Good Samaritan Laws

1. Good Samaritan Laws Jennifer Li, MD

2. Objectives • Describe the goals of Good Samaritan Laws • Define the criteria that must be met for Good Samaritan Laws to be applicable • Recognize how location is relevant to the utilization of Good Samaritan Laws • Identify when you are legally obligated to help • Discuss the obligations and protections in place for in-flight emergencies

3. Pretest

4. Question: True or False? • All 50 states and the District of Columbia have some form of the Good Samaritan law.

5. Answer • True

6. Question: True or False? • Good Samaritan laws protect providers from having to go to court.

7. Answer • False • Good Samaritan laws do not protect providers from being named in a lawsuit. Providers may still need to go to court and assert themselves.

8. Question: True or False? • Emergency Medicine physicians are required to respond to medical emergencies on a plane.

9. Answer • False

10. Question: True or False? • In all 50 states, there is no legal obligation to provide Good Samaritan care.

11. Answer • False • Rhode Island, Minnesota, and Vermont have laws that make it a crime if Good Samaritan care is not provided.This is the expectation for both professional healthcare providers and laypersons.

12. Question: True or False? • Licensed physicians acting as Good Samaritans are covered anywhere in the United States, regardless of the state(s) in which they have a medical license.

13. Answer • False • Exception: Kentucky • All states except Kentucky provide legal coverage for any licensed physician providing Good Samaritan emergency care in that state, regardless of the state(s) in which the physician has a medical license. • Kentucky provides legal coverage only to physicians licensed in Kentucky.

14. Question for Discussion • If a flight attendant was to ask if there was a doctor on board to assist another passenger, raise your hand if you would volunteer to help. • Why or why not?

15. Good Samaritan Laws • Goals: • To encourage healthcare providers to provide potentially life-saving care to those in need when the providers have no duty to do so • To protect healthcare providers from civil liability for any acts, omissions, or injuries occurred when delivering emergency care to victims

16. For Good Samaritan Laws to be Applicable… • The situation must be an emergency • The services rendered must be voluntary • The victim receiving care must be accepting of it - obtain consent whenever possible • The care provided must be rendered free of charge • The care performed must be done “in good faith” to help • The care provided cannot be considered as gross negligence or willful misconduct

17. Negligence • Ordinary negligence: The person providing aid did not perform as a reasonable health care provider would under similar circumstances. • In general, Good Samaritan Laws provide immunity from civil damages for injuries or death that are due to ordinary negligence • Gross negligence: The person did not follow the accepted standard of care. A “conscious, voluntary act or omission in reckless disregard of a legal duty and of the consequences to another party.” Their actions were “willful, wanton, or even malicious.” • Good Samaritan Laws typically do not protect against allegations of gross negligence

18. What Type of Negligence? • Scenario: You witness an individual go into cardiac arrest while at a party. You perform CPR by yourself the best that you can, alternating compressions and rescue breaths at a ratio of 15:2. However, the individual does not survive. When EMS personnel arrive, they note that the compressions and rescue breaths should have been performed at a ratio of 30:2. • Is this ordinary or gross negligence?

19. Answer • Ordinary negligence

20. What Type of Negligence? • Scenario: You witness an individual go into cardiac arrest while at a party. You start to perform CPR but then suddenly stop when someone tells you the individual is a known gang member. • Is this ordinary or gross negligence?

21. Answer • Gross negligence

22. Duty • Good Samaritan Laws do not protect physicians who have a pre-existing duty to provide care for a patient. • Examples of Pre-existing Duty: • If the victim is the provider’s current patient • If the physician has a contractual obligation to provide care to the victim • If there is an on-call agreement for which the physician is required to provide services.

23. Do You Have Good Samaritan Protection? • Scenario: You volunteer to provide first-aid at a high school soccer game, without pay, and a player develops a severe asthma attack and is in respiratory distress.

24. Do You Have Good Samaritan Protection? • The answer for this scenario is ambiguous. You may not necessarily have protection because of the duty implied in your agreement to serve in the role to provide first-aid.

25. Let’s Look at A Real Life Case…

26. Boccasilev Cajun Music Limited • Rhode Island - 1989 • Aline Champoux, RN, and Dr. Sara John volunteered to staff a first-aid station at the Cajun Music Festival • They were informed that “there was a man having a problem on the hill” during the event • Dr. John and members of the first aid crew went to provide emergency care. Nurse Champoux stayed at the first aid tent. • Dr. John discovered that the patient, Ralph Boccasile was experiencing an allergic reaction to seafood gumbo. Dr. John stayed with Boccasile while others went back to the tent to get medication and to call an ambulance.

27. Boccasilev Cajun Music Limited • Within a few minutes, someone returned with an EpiPen. Dr. John injected it into the patient’s thigh. Nurse Campoux joined Dr. John. • Boccasile lost consciousness. • Dr. John began resuscitative efforts and continued until EMS arrived. • Boccasile never regained consciousness and died the next day. • Boccasile’s widow sued Dr. John and Nurse Champoux, alleging that they were negligent by failing to bring the medical equipment to the scene. She also claimed that Dr. John and Nurse Champoux were not protected by the Good Samaritan law because they had volunteered their services at the music festival, thereby establishing a pre-existing duty. • Dr. John and Nurse Champoux felt that because they were volunteers and were not paid for their services, they were covered by the Good Samaritan law. • The case was dismissed in favor of Dr. John and Nurse Campoux based on Good Samaritan law.

28. Location Matters • Most Good Samaritan laws apply solely to care provided outside the hospital, clinic, or doctor’s office • However, in some states such as Colorado, Good Samaritan laws protect physicians who provide Good Samaritan care in a hospital • Example: If a physician is rounding on their patients and responds to an urgent request by staff to attend to another physician’s patient who becomes acutely unstable • Contingent upon it being outside the normal scope of the physician’s responsibilities, the physician has no duty to respond, and there is no additional pay

29. Real-Life Case in Texas from 1998 • Good Samaritan Law covered physician responding to in-hospital emergency. • Dr. Douglas McIntyre, an OB/GYN, happened to be visiting a patient on the labor and delivery floor when he heard a page for “Dr. Stork,” which signals that a physician’s assistance is immediately needed for a patient in labor. • The patient, Ms. Ramirez’s labor had progressed rapidly and her own OB physician was not present. • By the time Dr. McIntyre arrived to the room, the baby’s head had been delivered but there was shoulder dystocia. The baby was eventually delivered vaginally, but sustained neurologic damage and paralysis to the right shoulder and arm. • Ramirez sued Dr. McIntyre for negligence. • The Texas Supreme Court ruled in favor of Dr. McIntyre, stating that it was outside the normal scope of the physician’s responsibilities and there was no additional pay.

30. Another Physician Was Not so Lucky… • Real-life case in New Jersey from 2002 • Dr. Teresa Jiminez was the OB/GYN of the patient, Germane Velasquez • Ms. Velasquez’s vaginal delivery was c/b shoulder dystocia • After delivering the head, Dr. Jiminez called for help • Dr. Angela Ranzini, an OB/GYN physician assigned to the maternal fetal care unit, responded. Dr. Ranzini had no affiliation with Ms. Velasquez, and the patient was not on the maternal fetal unit. • After attempts to delivery the baby vaginally were unsuccessful, the two OB/GYN physicians performed a C-section • The baby was born with severe brain damage and died of pneumonia at age 2 years old

31. Another Physician Was Not so Lucky… • The Velasquez family sued the medical center, Dr. Jiminez, and Dr. Ranzini for negligence • Dr. Ranzini claimed she was immune from liability by the state’s Good Samaritan law because she had no duty to respond • However, the New Jersey Supreme Court felt that Dr. Ranzini was not someone who came upon the emergency "by chance.” They ruled that the state’s Good Samaritan law is not applicable to physicians working within a hospital.

32. Emergency Medicine practice groups that have a contract to provide coverage on the hospital floors for emergencies and procedures are not protected by the Good Samaritan laws, because they have already accepted reimbursement for the response beforehand

33. Are you Legally Obligated to Help? • Scenario: You are driving home from work when a car in front of you is T-boned by a truck. The car spins out of control and hits a tree. The driver of the car is slumped over in the seat.

34. Are You Legally Obligated to Help? • No, unless your state has a “duty-to-act” law

35. “Duty-To-Act” Laws • Rhode Island, Minnesota, Vermont • If a physician (or any person) does not provide assistance and instead leaves a scene in which an individual required emergency medical treatment, they can be in violation of the law. • Penalties for Violation of the Statute: • Rhode Island: Petty misdemeanor. 6 month imprisonment, fine up to $500, or both. • Minnesota: Petty misdemeanor • Vermont: Fine of not more than $100

36. Variations in State Good Samaritan Laws • All 50 states and the District of Columbia have some form of the Good Samaritan law • However, no two jurisdictions apply the same language in their laws • Know the laws in your state jurisdiction • If aid is provided, it only needs to be stabilization • All states and the District of Columbia’s Good Samaritan Laws exempt people from liability when using automated external defibrillators (AEDs) in an emergency

37. Variations in State Good Samaritan Laws • Some states only provide protection for trained providers • 8 states (California, Connecticut, Illinois, Indiana, Kansas, Louisiana, Missouri, Oregon) do not provide protection for individuals with no training at all • All states except Kentucky have statutory language that protect physicians licensed in any other state as well

38. Variations in State Good Samaritan Laws • Most states require that the emergency care provided occur at or near the scene of the accident or emergency • If a physician charges a fee for medical care provided in an emergency situation, Good Samaritan laws generally will not protect the physician

39. Table: Summary of Good Samaritan Laws in All 50 States and the District of Columbia • Who is protected? • Column 1: The state’s statute protects any person who acts as a Good Samaritan, including physicians. • Column 2: The state’s statute has language that protects health-care personnel licensed in any state. • Column 3: The state’s statute specifically mentions that physicians licensed in any state acting as Good Samaritans are protected in that particular state. • Column 4: The state’s statute specifically mentions that physicians licensed within that state itself have protection.

42. Stewart PH, Agin WS, Douglas SP. What does the law say to good samaritans? Chest. 2013; 143(6): 1774-1783.

43. Do Physicians Have an Ethical Duty to Respond? • American Medical Association’s (AMA) Code of Medical Ethics: • “A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.” • AMA’s Council of Ethical and Judicial Affairs: • Physicians should “respond to the best of their ability in cases of emergency where first aid treatment is essential.”

44. Do Physicians Have an Ethical Duty to Respond? • World Medical Association’s International Code of Medical Ethics: “A physician shall give emergency care as a humanitarian duty unless he/she is assured that others are willing and able to give such care.”

45. When to Hand over Patient Care… • Physicians who offer aid should not leave the scene until a provider of at least comparable capability can assume care of the patient • Otherwise, the physician can be charged with abandonment • Some possible scenarios: • Leaving the scene once experienced EMS providers have arrived • Traveling along with EMS and the patient to the hospital where patient care is handed off from one physician to another physician

46. What Happens in the Air… • In the United States, Canada, and United Kingdom, physicians are not legally obligated to provide assistance during in-flight emergencies

47. For those that do help in the air… • Aviation Medical Assistance Act of 1998: • Federal statute that covers aircraft registered in the United States, even if they are outside U.S. airspace • Amedically qualified individual have Good Samaritan protection and “shall not be held liable for damages in any action brought in a Federal or State court arising out of… providing or attempting to provide assistance in the case of an in-flight medical emergency unless the individual, while rendering such assistance, is guilty of gross negligence or willful misconduct.”

48. Definition • Medically Qualified Individual: “Any healthcare practitioner who is “licensed, certified, or otherwise qualified to provide medical care in a State, including a physician, nurse practitioner, physician assistant, nurse, paramedic, and emergency medical technician.”

49. Remember that the Good Samaritan provider must receive no monetary compensation. • Seat upgrades, credit for travel miles, or travel vouchers do not count as monetary compensation. They should be viewed as a “token of gratitude” from the airline for the provider’s inconvenience.

50. Aviation Medical Assistance Act • Also protects airline companies registered in the U.S. from liability sustained in “obtaining or attempting to obtain the assistance of a passenger in an in-flight emergency, or out of the acts or omissions of the acts of the passenger rendering the assistance…if the carrier in good faith believes that the passenger (that provides aid) is a medically qualified individual.” • “In good faith” requirement met when airline employees ask if the person who volunteers assistance is a health care provider. Flight crew may ask for some proof of licensure or documentation of medical credentials.