[2] The case holding that the burden of proof of causation is mitigated in a medical accident where a patient caused a sudden scambling in the course of a general anesthesia procedure and the cerebral damage was caused by the heart suspension and the death was caused

[3] The case reversing the judgment of the court below on the ground that there was insufficient examination as to the presumption of the occurrence of sudden training in the process of general anesthesia, the duty of care to prevent this, and whether the patient's heart fulfilled the duty of care to verify whether the conditions were normal enough to the extent that it does not interfere with general anesthesia treatment

[2] In the case where a patient was injured by cerebral injury as a result of cerebral injury, which occurred in a general anesthesia, the victim's act of medical negligence based on his common common sense in the series of medical procedures cannot be verified, and there is no other cause except a series of medical acts. In the case where the patient proves that there was no health defect that could cause such a result before the medical act was performed, unless the patient proves that the result was due to medical negligence, but due to all other causes, such as the patient's special transfer, the burden of proof should be mitigated so that the causal relationship between the medical negligence and the result can be presumed as equal to or more than the damage compensation system based on the guiding principle.

[3] The case reversing the judgment of the court below on the ground that the medical personnel predicted the occurrence of a sudden training in the course of performing a general anesthesia procedure, and the duty of care to prevent this, and the patient's heart fulfilled the duty of care to verify whether it is normal to the extent that it does not interfere with the general anesthesia procedure

On February 7, 1996, at least 15:30, the court below found that the deceased non-party 1 was working on the 2nd floor of the deceased and was hospitalized in order to undergo an operation to sacratate save the upper left-hand saccha, after he was sent back to the hospital operated by the defendant (hereinafter referred to as the "Defendant hospital"), and that the non-party 2, a medical specialist belonging to the defendant hospital, administered anesthesia in order to perform anesthesia before the above deceased non-party 1, and inserted the anesthesia into the 5th floor of the deceased's 2nd floor, and caused the death of the deceased non-party 1 to sacratate saculic sa, and caused the death of the deceased, and caused the death of the deceased's saculic saculic saculic sacium to remove the pulmonary sacium during the given period.

In addition, the lower court rejected the Plaintiffs’ first assertion that the Defendant hospital’s medical team, including the physician in charge of the Defendant hospital, conducted anesthesia surgery at will without the patient’s consent, and conducted anesthesia surgery at will until anesthesia for the surgery was conducted (the surgery treatment and general anesthesia), without any explanation about the medical method to be conducted in the future to the deceased Nonparty 1, his guardian, etc. (the surgery treatment and general anesthesia), the risk of leaving it neglected without such medical treatment, and the risk incidental to such medical method, etc., and without any explanation about the patient’s consent, or the first assertion that it constitutes a tort due to the patient’s formal consent, and rejected the medical team’s diagnosis and examination on February 7, 196, which had already been conducted by the deceased Nonparty 1 on the day of the above hospitalization, and conducted the examination on whether there was a possibility that the surgery and anesthesia surgery could be caused by anesthesia surgery at issue on the day before the surgery and anesthesia surgery and its detailed explanation about 14th surgery.

또 피고 병원은 전신마취를 하기에 앞서 사전에 철저한 검사를 실시하지 않았을 뿐만 아니라, 1996. 2. 9. 실시한 심전도 검사 결과 'V1-4 ST 분절의 상승'이라는 이상 소견이 나타났으므로, 이러한 경우 피고 병원은 마땅히 심초음파 검사, 심혈관조영술 등을 실시하여 심장의 이상 유무를 철저히 확인하여 전신마취를 하여도 되는지 여부를 판단하여야 함에도 이러한 검사를 전혀 실시하지 않은 채 만연히 전신마취를 강행함으로써 이 사건 사고를 일으킨 의료상의 과실이 있다는 원고들의 두 번째 주장에 대하여는, 내세운 증거를 종합하여, 피고 병원은 마취 전에 하는 일반 검사로 망인에 대하여 흉부 엑스선검사, 심전도검사, 혈액검사(빈혈검사, 간기능검사, 출혈소인검사, 전해질검사, 전염병 감염 여부 검사 등) 및 소변검사 등을 실시하였는데, 1996. 2. 8. 실시한 심전도 검사에서 '불완전 우각 차단 및 V2 ST 분절의 상승'이 있다고 판단되었고, 그 다음날 실시한 심전도 검사에서는 'V1-4 ST 분절의 상승'이 있는 것으로 판단되었을 뿐, 그 외의 검사에서는 아무런 이상이 나타나지 아니하였는데, 마취과 전문의인 위 소외 2는 위 심전도 검사결과가 전신마취를 하는 데 문제가 되는지 여부를 확인하기 위하여 피고 병원 내과 전문의인 소외 4에게 문의한 결과, 위 심전도 검사결과에 나타난 증상 중 '우각 차단(right bundle branch block)'이란 심장을 뛰게 하는 전기 흥분이 우심방에서 우심실로 가는 것이 차단되었다는 뜻으로, 우각이 차단되어도 위 전기 흥분이 좌심실로 전달되는 데에는 전혀 지장이 없어서 심장의 수축 및 이완에는 아무 문제가 없는 데다가 위 망인의 경우는 그나마도 불완전한 우각 차단으로 나타났고, 'ST 분절'이란 심전도상 QRS에서 T파로 이어지는 평탄한 부분으로 탈분극(동결절에서 발생한 흥분이 좌우의 심방으로 전달되어 심방이 흥분되는 과정)과 재분극(심실 흥분이 끝나 다음의 심실 흥분이 회복되기까지의 과정)을 행하는 중간의 정지기를 의미하는 것으로, 그 범위는 V1-3에서는 0㎜부터 3㎜까지를 정상으로 보는데, 망인의 경우는 1㎜에서 2㎜ 정도 상승하였기 때문에 소외 4는 위 심전도 검사결과는 임상적으로는 정상의 범위에 속한다고 회답한 사실, 또한 심비대는 비후성 심비대와 확장성 심비대의 두 가지로 나눌 수 있는데 위 망인에 대한 검시소견에 의하면 비후성 심비대로 추정되며, 비후성 심비대의 경우에는 심실의 내강이 늘어나 있지 않기 때문에 엑스선 검사상 심장의 외각 음영은 정상범위에 속하고 있어 흉부 엑스선 촬영으로는 이를 판별할 수 없으며, 통상 심비대의 진단은 심전도 검사를 통하여 알 수 있고 심전도 검사상 의심되는 소견이 발견되면 심에코도 검사를 통하여 이를 확인하는바, 위 망 소외1에 대한 위 심전도 검사결과에는 위 부검결과에서 나타난 심비대를 의심할 만한 아무런 징후가 엿보이지 않았으며, 또한 위 부검결과에서 나타난 좌측 관상동맥의 이상 주행 및 저형성 등의 소견은 위 심전도 검사결과로는 알 수 없으며, 이를 판별하기 위하여는 우선 24시간 홀터모니터링검사(단시간의 심전도 검사에서는 일과성으로 출현하는 부정맥이나 발작성 허혈성 변화를 포착하기 어려우므로 장시간 연속되는 심전도 기록장치를 환자에 부착하여 24시간에 걸쳐 심전도를 기록한 후 이를 해석하는 검사방법) 또는 심초음파 검사를 실시하고 나아가 보다 정확한 방법으로 심혈관조영술을 통하여만 이를 알 수 있는데, 임상적으로 정상의 범위 안에 드는 심전도 검사결과가 나온 환자에 대하여는 굳이 많은 비용과 시간을 들여서 추가로 위와 같은 검사를 하지는 않고 있으며, 특히 심혈관조영술의 경우에는 그 검사 자체가 몹시 위험하고 비용이 많이 들기 때문에 심전도 검사에서 허혈 소견이나, 심방 세동, 심실 조기수축 등의 양성반응이 나타나거나 일상 생활에서 그와 같은 증상이 나타날 때에만 극히 제한적으로 시행하는 것인 사실을 인정할 수 있다고 한 다음, 그 인정 사실에 의하면 소외 4가 망인에 대한 심전도 검사결과를 정상범위에 속하는 것으로 판단한 조치에 어떠한 잘못이 없고, 또한 위와 같이 임상적으로 정상의 범위 안에 드는 심전도 검사결과가 나온 위 망 소외1에 대하여는 굳이 많은 비용과 시간을 들여 심초음파 검사 또는 심혈관조영술 등의 추가적인 검사를 하여야 할 필요성이 있었다고 볼 수도 없고, 따라서 위와 같은 상황에서 소외 2가 망인에 대하여 심초음파 검사 또는 심혈관조영술 등의 추가적인 검사를 하지 않고 곧바로 전신마취를 하기로 결정한 데에도 의료상의 과실이 있다고 할 수는 없다고 판단하였다.

Finally, the plaintiffs' assertion that the non-party 2 did not prepare for the necessary medicine so that the non-party 1 might not have any contact with the institution due to the medical negligence in the process of anesthesia the above deceased, or that the non-party 2 did not have any contact with the institution, and that the non-party 2 did not have any way to pulmonary treatment, taking into account the facts that the non-party 1 was administered by the non-party 1, the non-party 2 was not an assistant principal for anesthesia, and the non-party 2 did not have any way to pulmonary treatment so that the pulmonary treatment of the institution was performed by the non-party 1, and the non-party 2 could not have any way to pulmonary treatment again after the pulmonary treatment of the institution was performed by the non-party 1, but the non-party 2 could not have any way to pulmonary treatment and pulmonary treatment of the institution itself, and determined that the pulmonary treatment of the institution and the non-party 2 had any way to pulmonary treatment.

2. As to the violation of the duty to explain

In light of the records, the court below's finding of evidence and fact-finding as to the first argument of the plaintiffs as above is just, and there is no violation of the rules of evidence as otherwise alleged in the ground of appeal.

3. As to medical malpractice

A. Generally, a doctor dealing with human life and health requires a duty of care to take the best measures necessary to prevent any danger that may arise from the procedure in light of the nature of his/her duties. In particular, general anesthesia, such as this case, has a significant impact on the patient's mid-tour boundary, respiratory machine, circular machine, etc., and may cause serious side effects on the patient's health condition, such as anesthesia or anesthesia. Since the anesthesia in the procedure may cause serious consequences such as the patient's death, etc., a doctor in charge of anesthesia must observe the patient's body structure and condition closely in preparation for all risks that may arise from the whole process of anesthesia prior to anesthesia, and in many methods, a doctor in charge of anesthesia requires a duty of care to select the most appropriate and safe method for the patient by sufficiently comparing and examining the advantages and side effects of anesthesia in a variety of methods.

In addition, in order to be held liable for tort due to breach of the duty of care or non-performance of the duty of care, as in other cases, the existence of causation between the violation of the duty of care in medical practice, the occurrence of damages, and the violation of the duty of care and the occurrence of damages should be premised. However, the medical procedure is an area where highly specialized knowledge is required, and only the patient himself/herself can be aware of his/her part, and the medical method to achieve the result of treatment depends on his/her own discretion. As such, the issue of whether the direct cause of damages is attributable to the medical malpractice is obvious as an ordinary person, not an expert, and it is extremely difficult for the patient to prove medically the causal relationship between the occurrence of damages and the violation of the duty of care in medical practice, and it is extremely difficult for the patient to prove the causal relationship between the patient's violation of the duty of care in medical practice and the occurrence of damages, as in this case, 90 square meters or more from the judgment of the Supreme Court to prove the occurrence of injury to the patient.

B. On the premise of these legal principles, examining the trial process that led to the judgment of the court below in light of the records, it is difficult to accept the judgment of the court below as follows, in determining whether a doctor's duty of care in a medical malpractice lawsuit has been violated.

First of all, according to the records, the above deceased non-party 1's anesthesia and specialized doctor of the defendant hospital administered anesthesia to the deceased non-party 1 for the purpose of treating general anesthesia prior to the labing of labation, and inserted the labic in the body before the deceased's labing of lab, and operated the labic, the deceased's labic caused the labic labic labic labic labic labic labic labic labic labic labic labic labic labic labic labic labic labic labic labic labic labic labic labic labic labic labic labic lab, which caused the death of the deceased non-party 1. Therefore, the court below determined that the first labic labic labic labic labic labic labic labic labic la.

Furthermore, according to the results of the autopsy on the deceased and the response to the director of the Incheon Metropolitan Council for anesthesia (196 pages), the heart of the deceased is almost normal, and such heart disease is presumed to have close relation with the deceased's private person. On the other hand, even if the heart test on the deceased belongs to the clinical range, it is obvious that there is anything much to a certain extent, even if it is difficult for the deceased to confirm whether there is anything wrong with the heart before anesthesia, it is difficult for the court below to find out the fact that the prosecutor's request for the examination on the medical records of the director of the first instance court for anesthesia to determine whether there is anything wrong. Furthermore, it is reasonable for the court below to deem that the heart of the deceased to have been presumed to have been non-party 4 as non-party 1's request for the examination on the medical records of the director of the first instance court, even if there is no further need for the examination on the aftermathic health of the deceased, and it seems that there is no more serious pulmonary prescription of the deceased's.

Therefore, in light of the above circumstances, the court below should further examine whether the medical professionals in the process of confirming why the medical professionals in the defendant hospital did not have any means to predict and prevent such competitive training even if the competitive training had been performed by the above deceased while performing all duties of care, and whether there was any error in the defendant's failure to discover abnormalness in the heart and to take any measures to the extent that the heart of the deceased did not interfere with the general anesthesia treatment. However, without examining this point, the court below concluded that the medical professionals before and after the anesthesia treatment did not have breached any duty of care on the sole ground of the circumstances stated in its reasoning. Thus, the court below did not err by failing to exhaust all the deliberation or by misapprehending the legal principles on the burden of proof of causation in the medical malpractice lawsuit, etc.

4. Therefore, the lower judgment is reversed, and the case is remanded to the lower court for further proceedings consistent with this Opinion. It is so decided as per Disposition by the assent of all participating Justices.

Justices Yoon Jae-sik (Presiding Justice)