By Ibrar Mahmood, case manager, Medical Protection.
Dr M, a newly-appointed consultant in obstetrics and gynaecology, went out for a meal with two friends, Mr B, a cardiothoracic surgeon from Ireland, and Mr T, an emergency medical consultant. Mr T 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 M, Mr B and Mr T identified themselves as doctors and Mr T started coordinating the resuscitation. Dr M and Mr B 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 T 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 B 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 M was worried she would be criticised as she did not normally treat children, although she was up to date with her resuscitation training. Mr B felt if he had more equipment he could have done more at the scene. Mr T was concerned he might be criticised for becoming involved while under investigation by his employing trust.
All three doctors contacted Medical Protection for advice.
How did Medical Protection help?
Dr M:
As a GMC registrant, Dr M’s professional obligation is as 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 M 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 M 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 M 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.
Mr T:
Mr T 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 M 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.
Mr B:
Mr B 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 B allowed her to take over the care.
All doctors:
Dr M, Mr B and Mr T 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 T and Mr B were also asked to consider if they felt they were competent to provide assistance given that they had been drinking.
Learning points
- 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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