Is There a Causal Relationship Between Acupuncture Treatment and Skin Necrosis?
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A patient complaining of tingling in the feet visited a Korean medicine clinic for acupuncture treatment. At the time of the visit, the patient reported tingling and pain in the feet and calves, and mentioned during the medical history interview that they had diabetes.
The Korean medicine practitioner assessed that the blood circulation was poor and decided to perform a bloodletting acupuncture treatment on the calf where the symptoms were severe. Afterward, the patient complained of worsening corns and cracks on the toes, along with intense pain in the feet. The practitioner reassured the patient that the condition was due to the discharge of bad blood and advised not to worry, continuing the same treatment along with prescribing herbal medicine and adding electrostimulation.
Despite this, the patient's symptoms did not improve, and they were referred for a dermatological examination. Later, the patient was diagnosed with diabetic foot ulcers, with necrosis progressing in the big toe, and underwent procedures such as partial amputation at a university hospital.
In this case, can the Korean medicine practitioner be held responsible for the acupuncture treatment as a form of negligence resulting in bodily injury?
Determining Medical Negligence in Healthcare
In medical malpractice cases, for a healthcare provider to be deemed negligent, it must be shown that they could have anticipated the outcome and avoided it, yet failed to do so. The level of negligence is determined by considering the general medical standards at the time of the incident, the healthcare environment, and the specific nature of the medical procedure. This principle also applies to Korean medicine practitioners.
In this case, it cannot be conclusively determined that the Korean medicine practitioner was negligent simply for performing acupuncture or bloodletting on a patient with diabetes. The patient had mentioned receiving treatment for diabetes at a hospital, and during their visits to the clinic, they also reported ongoing treatment at the hospital. Therefore, the practitioner likely believed that the patient was receiving appropriate treatment for their diabetes.
The bacteria found in the foot that was amputated after necrosis were common microorganisms found in diabetic feet, making it difficult to attribute these bacteria to the acupuncture or bloodletting treatment. Additionally, the area of necrosis was somewhat distant from where the practitioner had performed the acupuncture or bloodletting, and the patient visited a different hospital for dermatological treatment 13 days after being referred by the practitioner.
Despite being advised to be hospitalized, the patient did not comply and went home, only to later visit another hospital and be diagnosed with progressive skin necrosis, after which they were admitted for treatment.
Thus, it is difficult to conclude that the Korean medicine practitioner failed to meet the required level of care and that this failure directly caused the patient’s foot necrosis. Therefore, the decision by the lower court to convict the practitioner of professional negligence resulting in injury, based on a misunderstanding of the legal principles related to medical malpractice and causality, is erroneous (Supreme Court Decision 2014. 7. 24. Case 2013Do1601).
The Duty of Care for Korean Medicine Practitioners
In relation to the case above, a Korean medicine practitioner must ensure that detailed medical history records are kept during the diagnostic process. Furthermore, in medical malpractice cases, negligence can arise from various stages of the treatment process, including diagnostic, examination, medication, injection, surgical (or procedural) mistakes, failure to monitor progress, referral failures, failure to explain procedures to the patient, as well as issues with infection control and safety management such as falls. It is crucial for Korean medicine practitioners to be thorough in diagnosing patients, foresee potential risks, and take the necessary precautions to avoid harmful outcomes, documenting everything related to the treatment in medical records.
Specifically, if a Korean medicine practitioner is unable to conduct necessary tests due to the limitations of their medical facility or location, they must, unless there are exceptional circumstances, recommend that the patient undergo the appropriate tests at a specialized medical facility (Supreme Court Decision 1998. 2. 27. Case 97Da38442).
The principle of “survival of the fittest” might be attributed to Charles Darwin, but in the context of medical practice, “recording to survive” is more accurate — documenting and proving one's actions is vital for defense and accountability.
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