Court rules ERs cannot refuse patients due to 'lack of backup care'

The Seoul Administrative Court has dismissed Daegu Fatima Hospital’s request to revoke a corrective order issued by the Ministry of Health and Welfare.

Daegu Fatima Hospital, which was sanctioned for the 2023 death of a teenage severe trauma patient in Daegu, lost its administrative case against the government. It is the second regional hospital to do so, following Daegu Catholic University Medical Center, which filed a similar lawsuit.

Both hospitals argued they could not accept the patient due to an inability to provide adequate backup care. However, the court rejected this as a valid justification, finding that the hospitals failed to properly assess the severity of the patient’s condition.

On April 24, the Fifth Division of the Seoul Administrative Court dismissed all claims filed by the Missionary Benedictine Sisters of Tutzing, Daegu Priory, which operates Daegu Fatima Hospital. The court also ordered the hospital to bear the legal costs.

Daegu Fatima Hospital was the first regional emergency medical center that a teenage patient --identified as Ms. A -- was taken to after falling from a four-story building on March 19, 2023. The patient died of cardiac arrest later that day after being transferred from hospital to hospital in search of care.

According to the verdict, paramedics from the Northern Daegu Fire Department rescued Ms. A at around 2:14 p.m. She had swelling in the left occipital region and pain in the right ankle but was conscious and able to communicate. Believing her injuries were not severe, paramedics transported her to Daegu Fatima Hospital, the nearest facility.

At approximately 2:34 p.m., the paramedics informed an emergency medicine trainee, referred to as Dr. B, that the patient had likely fallen from a height of two to three meters and had stable vital signs. After speaking with the patient and her guardian, Dr. B recommended transfer to a university hospital for possible psychiatric hospitalization, as he suspected a suicide attempt.

At 3:20 p.m., the paramedics called again to ask if Ms. A could be accepted. Hospital staff declined, saying they could not provide psychiatric treatment or hospitalization. Ms. A went into cardiac arrest during a subsequent transfer at around 4:29 p.m. and was taken to the emergency department at Daegu Catholic University Medical Center, where she died at around 6:27 p.m. from presumed hypovolemic shock.

In May 2023, the Health and Welfare Ministry issued a corrective order and suspended subsidy payments for six months to four hospitals -- including Daegu Fatima Hospital and Daegu Catholic University Medical Center -- for refusing to confirm their ability to accept patients without sufficient reason. Daegu Fatima Hospital and Kyungpook National University Hospital were also fined for failing to comply with severity classification requirements.

Daegu Fatima Hospital argued that the ministry’s sanctions were unjustified.

The hospital said Dr. B had examined Ms. A’s face, reviewed her medical history, asked about symptoms, and assessed visible injuries. Based on the severity classification guidelines, suicide attempts are typically considered Level 2 severity, while lower extremity injuries fall under Level 5. Dr. B judged that while the trauma was not severe, the psychiatric risk was high, justifying a transfer.

The hospital also said that although the paramedics later called to ask if trauma care alone could be provided, no update was given about any change in the patient’s condition. Therefore, staff assumed her condition remained unchanged and declined the request, citing difficulty in treating patients with serious psychiatric conditions.

Court: Physicians failed to properly triage patient

The court disagreed.

It questioned whether Dr. B, a trainee, had properly assessed the patient’s severity and did not accept the argument that prioritizing psychiatric over emergency care was consistent with severity classification protocols.

“Emergency medical personnel -- particularly physicians -- must assess the patient's condition directly rather than relying solely on information from paramedics,” the court said. It noted that Ms. A remained on the stretcher for about five minutes and was never physically assessed. The medical staff made their decision based solely on secondhand information and subsequently refused to accept her.

“There is no evidence the staff took vital signs or thoroughly examined her injuries,” the court stated.

The court also said there was no indication this was a premeditated suicide attempt, which would warrant a Level 2 classification. It criticized the hospital's assessment of the trauma as a minor Level 5 lower extremity injury, citing it as a misclassification.

Moreover, the court highlighted that staff at Hospital D, which later examined Ms. A, diagnosed her with eyeball displacement, left occipital edema, and suspected cerebral hemorrhage. She died of cardiac arrest just one to two hours after leaving Daegu Fatima Hospital.

During the investigation, Daegu Fatima’s medical team said they canceled the admission because she was a psychiatric emergency case. “These patients are usually not critically ill, so I entered KTAS Level 5 [in the system] to cancel the admission,” one said. The court viewed this as a further indication of inappropriate severity classification.

Court finds no justification for refusal, but hospital appeals

The court concluded that because Daegu Fatima Hospital failed to properly assess the patient’s condition, it had no legal justification for refusing emergency care.

“Refusing treatment may be justified in cases of lack of specialists or equipment—but only after emergency personnel properly assess severity,” the court said.

The court also noted that during the second inquiry, paramedics had said, “The guardian wants trauma care first. Other hospitals are unable to accept trauma patients.” Still, Daegu Fatima declined. Even if paramedics failed to fully communicate the change in condition, refusal based solely on a lack of psychiatric care was unjustified, the court said.

By contrast, Hospital D, which diagnosed the hemorrhage, also declined admission due to unavailable specialists. However, it examined and classified the patient properly before doing so, making the refusal legally justified.

Accordingly, the court dismissed all of Daegu Fatima Hospital’s claims and upheld the Ministry’s corrective action.

The hospital has appealed, and the case is now under review by the 6-2 Administrative Division  of the Seoul High Court.

Daegu Catholic University Medical Center also lost both court cases

Before Daegu Fatima, Daegu Catholic University Medical Center also challenged a corrective order and subsidy suspension -- but lost in both the initial and appellate courts.

In September 2023, the Seoul Administrative Court’s 12th Division dismissed all claims filed by the Bonus-Pastor Education Foundation, which operates the hospital.

The hospital argued it lacked a neurosurgeon at the time and was therefore unable to provide treatment. However, the court ruled that this was not a valid reason for refusing a patient, especially since its medical staff did not perform a basic examination and relied solely on the paramedics’ report.

The hospital appealed but again lost. On May15, the Seventh Administrative Division of the Seoul High Court dismissed the appeal and upheld the lower court’s ruling.