Supreme Court Recognizes Hospital Negligence for Failing to Check Brain Hemorrhage in Patient Who Collapsed and Died After X-ray Examination and Surgery

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[Asia Economy Reporter Choi Seok-jin, Legal Affairs Specialist] The Supreme Court has issued a ruling recognizing the negligence of a hospital that failed to consider the possibility of cerebral hemorrhage after discovering swelling on the head of a patient who fainted and collapsed during a chest X-ray examination.

The Supreme Court's Third Division (Presiding Justice Kim Jae-hyung) announced on the 12th that it overturned the lower court's ruling, which had dismissed the damages claim filed by the deceased Mr. A's wife and children against the Korea Veterans Health Service, and remanded the case to the Seoul High Court.

In 2014, Mr. A, who visited the Central Veterans Hospital operated by the Korea Veterans Health Service due to symptoms such as generalized weakness, memory loss, and urinary incontinence, was diagnosed by a neurologist with cerebrovascular disease, carotid artery stenosis, and cognitive decline due to chronic alcohol consumption, and was transferred to the emergency medicine department for further examination.

However, while undergoing a chest X-ray examination in the emergency medicine department, Mr. A suddenly collapsed backward, sweating profusely.

The hospital sent Mr. A to the emergency room and attempted to perform a brain magnetic resonance imaging (MRI) scan, but Mr. A was uncooperative and the examination could not be conducted. Later, when Mr. A exhibited convulsions in both arms and legs, the hospital administered anticonvulsant medication.

The next morning, the medical staff conducted a brain computed tomography (CT) scan on Mr. A and discovered traumatic intracerebral hemorrhage, acute hemorrhages in both frontal and temporal lobes, cerebral edema, and subdural hemorrhage, and performed surgery to remove the intracerebral hematoma. However, 16 days after the surgery, Mr. A died from medullary paralysis caused by traumatic cerebral hemorrhage and cerebral edema.

Mr. A's wife and children filed lawsuits claiming damages of approximately 110 million won and 70 million won respectively, alleging that Mr. A's death was due to the hospital's negligence.

The bereaved family argued that Mr. A sustained skull and facial fractures by hitting his head on the floor when he collapsed during the X-ray examination, and considering Mr. A's past medical history including cerebral infarction, there was a possibility of cerebral hemorrhage or cerebral edema. They claimed that the hospital was negligent in failing to provide immediate emergency measures, neurological examinations, or at least a brain CT scan. They also argued that even after surgery, when Mr. A's cerebral edema did not subside, the hospital took no action and was negligent in follow-up observation.

Furthermore, the family pointed out that the hospital did not provide any explanation about the possibility of cerebral hemorrhage or cerebral edema when Mr. A collapsed, nor did it explain the potential for brain damage or death, the necessity of follow-up observation, or the need for medication and decompressive craniectomy after surgery, thus violating the duty to explain.

However, the first and second trial courts ruled that there was no negligence on the part of the hospital.

The lower courts first noted that although Mr. A showed signs of mental confusion when he visited the hospital, his consciousness was clear, he was able to walk independently without assistance, and there were no particular problems with motor sensation, so there was no need to take fall prevention measures during the X-ray examination.

They also judged that when the medical staff checked Mr. A's condition after he fell, there was no suspicion of head injury requiring emergency CT examination, and appropriate measures were taken for the convulsions. They found it difficult to recognize negligence on the part of the medical staff, considering that surgery was performed immediately after the CT scan and the symptoms of cerebral hemorrhage and cerebral edema improved.

However, the Supreme Court ruled that the hospital was negligent for failing to properly monitor the progress of a patient with a possibility of cerebral hemorrhage following a fall accident at the hospital.

First, the court found that Mr. A likely hit his head on the floor or equipment during the fall while undergoing the X-ray.

▲ The medical records prepared before the chest X-ray did not mention any trauma or swelling on Mr. A's scalp, ▲ the radiographer who took Mr. A's chest X-ray testified that "At the moment the machine was operated, Mr. A, who was holding the handle of the X-ray machine, fell backward. I ran immediately but could not catch him," and ▲ the brain CT scan report taken after the accident confirmed swelling on the left side of Mr. A's scalp were cited as evidence.

The court stated, "In light of these circumstances, it can be inferred that there was physical impact on Mr. A's head," and "Therefore, it is highly likely that the swelling on Mr. A's head was caused by the accident in which his head struck the floor or equipment."

The court also noted, "Before the accident, Mr. A did not exhibit symptoms suggesting cerebral hemorrhage, but about four hours after the accident, convulsions appeared in both arms and legs," and "Considering the standard level of medical care, the defendant hospital's medical staff should have anticipated that the cerebral hemorrhage caused by the accident could have been the cause of the convulsions."

Finally, the court pointed out, "After the accident, when Mr. A returned from the X-ray room to the emergency room, the hospital staff only measured vital signs and did not check for head injuries," and "The fact of the accident was not properly communicated to Mr. A's attending physician, who, upon observing convulsions in both limbs, did not consider the possibility of cerebral hemorrhage due to head trauma from the accident and only attributed the convulsions to alcohol withdrawal, administering anticonvulsants."

The court concluded, "The defendant hospital's medical staff only performed a brain CT scan about 19 hours after the accident, discovering cerebral hemorrhage and cerebral edema, and then performed surgery," and "It is difficult to find that the hospital staff recognized the possibility of cerebral hemorrhage after the accident and took necessary measures."

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