Today’s question revisits the issue of conflict between an employer’s expectations and a paramedic’s scope of practice. My correspondent is:

… a Paramedic in Western Australia, and work in the resources sector.

My workplace has created a new guideline where, upon patient arrival, the medical responder is to gather basic patient information (name, date of birth, etc) and call our on-call physician and begin a telehealth consultation. The exception to this is in urgent, life/limb-threatening circumstances.

Recently I have been specifically instructed not to perform a 12 lead ECG on a patient until I have our physician on the phone as per the guideline. I have informed my supervisor that I am happy to try and follow the guideline where possible, but I cannot categorically state it will happen every time whether it be due to poor/nil phone reception or other reasons, and I will not be delaying diagnosis or treatment. My understanding is that under my registration once a relationship exists between myself and a patient I am required to perform to the level of my training. Said training does not include delaying performing diagnostics, and I doubt many would find it reasonable. I am trained in the interpretation of ECGs. It may not be possible for me to determine whether someone needs urgent treatment or not until I have completed the ECG as the results may be deterministic.

Where does relevant law sit on this matter? Assuming I followed the instructions from my employer, could I be personally liable if the delay was found to have caused harm? Would the company be liable?

I’m aware that proving one specific delay caused the harm would be very difficult of course, however for the purpose of the argument please imagine that the delay is at least alleged to be contributory.

I have answered this question, or questions like it, many times – see Don’t let the patient die (June 11, 2019), Revisiting conflict between a paramedic’s skills and an employer’s duty statement (April 26, 2021) and all the posts you can find here https://australianemergencylaw.com/?s=%22let+the+patient+die%22.

Imagine a patient has a condition that can be identified by a 12 lead ECG and requires urgent treatment, but you cannot make that diagnosis without the ECG.  You don’t do the ECG, the diagnosis and therefore treatment is delayed and the patient suffers severe irreversible consequences, eg death.  You’re the patient’s spouse; are you going to accept the decision of a paramedic who:

  • had the equipment at hand, and
  • knew how to use it,
  • had sufficient information to indicate that its use was warranted in the circumstances to make a definitive diagnosis,
  • knew that if the diagnosis was made then urgent treatment was required, and
  • knew how to deliver and had the means to deliver that treatment
  • but who did nothing because a statement from their employer said ‘don’t use that equipment unless on the phone to a doctor’
  • in circumstances where the doctor could not be contacted?

I would suggest not. That is the paramedic you are going to sue and/or make a complaint to AHPRA about.    But surely this is also the case of the exception ie an ‘urgent, life/limb-threatening circumstances’ ie if you know the patient may have condition X and that if it is X it is urgent and life threatening, so you do what you can to make the definitive diagnosis?

An employee has to obey the reasonable directions of an employer, see Paramedic’s use of AI for clinical practice (November 15, 2024).  It cannot be reasonable for an employer to direct a paramedic to fail to take steps or do things that represent good paramedic practice.  If an employer directed an employed paramedic not to keep patient care records, not to assist non-employees at the work site, not to perform CPR when indicated, to treat patients in ways that are not supported by evidence (eg to treat burns by the application of crystals) then no-one would say that the paramedic is not personally and professionally responsible for failing to provide reasonable care or that the paramedic can avoid responsibility by saying ‘but that is what my employer told me to do’.   Equally the Paramedicine Board or a relevant Tribunal is unlikely to accept that a paramedic who followed those sorts of directions was not guilty of professional misconduct because they followed their employer’s directions. The regulation of the profession is designed to protect patients not to enforce industrial issues.  Patients are protected by having health professionals who have independent obligations and can stand up to employers who want to impose silly rules.

In the circumstances described the employer would be liable to pay money damages for any losses sustained if its direction was the cause of any harm  and because an employer is vicariously liable for any negligence by an employee. But that would not stop the family making a complaint to AHPRA or the Paramedicine Board and any professional sanctions would fall only on the registered paramedic.

The problem I see with the story as told here is that it implies the employer simply doesn’t trust its paramedic or other staff.  And if you’re a paramedic, why do you want to work for a company that only allows you to work under a doctor’s direction?  If they want a doctor on site, they should employ one.

Conclusion

The circumstances described in the question would appear to me to fall within the urgent exemption that the employer recognises. But if we take a step back and look at the broader picture an employer cannot direct a paramedic to provide other than good paramedic care, as defined by the Paramedicine Board’s Code of Conduct and professional standards.

For further discussion see Don’t let the patient die (June 11, 2019).

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.