Good Samaritan: Is there a doctor on board?

NO DOUBT most doctors would not hesitate in stepping forward in an unexpected emergency situation. This is borne out in a 2003 survey from Sheffield in which 91 per cent of medical practitioners said they would be willing to offer voluntary treatment in emergencies.1 The main reason cited was a professional responsibility to assist anyone in need of emergency medical care, regardless of whether an existing patient or a complete stranger.

This attitude is consistent with GMC guidance to doctors as stated in Good Medical Practice: “In an emergency, wherever it arises, you must offer assistance, taking account of your own safety, your competence, and the availability of other options for care”.

Doctors may not be overly concerned that a claim may be brought against them while acting voluntarily in an emergency situation – but there can be risks.

What is a Good Samaritan act?

Dr B walks into a local supermarket and notices someone having a seizure on the floor. The patient’s wife explains that he is being treated for epilepsy. Dr B announces that he is a doctor and offers basic emergency treatment. He cushions the patient’s head with a jacket and, when the convulsions stop, rolls the man into the recovery position. He checks airways and pulse and remains with the patient until he recovers.

This scenario can be regarded as a typical example of a Good Samaritan act. It occurs when an off-duty medical practitioner provides medical treatment in an emergency to someone who is not his existing patient. The treatment is administered in good faith, without asking nor having any intention to ask for fee or reward.

Most doctors will have at sometime been asked to act in a professional capacity outside of the working environment but involvement in serious emergencies is rare. In-flight incidents are perhaps the most familiar and dreaded scenarios. A recent Lancet review highlighted a growing number of such emergencies with the trend toward longer flights and an increasing number of older passengers with pre-existing medical conditions.2 Data suggest that there are some 50 to 100 in-flight medical events daily on US air carriers.

Legal liability

In general, Good Samaritan acts are unlikely to lead to litigation. Most doctors’ endeavours to ‘step up’ in difficult circumstances will be appreciated. Current tort laws in the USA and Australia have excluded Good Samaritan and certain volunteer acts from liability, in order to encourage medical assistance at accidents or emergencies. Many countries, including a number of states in the USA, also have Good Samaritan legislation which provides people offering emergency first aid various levels of immunity from legal liability. No such legislation exists in the UK nor is there yet clear precedent in the law.

The common law has a long history of endorsing the ‘No duty’ rule, which means in English law there is no legal duty to act as a Good Samaritan by aiding a stranger in distress. In other words, a doctor who witnesses a road accident is not bound by law to stop and help. Even if he does volunteer, his “only duty is not to make the victim’s condition worse”.3

Some GPs have a contractual duty under the core General Medical Services contract to attend at emergencies within their practice area no matter whether it is to a patient or not. But the most clearcut guidance can be found in professional ethical standards. In Good Medical Practice the GMC makes it clear that doctors are required to assist anyone in an emergency, except in situations posing real personal danger. Failure to act could prompt a charge of impaired fitness to practise.

Some general rules

In order to minimise potential legal risks, there are some general rules doctors should follow regarding Good Samaritan medical practice.

‘Proper care’ principle. Given special circumstances in some medical situations, such as lack of equipment, emergency training/experience and access to previous medical records, it is unreasonable to expect that medical Samaritans should fully exhibit the skills of an experienced accident and emergency specialist. The British Medical Association noted that volunteer doctors should recognise that just calling for help may be the most appropriate action in an emergency situation.4 In most cases, stopping blood loss, administering pain relief or even simply arranging transfer of the casualty to a hospital as soon as possible would be sufficient to show proper care of the casualty and, thus, an adequate defence against unmeritorious claims.

Acting within the limits of experience and qualifications. Researchers writing in a 2002 BMJ article commented that “even if well trained in hospital trauma management, a doctor will not be able to perform well at the roadside without considerable extra training”.5 The GMC advises in Good Medical Practice that: “In providing care you must recognise and work within the limits of your competence”. This would apply in providing emergency treatment but obviously it can become a ‘judgement call’.

Make a record. Whether emergency treatment is provided or just help to make the patient comfortable it would be wise to make some notes at or near the time of the incident to account for your actions. This could help counter any potential claims in future. You should also give your details to those at the scene such as police or airline crew.

Seek clarification from your medical defence organisation. It is important that doctors are aware of the level of cover being provided by their MDO in regard to Good Samaritan medicine. MDDUS policy is to offer members assistance and access to indemnity in respect of world-wide Good Samaritan acts, which are defined as “the provision of medical and dental services in emergency situations outside the scope of an individual’s normal contractual obligations or clinical practice”. Instant access to your MDO is unlikely in most critical emergencies but MDDUS advisers can provide guidance should any questions arise after the event.

• Yueyue Fitzgerald has a PhD in Law and is a research assistant at MDDUS

REFERENCES
1. Williams K. 2003 Doctors as Good Samaritans: some empirical evidence concerning emergency medical treatment in Britain. Journal of Law and Society Vol 30, No 2, June 2003
2. Silverman D, Gendreau M. 2009 Medical issues associated with commercial flights. Lancet, Early Online Publication, 19 February 2009
3. Capital and Counties Plc. V. Hampshire County Council [1997] QB 1035B
4. BMA. 1993 Medical Ethics Today: Its Practice and Philosophy. BMJ Publishing Group, London
5. Coats T J, Davies G. 2002 Prehospital care for road traffic casualties, British Medical Journal 324: 1136

GMC and Good Samaritan Acts

IN AUTUMN 2009 the GMC will be introducing the licence to practise. No longer will GMC registration alone signify that a doctor has the legal authority to practise medicine in the UK, and licences will require periodic renewal by revalidation. Doctors will be allowed to remain on the register without a licence but this has raised questions about their standing in regard to Good Samaritan acts. The GMC has now confirmed that the lack of a licence will not prevent doctors from “providing assistance in emergencies”.

There has also been recent concern over the decision by the GMC to end the exemption for registrants over 65 from paying the annual retention fee. Retired doctors now face the choice to either pay the ARF or allow their GMC registration to lapse. Many MDDUS members have wondered about their medico-legal status in undertaking Good Samaritan acts should they choose not to pay the ARF and, in effect, de-register. MDDUS has confirmed that retired members giving up GMC registration remain entitled to assistance and access to indemnity in respect of world-wide Good Samaritan acts.