The EMT Liability Quiz “Answers”
This is the second part of a two part post on EMT liability.
For this one to make sense, you need to read the first one …first.
The law isn’t often black and white. This is certainly true regarding matters of negligence, battery and other not-so-nice things that we can be accused of in the wonderful world of medicine.
Many of the acts described in my (mostly) fictional scenarios would need to be heard by a jury and the guilt or innocence of the parties involved could be influenced by a multitude of factors. Having said that. Here are my verdicts for the EMT Liability Quiz based on my understanding of U.S. law.
If you are one of the 350 or so readers who looked the quiz over, thanks for participating. A special thanks to the eight readers who decided to post their answers for all to see. Did anyone hit the nail on the head and go ten-for-ten? You’ll have to read on and find out.
Before we break down each of our ten scenarios, it would be helpful to quickly review the legal mumbo-jumbo you had to pick from.
- Negligence is the commission or omission of an act that causes harm to another. To be guilty of medical negligence, the responder must have a duty to act, they must breach that duty, they must cause harm and the harm must be directly related to the act or omission. The action of the provider must be unreasonable or inappropriate to be found negligent.
- Battery is touching another person without their consent.
- Abandonment is the act of leaving a patient after you have initiated care without seeing them safely to the care of another equally trained or high trained medical practitioner. In cases of refusal of care, abandonment can be the act of not insuring that the patient is competent to refuse care or not providing the patient adequate information to make an informed refusal.
- Assault is creating the fear of injury.
So let’s get to our scenarios.
#1 Where’s the oxygen? Answer: Possible Negligence.
The EMT’s may find themselves strapped with a negligence lawsuit. They had a duty to keep the portable oxygen stocked and they failed in that duty. The difficult thing for the prosecution will be to prove causation.
The family will need to demonstrate to the jury that it is likely the patient wouldn’t have gone into cardiac arrest had oxygen been provided sooner. Causation can be difficult to prove.
#2 Nitro blood pressure crash. Answer: Sounds OK to me.
Assisting a patient with Nitro is well within the EMT scope of practice. Precipitous blood pressure drops are a side effect of nitro, especially in some specific varieties of myocardial infarction. But without a 12-lead ECG, the EMT can’t reliably determine that on scene.
As long as the Nitro was indicated, there were no contraindications to its use and another reasonable EMT with similar training would have administered the drug, the blood pressure drop was an unforeseeable event.
#3 Off to the races. Answer: Possible Abandonment.
The paramedic supervisor may feel like he’s doing the right thing for everyone involved. But he has a duty to maintain the continuity of care for the two patients on scene until he has properly handed them off to another appropriate medical provider.
Some systems allow paramedic responders to hand off to EMT-Basic providers as long as they follow a pre-approved protocol. Waving to the incoming units and riding off into the sunset would not qualify as a proper hand-off.
#4 “But He’ll Never Play The Piano” Answer: Possible Negligence.
Sometimes we imagine that an act of negligence needs to involve really sick people and really bad decisions. That’s not the case. If you have a duty to do your job correctly and you do it incorrectly and you cause harm to the patient, you’ve committed an act of negligence.
In this case, the concert pianist could loose millions of dollars in future revenue. And you could be liable. It doesn’t matter how many other injuries the patient had or how big of a hurry you were in, bad care is bad care. If the jury agrees, this EMT might be writing a big check.
#5 “Walk to the ambulance” Answer: Possible Negligence.
This scenario is an obvious recreation of an actual scenario that played out in Pittsburgh this year and made national news. The answer is far from clear. You can hear some EMS big-wigs argue it out in this episode of EMS Garage.
The case against these crews will hinge on the duty to act. The duty to act isn’t absolute. You don’t have to run into burning buildings or dive into raging water to save people in distress. You do have to put forth a reasonable effort to help the people who call you for help.
The medics who turned around and left the patient at home to die will now need to explain to a jury why they couldn’t walk a few hundred yards in the snow. I’m sure they also wish that they hadn’t suggested that he walk to them instead. I’m guessing that if the call for help had been made by the mayor, they would have found a way to get to him. Did they fulfill their duty to respond? Only the jury can say now.
Some folks may be wondering, “Why not abandonment?” Great question. This patient was not yet under the direct care of the paramedics in the rig. Until they make actual patient contact, the question remains a question of duty, not continuity of care.
#6 Wheelchair shenanigans. Answer: Sounds OK to me.
This is an actual incident that occurred many years ago to a couple of paramedics where I worked. The incident was investigated by the facility, our company and the medical director. No charges were ever filed in the patient’s death. The ruling of the investigation was that the two paramedics had done no wrong. I agree.
The paramedics left the patient in a reasonably safe environment. The responded to her request to be left in her chair in front of the TV. They did a proper hand-off with the facility staff including reporting on her current disposition. The restraint device was properly attached to the chair.
We have to be careful of something called hindsight bias. In this case we see that a horrible, tragic outcome occurred and we assume that someone must be to blame. This incident wasn’t reasonably foreseeable and the crew involved broke no laws, legal or ethical. Their care was kind and appropriate. The outcome was tragic.
#7 “Sorry, I’m already off duty.” Answer: Sounds OK to me.
There are very few states that require an emergency responder to intervene when they are off duty. The few states that do make the requirement make the requirement of everyone, not EMS personnel specifically. In the vast majority of states, this EMT is completely within her rights.
One state (Texas) even has a law stating that nobody is ever required to help another person unless they are bound by the duty to act.
Some folks mistakenly believe that wearing you uniform somehow effects whether or not you are required to respond. I know of no state that has such a requirement. If you’re being compensated for your role as an EMS provider, you have a duty to act. If you are not, you don’t.
#8 “You called for what?” Answer: Possible Negligence.
We sometimes assume that only emergency responders have a duty to act. Once an organization has signed on to be the designated emergency provider for a region, the whole organization is bound by the duty to act.
This dispatcher had a duty to act and they failed in that duty. If the delay or lack of response can be linked to the cardiac arrest event, they will be guilty of negligence.
#9 A caring hand. Answer: Possible Battery
While it’s unlikely that the patient would press charges, the act could constitute battery. We should avoid placing our hands on a patient when they have specifically refused our care. If they are competent to refuse, they have a right to remain untouched until they grant us permission. Ask permission first, then touch.
#10 “The hard way.” Answer: Possible Assault
This is an overt way of threatening a patient. If we use our presence and our suggestion of force to intimidate a patient into complying with us, we may be found guilty of assault. Be careful how you phrase things to the patient. Inform them of their rights. Don’t ever scare or intimidate them. We are not ever allowed to use fear as a motivator.
So did anyone get a perfect ten? Some people came quite close, but failed to pull the trigger on an answer of two, or gave faulty logic for their answer. Most folks who tried got 70%-90%. Well done everyone.
Now it’s your turn: If you think I’ve missed the boat on my analysis let me know.
Or…read some more:
6 Reasons Why You Should Be a Better EMT
Great post Steve! I especially like the comment on hindsight bias. There are a few great studies discussing this heuristic with specific regard to the medical community (albeit mostly at the physician level). I searched around and unfortunately none of them appear to be free public access. If anyone does have academic access (library, etc.) there are two articles in specific which are worth checking out.
Bornstein & Emler (2001) in the Journal of Evaluation of Clinical Practice and Henriksen & Kaplan (2003) in Quality and Safety in Health Care.
The Bornstein article does a great job at explaining how the hindsight bias can lead individuals who already know the outcome of a medical diagnosis to overestimate the probabilities involved. The Henriksen article takes a more applied look and analyzes some of the risks of hindsight biases on medical decisions.
It’s been a few years (several in fact) but on #7, I do think you’re off base, if only a little. The uniform, as you indicate, has nothing to do with it. However, her level of training DOES. As a trained responder, she has a greater duty than does the average person. If not legally, then morally. Unfortunately in the legal world, morals often are pulled in. As our legal system is set on precedent, if there isn’t precedent on this particular scenario, if this situation ever came to light, it WOULD become legal.
I do recall from ethics classes that the duty to respond doesn’t come from paid job obligation. For example, if I am a trained EMT and a woman at the grocery store seizes and hits the floor, cracking her head, and I walk away saying nothing..that’s a problem.
In your scenario, the woman calls 911, doesn’t merely look then drive away, so she met a minimum obligation. That’s the legal standard. That point. Not the uniform, not her training.
It’s all very gray in this particular area, isn’t it?
But what I recall most from training is that if I’m trained, I have a moral/ethical obligation to step in if I can. If I don’t, then I become culpable to a certain degree. However, the law does not define exactly what needs to take place in that particular event, so it would seem a 911 call is sufficient…but really….is it? And that’s the question.
So maybe I agree with you…but to a point! (Devils’ advocate…..)