Medicolegal Consideration to Prevent Medical Malpractice Regarding Opioid Administration: An Analysis of Judicial Opinion in South Korea

Abstract

Jeongsoo Kim,1 SuHwan Shin,2,3 YoungHyun Jeong,4 So Yoon Kim,5,6 Ho-Jin Lee4,7 1Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea; 2Department of Medical Law and Ethics, Graduate School, Yonsei University, Seoul, Republic of Korea; 3Blue Urology Clinic, Seoul, Republic of Korea; 4Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea; 5Division of Medical Law and Bioethics, Department of Medical Humanities and Social Sciences, Yonsei University College of Medicine, Seoul, Korea; 6Asian Institute for Bioethics and Health Law, Yonsei University, Seoul, Korea; 7Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of KoreaCorrespondence: Ho-Jin LeeDepartment of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of KoreaTel [phone]Fax [phone]Email [email protected]: Although the use of opioids is increasing in South Korea, there have been no studies on the serious complications caused by the opioids. The aim of this study was to investigate the rare but serious complications through medicolegal analysis.Materials and Methods: From January 1994 to December 2019, we retrospectively reviewed the closed cases of lawsuits involving the complications of opioids using the database of judgments of the Supreme Court of Korea. General characteristics, opioid-induced complications, and judicial characteristics were analyzed.Results: Of the 46 cases, 31 cases of complications were finally included in the analysis. There were 28 (90.3%) cases of opioid administration for acute pain and 3 (9.7%) cases for chronic pain. The most commonly prescribed opioid was pethidine (n = 13, 41.9%), and the most common complication was respiratory depression (n = 17, 54.8%). All except two cases were associated with permanent injuries, including 18 (58%) deaths. Twelve (38.7%) cases were ruled in favor of the plaintiff in the claims for damages, with a median payment of United States dollar (USD) 126,346 (IQR: USD 77,275– 379,219). Of these cases, the most frequently admitted complaint by the court was the neglect of observation (n = 10, 32.3%), followed by the inappropriate drug choice (n = 4, 12.9%). Eleven (36.7%) cases were plaintiffs’ claims for violating explanation obligations, of which 2 (6.7%) were recognized in the court.Conclusion: Our results suggest that physicians must be aware of the serious complications related to opioids and health policies to prevent such complications and malpractice should be adopted.Keywords: acute pain, adverse drug events, complications, legislation and jurisprudence, medical liability, opioids

Keywords

• acute pain
• adverse drug events
• complications
• legislation and jurisprudence
• medical liability
• opioids