Yang Seong-gwan, chief of family medicine at Uijeongbu Paik Hospital
'Hold hospital accountable for disposal, but consider medical staff's good faith'
'If the nursing hospital is shut down, who will take these patients?'
A practicing physician has come to the defense of a nursing hospital at the center of a case involving a severed human leg found at a public recycling facility in Incheon, saying the hospital and its doctors "at least did not abandon the patient and tried their best within the limits of what they could do."
Yang Seong-gwan, chief of family medicine at Uijeongbu Paik Hospital and a physician-author, made the remarks in a Facebook post on June 22 in response to the case.
When the leg was first discovered at the recycling center, investigators initially suspected a violent crime. The full picture emerged after nursing hospital A in Jung-gu, Incheon, voluntarily reported that it had improperly disposed of the limb. Hospital staff told police that the left leg of a woman in her 80s had become so severely necrotic that they amputated it with scissors, wrapped it in bandages and discarded it as medical waste — but a cleaning worker mistook it for a mannequin and placed it in the recycling bin.
Yang said the case was far more complicated than it appeared. "The patient was an 89-year-old woman with severely diminished cardiac function," he said, describing the situation at the time. "Necrosis in her leg had progressed considerably due to impaired blood supply. There was a large amount of pus in the leg, and the tissue below the knee was already severely damaged."
He said that in such cases, an orthopedic surgeon would normally perform an amputation in an operating room at a general hospital or above, a procedure that requires general anesthesia. "If a referral had been made, a cardiologist at a university hospital would almost certainly have said: 'This patient is high-risk. She could die on the table — make sure the risks are fully explained before proceeding,'" Yang said.
"The family, the orthopedic surgeon and the anesthesiologist would all have had reason to hesitate," he said. "It is not easy to risk someone's life for an amputation — not to save the leg, but to remove it." He added that without surgery, the patient would have had little reason to remain at a university hospital, and that few nursing homes would have been willing to take in a patient with a gangrenous leg.
Yang said the family eventually found hospital A after an extensive search and pleaded with staff to admit the patient. The necrosis continued to advance until the leg was on the verge of falling off entirely. "Left untreated, sepsis could have put her life at risk," he said.
The medical staff at hospital A are understood to have performed the amputation in a patient room rather than an operating room, without anesthesia and in front of the family. Hospital staff told police that the nerves in the affected area had been damaged and the patient felt no pain, that the knee had already largely separated on its own, and that only the remaining soft tissue was cut with scissors.
Yang said the medical staff faced a situation "not found in any textbook," and noted that nursing hospitals charge a daily rate ranging from 48,000 won ($31) to as much as 87,000 won depending on a patient's condition. "Performing an amputation does not generate any additional revenue," he said, stressing that the hospital had no financial incentive.
He went on to say that if hospital A faced a suspension of operations — effectively a closure — "no nursing hospital or doctor would ever again be willing to readily take in a patient with a gangrenous leg." Even if a patient were admitted, he said, staff would likely "choose to do as little as possible rather than take risks and intervene actively."
"The medical staff at hospital A at least tried to solve the problem rather than turn the patient away," Yang said. "I believe the hospital and its doctors did not abandon the patient and tried their best within the limits of what they could do."
He added that he hoped the case would be resolved "in a way that holds the hospital accountable for negligence in the disposal of medical waste, while also taking into account the good faith of the medical staff and their efforts to treat the patient."
jshan@heraldcorp.com
