SPECIAL REPORT
Good Samaritan Law and the Emergency Physician: Where Are You Covered?
By Karen McGrane, MD, Emergency Medicine Residency, Madigan Army Medical Center, Tacoma, WA; Gregory P. Moore, MD, JD, Attending Physician, Emergency Medicine Residency, Madigan Army Medical Center, Tacoma, WA; and Laura Cookman, George Washington University School of Medicine.
Scenario: An emergency provider, you are driving down a busy interstate when you see an accident occur between two vehicles. Are you required to stop and render aid? Is calling 9-1-1 and continuing on your drive acceptable?
Many concerns come to mind when physicians are called upon in an emergency situation. Do I have a moral obligation to act? Will I be sued for helping? Typically, in the United States, there is no duty to come to the rescue of another person. There is no law in most states requiring a person to assist another in an emergency. However, a person may be held liable if there is a "special relationship." For example, if someone causes an accident, that person then has the duty to rescue, if able. That person must at least call 9-1-1 to obtain help. Another example of special relationships is parents and their children. Parents have a duty to rescue their children from harm. There are some states that have enacted duty-to-rescue statutes. In Vermont, the Duty to Aid the Endangered Act states: "A person who knows that another is exposed to grave physical harm shall, to the extent that the same can be rendered without danger or peril to himself or without interference with important duties owed to others, give reasonable assistance to the exposed person unless that assistance or care is being provided by others."1
The duty to rescue applies to the lay rescuer and health care providers. As a physician, there are ethical standards that are expected to be upheld, even in the case of an emergency. The American Medical Association's Principle of Medical Ethics states: "A physician shall, in the provision of appropriate medical care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical services."2
Can a Successful Lawsuit Occur if an ED Physician Stops to Help?
The Good Samaritan law was enacted to protect health care providers from civil liability for injuries or damages sustained when rendering emergency care to victims. Prior to the Good Samaritan law, a physician who stopped to render aid in an emergency started a "doctor-patient relationship" and thereby incurred all the responsibility that comes with that relationship. The Good Samaritan law was enacted to encourage physicians to stop and render aid at emergencies rather than continue on due to fear of potential litigation.3
There are five elements that must be satisfied in order for the Good Samaritan law to be applicable:
1. The incident must be an emergency;
2. the act of rendering care must be voluntary;
3. the victim receiving care must be accepting of it;
4. the care provided must be a good faith effort to help; and
5. the provider must not receive reimbursement for any of the care provided.
Furthermore, to avoid litigation, the care rendered must not be considered grossly negligent.4 An example of the Good Samaritan law in action is seen in a Montana case, McCain v. Baston.4 Dr. Baston was summoned to Ms. McCain's residence after she impaled her leg on rebar at a construction site while walking home. Baston attempted to clean the wound as best he could. He told McCain that it was not an emergency, but that she should seek medical care soon. McCain did not seek medical attention for over a week, during which time the wound became infected, requiring surgical management. She sued Dr. Baston for poor treatment of the wound. The court found in favor of the defendant, Baston.2
Good Samaritan Defense in the Hospital Setting
The Good Samaritan law and defense not only protect the rescuer in the field, but may also apply within the hospital setting. Such rescuers, however, must be practicing within their scope of practice to the best of their ability with the resources that are available at the location of the incident. A classic example of the Good Samaritan defense in the hospital is found in McKenna v. Cedars of Lebanon Hospital.5 In this case, Mrs. McKenna underwent a therapeutic abortion and tubal ligation at Cedars of Lebanon Hospital in January 1974. She had a seizure in the hospital later that afternoon and was treated by a resident of the hospital. She suffered cardiac arrest, was revived and remained in a coma, but died one week later. The resident physician involved in the action received a stat page and responded to Mrs. McKenna's room to assist. The jury in this case was instructed: "No licensed physician, who in good faith renders emergency care at the scene of an emergency, shall be liable for any civil damages as a result of any of his acts or omissions in rendering the emergency care." The appellants of the case argued that the Good Samaritan act did not apply to hospital emergencies, but the court refused to place a limitation on the definition of the scene of the emergency. An amendment to the Good Samaritan statute was added in 1976 that included "the emergency rooms of hospitals in the event of a medical disaster."3
In another case in Texas, the law again extended coverage to a physician responding to an in-hospital emergency.6 Here, an obstetrician, Dr. Douglas McIntyre, was visiting a patient on the labor and delivery floor when he heard the page for "Dr. Stork." This page signals that a physician's immediate assistance is needed for a patient in labor. By the time McIntyre arrived, the baby's head had already been delivered and the delivery was complicated by shoulder dystocia. Eventually, the baby was delivered vaginally; however, the delivery was complicated by several injuries to the baby, including permanent neurologic damage and paralysis to the right shoulder and arm. The patient, Ramirez, sued McIntyre for negligence. The Texas Supreme Court ruled in favor of the doctor, stating the state's Good Samaritan law applies to physicians providing emergency care to patients in hospitals as long as it is outside the normal scope of the physician's responsibility and there is no additional pay.
A different result occurred in another case, Velasquez v. Jiminez.7 The New Jersey Supreme Court ruled the state's Good Samaritan law does not apply to the actions of a physician responding to an in-hospital emergency. In this case, Dr. Teresa Jiminez was the obstetrician of the patient Germane Velasquez. The vaginal delivery was complicated by shoulder dystocia and after delivering the head, Dr. Jiminez called for help. Dr. Angela Ranzini, an assistant professor of obstetrics and gynecology assigned to the maternal fetal care unit at the medical center, responded. There was no prior relationship between Ranzini and the patient, nor was the patient on Ranzini's unit. After unsuccessfully trying to deliver the patient vaginally, the two physicians performed an emergency caesarean section. Velasquez's baby was born with severe brain damage and died of pneumonia at two years of age. Mr. and Mrs. Velasquez sued the medical center, Jiminez, Ranzini, and other staff for negligence. Ranzini claimed she was immunized from liability by the state's Good Samaritan act since she acted without having a prior duty to do so. The court rejected the argument, however, on the ground that the Good Samaritan act does not apply to physicians working within a hospital.
Although all 50 states and the District of Columbia have some version of the Good Samaritan law, the specifics and interpretations of these laws vary greatly. The laws fall into three broad categories: laws that clearly include hospital care, those that clearly exclude hospital care and those that have no explicit provision. Of the 29 states whose statues do not explicitly address in-hospital care, three states-Arizona, Indiana, and Oklahoma-have ruled Good Samaritan statues do not protect emergency care provided in the hospital. On the other hand, three other states-Georgia, Illinois, and Utah-have interpreted their laws as covering physicians who perform emergency care in the hospital. Realizing that individual states have taken different stances on the same issue, it behooves the emergency physician to be aware of the in-hospital Good Samaritan law/defense standards in his or her particular state.
It is important to realize that emergency practice groups that have contracted to provide coverage on the hospital floors for emergencies and procedures would not be allowed to utilize the Good Samaritan defense, as they have accepted reimbursement for the response in advance, and thus do not meet all five of the elements cited above.
Is an ED Clinician Covered by the Good Samaritan Law/Defense During In-flight Emergencies?
It is almost inevitable that at some point, an ED physician will be called upon to help during an in-flight emergency. According to MedAire, an in-flight emergency service, there are physicians aboard approximately 40% to 80% of flights in air.8 About 1,000 people die on flights each year (1 per 1 million passengers), most from cardiac causes.8 There is no required reporting for medical events aboard aircraft, so reporting on actual number of medical incidents is sparse. In April 1998, the Aviation Medical Assistance Act of 1998 was decreed. This act required the Federal Aviation Administration (FAA) to regulate the medical equipment on airlines as well as the training required by flight attendants in the use of the equipment on board. This act protects the airline and employees from being held liable for damages sustained in "obtaining or attempting to obtain the assistance of a passenger in an in-flight emergency, or out of the acts or omissions of the acts of the passenger rendering the assistance, if the passenger is not an employee or agent of the carrier and the carrier in good faith believes that the passenger is a medically qualified individual."10 It also protects the individual rendering assistance unless the individual "is guilty of gross negligence or willful misconduct." Essentially, this is the same protection as offered by the Good Samaritan statute. Thus, ED physicians are universally protected by the Good Samaritan defense during in-flight emergencies and should have no fear of liability when responding as long as they are not grossly negligent.
With in-flight emergencies, the question arises: What is the jurisdiction of the aircraft? Does the Good Samaritan statute apply to international airlines over international territory? Typically, it is safe to assume that the jurisdiction of the aircraft belongs to the country of origin. However, the country in which the incident occurs or the country of residence of the plaintiff or defendant may take precedence for jurisdiction. The United States, Canada, and United Kingdom do not require physicians to respond to in-flight emergencies-there is no duty to act. There are some European countries that do impose legal obligation to respond to a medical emergency. As of 2002, there have been no reports of litigations against physicians who respond to in-flight medical emergencies.10
Summary
In general, an emergency clinician should not hesitate to respond to a sudden medical emergency for fear of litigation. Courts and statutes have repeatedly protected physicians who respond to emergencies and provide care that is not grossly negligent. An exception is found in in-hospital emergencies. Not all states allow the protection of the Good Samaritan defense, and providers should be aware of the law in their particular state.
References
1. Duty to Aid the Endangered Act (Good Samaritan Law) Title 12, Chapter 23; SS 519.
2. American Medical Association Council on Ethical and Judicial Affairs. Principles of medical ethics. In: Code of medical ethics: current opinions with annotations. Chicago: American Medical Association; 2000: xiv.
3. Reuter SR. Physicians as Good Samaritans: Should they receive immunity for negligence when responding to hospital emergencies? J Legal Med 1999;20:157-193.
4. McCain v Batson, 760 P.2d 725 (Mont. 1988).
5. McKenna v. Cedars of Lebanon Hospital, Court of Appeal of California, 1979. 93 Cal.App.3d 282, 155 Cal.Rptr. 631.
6. McIntyre v. Ramirez, Texas No. 01-1203, June 26, 2003.
7. Velasquez v. Jiminez, New Jersey No. A-105-00, May 29, 2002.
8. MedAire. Personal communication.
9. Aviation Medical Assistance Act of 1998. Public Law 105-170-Apr. 24, 1998.
10. Gendreau MA, DeJohn C. Responding to medical events during commercial airline flights. N Engl J Med 2002;14:1067-1073.
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