Supreme Court Rules Medical Staff Not Liable in Liver Transplant Case Linked to Dapsone Side Effects

The Supreme Court has ruled that it is difficult to hold medical staff legally liable for professional negligence in a case where a patient suffered liver failure and required a liver transplant after taking the skin rash medication dapsone.

The Second Petty Bench of the Supreme Court (presided over by Justice Kwon Young-jun) overturned the lower court rulings that had sentenced a dermatologist, Dr. A, and a pediatrician, Dr. B, at a university hospital to suspended prison terms on charges of professional negligence resulting in injury, and sent the case back to the Uijeongbu District Court.

On July 12, 2013, Dr. A examined the victim, then 12-year-old C, who visited the hospital for a skin rash, and prescribed dapsone.

Because dapsone can cause side effects such as toxic hepatitis, regular blood and liver function tests must be conducted before and after administration, and patients and their guardians must be instructed and informed about the possibility of adverse effects.

Investigations showed that Dr. A failed to conduct these tests and did not explain the potential side effects.

Due to hypersensitivity reactions such as high fever, C visited the hospital's emergency room on August 4 of the following month and was treated by Dr. B, a pediatrician.

Two days later, on August 6, Dr. B received a first interdepartmental consultation reply from Dr. A stating, "Dapsone can be discontinued and steroids administered if necessary," but did not administer steroids.

Three days later, on August 9, 2013, after receiving a second consultation reply stating, "Systemic steroid administration is deemed necessary," Dr. B initiated steroid administration that afternoon.

Subsequently, Dr. B repeatedly started and stopped short-term administration of steroids, halting the treatment and then resuming it as C's condition worsened.

Ultimately, on August 21 of that month, C fell into a coma due to fulminant liver failure and received a liver transplant the same day, resulting in a Grade 5 liver disability rating.

Prosecutors indicted Dr. A for the negligence of failing to perform tests and provide explanations regarding dapsone side effects, and Dr. B for the negligence of failing to continuously administer steroids.

The first trial found only Dr. A guilty, but the second trial found both individuals guilty on all charges, sentencing each to eight months in prison with a two-year suspension.

The second trial concluded that Dr. B should have strongly suspected dapsone hypersensitivity syndrome at least after receiving the first consultation reply, yet delayed or suspended steroid administration, thereby worsening the symptoms.

The Supreme Court reached a different conclusion.

The Supreme Court cited the legal principle that "when performing medical practices, a doctor has a considerable scope of discretion to select treatment methods deemed appropriate based on the patient's condition, the level of medical practice at the time, and their own knowledge and experience," and that "unless that choice exceeds reasonable bounds, one cannot look back at the outcome and say that only one course of action was correct and any other measure was negligent."

The Supreme Court pointed out that throughout C's hospitalization, uncertainty persisted as to whether the condition was dapsone hypersensitivity syndrome or a bacterial or viral infection.

The Court judged that Dr. B's actions—such as withholding or suspending steroid administration, conducting infection tests while observing the clinical progress, or switching to immunoglobulins—"cannot be concluded to have exceeded the reasonable discretionary scope of a medical doctor when compared against the clinical medical knowledge and standards of that time."

Regarding Dr. A, the Supreme Court stated, "Even if professional negligence in failing to conduct tests and provide explanations is recognized, it is difficult to view it as proven beyond a reasonable doubt that the injury would not have occurred to the victim in the absence of such negligence," and ruled with an intent of acquittal.

(Photo: Yonhap News)
※ Please note: This article was translated by AI and may contain errors.