This question comes from a paramedic practitioner with a private provider rather than a state ambulance service. My correspondent tells me:
A recent cardiac arrest occurred outside a doctor’s clinic. Help was requested from the doctor’s clinic and was refused, stating the doctors are not legally required to assist and they were reluctant to as they are not covered by insurance.
I would have thought the Hippocratic oath and good samaritan legislation would have covered this scenario.
What are your thoughts?
Given my correspondent is from an ‘Events/Industrial’ paramedic service I’m not sure if they were there as part of their response, or just as citizen on the street. I also note I’m not sure what jurisdiction this question comes from but none of those things matter.
My thoughts are:
(https://imgflip.com/memegenerator/Computer-Guy-Facepalm)
Clearly 7 ½ years of writing this blog is just not making a difference.
I’m going to accept my correspondent’s version, ie the doctor’s excuse for not helping was ‘doctors are not legally required to assist and they were reluctant to as they are not covered by insurance’; not that they were engaged seeing other patients and in the middle of a procedure or any other reason.
Are doctor’s legally required to assist? The traditional view is that there is no duty to rescue (Stuart v Kirkland-Veenstra [2009] HCA 15) but doctors are in a special position by virtue of their training, the money the community spends on that training, the status they are given and the authority that comes with their position in the medical field. In short we don’t train doctors so they can earn money, we train them so they can provide medical care and we pay them to provide the care – but the principle of the profession is (or should be) the care that is provided.
So in Woods v Lowns, Dr Lowns was found liable – to the tune of $3m – for failing to render assistance to a young epileptic when he was approached by the boy’s sister at his surgery and was asked to come the short distance to where the boy was fitting. Dr Lowns was not yet seeing patients and there was no good reason not to attend. His Honour Mr Justice Badgery-Parker said (Woods v Lowns (1995) 36 NSWLR 344 (Badgery-Parker J); affirmed on appeal Lowns v Woods (1996) AustTortsReps ¶81-376 (Kirby P and Cole JA; Mahoney JA dissenting):
“… circumstances may exist in which a medical practitioner comes under a duty of care, the content of which is a duty to treat a patient in need of emergency care, such as will give rise to a cause of action for damages for negligence in the event of a breach of that duty consisting in a failure to afford such treatment as is requisite and as is within the capacity of the individual practitioner to give… Whether in a particular case a medical practitioner comes under such a duty of care must depend upon … the facts of the particular case…”.
Whether the circumstances described by my correspondent are sufficient to attract that duty would be a matter for a court and would require much more detail than we have, but it does show that a claim ‘doctors are not legally required to assist’ is at least ‘uninformed’ at worst ‘ignorant’ and either way ‘brave’ (in the way that term is used in ‘Yes, Minister’ for those old enough to remember that show).
As for ‘not covered by insurance’ I would bet, even without seeing the policy, that this is rubbish. A medical practitioner has to have a policy of insurance in order to be registered as a medical practitioner and the indemnity policy will have to cover them when practising medicine (Health Practitioner Regulation National Law Act 2009 (Qld) s 129; the Queensland law has been adopted as the law in every jurisdiction so this law applies across the country). A practitioner who assists a person outside their surgery when they have been requested to assist because they are a doctor, is practicing medicine (see Medical Board of Australia, Professional indemnity insurance arrangements registration standard (2010), definition of ‘Practice’). Now I haven’t see this doctor’s policy but I cannot believe that a policy that covered a GP in private practice would not extend to providing care either in or out of the practice remembering that this doctor was approached at the practice because he or she was a doctor.
Doctors don’t swear the Hippocratic oath anymore. The Medical Board of Australia’s Good Medical Practice: A Code of Conduct for Doctors in Australia (2014) does says, at [2.5] (emphasis added):
Treating patients in emergencies requires doctors to consider a range of issues, in addition to the patient’s best care. 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.
Whilst there may be limits on what a doctor can do taking into account the factors listed, good medical practice ‘involves offering assistance’, not refusing it and not refusing it for fear of legal liability. In Medical Board of Australia v Dekker [2013] WASAT 182 it was said:
Because saving human life and healing sick and injured people is a core purpose and ethic of the medical profession, and because members of the profession have the knowledge and skills to do so, the failure by a medical practitioner to make an assessment and render assistance when he or she is aware that a motor vehicle accident has or may have occurred in their vicinity and that people have or may have been injured, … would…reasonably be regarded as improper by medical practitioners of good repute and competency…
The finding that Dr Dekker was guilty of unsatisfactory professional conduct was set aside on appeal (see Further legal ruling affecting ‘Doctors as ‘good Samaritans’ – do I have to stop?’ (January 3, 2015)). In that case the Western Australian Court of Appeal said (Dekker v Medical Board of Australia [2014] WASCA 216):
The duty, as formulated, arises without regard to the mental state of the doctor, the circumstances in which the doctor is, or may be, aware that a motor vehicle accident has occurred in his or her vicinity, and the circumstances of the accident. The duty as formulated would apply, for example, to a medical practitioner who lacked mental capacity or, for example, was affected by alcohol (eg, a doctor who has been drinking and takes a cab on the way home at the end of a long social evening)…
So a general statement that a doctor always has to stop cannot be supported and in that case given the circumstances including that Dr Dekker was herself nearly involved in the accident, it was dark, she didn’t have a torch or first aid kit and the police station was only 5 minutes away all meant that a finding that she should have gone to the accident rather than the police station could not be supported. But the story I have is that the doctor is approached at the surgery, we don’t know what time but if the surgery was open presumably it’s business hours and daylight, so given the terms of the Medical Board’s code of conduct it could and I suggest would, still be the case that in the right circumstances failure to offer assistance in an emergency that takes account of the doctor’s safety, skills, the availability of other options and the impact on any other patients’ would constitute unsatisfactory professional conduct. Again the doctor’s belief that there is no legal obligation to assist is ‘brave’.
My correspondent refers to the Good Samaritan legislation. The Ipp Review of the Law of Negligence, in the Final Report (at 7.21) said:
The Panel understands that health-care professionals have long expressed a sense of anxiety about the possibility of legal liability for negligence arising from the giving of assistance in emergency situations. However, the Panel is not aware, from its researches or from submissions received by it, of any Australian case in which a good Samaritan (a person who gives assistance in an emergency) has been sued by a person claiming that the actions of the good Samaritan were negligent. Nor are we aware of any insurance-related difficulties in this area.
Even though the Ipp Review recommended against Good Samaritan legislation, every state and territory moved to enact it – see see Civil Law (Wrongs) Act 2002 (ACT) s 5; Civil Liability Act 2002 (NSW) s 56; Personal Injuries (Liabilities and Damages) Act 2003 (NT) s 8; Law Reform Act 1995 (Qld) s 16; Civil Liability Act 1936 (SA) s 74; Civil Liability Act 2002 (Tas) ss 35B;Wrongs Act 1958 (Vic) ss 31B; Civil Liability Act 2002 (WA) s 5AB). This legislation was written with doctors who are reluctant to assist, in mind.
The NSW version says:
A good samaritan does not incur any personal civil liability in respect of any act or omission done or made by the good samaritan in an emergency when assisting a person who is apparently injured or at risk of being injured.
So my correspondent says ‘I would have thought the Hippocratic oath and good Samaritan legislation would have covered this scenario’. It’s actually the Medical Board of Australia’s Good Medical Practice: A Code of Conduct for Doctors in Australia but otherwise that statement is correct.
Conclusion
A doctor who thinks “I’ll only practice where I’m confident I’m insured; not where I’m confident I’m competent” and who puts their insurance concerns ahead of patient care, probably needs to rethink their role in the profession.
My correspondent may well want to consider approaching the Medical Board of Australia and lodging a complaint regarding this doctor’s response.
Australian Emergency Law 
Its very vage in details.
as a paramedic in the rural events sector with current authority and drug lic, i find it hard to imagine why a paramedic would even call for assistance from a local gp.
I know full well they are not capable of doing any more than a bystander. Sure they have a great deal of medical knowledge.
the fact remains that they may not have any experience in emergency treatments.
if it was to ask for a defib, pillow or blanket or even an spo2 and bp cuff, id say that would make sence but thats not stated as you noted. Id actualy prefer thay stayed away whilst i 000 ,stableise pt as best i can and keep in contact with dispatch on any changes in condition.
In other words basic first aid works well in this instance.
Best out come for the patient is follow through of treatment and good handover. Treatment that may not be compatible to ambulance service may couse more harm than good
a Dr jumping in and performing some complex procedure may mean the Dr will have to go with the oncoming crew to continue that procedure. Not ideal.
Im mearly making a comment on the small amount of infomation provided.
You have coverd this extensively in other posts anyway.
Thank you for the above…a chestnut that keeps recurring and, rightly or wrongly, causes angst for some doctors.
Worth reflecting that all primary care practitioners are expected to maintain CPR skills as part of ongoing triennial continuing professional development and may be able to assist with provision of quality compressions and/or assist in on scene decision-making.
There is an unfortunate tension between confidence/competence and duties/professionalism, compounded by the employment circumstances of some clinics. One could envisage that request for help directed to a receptionist or practice manager to attend on scene may be declined on basis of insurance fearsmpr some other OH&S pretext. Whereas I think most doctors are well aware of the Lowns case and would make a decision to attend, factoring in proximity, training, availability of other resources etc
I do sincerely hope that clear guidance is given to the profession, both by AMA and specialty Colleges including ACRRM and RACGP to allay doctors’ fears of attending such out-of-clinic events.
Whilst I ackonlwedge the concerns above from a rural paramedic – and indeed agree that on scene an ‘enthusiastic amateur’ is perhaps a hinderance than a help, the converse is that some medical training may be better than none (compressions, decision-making) and PARTICULARLY in rural areas, many doctors have advanced skills in emergency medicine and anaesthesia (maintained through their work as visiting medical officers for rural hospitals in addition to private clinic roles) and are often called to assist ambulance personnel, particularly when rural services are staffed by volunteer ambulance officers – the local GP may be a boon in such circumstances.
I should point out my two conflicts of interests.
Firstly, I am a fervent proponent of GoodSAMapp, a smartphone app designed to enable offduty doctors-nurses-paramedics with verified BLS skills to be notified if a cardiac arrest occurs nearby, as a means of crowdsourcing CPR before ambulance arrives. A good idea, but there are often concerns in relation to ‘duty to respond’ and liability if decline a call, which causes angst particularly amongst doctors!
Secondly I am part of South Australia’s RERN (rural emergency responder network) which activates local rural doctors to assist ambulance on scene in defined circumstances – and only when will ‘value add’. This volunteer scheme removes ad hoc nature of responses, ensures sensible activation criteria, ensures responders are appropriately trained and equipped and operates under clinical governance. Whilst we carry a pager, if engaged in other duties, fatigued, incapable or otherwise engaged, we have the right to decline the invitation to attend. There are of course hopes to extend this scheme across Australia in order to value add in locations where patient needs outstrip local resources on rare occasions, utilising appropriate volunteer rural GP responders. See http://onlinelibrary.wiley.com/doi/10.1111/1742-6723.12432/abstract for details or google ‘RERN’
I do hope that the excellent advice from Dr Eburn will help pave the way for both crowdsourcing CPR using smartphone technology for OOHCA and also alleviate the tension around local GPs being involved in out-of-clinic or prehospital incidents.
Thanks Tim, for those comments.
As for the GoodSAMapp, see my post Crowd Sourcing First Aid (August 12, 2014).
With respect to a request for help being directed to the receptionist rather than the doctor, see the Inquest into the Death of Brian Raymond Turner, Coroners Court of South Australia 17 August 2009 (and thank you to Shane Bolton who brought this to my attention in a comment to this post on the Facebook site for this blog).
In this case, Mr Turner was feeling unwell. His wife was in the process of driving him to hospital when he ‘took three gasps and then seemed to become unresponsive.’ She pulled into the car park of a medical clinic and ran in to seek assistance. She spoke to the receptionist who advised the doctor that there was a man outside with ‘difficulty’ breathing. There was a dispute between the doctor and the receptionist as to whether or not the doctor was asked to come outside to help (he was already with a patient) or whether he was just asked for some directions as to what to do. The Coroner said:
At the end of the day, however, it would not have made any difference – ‘The probability is that Dr Vlahakis would not have been able to save Mr Turner, even if he had attended in the car park.’
Remember a coroner reviews the circumstances of a reportable death. A coroner can make no finding of civil or criminal liability. He or she may make recommendations in order to mitigate against the risk of future similar occurrences. In this case the attendance by Dr Vlahakis would not have made a difference to the outcome so the coroner made no recommendations. I am unaware of whether any other action was taken with respect to Dr Vlahakis.