Today’s question is about cancelling an ambulance. My correspondent tells me that her adult son:

… became seriously unwell. He had a fever, was delirious and had been vomiting for several days unable to keep even water down.

In a moment of clarity, my son called 000 requesting an ambulance. Whilst he was on the phone to 000, [another person] …  came into the room, took over the call and was easily able to cancel the ambulance by stating “I will take him to the hospital”, which he did not.  

As a result, there was a considerable delay in getting medical care with a tragic and ultimately fatal outcome. I’m asked:

  1. Firstly, are there any guidelines set out that 000 call centre operators must adhere to or abide by when a request for an ambulance to be cancelled is made?
  2. What criteria must be met before a cancellation can occur?
  3. Who decides or authorises a cancellation?
  4. If the ambulance is being cancelled by a third party, how do they identify who that third party actually is?
  5. Are there any follow ups made if an ambulance is cancelled?
  6. And finally, if an ambulance is called by person A and that ambulance is then cancelled by person B and person A dies because they did not receive medical care, who is accountable for person A’s death?

a) The call centre operator who took the call,

b) Person B,

c) Both the call centre operator and person B share accountability,

d) No one is accountable.

I am a lawyer and have been described as a ‘black letter lawyer’, a tag I don’t disagree with.  In essence it means I take a formal view of what constitutes ‘law’ and I look to the legislation and case law and in particular decisions from the superior courts.  There are many other things that regulate behaviour including formal and informal codes of conduct and practice.  Those are not law (though they can be relevant evidence on legal issues) and I have no particular access to those.   What that means is even though I have had a long involvement in this area I cannot answer the first 5 questions. There is no ‘law’ (as I’ve defined it) that addresses those issues; they are matters for the ambulance services and as their control room protocols are not publicly available I cannot comment on them.

I can comment on question 6. 

Person B

In a recent post (Important UK case on liability of emergency services (October 25, 2024)) I discussed the concept of the ‘interference principle’ that is said to be part of the common law of the UK and perhaps Australia. That principle says that there is a legal duty of care where a person ‘has done something which prevents another from protecting [person] B from … danger’.  In the context of today’s question that is the person who took over the call and cancelled the ambulance, thereby stopped, or at least discouraged, the ambulance service from responding and in that context made the situation worse than it would have been had they not intervened.  That would give rise to a relevant duty to provide a reasonable response to the patient’s circumstances.

In an Australian case, R v Taktak (1988) 14 NSWLR 226 the accused, Taktak was charged with manslaughter by criminal negligence. Taktak, himself a drug addict, had taken a woman who was affected by drugs from a party to his home where he, ineffectually, tried to care for her.   Had he left her where she was, she probably would have been found by others and could have expected better care. As it was there was no-one going to provide further help in Taktak’s apartment and she died.  The Court of Criminal Appeal confirmed that a duty of care arose where a person ‘assumed the care of the stranger in such a way as to seclude him or her so as to prevent others from rendering or obtaining aid’.   Where there is a duty to act, a negligent failure to act – an omission – can lead to civil and/or criminal liability.

After deciding Taktak did owe a legal duty to the deceased, the question was whether his conduct amounted to gross negligence to warrant criminal, not just civil liability. In response to questions from police he said:

I threw a jacket over her and a blanket, she smelt a lot, of vomit… I spent a few hours trying to wake her up. But nothing happened she wouldn’t wake up… I slapped her face a couple of times, washed her face with cold water, pumped her chest, gave her mouth to mouth but she wouldn’t wake up.

Readers of this blog, particularly those members of the emergency services (let alone the paramedics) will be aghast at such ineffectual attempts at care and a failure to call triple zero.  But Tatktak was not the sort of person to have done a first aid course, but he tried. Negligence comes in degrees and a high level of negligence is required before a criminal conviction (see Professional discipline after serious criminal conviction – lessons from the UK (January 29, 2018). In Taktak Yeldham J said:

In the present case, although it is clear that a doctor should have been called to the deceased at an early stage, and that (assuming she was then alive) if he had given her the appropriate treatment, she may well not have died, I consider that a finding that the appellant was criminally negligent cannot be supported. Mere negligence or mere inadvertence is not enough…

The appellant himself was a heroin addict. He had no medical knowledge. The time involved, on any view, was short. Plainly he did make some ineffectual attempts to bring her out of her apparent state of unconsciousness. Reasonable care and common prudence demanded that he should have called medical help, notwithstanding the hour of the morning. But to hold that he was criminally negligent, and that such negligence caused or accelerated death, was in my opinion a verdict which was dangerous and unsatisfactory. There was no evidence that the appellant knew the extent of the ingestion by the deceased of any drug or that, if medical help was not obtained for her, she would be likely to die. Nor is there any evidence that he was aware that death, if likely, might have been prevented by the administration of Narcan or any other preparation. Any finding against him on these issues involved at least some guesswork.

In short, Taktak’s actions in taking the deceased into his care gave rise to a duty of care, but his negligence was not sufficiently gross or ‘wicked’ to amount to criminal negligence.

What follows from these cases is that one can infer that by taking the phone and telling the call taker that ‘I will take him to the hospital’ the person who intervened (Person B in my correspondent’s question) came under a duty to take reasonable care of the affected young man but whether the failure to take him to hospital or otherwise seek further care amounted to negligence would depend on all the facts.

The call taker and the ambulance service

Ambulance services owe a duty of care to those that call them (Kent v Griffiths [2001] QB 36) so would owe a duty of care to the caller, but again that is only the first step. One then has to consider whether accepting the advice of the person who intervened, that they would ‘take him to hospital’ meant that it was reasonable not to dispatch an ambulance.

In Alexander v Heise [2001] NSWCA 422 the NSW Court of Appeal considered the potential liability of a doctor’s practice after a patient rang to make an appointment for her husband. She gave some information to the receptionist who made ‘an assessment that the patient’s condition was not life threatening and that he was not in any pain or discomfort. It was perfectly understandable that she would not conclude that it was an urgent problem or that she needed to refer it immediately to Dr Heise’.  There was no breach of duty even though the plaintiff’s husband died the day before his appointment.

Applying the reasoning from Alexander’s case one would infer that the ambulance service, like the medical practice, did owe a duty of care but that relying on the information provided allows the call taker – in Alexander’s case the receptionist, in the case under discussion, the ambulance call taker – to make an assessment.  If they are told by a person who is on the scene (remembering Person B took over the phone call) and who says that an ambulance is not required, and that they will take the patient to hospital then not responding the ambulance might well be a reasonable response.

Other circumstances may not lead to the same conclusion.  If a person makes a separate call to say an ambulance is not required the call taker would have to try and understand where the person making the call is located, are they with the patient? In any case there would have to be some attempt to assess the person making the call, do they sound competent, or do they sound like they are intoxicated, abusive or not taking the situation seriously?  It’s a difficult situation, we don’t want to send emergency ambulances to people who don’t need or want them but on the other hand, we don’t want to not send them when needed.   In Alexander’s case the court spent considerable time considering the information provided and ‘the `guidelines’ in the Royal Australian College of General Practitioners Handbook for Medical Receptionists’ to determine that the receptionists conduct was reasonable in all the circumstances.  Similar matters would need to be considered when deciding whether a decision to accept ‘Person B’s’ assurance that an ambulance was not required was reasonable.

Conclusion

If we return to question 6 (the only question I can answer) it was:

… if an ambulance is called by person A and that ambulance is then cancelled by person B and person A dies because they did not receive medical care, who is accountable for person A’s death?

a)       The call centre operator who took the call,

b)       Person B,

c)       Both the call centre operator and person B share accountability,

d)       No one is accountable.

The answer is (c) ‘Both the call centre operator and person B share accountability’ but that simply means that they are accountable for their decisions, not that they are accountable for, or liable for the outcome. That the ambulance service, the call taker and Person B owed a duty of care to the patient can be accepted.  Whether their conduct was negligent or not depends on much more than the unfortunate and tragic outcome in this case.  A poor outcome does not prove negligence or a lack of reasonable care.   To answer whether anyone is ‘accountable’ (by which I infer my correspondent to mean in some way liable) would require a great deal of more detailed evidence. 

This blog is made possible with generous financial support from (in alphabetical order) the Australasian College of Paramedicine, the Australian Paramedics Association (NSW), the Australian Paramedics Association (Qld), Natural Hazards Research Australia, NSW Rural Fire Service Association and the NSW SES Volunteers Association. I am responsible for the content in this post including any errors or omissions. Any opinions expressed are mine, and do not necessarily reflect the opinion or understanding of the donors.

This blog is a general discussion of legal principles only.  It is not legal advice. Do not rely on the information here to make decisions regarding your legal position or to make decisions that affect your legal rights or responsibilities. For advice on your particular circumstances always consult an admitted legal practitioner in your state or territory.