Court jails doctor over fatal liposuction, citing negligence despite worsening vital signs

A doctor who performed liposuction exceeding recommended levels was convicted of professional negligence resulting in death after a patient died during surgery. The court found that the procedure continued despite worsening of the patient’s condition, including decreased oxygen saturation linked to bleeding.

The Seoul Central District Court recently sentenced the doctor, identified as Dr. A, to one year and six months in prison on charges including professional negligence resulting in death and violations of the Medical Service Act.

A doctor was convicted of professional negligence resulting in death after performing liposuction exceeding recommended levels. (Credit: Getty Images)

Dr. A, a general practitioner, was indicted after a patient died from hypovolemic shock during liposuction and fat grafting surgery in June 2022. He was also charged with violating the Medical Service Act and the Narcotics Control Act (psychotropic substances) for delegating propofol administration to a nursing assistant rather than a licensed medical professional, and for falsifying medical records by underreporting the actual amount of propofol used during surgery.

Prosecutors determined that Dr. A acted negligently by proceeding with surgery without preparing for a possible blood transfusion despite a high risk of bleeding, administering propofol in amounts exceeding recommended levels, and continuing the operation even as the patient’s vital signs deteriorated.

On the day of the incident, about two hours into the surgery, Dr. A aspirated 5,025 cubic centimeters of fat from the patient—an amount exceeding recommended limits. About 20 minutes later, at around 3:05 p.m., an alarm from a monitoring device attached to the patient’s foot indicated that oxygen saturation had dropped below 90 percent.

A nursing assistant checked the patient, and four minutes later, at 3:09 p.m., another staff member discontinued propofol administration. The nursing assistant then lifted the patient’s head to secure the airway. However, Dr. A halted the surgery only around 3:13 p.m., eight minutes after the initial alarm sounded.

Medical staff turned the patient to reposition him and resumed propofol administration around 3:22 p.m. About 15 minutes later, a nurse observed cyanosis on the patient’s face. Dr. A performed cardiopulmonary resuscitation, but the patient did not recover. Emergency services (119) were called at around 3:48 p.m. The emergency team arrived about 10 minutes later and transported the patient to a nearby hospital, where he died at 9:31 p.m.

The National Forensic Service concluded through autopsy that the patient died from hypovolemic shock caused by insufficient compensatory measures for blood loss during liposuction. It also found that inadequate monitoring of the patient’s vital signs during surgery contributed to the onset and worsening of the shock.

Dr. A’s defense argued that the patient died from fat embolism syndrome rather than excessive bleeding, claiming the death resulted from an unpredictable surgical complication and therefore could not be attributed to professional negligence. An initial medical record review also raised the possibility of fat embolism, citing the absence of visible bleeding, no evidence of active or vascular bleeding on emergency ultrasound, and CT findings suggesting an underlying condition rather than bleeding-induced hypovolemic shock.

A medical examiner noted that while the absence of bleeding could not definitively rule out blood loss, even if bleeding had occurred, it was unlikely to have been the primary factor worsening the patient’s condition or contributing to death.

However, the court reached a different conclusion after reviewing the National Forensic Service autopsy findings and other evidence. It determined that the patient died from hypovolemic shock caused by inappropriate intraoperative management.

“The patient suffered an estimated blood volume loss of approximately 40 percent, and a significant amount of blood was observed within the aspirated fat,” the court said. “During the procedure, the heart rate also dropped sharply after propofol administration was resumed, which aligns with the typical progression of bleeding that gradually accumulates and leads to hemorrhagic shock.”

Although fat embolism was observed in the autopsy, the court noted that fat emboli in lung tissue are commonly seen in trauma-related deaths and that the likelihood of clinically severe fat embolism occurring in this case was low. It also found that the patient’s clinical course was inconsistent with the typical presentation of fat embolism syndrome.

Even if fat embolism had contributed to the patient’s death, the court ruled that this did not negate Dr. A’s professional negligence.

“Dr. A could have readily recognized abnormalities in the patient’s vital signs, including blood pressure and oxygen saturation, yet failed to take appropriate measures such as blood transfusion or oxygen administration,” the court said. “Although nursing assistants took limited actions, including securing the airway and correcting the oxygen line, Dr. A neither immediately halted the procedure nor implemented meaningful emergency measures.”

The court added that Dr. A misjudged the patient’s condition as having improved and ordered the resumption of propofol to continue the surgery. It noted that emergency services were contacted approximately 43 minutes after oxygen saturation first fell below 90 percent and about 11 minutes after it dropped below 70 percent.

“Despite the patient’s rapidly deteriorating condition and the emergency nature of the situation, Dr. A failed to take active life-saving measures beyond airway management and did not transfer the patient to a higher-level medical facility,” the court said.

In sentencing, the court emphasized that despite the serious breach of professional duty and the resulting death, Dr. A denied wrongdoing and showed no remorse. It also noted that he committed an additional offense during the investigation by falsifying medical records to minimize his responsibility.