Hello, this is attorney Seunghyun Oh of Cheongchul Law Firm.

The emergency room is the first place people go when life is on the line. Yet there are cases where a misdiagnosis or delayed treatment in the ER costs a precious life or leaves a severe disability. Can a hospital's defense that "it was an emergency and nothing could be done" or "the patient was already in critical condition" actually exempt it from legal liability?

While courts recognize the special nature of the emergency setting, they strictly find medical malpractice for omitted basic tests, misdiagnosis, delayed transfer, and careless handover. Today we take a detailed look at the standards for emergency medical malpractice and the damages awarded, through actual court decisions.

What Makes ER Malpractice Different from Ordinary Care?

Relaxed Duties vs. Heightened Duties

Emergency rooms operate in a unique environment of limited information, time pressure, and simultaneous care of multiple patients. Courts relax some explanation and consent procedures when time is short, but they apply the duty of priority care, the prohibition on discontinuing emergency treatment, and the duty of transfer even more strictly. In other words, "the ER was busy" alone does not justify a misdiagnosis or a delay in treatment.

The Diagnostic Standard in the ER – "Ruling Out Dangerous Conditions," Not "Confirming a Diagnosis"

Courts hold that an ER physician's duty is not to "confirm the exact diagnosis" but to "first rule out life-threatening conditions." Omitting an ECG or cardiac enzyme test for a chest-pain patient, or missing abnormal CT findings in a patient with decreased consciousness, constitutes clear negligence. As the case law shows, courts find negligence when standard emergency protocols (KTAS, emergency medical guidelines) are violated.

Major Types of Emergency Medical Malpractice

① Diagnostic Negligence – Misdiagnosis, Omitted Tests, Imaging Misreads

This is the most frequent type of negligence in the ER. Failing to detect abnormal findings on a brain CT, performing only a routine blood test whose results take 12 hours instead of an emergency blood test, or never once measuring a critically ill patient's respiratory rate all fall into this category. Courts also treat "a test was performed but the abnormal findings were not properly read" as clear negligence.

② Ignoring Contraindications – Proceeding with a Procedure Despite Known Risks

Performing extracorporeal shock wave lithotripsy while a urinary tract infection is uncontrolled, or proceeding with laryngoscopy on an acute epiglottitis patient without preparing for intubation, are treatments that ignore contraindications and are negligent in themselves. Courts strictly find negligence where a procedure that is contraindicated under medical guidelines was carelessly carried out.

③ Delayed Transfer and Failure to Disclose Inability to Accept a Patient

Article 11 of the Emergency Medical Service Act (응급의료에 관한 법률 제11조) requires that when a medical institution cannot provide appropriate emergency care with its own capabilities, the patient be transferred to another institution without delay. Merely observing a myocardial infarction patient who needs transfer for several hours, or replying that the hospital can accept the patient when in fact no specialist is available so that a re-transfer becomes necessary, also constitutes negligence.

④ Failure to Ensure Safety During Treatment

Moving a patient at risk of airway obstruction without medical staff accompaniment, or leaving a patient with a high likelihood of acute deterioration unattended for a long time, is also negligent. Patients in the ER whose condition is expected to worsen require continuous observation and a prompt response.

Analysis of Key Emergency Medical Malpractice Cases

Death After ST-Segment Elevation Was Confirmed but the Patient Was Only Observed Without Transfer – Uijeongbu District Court 2013Gahap376

An adult man with a history of diabetes and hypertension was brought to the ER with chest pain, and an ECG confirmed ST-segment elevation, the foremost warning sign of acute myocardial infarction. The finding was reported to a cardiologist, but the specialist only ordered "admission to the ICU and observation." Without an immediate transfer to a hospital capable of percutaneous coronary intervention, the patient was given only IV fluids, aspirin, and painkillers, and died of cardiac arrest.

The Uijeongbu District Court (decided Oct. 12, 2016, final) found a breach of the duty of care to transfer the patient immediately to a PCI-capable hospital once ST-segment elevation was confirmed. Considering the patient's diabetes and hypertension and the inherently poor prognosis of myocardial infarction, the court limited liability to 55% and ordered damages of approximately KRW 137.64 million.

16-Year-Old Girl's Stroke – CT Misread, Vasovagal Misdiagnosis, and a 6-Hour Transfer Delay – Incheon District Court 2014Gahap4312

A 16-year-old girl collapsed after losing consciousness and was brought to the ER in a semi-comatose state. The radiologist failed to detect low density in the left lentiform nucleus and early infarct signs on the brain CT and reported "no specific findings," and the emergency physician misdiagnosed vasovagal syncope. Even after stroke signs such as vomiting, speech impairment, and facial asymmetry appeared, no further tests such as MRI were performed. Even after suspected stroke was noted in the chart, the patient was transferred to a tertiary hospital only six hours later, during which time the left middle cerebral artery infarction expanded.

The court found negligence in the CT misread and the delayed transfer. With liability limited to 60%, approximately KRW 533.83 million (including lost income, nursing costs, and medical expenses) was awarded to the patient and KRW 5 million to her father. The case became final through compulsory mediation on appeal.

Death from Myocardial Infarction After the Hospital Confirmed It Could Accept the Patient but the Specialist Was Absent and Transfer Was Delayed – Seoul Eastern District Court 2018Gadan125731

A patient with ST-elevation myocardial infarction was transferred from a primary hospital to the defendant hospital. The defendant hospital had replied that "PCI is available" and accepted the patient, but the on-call cardiologist was in fact absent, making immediate intervention impossible. Fifteen minutes after the physician was paged it was confirmed that the procedure could not be performed, and the patient died of cardiac arrest while a re-transfer was being arranged. The recommended treatment window for myocardial infarction (within 120 minutes of first medical contact) was jeopardized by this delay.

The Seoul Eastern District Court (decided Dec. 19, 2019, final) found negligence in failing to notify in advance that the hospital could not accept the patient, due to problems in its internal communication system. With liability limited to 80%, damages centered on consolation money were awarded to the bereaved family.

Lithotripsy Performed Despite a Contraindicated Urinary Tract Infection → Death from Sepsis – Suwon District Court Ansan Branch 2019Gahap8075

Although a 47-year-old woman was diagnosed with suspected pyelonephritis in the ER, a urologist performed extracorporeal shock wave lithotripsy without any test to rule out acute pyelonephritis. An uncontrolled urinary tract infection is a clear contraindication for this procedure, yet it was carelessly carried out. After the procedure the pyelonephritis worsened, sepsis developed, and the patient died.

The Suwon District Court Ansan Branch (decided Nov. 24, 2022) found negligence in proceeding with a contraindicated procedure. With liability limited to 30%, approximately KRW 108.97 million was awarded to the patient's son, and the judgment became final when the Suwon High Court dismissed the appeal.

Sepsis Patient – No Emergency Tests and No Transfer – Seoul High Court 2018Na2024378

This case involved a patient who came to the ER with tachycardia (125–137 beats per minute), generalized muscle pain, and weakness. The medical staff performed only a routine blood test whose results would take 12 hours and never once measured the respiratory rate despite the tachycardia. No laboratory technician was on duty at the time, so an emergency blood test was not possible, but in such a case the patient should have been transferred to another hospital immediately. The sepsis (Staphylococcus aureus) markers were confirmed only after the patient's death.

The Seoul High Court (decided Jan. 17, 2019, final) found negligence in failing to perform emergency blood tests and failing to transfer. Approximately KRW 23.33 million was awarded to the spouse and approximately KRW 54.24 million to each of the three children.

Acute Epiglottitis – Laryngoscopy Without Intubation Preparation and Cardiac Arrest While Moving Without Staff Accompaniment – Busan District Court 2018Gahap47093

For a patient transported with acute epiglottitis (a risk of airway obstruction), an ENT physician performed laryngoscopy in an outpatient room without preparing for endotracheal intubation or tracheostomy. In acute epiglottitis, laryngoscope stimulation can trigger sudden airway obstruction, so preparation for surgical airway access is essential, yet this was disregarded. Even after recognizing after the examination that surgery might be needed, the physician sent the patient alone to the ER without staff accompaniment, and during the move the patient's oxygen saturation plummeted and cardiac arrest occurred.

The Busan District Court (decided Sept. 25, 2019, final without appeal) found negligence in performing laryngoscopy in a contraindicated situation and in failing to accompany the patient. Approximately KRW 96.45 million was awarded to the spouse and approximately KRW 59.3 million to each of the two children, for a total of approximately KRW 215.05 million.

Emergency Medical Malpractice Cases at a Glance

• Uijeongbu District Court 2013Gahap376: delayed transfer for myocardial infarction → 55% liability, KRW 137.64 million

• Incheon District Court 2014Gahap4312: stroke CT misread and 6-hour transfer delay → 60% liability, KRW 533.83 million

• Seoul Eastern District Court 2018Gadan125731: specialist absent and re-transfer delayed for myocardial infarction → 80% liability, mainly consolation money

• Seoul High Court 2018Na2024378: no emergency tests and no transfer for sepsis → approximately KRW 190 million in total to the bereaved family

• Suwon District Court Ansan Branch 2019Gahap8075: contraindicated procedure and death from sepsis → 30% liability, KRW 108.97 million

• Busan District Court 2018Gahap47093: unprepared laryngoscopy and cardiac arrest without staff accompaniment → approximately KRW 215.05 million in total

Legal Steps Victims of Emergency Medical Accidents Need to Know

Step 1. Secure Medical Records and CCTV Footage Promptly

Secure the KTAS triage records, vital sign records (including respiratory rate), test results, and minute-by-minute nursing notes without omission, and immediately request preservation of the ER CCTV footage. CCTV footage is automatically deleted after a certain period. The 119 ambulance activity log can also be viewed on request to the fire station and is key objective evidence of the patient's condition on arrival.

Step 2. Reconstruct a Minute-by-Minute Timeline

Reconstruct, minute by minute, the time the patient arrived at the ER, the time each test was performed and its results checked, the times of physician examination, treatment, and medication, and the times of the transfer decision and transport. This timeline is what proves whether action was taken within the golden hour and whether the transfer was delayed.

Step 3. Strategy for Proving Causation – Using the Golden Hour

For conditions with a clear golden hour, such as stroke (thrombolytic administration within 3 hours) and myocardial infarction (reperfusion therapy within 90–120 minutes), the more specific the delay, the easier it is to prove causation. The key is to support the point that "a better outcome would have been possible with timely treatment" with a written opinion from a medical expert.

Step 4. Statute of Limitations – Claim Within 3 Years / 10 Years

The statute of limitations for a medical malpractice damages claim is three years from the date the victim became aware of the damage and the wrongdoer, and ten years from the date of the tort. Consult a legal professional promptly after the incident to avoid the claim becoming time-barred.

Closing

Misdiagnosis, delayed treatment, delayed transfer, and contraindicated procedures in the ER are not excused simply because "it was an emergency." Courts have recognized breaches of the duty of care by medical staff in a wide range of emergencies, including myocardial infarction, stroke, sepsis, and airway obstruction, and have ordered damages ranging from tens of millions to hundreds of millions of won to victims and their families.

If you have been harmed by an emergency medical accident, it is important to secure evidence quickly before records are deleted and to consult a lawyer specializing in medical malpractice. Cheongchul Law Firm has a dedicated medical malpractice team and supports clients in a wide range of emergency medical disputes, including ER misdiagnosis, delayed treatment, and delayed transfer. Please feel free to request a free consultation at any time.

Thank you.