Nursing hospital amputation case raises red flags — and larger questions

A physician has urged the public to take a more balanced view of the controversial nursing hospital leg amputation case, arguing that medical staff may have been doing their best under extraordinary circumstances, after details emerged that the procedure was completed in a hospital room using scissors.

"When I first heard about the nursing hospital leg amputation case, I could hardly believe it myself," wrote Yang Seong-kwan, a family medicine physician at Uijungbu Paik General Hospital and an author, in his Facebook post on Tuesday. "[Other] doctors reacted similarly to me, saying 'how could a leg be amputated in a hospital room, not an operating room, and with scissors instead of a scalpel?'”

The case came to light after a human leg wrapped in bloodstained bandages was discovered at a recycling facility in Songdo, Incheon, on June 10. Although police initially suspected a violent crime, the investigation took a different turn on June 19 when authorities confirmed that the limb belonged to an 89-year-old patient at a nursing hospital in Jung District, Incheon.

The patient reportedly suffered from severe leg necrosis caused by heart failure. The patient had to be discharged from the larger hospitals where they had previously been admitted because the doctors determined they couldn’t provide further treatment.

The patient's family then struggled to find another hospital that would admit them. After contacting multiple hospitals, the family finally found a nursing hospital that would take the patient.

The investigation found that the patient's necrosis worsened after admission, and the medical staff had to amputate the leg in the patient's hospital room on June 8. A volunteer at the hospital mistook the severed limb for discarded plaster bandages while cleaning, and reportedly disposed of it in a recycling bag.

Yang found that the more he learned about the case, the more complicated it appeared.

"Under ordinary circumstances, a patient with this degree of necrosis would undergo an amputation performed by an orthopedic surgeon at a general hospital or larger medical center," Yang wrote. "But for an older patient whose heart function has severely deteriorated, the surgery itself can be life-threatening.”

Yang emphasized that any surgeon would think twice because it is difficult to risk a patient's life for an amputation.

The nursing hospital that caved in to the family’s desperate plea was most likely the patient’s last resort. No nursing homes or larger medical centers would have accepted such a liability, according to Yang.

"Nursing hospitals do not have operating rooms, and this patient had already been deemed unsuitable for surgery at a university hospital," Yang wrote. "The liability leaves both the hospital and its physicians in an extremely difficult position. "But if left untreated, the condition would only worsen and potentially put the patient’s life at risk with sepsis."

The medical team ultimately had to amputate the necrotic leg in the patient's hospital room without anesthesia, with the patient's family present.

The medical staff reportedly found the blood flow to the affected area “had long been cut off,” and the nerves had been damaged, so the patient was “unable to feel pain.”

Yang added that most of the knee had already separated naturally and that only the remaining soft tissue was cut with scissors.

"It was not a textbook treatment, but neither was the situation facing the medical staff," Yang said.

He argued that the case should be examined not only in terms of medical law and the handling of medical waste, but also in the broader context of caring for critically ill older patients.

“If the nursing hospital is effectively forced to close because of a business suspension, no nursing hospitals and physicians will accept patients with severely necrotic limbs,” Yang argued. “Even if they accept such patients, [doctors] may choose to do as little as possible rather than try to help at the risk of [potential] liabilities.”

Yang acknowledged that the case was "not a story of perfect medical care" and that it had raised legitimate legal and administrative concerns. However, he found that the medical staff “tried their best to solve the issue rather than ignoring the patient in need.”

“Holding those responsible accountable for mishandling medical waste should not come at the expense of recognizing the medical staff's good faith and efforts to treat the patient,” Yang argued. “Only then will the doctors continue caring for high-risk patients rather than avoiding them, even when they cannot provide ideal treatment."

BY JANG GU-SEUL [[email protected]]