hankyoreh

Still from CCTV footage of Park, who is being put in a five-point restraint by three male orderlies on May 24 at 11:36 pm. Park does not appear to be resisting. 

“Rather than exhibiting symptoms of psychosis, the patient was in a state of an extreme aversion response due to environmental changes, including hospitalization. From the very first day, [the hospital staff] appear to have administered pharmaceuticals equivalent to [those used with] acute schizophrenia or mania associated with bipolar disorder.”

This was the conclusion shared with the Hankyoreh on Monday by a psychiatrist surnamed Kang after viewing treatment records for a 33-year-old woman surnamed Park who died at W Jin Hospital in Bucheon 17 days after being admitted to its psychiatric ward.

Kang, who has been a psychiatrist for almost a decade, suggested that the medications were administered to Park in an excessive way, despite the possibility of serious side effects. This comes amid claims by Park’s family that she died as a result of abdominal pain and intestinal obstruction as side effects of pharmaceutical use.

Because of the risks, Kang argued that although Park’s family members or another legal proxy should have been sufficiently advised about the medications’ main and side effects, and her state should have been closely observed after administration, neither of these processes happened.

In their criminal accusations against six physicians — including hospital director Yang Jae-woong — the family has contended that the hospital neglected Park as her condition worsened. Rather than the typical charges of professional negligence resulting in death, they have applied charges of death caused by abandonment.
 
Massive amount of pills given on hospitalization

The Hankyoreh asked Kang to perform an analysis of various records of Park’s treatment that the family had acquired from the hospital, including nursing records, progress records, isolation and restraint records, and closed-circuit television tables from the isolation wards.

Kang’s first observation was about the administration of high volumes of sedatives early in Park’s hospitalization.

Park, who was 33 at the time, was admitted to the hospital on May 10 for treatment of diet pill addiction. Having studied overseas in the US from a young age, she had a seven-year history of taking Dietamin (Daewoong Pharmaceutical), a leading appetite suppressant used in internal medicine clinics.

Still from CCTV footage shows Park taking medicine given to her by a doctor on May 10 at W Jin Hospital in Bucheon. 

Park had previously been admitted to various university hospitals in Seoul and undergone outpatient treatment for symptoms of Dietamin addiction, including excessive sleep and mysophobia (fear of germs). At her mother’s recommendation, she was admitted for what was intended to be a period of up to four weeks at W Jin Hospital in Bucheon.

On the day of her admission, Park exhibited a strong aversive response to the new environment, at one point calling the police to report the situation. But the police officer who arrived at the scene left after speaking to hospital staff, and a resigned Park agreed to be admitted.

Closed-circuit footage from the isolation ward showed a lengthy scuffle with medical staff when she refused to wear her hospital gown on the first day of her admission on May 10. At around 3:55 pm, she swallowed medications given to her by the physicians.

According to her progress notes, the medications administered that day were 5 mg of haloperidol, 1 mg of Ativan (lorazepam), 2 mg of risperidone, 100 mg of Quatine (quetiapine), and 2 mg of Koetin SR Cap.

“[The physicians] appear to have concluded that one medication alone would not produce a sufficient sedative effect,” Kang said. “Most of these are antipsychotic or psychotropic medications, with risperidone in particular being a high-potency medication.”

A mixture of these pharmaceuticals produced a strong enough impact to bring down an elephant. Obviously, side effects are also associated with them.
 
Medications causing “diminished consciousness and digestive and muscular side effects”

According to subsequent nursing records, Park exhibited signs of excessive sedation, including tiredness and drooping. She also showed intermittent hunger and requested snacks.

Kang suggested this may have resulted from a combination of increased appetite due to withdrawal from the phentermine in the Dietamin that Park had been taking before admission, together with the appetite-enhancing effects of her psychiatric medications.

A record from May 14 referred to Park being “incoherent.” On May 19, records of delirium began to appear.

“Whenever I talked to my daughter on the phone after her admission, she was always out of it, and in the one visit we had, she was staggering,” said Park’s mother, who is 60.  

Kang said the side effects of psychoactive medications appeared to have caused digestive and muscular issues.

“Common side effects of psychoactive medications include anticholinergic effects [such as dry mouth, diminished organ activity, indigestion, constipation, difficulty urinating, dry eyes, and delirium] along with muscular side effects [such as muscle spasms, acute dystonia, akathisia, and neuroleptic malignant syndrome],” they explained, adding that there was “almost no checking on this by medical staff in the early stages.”

They added that the delirium “may have occurred not as a psychiatric side effect but from the accumulation of digestive and muscular side effects, which they concluded were psychiatric symptoms and attempted to suppress with medications.”

According to Kang, the ongoing suppression of intestinal absorption and peristalsis could lead to intestinal obstruction or septic shock (systemic inflammatory response syndrome). They added that records of “fecal leakage” from the later stage of treatment suggested a failure of excretory regulation and obstruction of digestive organs.
 
Inability to take medications orally leads to even stronger injections

Despite the issues, the administration of high-potency sedatives appears to have continued until the day of Park’s death.

According to her medication administration record, the side effects of sleepiness and languor left her unable to swallow, resulting in an increasing reliance on injections over oral drugs in the later stages. In other words, as Park found herself unable to control her functions enough to swallow, the hospital resorted to even higher-potency medications.

On the evening of May 26, Park, who was then confined in the stabilization (isolation) ward, began pounding on the door, complaining of stomach pains. Rather than taking appropriate measures, an orderly and nursing assistant bound her to her bed by her hands, feet and chest at 12:30 am on May 27.

She ended up being released from her restraints as she exhibited shortness of breath and a nosebleed. Less than an hour and a half later, she passed away.

Based on an autopsy, the National Forensic Service concluded that the cause of death was “acute intestinal pseudo-obstruction.”

Kang raised the possibility of issues relating to the phentermine that she had been taking before her admission to W Jin Hospital, a women’s hospital. 

“[Phentermine] can often be simply taken as a ‘diet drug,’ and there doesn’t seem to have been much awareness of the serious side effects,” they said, explaining that it was taken off the market in the UK in 2000 due to cardiotoxicity and severe dependency and abuse issues.

In Korea, it remains on the market, where it is categorized as a non-benefit medication not covered by national health insurance. Within this blind spot in the national monitoring system, prescriptions have increased amid a trend of diet drug use.

Kang, a doctor specializing in psychiatry, reviews medication administration records for Park while speaking to the Hankyoreh at a café in Seoul’s Hyochang neighborhood on Aug. 1, 2024. (Koh Kyoung-tae/Hankyoreh)

Kang explained that psychiatric drugs are less oriented toward “curing” psychiatric conditions than toward mitigating psychiatric and behavioral issues.

“Because of this, medications need to be used appropriately, and interpersonal psychotherapy needs to be applied,” they stressed.

Yet conditions in psychiatric hospitals throughout South Korea are dismal. Legislation regarding improving mental health and mental health patients (Act on the Improvement of Mental Health and the Support for Welfare Services for Mental Patients) requires one physician who specializes in mental health per 60 patients admitted annually and one nurse per 13 admitted patients. Even if such regulations were followed, it would be difficult for such sparse personnel to properly administer psychiatric medication while conducting thorough psychological evaluations of patients. A human-centric approach is impossible under such conditions. 

The recent deaths of mental patients who were restrained to their hospital beds should serve as an opportunity to highlight systemic issues and reflect on the proper solutions. 

“These incidents should serve as an opportunity to reflect on our systemic approach to dealing with mental health patients, rather than as an excuse to attack mental health professionals,” said Kang. 

“We should interpret the situation as a sign that there’s a limit to the current treatment and prescription methods,” the specialist added.

“As with all fields of medicine, mental health treatments lie on a spectrum of effectiveness and side effects, and all treatment methods should be selected with such respect to such considerations.” 

By Koh Kyoung-tae, senior staff writer

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