Supreme Court: Nurses Can Also Collect Bone Marrow Samples... Not a Violation of Medical Law

The Supreme Court has ruled that nurses can also perform the task of collecting specimens for bone marrow examinations.

The Supreme Court's 2nd Division (Presiding Justice Oh Kyung-mi) on the 12th overturned the original ruling that sentenced the Asan Social Welfare Foundation to a fine of 20 million won for violating the Medical Service Act and remanded the case to the Seoul Eastern District Court.

The Asan Social Welfare Foundation was prosecuted for violating the Medical Service Act on the grounds that 12 professors from the departments of Hematology, Oncology, and Pediatric Oncology-Hematology at Seoul Asan Medical Center, under its jurisdiction, instructed nurses affiliated with the same hospital to perform 'periosteal puncture' to collect bone marrow specimens necessary for bone marrow examinations from April to November 2018.

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The key issue was the legal nature of periosteal puncture. If periosteal puncture is considered a 'medical practice' that only doctors can perform, then the nurses' actions violate the Medical Service Act. Conversely, if periosteal puncture is regarded as a 'medical assistance act' that nurses can perform under a doctor's supervision, the verdict depends on whether appropriate instructions and supervision by the doctor were present.

The first trial court acquitted, the second trial court convicted, and the Supreme Court reversed the decision back to acquittal.

The Supreme Court stated, "Bone marrow examination cannot be regarded as a medical practice that only doctors can perform," and added, "It should be considered a medical act that nurses, who possess the qualifications and skills for bone marrow examination, can perform as an auxiliary medical act under general guidance and supervision without the doctor needing to be physically present."

The Supreme Court cited reasons such as the relatively low risk of bone marrow examinations, minimal anatomical differences among individuals, and limited discretion for the examiner if guidelines are followed.

However, the Supreme Court added that in cases where the patient is small in stature or a child, the doctor must provide direct and specific guidance and supervision on-site.

Considering that this case required specialized medical knowledge, the Supreme Court held a public hearing on October 8 to hear expert opinions before reaching this conclusion.

The Korean Medical Association issued a statement regarding this, saying, "Periosteal puncture should only be performed by licensed doctors to ensure safety," and expressed strong opposition, stating, "Today’s ruling, which undermines the previous Supreme Court's stance, is beyond concerning and deeply distressing."

They continued, "Through the 'Nurse Illegal Medical Practice Reporting Center' operated by the association, we will continue to report and take measures against illegal acts by nurses to prevent harm to the public caused by the collapse of the healthcare system, and we will also prevent illegal medical practices by nurses and other professions."

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