in Daegu -- who received a patient with a forehead laceration but transferred him to another medical center in April 2024 -- have been recently referred to prosecutors for violating the Emergency Medical Act. The police considered the transfer without providing basic emergency medical care a "denial of emergency medical care."

However, legal experts emphasized that a broader judicial review is necessary, considering the circumstances surrounding the mass resignation of trainee doctors at the time, which was triggered by the government-doctor conflict.

On Jan. 22, the Daegu Metropolitan Police Department referred four emergency medicine specialists and two emergency medical technicians from one general hospital and two tertiary hospitals in Daegu to prosecutors on charges of violating the Emergency Medical Act in connection with the death of a patient with a temple laceration at a psychiatric hospital in Daegu. The patient was transferred to three university hospitals consecutively but died of cardiac arrest in the emergency room of the last hospital.

“We can't comment specifically on the case because it's under investigation,” a police official told Korea Biomedical Review. “But basically, we believe it was a violation of the Emergency Medical Act because the necessary first aid was not provided.”

Regarding why the paramedics were also referred to prosecutors, the official remained reserved, stating, “It's an ongoing investigation.”

The police stated that they also “referred to the ‘Guidelines for Justified Reasons for Refusal of Medical Treatment under the Emergency Medical Act’ released by the Ministry of Health and Welfare in September last year” during the investigation.

Regarding why the doctors were referred to prosecutors nearly a year after the incident in April, they explained, “The investigation process was long.”

According to the government's Guidelines for Justifiable Reasons for Refusal of Medical Treatment under the Emergency Medical Act, the “justifiable reasons” specified in Article 6 of the Emergency Medical Act include the inability to provide appropriate emergency medical treatment to emergency patients. Additionally, a lack of necessary emergency medical resources—such as manpower, facilities, and equipment—can also be considered a legitimate reason for refusing or avoiding medical treatment.

‘Is it right to punish doctors every time a patient dies?’

The Korean Society of Emergency Medicine (KSEM) argued that the rhetoric surrounding the case is unfairly criminalizing doctors who "rightfully refused treatment" because they were unable to provide adequate emergency care. They emphasized that medical judgment determined the patient required specialized treatment, and transferring him to another hospital was the most appropriate course of action.

KSEM also emphasized that the patient's airway, breathing, and circulation were stable enough for him to respond to an emergency physician's examination. While the police autopsy concluded that excessive blood loss from the lacerations was the cause of death, a blood test conducted during CPR indicated that the patient had a hemoglobin level of 10 g/dL—suggesting anemia but not an immediate need for a blood transfusion.

Dr. Lee Kyung-won, PR director of KSEM, stated, "A hemoglobin level of 10 g/dL is not indicative of excessive bleeding. The patient was in his 40s and passed away, so now they are looking for someone to hold accountable. But even if they are punished under the Emergency Medical Act, it doesn’t end there—civil and criminal lawsuits will follow. Is it right to punish doctors like this every time a patient dies?"

‘Whether to indict emergency medicine specialists will be the key’

Observers noted that a key issue will be whether to prosecute the emergency doctors at the first general hospital who assessed the patient in person. The second and third hospitals are likely to shift responsibility to the emergency medicine specialist at the first hospital, as paramedics conducted severity assessments during each hospital’s triage process. Based on these assessments, the emergency medicine specialists decided to refuse to accept the patient.

Dr. Lee Hyung-min, president of the Korean Emergency Medicine Association, stated, "The doctors who actually treated the patient could be the ones held accountable. Those who refused at the door or were not directly involved in the consultation process are likely to avoid major charges." He added, "I hope doctors will not face prosecution simply for conducting basic tests or assessing the risk of death."

"About 60 percent of the nation's 400 hospitals have emergency departments staffed by a single emergency physician. If a patient arrives with a facial laceration, suturing can take 30 minutes to an hour, during which the doctor is unable to treat other emergency patients. As a result, most hospitals are unable to accept such cases."

The legal community is also advocating for a broader interpretation of “justifiable denial of care” in light of last year’s national healthcare crisis. They emphasize the need to consider the circumstances in April last year when a shortage of doctors and specialists led to a lack of emergency medical resources.

In April of last year, there was a shortage of emergency medical resources to accommodate patients in emergency rooms due to a lack of specialists,” said Kim Joo-sung, managing partner at law firm Banwoo. “Hospitals were already at full capacity and unable to accept new patients. When operating at their limit, providing additional treatment simply wasn’t feasible.”

Kim emphasized, “The national crisis must be taken into account—emergency rooms were not functioning properly.”