Supreme Court: "Doctor's Order to Nurse Assistant for Stitch Removal Without Direct Patient Check Is Illegal"

Supreme Court, Seocho-dong, Seoul.

[Asia Economy Reporter Choi Seok-jin, Legal Affairs Specialist] The Supreme Court has ruled that even if the removal of stitches from a surgical site is a medical assistance act that a nursing assistant can perform under a doctor's instruction, if the nursing assistant independently checks the condition of the stitch site and removes the stitches without the doctor examining the patient at all, it constitutes a violation of the Medical Service Act.

The Supreme Court's 2nd Division (Presiding Justice Lee Dong-won) announced on the 27th that it upheld the lower court's ruling sentencing Doctor A to a fine of 3 million won and suspending the sentence of 1 million won for Nursing Assistant B in the appeal trial of both, who were jointly prosecuted for violating the Medical Service Act.

The court stated the reason for dismissing the appeal, saying, "There is no error in the lower court's judgment that did not violate the rules of logic and experience, did not exceed the limits of free evaluation of evidence, and did not misinterpret the legal principles regarding 'unlicensed medical practice,' 'medical assistance acts,' the principle of in dubio pro reo, the principle of ne bis in idem, justifiable acts, and joint perpetration under the Medical Service Act."

Doctor A, who runs a clinic in Dongnae-gu, Busan, entrusted Nursing Assistant B with removing the stitches of Patient C, who visited the hospital on the morning of January 28, 2020, to have stitches removed after undergoing a forehead lift surgery (a procedure that lifts sagging eyelids up to the forehead) and other surgeries.

The reason given was that Doctor A was performing surgery on another patient and had no time to treat Patient C. Following Doctor A's instructions, Nursing Assistant B used a scalpel and tweezers to remove stitches from both the upper and lower parts of Patient C's eyes.

The prosecution filed a summary indictment against both for violating the Medical Service Act.

In court, both argued, "The act of removing stitches is not a medical act that only a doctor can perform but a medical assistance act that a nursing assistant can also perform."

They also claimed that Nursing Assistant B checked Patient C's condition, reported to Doctor A, and removed the stitches under Doctor A's instructions, and since Doctor A was in the same hospital, it did not constitute a violation of the Medical Service Act.

However, both the first and second trials rejected these claims.

While removing stitches after surgery is indeed a medical assistance act that a nursing assistant can perform under a doctor's instruction, the procedure of checking for abnormalities at the surgical site before removing stitches is strictly considered 'medical treatment' and must be performed by a doctor.

The first trial court stated, "Considering the evidence lawfully collected and examined by this court, it appears that Nursing Assistant B independently treated Patient C and removed the stitches on the facial area without prior instruction or involvement from Doctor A. Even if, as the defendants claim, Nursing Assistant B reported the condition of Patient C's stitch site to Doctor A during surgery and then removed the stitches after receiving instructions, since Nursing Assistant B alone conducted the medical examination to confirm the presence or absence of abnormalities at the stitch site prior to removal, the medical judgment based on the nursing assistant's observation report cannot be considered equivalent to the doctor's medical judgment through face-to-face examination. Therefore, such acts cannot be regarded as lawful medical assistance acts."

The first trial court sentenced Doctor A to a fine of 3 million won, while suspending the sentence of 1 million won for Nursing Assistant B, considering her remorseful attitude, lack of prior criminal record as a first offender, and mitigating circumstances leading to the offense.

The second trial court also found no problem with the first trial court's judgment. However, it pointed out an error in applying the pre-amendment penal provisions instead of the amended provisions according to the Medical Service Act's supplementary provisions, overturned the first trial court's ruling, and remanded the case, sentencing the same penalties as the first trial.

The Supreme Court also judged that the acts of both individuals violated the Medical Service Act and dismissed the appeal.

This content was produced with the assistance of AI translation services.