Five days after 4-year-old Kim Dong Hee had his tonsils removed, he started vomiting blood. He passed out before an ambulance arrived.
As he was being raced to the hospital where he had his tonsillectomy, near Busan, South Korea’s second largest city, doctors told the paramedics that the emergency room was full. The nearest available E.R. was more than 10 miles away. The trip felt like an eternity to his mother, Kim So Hee. “My vision went white and my head went blank,” she said.
By the time a doctor saw Dong Hee, about 30 minutes after the initial call, his airways had been blocked by blood and he had suffered severe brain damage from a lack of oxygen. He remained in a vegetative state and died five months later.
Despite being one of the wealthiest countries in Asia, South Korea has a buckling emergency-care system. A chronic shortage of E.R. doctors, fewer legal protections for physicians than in other rich nations and a quirk in the emergency response system — paramedics must wait for hospital permission before transporting a patient to an E.R. — have led to delays that can be fatal.
These hospital rejections — called “E.R. runaround,” “ambulance pingpong” or E.R. “merry-go-round” by the local news media — have become more acute in recent years, government data shows. President Lee Jae Myung has described the failures as systemic.
“Patients are dying on the streets, unable to find an E.R. for hours on end,” he said at a cabinet meeting in December and ordered his Health Ministry to fix the system.
It will not be easy.
The average time it takes for major trauma patients to be accepted by an E.R. has doubled since 2019 — the year Dong Hee had his tonsils removed — to 16 minutes and 30 seconds, according to data released by Representative Yang Bu-nam, who is part of a committee that oversees the National Fire Agency.
Last year, the data show, there were more than 1,000 instances when ambulances had to call over 20 hospitals before finding beds for their patients.
In October, a woman in her 60s was hit on a crosswalk by a cargo truck in the city of Changwon. An ambulance arrived on the scene quickly but the medics — who called 30 hospitals — could not find an E.R. willing to accept her and she died a couple of hours after the accident, according Representative Yang.
South Korea has universal health care and its medical system is considered above average among wealthy nations. But it has fewer doctors per capita than most developed nations and many doctors prefer to specialize in fields that pay more than emergency care, such as dermatology and plastic surgery.
On top of this, patients seeking care at hospital emergency rooms for “low acuity” conditions can lead to overcrowding, “causing delays in treating high-risk patients,” according to Chris James, a senior health economist at the Organization for Economic Cooperation and Development.
The country’s 119 dispatch system mirrors the U.S. fast response system, where paramedics typically have the authority to determine the best hospital for a patient’s needs. But in South Korea, they must first get permission to arrive from hospitals, which can refuse patients for reasons including staff shortages and an excess of patients.
This, paramedics say, leaves them scrambling to secure a patient’s admission in the race against the “golden time,” or the period in which a critical patient must receive care before suffering permanent damage or even death.
When this happens, “you feel yourself starting to shrink as the stress builds,” said Kim Sung-hyun, who has been a paramedic for over a decade.
“If we leave this situation as it is, patients will continue to die,” Representative Yang said at an interview at his office in Seoul.
He is pushing for a legal amendment that would grant paramedics the authority to designate hospitals for emergency patients. Separately, the Health Ministry launched a pilot program last month in two provinces and one city that designates specific hospitals as priority destinations for emergency patients.
Some E.R. doctors have opposed these plans. “Forcing us to take in patients might reduce the number of rejections on paper, but does little to ensure they receive the care they actually need,” said Kim Changyu, a resident at a hospital E.R. in Seoul.
E.R. doctors also worry about legal liability. Physicians in South Korea face criminal charges for medical negligence at rates that are significantly higher than in other wealthy nations, according to studies.
“The fear of litigation or losing our licenses is what forces us to turn patients away,” Dr. Kim said. “We are human, too.”
Other doctors, like Changwoo Han, a professor of preventive medicine at Chungnam National University, are in favor of the pilot program because it would expedite the transfer of urgent patients, and put paramedics and hospitals on the same page.
Many of the doctors’ concerns surfaced during an 18-month junior doctors’ strike that ended in September 2025.
While the core of that dispute was centered around a government proposal to increase the number of medical school students, doctors’ grievances included tough working environments, low wages in departments like emergency care and a lack of legal protection for physicians working with critical patients.
Mr. Lee’s government has taken a more conciliatory tone with the medical community and agreed to scale back plans for medical school admissions.
The majority of E.R. patients in South Korea do not call for an ambulance but are walk-ins, according to government figures. That is a testament to the quality of care people get, but even walk-in patients are often turned away.
In the summer of 2024, Andrea Kwon, who works in marketing in Seoul, developed a fever and sore throat that lingered for weeks. Then, her skin turned yellowed, her stomach began to bloat and the mere smell of food triggered nausea. After visiting several neighborhood clinics, she was diagnosed with liver stones and was advised to go to an E.R.
Ms. Kwon, who said she is in her 20s, went to one only to be told to go home as no liver specialists were available. A referral to another hospital brought similar news.
By that point, she was feeling so ill she could not walk properly. “I was terrified. I felt completely helpless,” she said. Eventually, Ms. Kwon was able to get an appointment with a specialist at a hospital who diagnosed her with the Epstein-Barr virus, an infection that can sometimes attack the liver.
While the government and doctors quibble over policy, patients and their families say lives are being put at risk. Some have turned to the courts in hopes of seeking justice for loved ones who they believe died because of rejections at E.R.’s.
In December 2019, Ms. Kim, Dong Hee’s mother, filed a criminal complaint against the doctors and hospital that refused to accept her son.
Last year, a court ruled that the doctors were not guilty of professional negligence. But it said some were guilty of violating medical law and that one had falsely claimed that the emergency room was busy with another patient.
“The verdict is truly disastrous. Medical professionals know better than anyone that the result of refusing a patient could be death,” said Ms. Kim, who plans on appealing the verdict. “Everything is backward.”
Ms. Kim now lives with her parents and younger son in Busan. Her husband, Dong Hee’s father, died after a yearslong battle with leukemia in 2022. “Dong Hee was a bright, brave and precious child,” she said. “He was the hope that kept his father fighting for his life.”
Jin Yu Young is a reporter and researcher for The Times, based in Seoul, covering South Korea and international breaking news.
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