[Tracking the Times] The Mystery of the Nursing Hospital That Discarded an Amputated Leg as Garbage

(1) A leg amputated in a patient room instead of a general hospital ER?
(2) An amputated leg discarded arbitrarily by a volunteer?
(3) Did the large hospital send the patient away knowing the leg was necrotic?

On the 10th, during recycling sorting at a household resource recovery facility's waste yard in Songdo, Incheon, part of a severed human left leg was discovered, throwing the entire city into an uproar.

The discovered leg was 41cm long with a foot size of 210mm; because it was a dismembered body part of a relatively small build, a large investigation headquarters was formed over the possibility of a violent crime. On social media (SNS), various rumors spread, such as "it is the body of a young woman" and "it is a student's leg."

A police investigation confirmed that the amputated leg belonged to A, an 89-year-old female patient hospitalized at a nursing hospital in Jung-gu, Incheon. According to police, the necrosis was so severe that the knee had nearly separated, so an emergency amputation was performed in a nursing hospital patient room; then, through a cleaning volunteer's mistake, the amputated leg was placed in a recycling garbage bag and ended up at the household resource recovery facility.

But there is more than one hard-to-understand point in this process. "Donghaeng Media Sidae" tracked the full story of this bizarre case.

(1) A leg amputated in a nursing hospital room instead of the general hospital ER right next door?

On the 19th, the B nursing hospital in Jung-gu, Incheon, visited by a "Donghaeng Media Sidae" reporter, appeared calm but was highly wary. When asked to meet the hospital director, only the answer "It is difficult right now" came back. When asked about A or her guardian, the reply was, "Other than the fact that A is hospitalized, we cannot tell you anything else."

The recycling waste yard set up on one side of B nursing hospital's underground parking lot was neatly organized. This contrasted with another nursing home run by the same foundation about a 10-minute walk away, where patients' hospital records were piled up in disarray inside the parking lot.

The most incomprehensible point in this case is that a leg amputation emergency surgery was performed at a nursing hospital that has no operating room. Police stated, "(A's) leg necrosis was quite severe, a large amount of pus came out, and the nerves themselves were damaged to the point that (during amputation) anesthesia was unnecessary," adding, "When the leg was lifted the knee was already separated, and the back part was cut with scissors."

In other words, with no operating room, a leg amputation was performed in an ordinary patient room without anesthesia, using scissors. On this, one doctor said, "No matter how severe the necrosis or how dead the nerves, the remaining blood vessels must be precisely stanched to complete surgery without additional harm," adding, "Moreover, if an amputation was carried out with no facilities whatsoever to prevent infection, it could easily lead to a larger infectious disease such as sepsis." He continued, "A nursing hospital would typically send a patient to another hospital when an urgent situation arises, if only to avoid liability, so this case is utterly incomprehensible."

What makes B nursing hospital's emergency decision even more questionable is that the emergency room of C General Hospital is in the building right next to B nursing hospital. A C General Hospital official said, "When a patient's condition worsens at B nursing hospital, they usually refer them to our ER, but we have not grasped anything about this case." B nursing hospital is registered as employing four doctors in total: one neurosurgeon, one general surgeon, and two oriental medicine doctors.

(2) An amputated leg discarded arbitrarily by a volunteer?

It is also difficult to readily understand that a cleaning volunteer mistook the amputated leg for a medical cast and threw it away in a garbage bag as general waste.

Unlike other waste, medical waste carries a high risk of infection, so it must be placed in dedicated containers and tagged with an electronic tag (RFID). This is to monitor in real time the entire process by which medical waste is transported in dedicated vehicles and incinerated by specialized companies. The electronic tag also makes it possible to immediately identify the type, quantity, and discharger of the medical waste.

Yet the necrotic amputated leg, which posed a higher infection risk than any medical waste, passed through the hands of a cleaning volunteer with no expertise and was discharged in a recycling garbage bag. In short, the medical waste handling process was riddled with negligence.

The facility management team leader of the household resource recovery facility, who found the amputated leg at the waste yard and reported it to police, met with a "Donghaeng Media Sidae" reporter and said, "A leg-shaped object was wrapped in bandages, and it was clearly different from an object like a mannequin."

(3) Did the large hospital send the patient away knowing the leg was necrotic?

Another question is that the necrosis became severe enough to require amputation exactly one week after A was transferred from a large hospital to B nursing hospital. Police said, "The patient was transferred from the large hospital to the nursing hospital on June 1, and at the time of admission the (leg) was already completely necrotic," adding, "The amputation took place on June 8 in the relevant (nursing hospital) room." If so, the large hospital sent A out of the hospital while knowing that her condition was very critical.

Jang Se-chang, senior attorney at Daeryun LLC (holding a medical license), said, "If the large hospital knew the condition required amputation surgery, I believe the correct approach would have been to perform surgery, allow some recovery period, and then transfer her to a nursing hospital," adding, "However, the necrosis may have progressed rapidly, so it must be examined which hospital failed in monitoring the patient's progress." He also added, "Given that a tertiary general hospital may face disadvantages under the fee system if a patient's length of stay grows long, it is necessary to examine whether such a fee structure influenced the decision to discharge A."

Roh Dong-hoon, an expert committee member of the Korea Association of Geriatric Hospitals, said, "In principle a nursing hospital is not a hospital that performs surgery, and because it operates under a bundled-payment system, performing surgery brings no reward," adding, "But for elderly patients who find it hard to be admitted to a large hospital yet need surgery, I wish the government would establish standards for operating rooms and infection control, limited to nursing hospitals equipped with appropriate facilities."

This case, in which an elderly patient who was discharged from a large hospital without a linked hospital underwent a leg amputation at a nursing hospital, on a hospital bed rather than in an operating room and at the risk of infection, and whose amputated part was thrown out in a recycling garbage bag rather than handled as medical waste, can be called a total failure of patient management in a super-aged society. Observers note that this case forces our society to ask anew how far a nursing hospital's unavoidable medical acts extend and how much management responsibility must be borne.

Reporter Cho Ah-hyun (choah@sidae.com)

Reporter Choi Hye-seung (hsc@sidae.com)

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