Ghost surgery in Korea, and the CCTV law that followed

Ghost surgery — 대리수술, daeri susul — is where someone other than the surgeon a patient agreed to performs the operation, while the patient is under general anaesthetic and cannot know. It is illegal in Korea and it has been prosecuted. It is also the reason Korean operating rooms now have cameras in them, under a law that took effect on 25 September 2023.

The law is narrower than the headlines suggested. Installation is compulsory; recording is not. The camera is switched on only if the patient asks, and a hospital may decline in circumstances the Health Ministry has defined loosely enough that patient groups object to them. Knowing exactly where those lines fall is more useful than knowing that the cameras exist.

대리수술 means someone else did the operating

The substitution is the point. A patient chooses a named surgeon, often on the strength of that surgeon’s reputation or advertising, and a different person does some or all of the work once the patient is unconscious. The substitute may be another doctor, a junior doctor, a dentist, a nurse or a nursing assistant, or, in cases reported in Korea, a medical device company employee. CNN’s 2021 investigation described substitutes waiting in a basement at one large clinic until they were called up to operate, and not appearing as staff on the clinic’s website.

Two features of the Korean market make it possible. The first is that any doctor holding a medical licence may legally perform cosmetic procedures, as Al Jazeera noted in 2024, so the presence of a doctor in the room is not evidence that the right doctor is in the room. The second is volume: a surgeon whose name sells operations cannot personally perform all of them and also hold consultations, and the gap between the name and the hands is where the practice lives.

Proving it afterwards is the hard part. Substitutes often do not record their involvement in the notes, and before 2023 most operating rooms had no camera, which is why the lawyer representing one bereaved family told CNN the charges were difficult to establish.

One death produced the law

On 8 September 2016 Kwon Dae-hee, a 24-year-old university student, had bone removed to reshape his jawline at a clinic in Gangnam. The operation cost 6.5 million won. He bled heavily, was moved to hospital, and died there seven weeks later.

The clinic had CCTV — voluntarily, since nothing then required it — and offered the footage to the family to show that the surgery had been normal. His mother, Lee Na Geum, watched it, by her own account, 500 times. According to CNN’s reconstruction, the operation began at 12:56. After about an hour the plastic surgeon left and another doctor came in. For almost 30 minutes there was no doctor in the room at all, only nursing assistants. The surgery ended at 16:17. The second doctor was a general doctor without a plastic surgery licence who had recently graduated from medical school, despite advertising that said the clinic’s head doctor would operate from start to finish. As Kwon bled, the assistants mopped the floor thirteen times.

In May 2019 the family won 430 million won in damages. Lee then spent years outside the National Assembly with a placard, and the bill she was demanding became known informally as the Kwon Dae-hee bill. It passed in 2021 with a two-year grace period before it took effect.

The scale behind the case is only partly measurable. CNN cited Korea Consumer Agency figures that between 2016 and 2020, 226 people were injured, suffered side effects, needed further surgery or died in connection with plastic surgery, and Ministry of Health and Welfare data showing 28 administrative dispositions against doctors who ordered substituted surgery between 2015 and 2019, of whom five lost their licences. A Health Ministry deputy director put the underlying problem plainly to CNN: “Since ghost surgery or substituted surgery occurs secretly, it is very difficult to find out the statistics or the current situation.”

What Article 38-2 requires

Article 38-2 of the Medical Service Act took effect on 25 September 2023. Medical institutions that perform operations on patients who are unconscious — in practice, under general anaesthesia — must install CCTV in the operating room. The Korea Herald described the scope as any room where patients undergo surgery under general anaesthetic.

Recording, where it happens, is governed by the same article. Footage must be kept for at least 30 days. Leaking, damaging or falsifying it carries up to five years’ imprisonment or a fine of up to 50 million won. Failing to install a camera at all carries a fine of up to 5 million won — a gap in the penalties worth noticing, since destroying the evidence is punished ten times more heavily than never creating it.

Access is restricted. Viewing is permitted on the request of an investigative body or a court, or where the patient and all of the medical personnel who appear in the recording consent. You cannot simply ask the clinic for the file.

Recording is not automatic, and the exemptions are wide

This is the part most summaries get wrong. The camera is in the ceiling by law; the red light comes on only if the patient or their guardian requests it. Nobody will offer.

Health Ministry guidance also lets a hospital refuse the request. The stated grounds are emergencies, and cases where recording is judged to disrupt the operation, to interfere with the training of resident doctors, or to hinder life-saving measures. The Korea Herald summarised the position as surgeons being unable to refuse “unless there is a valid reason, such as an urgent surgical need”. The Korea Times reported on the day the law came into force that patient groups considered these exemptions too vague to be meaningful.

Doctors fought the law, and their reasons matter to patients

Korean doctors opposed the measure, and the opposition is documented in their own journals rather than only in press releases. Writing in the Journal of Korean Medical Science in 2022, Yongsik Jung called the law globally unprecedented and quoted the then president of the World Medical Association describing it as having “a strong Orwellian tendency”. He argued for collecting the minimum video information necessary, questioned whether a retention period of more than 30 days was justified given the security risk, and pointed out that the roles of physician assistants and other operating-room personnel had not been defined.

In the Journal of the Korean Medical Association in 2023, Ji Yeun Lim, Sun Mi Lim and Kye-Hyun Kim reported a survey of 1,267 doctors taken in September 2023, immediately before the law took effect. Of those, 91.2% believed it infringed fundamental constitutional rights and 90.7% expected essential medical services to suffer as surgeons avoided high-risk work. The authors’ proposed alternative is relevant here: stricter penalties for ghost surgery itself, rather than surveillance of every operation.

Set against that, the Korea Herald cited a 2021 survey by the Anti-Corruption and Civil Rights Commission in which 98% of respondents supported installing the cameras. Both things are true, and the compromise between them is the law as written: cameras everywhere, recording almost nowhere unless somebody asks.

What you can do before the operation

The useful window is before you are unconscious, not after.

Get the operating surgeon’s name in writing. Article 24-2 of the Medical Service Act already requires that written consent identify “the principal physician, dentist, or doctor of Korean medicine who participates in the surgery”, and that if that person changes, the reason and details be given to the patient in writing. Ask for the consent form in advance, with the name already filled in. Paragraph (3) of the same article gives you the right to request a copy of it, and says the doctor “shall comply with the request without good cause” — so keeping one is not a favour you are asking for.

Request recording, in writing, before the day. Put it in an email so the request and any refusal both exist on paper. If the institution declines, ask which ground it is relying on and ask for that in writing too. A clinic that will not answer that question in an email has answered it.

Ask who else will be in the room. How many people; their roles; whether any resident, fellow, assistant or sales representative will be present; who will be present if the named surgeon steps out; and whether more than one operation is scheduled in the same hours.

Ask what happens if the surgeon changes. The statute already tells you the answer is meant to be written notice. Ask the clinic to confirm that, and to say who the substitute would be.

What the footage is good for, and what to do next

Recording does not prevent anything. It does not stop a substitution, it does not improve a surgeon’s hands, and it will not be watched by anyone while you are on the table. What it does is convert a dispute about what happened into a dispute about evidence, which is a much better dispute to be in. It also changes the room: asking for it signals that you are the kind of patient who reads the law.

Its limits are real. Access is not automatic. You cannot obtain the file by asking, and the 30-day retention floor means that a complication which declares itself slowly can outlive the recording. If you think you may need it, say so early and in writing.

If something has gone wrong, the practical next step is the Korea Medical Dispute Mediation and Arbitration Agency, which mediates medical disputes, is open to foreign nationals, and gives a mediation agreement the effect of a court settlement. Before you get that far, the checks that prevent most of this are ordinary and dull: read how to choose a clinic in Korea for how to verify an institution and a specialist, work through the checklist before you pay a deposit, and read is plastic surgery in Korea safe for what the wider record shows.