The Supreme Court has ruled that a doctor cannot be held criminally liable for medical malpractice if a patient with skin rash suddenly develops severe liver dysfunction and is diagnosed with a level 5 liver disability after receiving a prescription, as long as it was not possible to diagnose Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome early on.
According to legal circles on Tuesday, the Second Division of the Supreme Court (presided over by Justice Kwon Young-joon) overturned the lower court’s decision that sentenced dermatologist A and pediatrician B to 8 months in prison, suspended for 2 years, on charges of professional negligence resulting in injury. The case has been sent back to the Uijeongbu District Court.
The medical incident occurred in 2013. The victim, C, then 12 years old, visited the dermatology clinic where A worked to treat a skin rash. C was prescribed Dapsone and later admitted to the emergency room of the hospital where B worked due to high fever.
C’s liver function suddenly deteriorated, leading to fulminant hepatic failure and a coma. Ultimately, C was diagnosed with a level 5 liver disability.
A was indicted for prescribing Dapsone without informing C of the risks and failing to explain that the medication should be discontinued if side effects occur.
Dapsone is an antibiotic that can cause side effects such as toxic hepatitis. Doctors are required to perform regular blood tests and liver function tests before and after Dapsone administration, and have a duty to explain general precautions to patients when prescribing it.
B was indicted for not administering steroids despite receiving a dermatology consultation response on August 6, 2013, stating discontinue Dapsone and consider administering steroids as needed.
B belatedly administered steroids three days later on August 9, 2013, after receiving a second consultation response. However, it was found that B did not continue steroid treatment consistently, instead alternating between administration and discontinuation.
The first trial in November 2021 sentenced A to 8 months in prison, suspended for 2 years, stating that the culpability was not light given that serious injury occurred to C due to professional negligence in failing to fulfill the duty to explain.
In contrast, B was found not guilty in the first trial. The court reasoned that B had already ordered the discontinuation of Dapsone before receiving the dermatology consultation response and appeared to have decided to observe the situation and take appropriate next steps, which could not be considered a wrong choice.
The second trial in February 2023 dismissed A’s appeal and maintained the sentence of 8 months in prison, suspended for 2 years. However, it overturned the not guilty verdict for B and sentenced them to 8 months in prison, suspended for 2 years.
The second trial accepted the prosecutor’s claim of misapprehension of facts, stating that repeatedly administering and discontinuing steroids for short periods without implementing continuous steroid treatment constituted professional negligence.
However, the Supreme Court found it difficult to establish a causal relationship between professional negligence and the occurrence of injury, stating that even if A had discontinued Dapsone and performed various tests, it would have been impossible to diagnose DRESS syndrome early on.
The Supreme Court pointed out that to establish a causal relationship between professional negligence and the occurrence of injury, it must be proven beyond reasonable doubt that if complete blood count and liver function tests had been performed, the results would have allowed for the diagnosis of DRESS syndrome, leading to early treatment for C and preventing the injury.
Regarding B, the court also found it difficult to recognize professional negligence, stating that while there was a possibility C could have been in a milder condition if steroids had been administered continuously at an earlier stage, this was a retrospective assessment.
The Supreme Court explained that the eosinophil count, a type of white blood cell that plays a role in regulating allergic reactions, is a key diagnostic indicator for DRESS syndrome. C’s eosinophil count never exceeded the upper limit of the normal range from the time of admission to the emergency room until transfer.
The court added that symptoms such as fever, rash, and abnormal liver function test results can also occur in bacterial or viral infections, making them non-specific symptoms. It concluded that the decision to observe C’s progress while conducting tests for infections without administering steroids could not be definitively considered outside the reasonable discretion of a physician when viewed in light of clinical medical knowledge and standards.
