Administration and Leadership, Columns

Pro Bono: Is Leaving One Patient to Help Another Abandonment?

Issue 1 and Volume 41.

A recent incident in New York—where a private ambulance transporting a patient from a hospital to an assisted living center stopped to assist a 7-year-old choking victim—generated significant discussion after the EMT who stopped the ambulance to assist the young girl was suspended from his job.

According to news reports, the first patient was in the back of the ambulance with an EMT while the EMT driver got out to assist the choking child. There’s no indication the first patient suffered any compromise or harm as a result of this delay in transport. The big question was: Did he abandon the first patient by assisting the second patient?

This situation raises both legal and ethical issues. Whether the first patient was “abandoned” is a question of both law and fact. Medical dictionaries generally define abandonment as the unilateral termination of the provider/patient relationship at a time when continuing care is still needed.

Abandonment is really a form of negligence under common law principles. It’s hard to prove, as a plaintiff must show there was a duty to the patient, and that this duty was breached by ceasing to provide care when it was still needed.

Typically, if an EMS provider is already engaged in the care of one patient, there would generally not be a duty to initiate care for the second patient whom the EMS provider comes upon. But negligence is all about reasonableness. Juries could find you negligent if you didn’t act as a reasonable and prudent EMS provider would, given the same or similar circumstances. If you did absolutely nothing to assist a critical patient you came upon while transporting a stable patient in no distress, a jury could potentially find that you had a duty to assist that second patient. What may be “reasonable” to one juror may not be reasonable to another.

So whether there was legal abandonment really depends on the situation. If the first patient was in dire need of medical assistance and suffered harm as a result of the ambulance stopping for a second patient, then the EMS provider’s actions would be more likely negligent than if the first patient suffered no harm. But if the first patient was simply being transported under routine conditions with no need for medical interventions and the delay didn’t harm that patient while assisting the second patient, a successful claim of negligence would be unlikely.

Anytime an ambulance is transporting a patient and a second patient who needs help suddenly appears or the ambulance literally has to drive by that patient on the route of travel, ethical dilemmas emerge. Should the ambulance stop? Should the ambulance contact dispatch for a second unit to be sent? Should the ambulance keep going without interrupting the first transport? There’s simply no easy answer as it all depends on the situation and using common sense and good judgment to help those who need care the most.

The key to avoiding potential legal and ethical issues in these situations is to preplan accordingly. This means developing a policy that defines what should be done when encountering this situation and educating everyone on that policy. Under what circumstances would it be permissible for the ambulance to stop and assist a second patient? The typical scenarios can be defined. But not everything can be defined, and sometimes we have to rely on common sense and good judgment in the hopes of making the best decision possible for the patients involved when confronted with conflicting interests.

As Jim Page said in his classic book The Magic of 3 A.M., “In the process of trying to keep everybody’s rear covered, we tend to forget that the exceptional performers in EMS occasionally need the liberty to do what they do best—make quick decisions and stick their neck out to save a patient. There will always be a need for people who are brave enough to think for themselves and take a chance when a human life is at stake.”

There’s no protocol for every difficult situation we’ll encounter, and at times we need to see the bigger picture and do what we think is right, or in the best interest of all concerned when the situation doesn’t fit the policy or procedure.

Pro Bono was written by the attorneys at Page,Wolfberg & Wirth, The National EMS Industry Law Firm. Visit the firm’s website at www.pwwemslaw.com or find them on Facebook, Twitter or LinkedIn.

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