Calls are growing to address structural blind spots in South Korea's medical referral system for severely ill, elderly patients following a controversial incident at a long-term care hospital in Incheon. An 89-year-old woman suffering from advanced leg gangrene underwent a tissue-trimming procedure directly in her hospital room, sparking a police investigation and exposing deep systemic fractures.
While authorities are determining whether the incident violated the Medical Service Act, practicing physicians argue that the crisis should not be treated as a problem confined to a single long-term care hospital. Instead, they contend it raises a fundamental, institutional question: Who is responsible for critically ill older patients who have nowhere else to go?
According to the police, the patient, Ms. A, had previously been treated at a large tertiary hospital but was discharged after clinicians determined that further acute treatment was no longer viable. Her family scrambled to find a facility willing to take her, eventually admitting her to Y Nursing Hospital in Incheon on the 1st of the month. One week later, at the explicit request of her legal guardian, the hospital treated the necrotic portion of her leg inside her regular hospital room.
The hospital informed investigators that the patient's knee area had already separated naturally due to advanced necrosis, meaning medical staff only needed to trim away a small amount of dead tissue at the back with scissors. Because the patient’s local nerves were entirely destroyed by the gangrene, anesthesia was medically unnecessary.
Many medical experts note that this explanation is highly plausible. When blood supply is severed for a prolonged period and necrosis runs its course, a distinct boundary forms between dead and healthy tissue, which can cause dead portions to detach naturally. Based on this clinical reality, several physicians view the procedure as a conservative removal of dead tissue rather than a standard surgical amputation of healthy limbs.
A Systemic Vacuum in Elderly Medical Care
Yang Seong-gwan, head of the Department of Family Medicine at Uijeongbu Baek Hospital, defended the facility on social media, writing, “It appears the hospital and doctors did not abandon the patient but tried their best within their structural limitations.” He highlighted the catch-22 facing families: “You cannot stay at a university hospital long-term when there is no active acute treatment left to give. But you also cannot take a heart-failure patient with a rotting leg home or to a nursing home with no doctor on site. The only option left is a long-term care hospital.”
Yang Seong-gwan warned that if the facility faces an administrative business suspension that forces its closure, long-term care hospitals nationwide will simply stop accepting patients with severe necrosis to avoid legal liabilities, leaving future patients entirely stranded.
Physician Shin Je-uk echoed this sentiment on his YouTube channel, “Dr. Shin TV,” stating, “The core issue is not that the procedure occurred in a regular room, but rather that no other hospital would accept this patient in the first place. If only long-term care hospitals are penalized, the systemic avoidance of these high-risk patients will rapidly worsen.”
The incident highlights a critical infrastructure gap between different tiers of elderly care. Nursing homes, which families frequently turn to, are classified as welfare facilities under the Long-Term Care Insurance for the Elderly Act, not medical institutions. They provide general caregiving and daily living support but do not have physicians on site, making professional medical interventions like surgery, infection control, and advanced wound management impossible.
Conversely, long-term care hospitals are legitimate medical institutions staffed by physicians, but they are designed to handle chronic disease management and long-stay rehabilitation. Under the Medical Service Act, long-term care hospitals are not legally required to build or maintain operational surgical suites. Consequently, the vast majority of these facilities lack the infrastructure to perform active surgeries or emergency procedures.
This leaves severely ill elderly patients trapped in a structural blind spot. The government is currently restructuring tertiary general hospitals to focus exclusively on high-difficulty acute conditions like cancer, severe trauma, and cardio-cerebrovascular diseases, automatically transferring post-acute patients down to regional general hospitals or long-term care hospitals.
However, the receiving tiers lack the facilities to match the medical needs of the critically ill. As Shin Je-uk noted, “If university hospitals keep all severely ill older patients long-term, acute-care beds effectively turn into long-term care beds, blocking emergency care for critically ill patients. But if long-term care hospitals also begin avoiding these patients out of fear of punishment, the sickest elderly will ultimately have nowhere left to turn.”
