In a medical emergency, health professionals can find themselves put on the spot.
Picture yourself sitting on a plane, at cruising altitude, reclining your seat, finally taking a well-earned holiday.
Ping! “If there is a doctor on board this flight, please make yourself known to cabin crew by pressing the call button above your seat.”
What do you do in a situation like this?
For Aidan Baron, a Sydney-based paramedic, emergency medicine researcher and medical student, the first thing is to find out if there’s someone more qualified or better placed to help.
“Typically, I’ll press the buzzer and say, ‘I’m a paramedic, I’m happy to give you a hand if there’s no one else’. Often if there’s a few healthcare professionals, it’s about ensuring one or two appropriately skilled people are involved and the most useful thing for the rest of us is to let them know they’re welcome to call us back, then go back to our seats,” he told TMR.
As the world reopens to travel and people start to move around more freely, it’s a good time to revisit the obligations doctors and other healthcare professionals have to act as Good Samaritans and assist someone requiring medical attention in a public setting.
The short version is this:
• Doctors and healthcare workers have an ethical and a professional – but in most instances not legal – obligation to assist in an emergency.
• All Australian jurisdictions have legislation that protects Good Samaritans from liability, provided they are acting “in good faith”.
• If you do act as a Good Samaritan, create a contemporaneous record of your actions and contact your medical defence organisation immediately after the event.
Don’t believe everything you see on TV
Television and movies frequently dramatise doctors and other healthcare professionals acting as Good Samaritans, often performing emergency surgery in MacGyver-like situations. But according to Mr Baron, things are often much easier to manage. In most cases, Good Samaritans help bring a sense of calm and organisation.
On one international flight, Mr Baron was called to assist a passenger who was experiencing chest pain. If this was a heart attack, the flight would need to be diverted.
“I asked the patient if they had any known medical conditions. It turns out they had pneumonia and had been prescribed antibiotics two days ago,” he recalls.
“After further questioning, it became apparent that the patient was familiar with this kind of pain and had forgotten to take their antibiotic that day.”
The end result for the patient? Taking their antibiotics, some Panadol and sitting back down.
What are doctors’ obligations?
It depends on the context.
According to Professor Cameron Stewart, a professor of health, law and ethics at the University of Sydney Law School, doctors and other healthcare professionals do have an ethical obligation to act as Good Samaritans.
Section 3.5 of the Medical Board of Australia’s code of conduct clearly states medical practitioners have a professional duty to provide care in an emergency.
“Good medical practice involves offering assistance in an emergency that takes account of your own safety, your skills, the availability of other options and the impact on any other patients under your care; and continuing to provide that assistance until your services are no longer required,” says Professor Stewart.
However, while this is a professional code of conduct, Australian doctors and healthcare professionals do not have a legal obligation to assist when a medical emergency occurs in public, except in the Northern Territory and NSW.
Section 155 of the NT Criminal Code states, “Any person who, being able to provide rescue, resuscitation, medical treatment, first aid or succour of any kind to a person urgently in need of it and whose life may be endangered if it is not provided, callously fails to do so is guilty of an offence and is liable to imprisonment for seven years.”
Kristy Bradshaw, national manager of medico?legal advisory services at medical defence organisation MDA National, says she is unaware of any cases involving medical practitioners invoking this section of the criminal code.
Similarly, “Refusing or failing, without reasonable cause, to attend (within a reasonable time after being requested to do so) on a person for the purpose of rendering professional services in the capacity of a medical practitioner if the practitioner has reasonable cause to believe the person is in need of urgent attention by a medical practitioner, unless the practitioner has taken all reasonable steps to ensure that another medical practitioner attends instead within a reasonable time,” constitutes “unsatisfactory professional conduct under section 139C of the Health Practitioner Regulation National Law (NSW)”.
The most publicised Australian case of a doctor failing to assist in a medical emergency has been that of Dr Leila Dekker, who was a consultant radiologist when she was involved in a near-miss motor vehicle accident in remote Western Australia in April 2002.
Dr Dekker was waiting to turn right at a dark T-intersection when another vehicle suddenly veered towards her. She was able to avoid a collision by driving her car forward.
Although Dr Dekker could not see the other vehicle after it passed behind her, she heard it cross the dirt road and hit an embankment before rolling into a ditch.
Shaken from the close call and without a torch, medical equipment or a mobile phone, Dr Dekker elected to drive to the nearby police station and report the incident, rather than assessing the scene to determine if medical assistance was required.
Unbeknown to Dr Dekker, a passenger had been thrown from the second vehicle and died.
A tribunal in 2013 found Dr Dekker guilty of “improper conduct in a professional respect” but the verdict was overturned by a Court of Appeal a year later, citing that at the time of the incident there was no evidence Dr Dekker had a professional duty or obligation to immediately assess the occupants of the second vehicle and render assistance if necessary and possible.
What protections are available if you help?
Each state and territory in Australia now has some form of legislation providing legal protection to Good Samaritans against claims of negligence, provided they did not cause the incident, were acting “in good faith” by trying to assist and were not impaired by alcohol or drugs when offering assistance.
Good Samaritan legislation was implemented despite the findings of the national 2002 Ipp Review into the Law of Negligence.
The review was called for after rising concerns about the cost and availability of public liability insurance and sought to determine how to reform common law to minimise liability and financial damages associated with personal injury and death.
Good Samaritan acts were not originally part of it, but potential legal protections were discussed in the report.
“The panel understands that healthcare professionals have long expressed a sense of anxiety about the possibility of legal liability for negligence arising for the giving of assistance in emergency situations,” the report reads.
“A complete exemption from liability for rendering assistance in an emergency would tip the scales of personal responsibility too heavily in favour of interveners and against the interests of those requiring assistance. In our view, there are no compelling arguments for such an exemption.”
Professor Stewart tells TMR the main reason the Good Samaritan legislation was created was to reduce the fear of potential legal action.
“It wasn’t a piece of legislation that was there to solve a problem, but it was there to make people feel more secure over an issue that they really didn’t need to be concerned about.
“I don’t think anyone expects doctors to put themselves at serious risk [by providing assistance or] later be admonished because they didn’t do that,” he says.
Ms Bradshaw says it is rare for medical defence organisations to be called upon, “because generally people are just grateful that someone has tried to help them”.
It’s all part of the job
Brendan, an Adelaide-based registrar in a non-acute medical specialty who has acted as a Good Samaritan on numerous occasions, says legal concerns are not foremost in his mind.
“I can’t say that I’ve ever been concerned that anyone would take litigation against me for my actions … People seemed very grateful that a doctor or health professional was present at the time, had introduced themselves and offered to help,” he says.
Mr Baron says that for many who pursue careers in healthcare, helping out when needed is simply part of the job.
“We all have altruistic intentions and enjoy being able to help people, particularly those [of us] who go into acute care specialties and paramedicine,” Mr Baron says.
“Once you’re identified as a doctor, there’s an expectation to uphold the reputation of the profession [by providing medical care to those who require it].”
Brendan shares this view.
“As someone with medical training, I’m in a unique position to help people in my capacity as a first responder … I am happy to accept that responsibility and offer assistance [when needed],” he says.
Being aware of the protective legislation can provide a sense of reassurance when faced with a potential Good Samaritan situation.
Doctors and other healthcare professionals learn about Good Samaritan laws from a range of sources, including discussions in tutorials or dedicated lectures at university, conversations with more experienced staff at work or through information disseminated through medical defence organisations.
“As a Good Samaritan, I’ve always gone into those situations with the confidence that the Act protects me,” Brendan says.
Both Brendan and Mr Baron say they would not hesitate to provide assistance again if required, with the latter encouraging all medical practitioners to do the same, provided they feel comfortable doing so.
“Now when I get on [a flight], I’ll usually tell one of the crew, ‘Hi, I’m sitting in seat XYZ and I’m a paramedic.’ When you tell them that on a long-haul flight, their faces light up. They’re incredibly appreciative,” says Mr Baron.
Brendan says his obligations to be a Good Samaritan do come to mind in a public setting. “For example, if I’m in a crowded auditorium, theatre or airplane I start to think, ‘Well, if the person next to me suddenly passes out, how would I meaningfully assist them in that context?’ But it hasn’t been a significant detractor from my enjoyment of getting out and doing things,” he says.
Tips for potential good samaritans
First, assess whether you feel you can safely provide assistance, medicolegal advisor Ms Bradshaw suggests.
“That includes the doctor’s own safety, as well as safety in terms of the care that they are able to provide,” she says.
If you choose to assist in an emergency, identify yourself to the patient and any onlookers.
“When presenting myself as a doctor in these situations, I have felt the need to declare what sort of doctor I am so to not give the patient any false impressions about my current scope of practice,” Brendan says.
And just like in a professional setting, providing an appropriate patient handover is vital.
“Whenever the paramedics or an ambulance arrived, I would hand over to them and remain on scene, looking for other ways I could offer support. The same would happen if an emergency medicine physician arrived,” Brendan says.
Creating a contemporaneous record immediately after the event is important for future potential investigations or legal complaints, according to Ms Bradshaw.
“I would suggest the doctor involved make their own medicolegal record of what occurred while it is fresh in their mind, then also contact their medical defence organisation to notify them of the events and potentially provide a copy of the record that they’ve created,” she says.
Still more work to do
There is still a way to go to reassure the medical community they have adequate legal protection available, should they act as a Good Samaritan, says Professor Stewart.
“I have conversations [with doctors] about this and they automatically think that they’re liable, but they’re not. It’s one of those areas where the law is 100% supportive of the rescuer and wants the rescuer to be protected legally, and does so,” he says.
Ms Bradshaw says while the introduction of Good Samaritan legislation has largely achieved the desired effect among the medical community, some individuals are still apprehensive.
“There is still a level of concern amongst the profession, about any exposure that they may face if they do get involved, and also about whether there is going to be any criticism of them if they choose not to get involved,” she says.
“Some of the commentary I’ve seen about this [suggests that doctors] feel like they’re stuck between a rock and a hard place because obviously, the legislation is intended to encourage them to get involved. But for personal reasons, they may choose not to in certain circumstances, and then they’re concerned about the Medical Board’s expectations [and] whether they’ve met those.”
Both Ms Bradshaw and Professor Stewart feel education plays a key role in raising awareness of the existing protections, which they hope will encourage more individuals from the medical community and the public to assist when needed.
“Education at medical school is really important. We also encourage doctors to contact their medical defence organisations. They’re very happy to talk through the situation in the relevant jurisdiction for each individual practitioner, and what they can do to make sure [the practitioner] is adequately protected should a situation arise,” Ms Bradshaw says.
Professor Stewart encourages doctors to stay up to date with their knowledge.
“It’s incumbent on doctors when they are thinking about doing their CPD to not only think about doing areas of technical competence, but also to think about how they might do some CPD on the ethical, legal and regulatory side as well,” he says.
