Chungnam National University Hospital Delays Treatment for Placental Abruption Mother, Newborn Brain Disease... Court Orders 700 Million Won Compensation

Cheongju District Court Building. Photo by Cheongju District Court website

[Asia Economy Reporter Choi Seok-jin, Legal Affairs Specialist] A court ruling has recognized a large compensation liability against a university hospital that failed to suspect placental abruption despite a pregnant woman being brought to the emergency room with vaginal bleeding and abdominal pain, resulting in the newborn suffering brain damage and other disabilities.

According to the court on the 5th, the 11th Civil Division of Cheongju District Court (Presiding Judge Lim Byeong-ryeol) recently ruled partially in favor of plaintiff A (5 years old) in a damages claim lawsuit against Chungnam National University Hospital, ordering the hospital to pay approximately 754.4 million KRW plus interest from the day after the incident (September 9, 2017).

A’s mother, Ms. B, experienced vaginal bleeding around 2 a.m. on September 8, 2017, during her pregnancy and was transported by a 119 ambulance to the emergency room of Chungnam National University Hospital.

The hospital medical staff began treatment at 2:55 a.m. that day, conducting ultrasound, blood tests, and non-stress tests to monitor the fetal heart rate.

As they observed the progress, at around 4:17 a.m., when Ms. B’s vaginal bleeding continued and she persistently complained of abdominal pain, the medical team performed an emergency cesarean section, delivering A, a male infant weighing 2.83 kg.

However, immediately after birth, A’s initial heart rate was severely low at 60 bpm, and he had significant blood clots in his mouth, was silent, limp, and showed signs of generalized cyanosis.

Despite securing A’s airway, his heart rate did not recover promptly, so about four minutes after birth, the medical staff performed endotracheal intubation (a procedure supplying oxygen via a manual device to patients who have difficulty breathing independently). After confirming a heart rate of 100 bpm and 100% oxygen supply, the plaintiff was moved to the neonatal intensive care unit.

From around 5:40 a.m. the same day, the medical team administered intravenous fluids and mechanical ventilation to A. After observing jaw tremors, abnormal brain waves, and seizures, they continued blood pressure monitoring, fluid and glucose infusion, and ventilator treatment.

Despite these efforts, Chungnam National University Hospital diagnosed A with neonatal hypoxic-ischemic encephalopathy and severe birth asphyxia.

About a year later, in December 2018, A was classified by the Yuseong District Office in Daejeon as having first-degree brain lesion disability and fifth-degree hearing impairment. At the time of filing the lawsuit, A suffered from limb paralysis and cerebral palsy due to hypoxic brain injury, resulting in walking, cognitive, and speech disabilities.

A’s side argued that since Ms. B continuously complained of abdominal pain and vaginal bleeding, the medical staff should have suspected or diagnosed placental abruption and immediately taken emergency delivery measures. However, the medical team excluded the possibility of placental abruption for about two hours and delayed emergency cesarean surgery, failing to take prompt emergency action, which caused A’s brain damage and other disabilities. They filed a lawsuit claiming approximately 1.188 billion KRW plus interest. They also claimed that after delivery, the hospital failed to take appropriate emergency measures or fulfill the duty to explain to prevent further harm.

On the other hand, the hospital argued that ultrasound and non-stress tests performed on Ms. B showed no medical signs or symptoms to suspect placental abruption, and that they did not neglect monitoring the mother or fetus. They emphasized that upon observing additional vaginal bleeding, they suspected placental abruption and immediately performed emergency cesarean surgery, asserting no negligence on their part.

Placental abruption (Placental abruption) is an obstetric condition where the normally positioned placenta separates prematurely from the implantation site after 20 weeks of pregnancy but before delivery. The formed decidual hematoma detaches, compresses, and destroys the surrounding placenta, causing vaginal bleeding or concealed hemorrhage, which can lead to serious complications for both mother and fetus.

For the mother, bleeding between the uterus and placenta can cause disseminated intravascular coagulation, massive hemorrhage, and postpartum bleeding. For the fetus, oxygen supply may be compromised, leading to fetal distress or imminent fetal death (a dangerous state where insufficient oxygen supply in the womb causes the fetus to struggle with pulmonary respiration and enter a critical condition).

The court first cited a Supreme Court ruling that relaxed the burden of proof on the victim in medical malpractice cases.

Previously, the Supreme Court stated, "In cases of medical malpractice, if the victim proves that there was medical negligence based on common sense during a series of medical procedures and that no other cause besides the medical acts could have intervened?such as proving the patient had no health defects that could cause such results before the medical acts?then unless the medical provider proves that the result was caused by a completely different reason, the causal relationship between medical negligence and the outcome is presumed, thereby easing the burden of proof. This aligns with the principle of equitable and reasonable distribution of damages in tort law."

The court then presented the following grounds: ▲ The most frequent signs of placental abruption are vaginal bleeding and abdominal pain, and Ms. B visited the defendant hospital’s emergency room due to these symptoms and continuously complained of them to medical staff after arrival; ▲ When a mother is in labor, in addition to non-stress tests, ultrasound, and blood tests, tests such as nitrazine, pelvic exam, uterine dilation, fetal descent, and cervical effacement should be conducted to carefully diagnose placental abruption. However, emergency room records at the time made no mention of placental abruption, and no related medical records were found in nursing or obstetrics records, suggesting the obstetrics staff only considered premature labor and did not consider placental abruption at all during treatment and surgery; ▲ Although the defendant claimed no special signs to suspect placental abruption early on, pediatric initial records noted signs of placental abruption; ▲ The attending physician admitted to misdiagnosing labor as caused by ruptured membranes; ▲ Despite knowing about the onset of vaginal bleeding, the medical staff delayed emergency cesarean surgery for about 2 hours and 45 minutes. Based on these, the court found it reasonable to conclude that the emergency cesarean surgery was delayed due to negligence by the hospital staff.

The court concluded, "Considering these circumstances, it is reasonable to find that the defendant hospital’s medical staff violated their duty of care during delivery by failing to diagnose Ms. B’s placental abruption and delaying treatment, which ultimately caused the plaintiff (A) to develop hypoxic-ischemic encephalopathy."

However, the court did not accept A’s claims that the medical staff failed to provide appropriate emergency measures or violated the duty to explain after delivery.

Furthermore, considering ▲ medical procedures inherently involve bodily invasion and childbirth is a highly risky act where unexpected outcomes can occur despite all efforts; ▲ it is generally difficult to accurately diagnose placental abruption prenatally with routine tests; ▲ the plaintiff’s heart rate and ultrasound results were relatively normal at times, the court limited the hospital’s liability to 70%.

The court calculated A’s lost future earnings (lost income) at 537.8 million KRW, assuming A, who completely lost labor ability due to brain damage causing limb paralysis and cerebral palsy, would have earned this amount if the accident had not occurred. It included treatment costs already incurred (about 53.1 million KRW) and future treatment costs (about 61.8 million KRW), and expenses for a manual wheelchair and a mattress to prevent bedsores (about 18.4 million KRW).

Additionally, the court included caregiving costs of about 300 million KRW for hiring someone to care for A, who cannot eat, bathe, or use the restroom independently, from ages 5 to 10 (5 years). The total property damage was estimated at about 977 million KRW, and applying the 70% negligence ratio, the hospital was held liable for approximately 684 million KRW. Adding 70 million KRW for mental distress damages (consolation money), the total compensation was set at about 754 million KRW.

The court also ordered the hospital to pay delayed interest calculated at 5% annually from September 9, 2017 (the day after the incident) to September 23, 2022 (the first trial ruling date), and 12% annually from the day after the ruling to the actual payment date, according to the Special Act on Promotion of Litigation.

Shin Hyun-ho, lead attorney at Law Firm Haewool representing A, said, "Due to recent obstetrics society evaluations, there have been few cases recognizing hospital liability for delivery accidents, especially placental abruption. This is a rare case where the court acknowledged medical staff’s misdiagnosis responsibility and negligence in delaying emergency cesarean surgery in a birth brain injury caused by placental abruption."

Attorney Shin added, "Recently, hospital liability in medical accidents has been greatly limited, and there have been almost no delivery accident rulings exceeding 400 million KRW. This case recognized a large compensation amount of about 1 billion KRW including interest, imposing strict liability for violating the duty to protect fetal life."

He further noted, "Following amendments to the Civil Procedure Act, courts have employed physicians as permanent expert advisors in medical lawsuits, which tends to significantly reduce recognition of medical negligence. In this context, it is meaningful that the court recognized medical staff’s negligence responsibility through normative judgment."

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