Supreme Court: "In Medical Malpractice, 'Patient's Burden of Proof' Requires Only Demonstrating Plausibility of Causation"

Criminal Lawsuits for Medical Accidents Require "Proof Beyond Reasonable Doubt">

The Supreme Court has made a ruling that relaxes the burden of proof on the patient side in lawsuits claiming damages related to medical malpractice. The patient side only needs to prove that there is a 'likelihood' that medical negligence caused the patient's damage. Until now, courts required the patient, as a layperson, to prove that there was no health defect that could have caused the medical accident prior to the medical treatment.

Supreme Court, Seocho-dong, Seoul.

The Supreme Court's First Division (Presiding Justice Kim Seon-su) announced on the 17th that it upheld the appellate court ruling recognizing a causal relationship between the medical staff's negligence and the death of Mr. A, who suffered cardiac arrest during general anesthesia, in the final appeal filed by Mr. A's bereaved family against Hospital B for damages.

Mr. A (aged 73 at the time) underwent surgery at Hospital B in December 2015 after falling on the floor and sustaining a right shoulder rotator cuff tear, among other injuries. Dr. C, an anesthesiologist at the hospital, administered general and partial anesthesia around 10:15 a.m. on the day of the surgery and instructed a nurse to monitor Mr. A's condition at 10:42 a.m. before leaving the operating room.

Subsequently, when Mr. A's blood pressure dropped and oxygen saturation levels declined, the nurse contacted Dr. C four times, and Dr. C administered epinephrine and other vasopressors around 11:20 a.m. Despite these efforts, Mr. A's condition did not improve. Dr. C stopped the surgery and performed cardiopulmonary resuscitation before transferring Mr. A to a university hospital, but Mr. A ultimately passed away. Mr. A's spouse and children filed a lawsuit against Hospital B seeking damages.

The first trial court found that Dr. C neglected monitoring duties for Mr. A, which led to an emergency situation and failure to perform timely CPR, establishing a significant causal relationship between Dr. C's negligence and Mr. A's death. The court ordered payment of approximately 99 million KRW to the bereaved family. The second trial court upheld the first trial's decision but reduced the compensation for funeral expenses, ordering about 92 million KRW in damages to the family.

The Supreme Court agreed with the second trial court's ruling. It issued a new judgment stating, "When the patient side proves that there is a likelihood that medical negligence caused the patient's damage, it is reasonable to presume a causal relationship between the medical negligence and the damage, thereby easing the burden of proof for causation."

While the court still presumes that the patient side bears the burden of proving 'medical negligence,' it ruled, "If the patient side proves the existence of an act evaluated as medical negligence?i.e., a violation of the duty of care required of ordinary medical practitioners under the medical standards practiced in clinical medicine at the time of treatment?and proves that such negligence likely caused the patient's damage, it is reasonable to ease the burden of proof for causation."

However, the court added, "The likelihood of damage occurrence does not need to be proven beyond doubt from natural scientific or medical perspectives, but if recognizing causation between the negligence and damage contradicts medical principles or if the negligence only presents a vague possibility of causing damage, it cannot be considered proven." It also stated, "Even when causation between medical negligence and damage is presumed, the medical provider can rebut the presumption by proving that the patient's damage was not caused by the medical negligence."

On the other hand, in the criminal appeal related to this case, where Dr. C was charged with professional negligence resulting in death, the Supreme Court overturned the original sentence of eight months imprisonment and a fine of 7 million KRW and remanded the case to the appellate court.

The Supreme Court's First Division (Presiding Justice Kim Seon-su) found insufficient evidence to prove causation between Dr. C's professional negligence and Mr. A's death. The court noted that it is difficult to determine whether Dr. C could have taken additional measures or prevented cardiac arrest if he had directly observed Mr. A or promptly responded to the nurse's calls by quickly returning to the operating room.

The court stated, "There is insufficient proof that if the defendant had directly observed the victim when cardiac arrest occurred and taken measures such as CPR, the victim would not have died," and added, "In criminal cases, the standard is proof beyond a reasonable doubt, and the doctrine of presumed causation does not apply."

A Supreme Court official explained, "This ruling clarifies that in criminal cases related to medical malpractice, the mere fact that 'professional negligence' is proven does not automatically lead to presumed causation or reduced proof standards resulting in a guilty verdict."

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