Anesthesiology resident Max Feinstein, MD, is joined by medical ethicist Jacob Appel, MD, JD, to discuss the legalities of intervening in emergency situations outside of a medical setting.
Following is a partial transcript (note errors are possible):
Feinstein: My name is Max Feinstein and I'm an anesthesia resident at the Mount Sinai Hospital in New York City. I was recently driving down the highway and I found a man laying unconscious in the middle of the highway, so I got out and started doing CPR. Afterwards, I began to wonder, what are the medico-legal implications of actually providing out of hospital care? To answer that question, I decided to ask a lawyer.
Appel: Hi, I'm Jacob Appel. I am both an attorney and a physician. I'm the Director of Ethics Education in Psychiatry here at Mount Sinai Hospital and I get asked questions like this a lot. The first thing I tell people is that in most states you don't have to help anybody in a situation like this. There are a handful of states that have rules called "duty to assist" laws that make anybody have an obligation to help a stranger in need. But New York State, for example, is not one of them. You want to keep on driving? You want to wave goodbye? You can do that.
The only exception, by the way, is a "half-rescue." Let's say you're walking by a pond and you see someone drowning. You swim out to save them and then you realize that it's your boss, and you don't like him, so you wave and you swim back. That you can't do because you deterred other people waiting along the side of the water from jumping in to save him. Other than a half-rescue, you are free to drive by in New York. That doesn't mean it's the right thing to do.
There is another law in New York State and most states called the Good Samaritan law that protects you if you do offer assistance to a stranger in need. It applies if you're a doctor or if you're a layperson. This rule basically says that if you engage in care with the best of intentions, meaning you're acting out of the goodness of your heart, not an ulterior motive, you are protected from lawsuits for negligence.
The exceptions are if you engage in intentional damage to the person. Like you realize it's your boss and you don't like him, so then you stab him with your scalpel. Then you're not protected. Or if you engage in reckless conduct, or some might call it gross negligence, you don't uphold the standard that an ordinary person would know is the standard to behave with. But beyond that, you're protected from liability if you help a stranger in need. It does not apply in the hospital setting. It does not apply if you're their doctor. But a stranger in public, you're protected.
Feinstein: Interesting. One of the things that I started thinking about after this incident that I described is wondering whether I should carry any sort of medical equipment in my car. One of the things that I wish that I had had, for example, was at least a pair of gloves. Then I started wondering, well, would it make sense for me to carry, say, a bag-valve mask? Or you know -- and I don't think that I would do this -- but carrying intubation equipment. This would not be something that I have ever thought about before until I found myself in the situation. I'm curious what you would recommend.
Appel: I mean, you certainly could. Carrying equipment that is suitable to the kind of expertise you have can only be a good thing and you're going to be protected if you use that equipment in the appropriate, or roughly appropriate, ways. I'm a psychiatrist. I don't carry a couch with me, so there are limits.
But I always say in a situation where you're helping a stranger there are three things you should do as a physician: First, you should announce that you're a physician, because that will deter people who are not physicians from intervening and they'll know why you're stepping forward.
Then you should explain what your specialty or expertise is. If I'm a psychiatrist and I step forward and say, "I'm a physician," I'm a psychiatrist, and the chief resident in anesthesia is standing behind me, they may be more suited to help in a particular situation. They won't assume I know what I'm doing.
Then finally, you should turn to someone, point them out specifically, and tell them "get help or call 911." Because, as I mentioned, you can't do a half-rescue. Until EMS or the police, or someone else comes to intervene, you're going to be trapped in that situation once you start.
Feinstein: One of the questions that also came up, and I'm thinking about this as you're describing laws varying state-by-state, is what happens if you're 30,000 feet off the ground in a metal tube traveling at 500 miles an hour?
Appel: Generally, state laws are not protective, but there are complex rules governing aviation. What I always say is if you help someone in a plane, there are two principles to keep in mind. One is if you ever go before a jury or a State Medical Board and you've tried to save someone's life in a plane and explain what they did, they're not going to care what the technical rules of the law are. They are going to say you were a doctor and did a good deed. It's going to brew down to your advantage. In contrast, if you stand back and say I don't want to help you, and you're in a confined space like a plane and there is no other doctor, whatever the law says, it's not going to turn out well for you.
On the other hand, many Good Samaritan laws have an exception that says it doesn't apply if you do it expecting compensation. I always tell people -- because everybody knows that airlines give you frequent flyer miles, a free drink, and all sorts of benefits if you help someone on a plane -- a malevolently intentioned plaintiff's lawyer might argue that you expected that. Therefore, you should turn down any free compensation they offer you for helping someone on a plane.
Feinstein: Would you generally recommend that you turn down compensation if you provide care on an airplane?
Appel: Yeah. I would say in any setting, you want to do your good deed, you want to specify so that nobody doubts it that you're not becoming the patient's doctor, and you don't want to accept any compensation. Whatever limited amount they give you -- the 500 miles in frequent flyers or the free drink -- isn't worth the hassle it could generate.
Max Feinstein, MD, is a PGY-4 anesthesiology resident at the Mount Sinai Hospital in New York City, where he is also chief resident of teaching. His focuses on perioperative medicine, especially the role of the anesthesiologist.