Statutory Immunity for EMS Holds in Delayed Transport Case

The New Jersey Superior Court ruled on a tragic case earlier this year that again highlights the issue of statutory immunity for EMS transport providers, and shows that immunity given to EMS will shield them from certain types of litigation.

 

The parents of shooting victim Odis Murray filed suit for negligence against the Plainfield Rescue Squad and John F. Kennedy Medical Center, alleging that they delayed transport after Murray was shot. The family later tried to amend their complaint to add two individual paramedics, but the court denied their request on the grounds that it was untimely. Murray had been shot by his brother, Akeem, who used their father’s gun, retained from his years as a Jersey City police officer. Akeem was sentenced to 20 years for aggravated manslaughter.

Facts of the case

The Murrays lived in Plainfield with three of their four sons. Shortly after 5 a.m., the father heard gunshots and looked out into the back yard. Seeing nothing, he checked the front yard and found his second son, Odis, bleeding from a chest wound. Odis tried to tell him who the shooter was. Odis’ mother called 9-1-1 immediately. The Plainfield police and rescue squad arrived, and a mobile intensive care unit (MICU) from JFK Medical Center (“Mercy 9″) was summoned.

 

The police department had received several calls and dispatched an officer at 5:10 a.m. while the rescue squad was dispatched at 5:15. Three EMTs arrived at the scene at approximately 5:17 a.m. and approached the victim once police had cleared the scene. A call for MICU paramedics was made. The closest one, Mercy 6, wasn’t available, so Mercy 9, based at JFK, was dispatched. Apparently, a request for a medical helicopter was also made, but it was canceled by Mercy 9 when it was reported that the victim had gone into cardiac arrest.

 

The appellate opinion indicates that the facts about whether Mercy 9 ever actually arrived at the scene were disputed: The plaintiffs maintained that it never arrived, but the defendants asserted that it did. The report prepared by law enforcement indicates that Mercy 9 arrived at 5:28; Mercy 9’s run sheet indicated it arrived at 5:29 with two paramedics on board.

 

The EMTs testified that their initial assessment of Odis revealed that he was unconscious, unresponsive and pulseless. They initiated CPR and bag-valve mask ventilation, and placed him in a C-collar and on a spineboard. His ECG showed no cardiac activity. Odis’ mother, an ICU nurse, asked the squad why her son had not been intubated. She testified that they looked at her like a “deer in the headlights.” The squad subsequently transported him to the closest hospital, where he was pronounced dead.

 

It was unclear from all of the documentation whether the patient was already in the rescue squad’s unit when Mercy 9 arrived, but the paramedics’ report indicated that they attempted to intubate but were unsuccessful due to the patient’s large size, so they used a laryngeal mask airway. The autopsy report showed the patient as being 260—270 lbs. The paramedics’ report also showed that attempts to start an IV at 5:34 were unsuccessful.

 

The ambulance left the scene at 5:47 a.m. with the paramedics on board and arrived at Muhlenberg Hospital, two miles away, at 5:49 a.m. Odis was asystolic on arrival, although an emergency department record shows a blood pressure of 66/47 with cardiac electrical activity. A respiratory therapist testified that Odis was apneic on arrival and that she tried to intubate him but was met with blood in his mouth and throat, which had to be suctioned before she was able to accomplish endotracheal intubation. The hospital records show that Odis was asystolic at 6:06 a.m. and that he was pronounced dead at 6:10 a.m.

 

The autopsy showed that the bullet perforated Odis’ aorta, lacerated his left lung and left pulmonary vein and severed his spinal cord–with his death being the result of hemorrhage.

The complaint & expert testimony

The complaint alleged negligence against the rescue squad for a 30-minute delay in transporting Odis to the hospital, contending that Mercy 9, the paramedic unit, never responded to the scene. The plaintiff presented an expert witness report from Ira Mehlman, MD, an emergency medicine physician, who gave an opinion that Mercy 9 didn’t arrive at the scene in a timely manner, and that the rescue squad delayed in transporting the patient.

 

The plaintiffs also presented a report from a pathologist, William Manion, MD, PhD, JD, MBA, indicating that any chance of survival was lost when “Plainfield Rescue inexplicably delayed transport and wasted over 30 minutes at the scene”1. It was his opinion that with rapid transport, the patient would have had a “high degree of probability” of surviving the injury.

 

That “high degree” of probability was quantified at the deposition as 20—30%1. He based this opinion on the ED records, which showed that Odis still had a blood pressure on arrival at the hospital.

 

Defendant JFK retained Richard Neibart, MD, a cardiovascular and thoracic surgeon, who testified that Odis had no chance of survival no matter what was done for him in the prehospital setting.

 

Much of the appellate opinion focused on immunity issues. New Jersey provides immunity for members of “first aid, ambulance or rescue squads,” and the court found that the Plainfield squad fit this definition. This immunity is conditioned on a qualifying term: that the EMTs must have acted “in good faith.” The court interpreted this term to mean that ordinary negligence doesn’t suffice, and that if one acts in an objectivelyreasonable manner, or with subjective good faith, they’re entitled to the statutory immunity.

 

Although the plaintiffs insisted that the delay in transport indicated a lack of good faith, the court found that it was unable to demonstrate a lack of acting in an objectively reasonable manner or with a lack of subjective good faith.

 

The court also considered the squad’s claim of immunity under the state’s Good Samaritan Act but rejected this immunity because the rescue squad didn’t arrive by chance; instead, it was dispatched and had a duty to render assistance to the patient.

 

The court dismissed claims against JFK, finding that the evidence was “overwhelming” that Mercy 9 did arrive at the scene, although discrepancies in the documentation regarding its arrival time were problematic. One report indicated the victim had been shot in the head.

 

The court further found that the expert testimony against JFK was insufficient to support the claims of negligence because it rested on bare conclusions without Mehlman being able to demonstrate an understanding of the facts of the case.

Conclusion

This case highlights the fact that statutory immunity for EMS is alive and well under the right circumstances. The court clearly found that the immunity granted by the New Jersey legislature to emergency medical personnel was applicable under these circumstances.

 

The case also points out the importance of good documentation of dispatch and arrival times in addition to the patient’s condition.

Reference

  1. New Jersey Superior Court. 2011. Geraldine and Odis E. Murray (Estate of Odis P. Murray) v. Plainfield Rescue Squad and John F. Kennedy Medical Center. 418 574, 15 A3d 30

 

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