[Medical] “Patient died due to lack of appropriate measures despite symptoms of suspected duodenal perforation… Hospital responsible 60%”

[Ulsan District Court] Attending physician recognized as negligent in diagnosis

Although the patient with a duodenal ulcer had symptoms that suggested the possibility of perforation, the hospital failed to conduct additional tests and provide treatment, leading to the patient's death.

Ulsan District Court Judge Woo Jung-min acknowledged 60% of the defendants' responsibility in the lawsuit (2024 Gadan 105323) filed by the husband and two children of Patient A (58 years old at the time) in Chungju City against Hospital B in Chungju and the head of internal medicine at Hospital B, who was the attending physician, demanding compensation for damages on April 10, saying, "The attending physician should stand in solidarity with Hospital B and pay a total of 156 million won to the plaintiffs." ruled. Hospital B was declared bankrupt in September 2024, and the plaintiffs' claims for damages against Hospital B were confirmed as bankruptcy claims.

On September 18, 2023, A visited the internal medicine department of Hospital B with symptoms such as abdominal pain and vomiting, was diagnosed with gastroenteritis and colitis, and was hospitalized for treatment. However, his symptoms worsened and he was transferred to another hospital on September 26, where he was diagnosed with acute peritonitis due to a perforated duodenal ulcer and underwent surgery, but ultimately died.

Judge Woo acknowledged the attending physician's diagnostic negligence.

Judge Woo said, "Although perforation was not confirmed in the endoscopy performed by the attending physician on September 25, 2023, if a duodenal ulcer accompanied by severe bleeding was observed and abdominal pain continued to be complained afterward, there is room for suspicion of duodenal ulcer perforation. Even if there was no perforation, a nasogastric tube should have been inserted to check for bleeding or a computed tomography scan to check for active bleeding and necessary treatment should have been considered. However, the attending physician should have checked the presence of active bleeding the next day. He pointed out that "only symptomatic treatment such as administration of antipyretics and dopamine was administered until 18:00," and that "although the attending physician was prescribing peptic ulcer treatment to A after the endoscopy, symptoms such as decreased blood pressure, increased pulse, and oliguria were observed in A around 14:40 on September 26, 2023, and anuria was confirmed at around 15:00 after insertion of an indwelling urinary catheter, multiple organ failure. “Although septic shock was suspected and it was very urgent and important to determine the cause, the medical records submitted by the defendant hospital do not confirm the tests or diagnosis performed by the attending physician to determine the cause.”

Judge Woo also pointed out, "A's condition deteriorated rapidly between September 25 and 26, 2023, and the expert judge judged that the prognosis could have been different if the attending physician had made an appropriate diagnosis and treatment before A fell into multiple organ failure and septic shock, or if A had been immediately transferred for treatment if treatment at the defendant hospital was judged to be impossible," and "A's prognosis could have been different after the attending physician performed an endoscopy." “It can be acknowledged that A failed to provide appropriate treatment to A due to negligence in diagnosing the condition, leading to A’s death from peritonitis and multiple organ failure due to perforation of the duodenum.”

Judge Woo stated, however, that the defendant's medical staff failed to diagnose duodenal perforation, peritonitis, and multiple organ failure in a timely manner, and as a result, A died without receiving proper treatment. However, the defendant's medical staff also performed abdominal radiography and endoscopy in response to A's complaints of abdominal pain, and the results showed no findings suspicious for perforation. Basic treatment according to A's symptoms was continued, and the causes of abdominal pain were diverse, so perforation or peritonitis was diagnosed when a duodenal ulcer was diagnosed. Considering that there may have been some difficulties, the defendants' liability was limited to 60%.

Daeryun Law Firm represented the plaintiffs.

For the full text of the ruling, please refer to the Ulsan District Court website.

Legal Times Reporter Kim Deok-seong (dsconf@legaltimes.co.kr)

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[Medical] "Patient died due to failure to take appropriate measures despite symptoms suspected of duodenal perforation... 60% of hospital responsibility" (Shortcut)