After reflecting on the care they had provided in an emergency, three consultants contact Medical Protection for advice.
(Names and locations have been changed to protect member confidentiality)
Dr Mary Sharpe, a newly-appointed consultant in obstetrics and gynaecology*, went out for a meal with two friends, Mr Ben Thompson, a cardiothoracic surgeon from Ireland*, and Mr Tim Ryan, an emergency medical consultant*. Mr Ryan was under investigation by his employing Trust because of allegations of bullying. During the meal, all three consumed alcohol.
They became aware of a commotion outside and the waiter informed them that a young teenage boy had been stabbed at a nearby bus stop. All three doctors attended the scene and found the boy was unconscious and had suffered multiple stab wounds to his chest and abdomen. An off-duty paramedic was tending to him and reported that the boy was making no respiratory effort and had a weak pulse.
Dr Sharpe, Mr Thompson and Mr Ryan identified themselves as doctors and Mr Ryan started coordinating the resuscitation. Dr Sharpe and Mr Thompson started cardiopulmonary resuscitation while the off-duty paramedic spoke to the emergency services. An ambulance crew arrived and two further paramedics, listening to the chest, identified there was no air entry on the left side. Mr Ryan proceeded to carry out a needle decompression, which resulted in a temporary improvement in the patient’s clinical state.
A further ambulance crew arrived with an emergency medical doctor, the patient was intubated and ventilated, and a decision was made to perform a thoracostomy. Mr Thompson offered to do the procedure, but the emergency doctor said she would perform it. Following treatment there was a further improvement in the patient. He was transferred to hospital but unfortunately died some hours later.
Reflecting on the event, Dr Sharpe was worried she would be criticised as she did not normally treat children, although she was up to date with her resuscitation training. Mr Thompson felt if he had more equipment he could have done more at the scene. Mr Ryan was concerned he might be criticised for becoming involved while under investigation by his employing trust.
All three doctors contacted Medical Protection for advice.
What was Medical Protection’s advice?
Our response to Dr Sharpe:
As a GMC registrant, Dr Sharpe’s professional obligation is set out in paragraph 26 of Good Medical Practice. It states:
“You must offer help if emergencies arise in a clinical setting or in the community, taking account of your own safety, your competence and the availability of other options for care.”
In this scenario, Dr Sharpe was acting as a Good Samaritan, as she was providing medical assistance free of charge, in a bona fide medical emergency, which she had happened on by chance in a personal as opposed to a professional capacity.
Before offering assistance, Dr Sharpe needed to decide if her ability to assist was in any way impaired by alcohol and if she was sufficiently competent to provide care. Although Dr Sharpe was not normally involved in the treatment of children, she was adequately trained in resuscitation and, subject to her not being intoxicated, her professional responsibility was to assist.
Our response to Mr Ryan:
Mr Ryan was reassured that the ongoing investigation with his employer did not impact his ability to provide care and treatment in an emergency situation. Like Dr Sharpe he too was acting as a Good Samaritan and was assured that in the event a claim arose from his actions he could seek assistance from Medical Protection.
Our response to Mr Thompson:
Mr Thompson was not registered with the GMC, but he was registered with the Irish Medical Council and their guidance states: “You should provide care in emergencies unless you are satisfied that alternative arrangements have been made. You should also consider what assistance you can safely give in the event of a major incident, a road traffic accident, fire, drowning or other similar occurrences.”
Although he had expertise that was very relevant to the nature of the emergency, in this setting he was acting as a Good Samaritan. The emergency doctor who attended with the ambulance was acting in a clinical capacity and it was appropriate that Mr Thompson allowed her to take over the care.
How Did Medical Protection help?
Dr Sharpe, Mr Thompson and Mr Ryan were reassured that if a claim arose from their actions as a Good Samaritan, they could seek assistance from Medical Protection. We also assisted them in writing a detailed statement promptly as this incident was likely to result in a criminal investigation, a child death inquiry and a coroner’s inquest. They were also encouraged to include this event in their annual appraisal. Mr Thompson and Mr Ryan were also asked to consider if they felt they were competent to provide assistance given that they had been drinking.
Take aways
In the UK, outside a clinical setting there is no legal obligation for a doctor to provide assistance but there is a professional obligation. GMC guidance states you “must”, which means it is an overriding principle.
In scenarios such as this, you must consider your own safety, competence and the availability of other options of care.
The risk of being sued after acting as a Good Samaritan is very low. The Social Action, Responsibility and Heroism Act 2015 requires the court to consider whether the action was a reasonably responsible intervention in an emergency for the benefit of an individual or society.
If you assist in an emergency in a non-clinical setting you should draft a detailed statement promptly as you may be required to provide an account of your involvement in the event of further investigations of the incident.
You should notify your indemnifier as soon as possible after an incident.
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