WhiteCoat

Mandating medical care?

Should medical personnel be forced to help people in need of medical care?

Two EMTs were asked to help someone who had collapsed at a donut shop. They told shop owners to call 911 and then left.

Mayor Michael Bloomberg blasted the EMTs, stating that “there’s no excuse whatsoever” for their actions. Now the EMTs have been suspended from their jobs without pay.

Set aside the moral arguments that everyone “should” help their fellow man. Should we be required to do so?

If the EMTs were on duty, there are certain procedures they must follow. We don’t know if they were called out to another emergency.

But if the EMTs were off duty, isn’t saying that they are required to perform services without compensation kind of like forcing off duty taxis to provide free rides in an emergency, or like forcing off duty attorneys to provide free legal services in an emergency – at any time, or like forcing billionaire mayors to give money to people in financial emergencies?

Should we suspend people from their jobs for failing to do what is morally correct?

69 Responses to “Mandating medical care?”

  1. ERP says:

    I gotta agree with the mayor. It sounds like they were on “break” since they were sitting there in their uniforms having doughnuts. This is akin to a nurse on break sitting there while her patient codes and tells us to just call the one covering her. Wrong on every level. Now, if they were TOTALLY off duty – ie in street clothes and not working, I think it should not be mandated that they help but it does go against human decency to not help. I don’t know how anyone would have identified them as EMT’s if they were sitting there in street clothes however, so they could have just assisted as “good samaratins” and not in the offical capacity as EMT’s.

    • WhiteCoat says:

      The lady had passed out, there’s nothing that said she was “coding.” We don’t know if she fainted, if she had a seizure, or what else may have caused her to pass out.
      Docs driving by the scene of an accident should be *required* to stop at all accident scenes?
      Nurse eating lunch in the break room should be required to stop eating and help any time there is a potential emergency?

      I think everyone would agree that morally the EMTs “should” have helped the woman. Call them what you want.

      What’s the general moral rule that we are going to create, then?
      All people should be required to help anyone else in any type of a emergency and, if they don’t, they are subject to liability?
      Or are we just going to restrict the requirement to help to medical personnel?

      The legal term for the EMTs’ actions is called “nonfeasance”.
      From a legal encyclopedia:

      Nonfeasance is a term used in tort law to describe inaction that allows or results in harm to a person or to property. An act of nonfeasance can result in liability if (1) the actor owed a duty of care toward the injured person, (2) the actor failed to act on that duty, and (3) the failure to act resulted in injury.
      Originally the failure to take affirmative steps to prevent harm did not create liability, and this rule was absolute. Over the years courts have recognized a number of situations in which a person who does not create a dangerous situation must nevertheless act to prevent harm.
      Generally a person will not be held liable for a failure to act unless he or she had a preexisting relationship with the injured person. For example, if a bystander sees a stranger drowning and does not attempt a rescue, he cannot be liable for nonfeasance because he had no preexisting relationship with the drowning person. The bystander would not be liable for the drowning even if a rescue would have posed no risk to him.
      However, if the victim is drowning in a public pool and the bystander is a lifeguard employed by the city, and if the lifeguard does not act to help, she may be held liable for the drowning because the lifeguard’s employment places her in a relationship with swimmers in the pool. Because of this relationship, the lifeguard owes a duty to take affirmative steps to prevent harm to the swimmers.
      Courts have found a preexisting relationship and a duty to act in various relationships, such as the relationship between husband and wife, innkeeper and guest, employer and employee, jailer and prisoner, carrier and passenger, parent and child, school and pupil, and host and guest. A person who renders aid or protection to a stranger also may be found liable if the rescuer does not act reasonably and leaves the stranger in a more dangerous position, even if the rescuer had nothing to do with the initial cause of the stranger’s dilemma.

      Absent a preexisting relationship, you can’t be held liable for not helping, but you can be held liable if you help and you do it wrong.

      • BK says:

        you’re ignoring the good samaritan laws which state in essence that you can’t be held liable for helping someone in good faith or through rational actions.

      • WhiteCoat says:

        You can be held liable under Good Samaritan statutes if you make someone’s condition worse.
        Look up the statutes. Here’s one site describing the concept. I don’t think any Good Samaritan statutes make grossly negligent actions immune from liability. Some require there to be an “imminent emergency” before immunity applies.

        If someone is in a car accident and you move them from the car, causing their unstable neck fracture to paralyze them, you may be liable for the injuries.
        If you move someone’s broken arm and cause a piece of bone to poke through the skin, you may be liable.
        If you pull a knife out of someone’s chest and they bleed to death, you may be liable.

        Of course, when do all those determinations get to be made?
        After the fact sitting in a courtroom with people having had months and years to analyze the decisions the Good Samaritan had to make in an instant.

      • ERP says:

        Maybe she did not code but even still, if they were in uniform on duty, but just on break, they should be mandated to help. That is what they signed up to do, render help in emergencies! And if a nurse is sitting at the computer on break when someone collapses in front of her, she should also be mandated to help.
        This does not apply when they are TOTALLY off duty. They SHOULD help but not be mandated in that case.

      • BK says:

        “If someone is in a car accident and you move them from the car, causing their unstable neck fracture to paralyze them, you may be liable for the injuries.”

        this was actually brought up in one of my classes and there was a case on it that i have long since forgotten the name of.

        they lost because this is a reasonable action to take. reasonableness is typically construed broadly and if you have a reason to believe that another car might hit the first, or have difficulty maintaining an airway, or smell gas or see smoke or any number of other entirely reasonable reasons then you have a good faith defense and are not held liable.

        “Statutes typically don’t exempt a good samaritan who acts in a willful and wanton or reckless manner in providing the care, advice, or assistance”

        you should have read this sentence in your own link.

        moving someone arm in an attempt to relieve pain does not live up to “willfil and wanton or reckless” behavior and would be protected. trying to stop someone’s bleeding by shooting them would fail the test and the person would be held liable.

      • WhiteCoat says:

        “moving someone’s arm in an attempt to relieve pain does not live up to “willful and wanton or reckless” behavior and would be protected.”

        That determination isn’t made by the authors of the article.
        The determination is made by a jury.
        If an attorney can convince the jurors that there was no good reason to move the arm and that it was “obvious” to anyone that [insert bad outcome here] would have occurred if the arm was moved, then there could be liability for doing so.

      • BK says:

        show me a case where that has happened despite the numerous cases i’ve seen to the contrary and then i’ll believe you.

        1) you have to find a lawyer willing to take the case.
        2) the case has to get to trial.
        3) the plaintiff has to somehow get around the fact that he consented to the defendant’s help. if the plaintiff is not conscious then a) he has other injuries which would increase the reasonableness of moving his arm and b) implied consent opens an additional can of worms
        4) a jury is made up of normal regular people just like the defendant.
        5) a jury of normal people would have to conclude that an action most of them would likely take in the first place is unreasonable.

        i know you and many other people on this site wet their pants at the mere hint of a lawsuit but the likelihood of the above happening is ridiculously small.

      • throckmorton says:

        BK

        Here is the famous case in California.

        http://articles.latimes.com/2008/dec/19/local/me-good-samaritan19

        Please note this was also upheld by their Supreme Court

      • WhiteCoat says:

        I just peed.

  2. Don Miller says:

    It depends on who they worked for and how they were paid.

    To control overtime costs, some ambulance districts have been forcing EMT’s to go off the clock for meal breaks and such.

    If they help, they go back on the clock, then the supervisor suspends them for violating the overtime rules.

    Another possibility is that the district may have a policy that the EMT’s can’t respond to an emergency if it hasn’t gone through the 911 system. Can’t allow freelancing you know, it isn’t NIMS or ICS compliant.

    Based on this article, I can’t tell what was going through their head.

    My district does 24hr shifts and just sucks up the 8hrs of overtime per person into their budget as part of the normal expense.

    If we witness an event, we can radio dispatch and tell them about it, and that they need to start a run sheet for us.

  3. hashmd says:

    And of course there is always the liability issue. If they were off duty (like on the way home after work) is their liability carrier going to cover them? Likely not. Would they be covered under good Samaritan laws? Likely not if they were in their uniforms. They would be held to the higher standard of their profession if a negative outcome occurred.

    If they were on duty, but not in their service area, they would face disciplinary action for being unavailable while on duty.

    So they get 3 negative choices and one positive choice. If they had already been disciplined before, they may have responded in the only knee-jerk way they had been taught: get the hell out of there because they don’t want to lose their job by helping out.

    It doesn’t cover their moral obligation, but explains their rationale.

  4. BK says:

    when i trained to be an EMT, we were taught that it was legally mandated to help if you are in uniform. (this was in CA). the rationale being that if someone comes along and sees uniformed emergency personnel in the area of someone who is injured they aren’t going to offer assistance or call 911. this makes intuitive sense…how many people call 911 after the fire department has arrived? or after the police have captured the thief?

    if they were in uniform and they refused to help then they absolutely should be punished. if they were not in uniform then they ethically/morally compelled to help (provided that it does not put them in harms way), but it is not required and they should not be punished. they do however deserves the criticism they’ll get as the pricks they are.

    “If the EMTs were on duty, there are certain procedures they must follow. We don’t know if they were called out to another emergency.”
    1) company procedure does not override their legal responsibilities.
    2) if they were in a donut shop dilly dallying despite having been called out to another emergency then they absolutely should be punished.
    3) if in the extremely unlikely coincidence that the guy passed out and they were called to another emergency at exactly the same time, it is my understanding that they respond to the one that occurs in front of them. all EMT companies have procedures in place to handle EMT witnessed emergencies (they have a specific name for it that i can’t remember right now). in that case the EMTs report that they are already at the scene of an accident and the company sends another ambulance out to the other emergency.

  5. WC, gotta say you might be overanalyzing this. Spike Lee..Do The Right Thing. Compensation or not, mandated or not. Decent people, EMT or plain folk, offer assistance in emergencies. Period. If they were on duty, treat. Off duty no equipment available but they could assess and wait while 911 came. Doesn’t seem complicated to me.

    • WhiteCoat says:

      Perhaps overanalysis, but the general point is an important one and the willingness for people to use the retrospectoscope is dangerous. Anyone can take a bad outcome, look back retrospectively, and say what “should” have been done to avert the bad outcome. This is how plaintiff attorneys make their millions and makes for great discussions on Monday morning between all the football fans whose teams lost the day before.

      I’m asking everyone to look at things prospectively. What prospective moral rule do we create so that things like this don’t occur again? Should everyone be legally liable if they don’t “Do The Right Thing”?

      Should everyone who walks by the guy begging on the street without giving him food be subject to liability for his starvation death? After all, everyone knows that a decent person would offer assistance in that emergency.

      • Dangerous to travel down the moral rule road.A pregnant woman collapsing does not equal someone begging for food unless they’re cachexic and near death. I don’t think these guys were worried about liability..they just seemed not to care. And there’s the rub. Who knows if intervention would have saved these lives except for the all knowing soon to be plaintiff’s lawyer (I’m sure they’re lining up as I type to take this one on) But don’t lose sight of the bigger picture..they made a choice to walk away and even if NO negative outcome had occurred, it just seems to violate a common tenet of human decency. Perhaps this just falls under practice random acts of kindness and we’ll leave the prospective moral rule out of it.

      • Max Kennerly says:

        The prospective rule in most jurisdictions would be pretty easy to establish.

        Consider the old yarn about the police officer in uniform on his way to work who causes a car accident. A good number of jurisdictions will cloak the police officer in the doctrine of governmental immunity and hold them free and clear of any liability.

        What’s good for the goose is good for the gander. In jurisdictions where first responders in uniform get special protection, they should be subject to the duties of the job at those same times.

        Off-the-job, out-of-uniform is a bit harder to determine but, well, what’s so hard about going to check a pulse? About sticking around and offering modest assistance until the on-duty EMTs arrive?

        What about being the ones to call 911 and explaining the situation and offering a professional analysis/report of what they’re observing?

        Is that really so hard? Would it be “unreasonable” to say that an EMT who personally witnesses a developing emergency should call 911 and give their assessment of the situation?

        Nobody’s saying the EMTs should have whipped out the cutlery and started an emergency c-section. But in the time it took them to be smartasses and tell the manager to call 911, they could have checked out the person and called 911 themselves.

  6. Finn Haddie says:

    The EMTs in question
    a) appear to have been on break, not off duty, and
    b) according to the FDNY spokesman, have sworn an oath “to assist others whenever they’re in need of emergency medical care.”

    So they definitely deserve to be punished.

    This does not mean all medical or other professional personnel are required to provide their services without compensation whenever they’re needed; it does mean that they’re required to fulfill the obligations of their jobs when they’re at work, and to uphold any oath they’ve taken.

    • WhiteCoat says:

      “they’re required to fulfill the obligations of their jobs when they’re at work, and to uphold any oath they’ve taken.”

      Agree 100%

  7. Leslie says:

    Not just “someone who collapsed” but a pregnant woman…she and her baby both died. Two lives lost.

    That is NOT in the same category as taxis giving free rides during an emergency, unless of course death is imminent. Certainly a wealthy mayor not contributing to people in financial stress is not an emergency. No that is comparing apples to oranges. A better comparison would be this: suppose a child were drowning and a life guard was on the shore, but chose not to help because he was off duty and the child subsequently died.

    If you were the person who paid that life guard, would you keep THAT sort of a person on your payroll? I wouldn’t.

    If you have an emergency, would you want those two attending to you? If it were my choice both those EMT’s would be fired. They need to find a different field to work in…might I suggest the world needs more garbage collectors.

    • WhiteCoat says:

      If the taxi driver didn’t stop and it was an emergency, then should the taxi driver be liable?
      If someone starved because they couldn’t afford food or died because they couldn’t afford necessary medications then is the mayor liable?
      What if the sea shore was filled with bystanders who knew how to swim, but didn’t help the drowning child? Are all of them liable for the child’s death for not offering to help?

      Again, what is the *prospective* rule that we should use to determine liability for failing to help someone?

      In other words, complete this sentence:
      “Every person in the United States should be legally liable for failing to help someone else when ___________________________.”

      • You’re liable if that’s your job and you’re at work. They were on break not off duty. I’ll finish the sentence…you are an emergency responder and are at work. Paid for by the publix taxes no less. Job suspension would happen to anybody in this field or any other related field who chose to do this…. you and me included.
        Love you WC and you’re usually spot on but this…not so sure.

  8. A Random Person says:

    I think this is a sticky situation. Had this happened, and the patient had been fine and the outcome good, I imagine that the outrage wouldn’t have gone beyond the people who had asked for help and not gotten it.

    But because there’s a bad outcome, there is need for “justice”, and it’s easy for people to, on reading the article, think that perhaps if the EMTs had responded, the woman and her baby might still be alive (whether or not that is accurate or even feasible is obviously unknown).

    I don’t necessarily think it’s “fair” that the EMTs were suspended, but I have to say, given the circumstances, I’m not sure if socially, there is anything else the mayor could have done, once this got to the point of being media worthy.

  9. AR says:

    When I did first aid/CPR training as a ‘health care professional’ (first as a pharmacy technician, then as a pharmacy student) in California, we were taught that now that we were certified, we were “legally obligated” to help if we came across someone needing it. If you’re out to dinner and some guy is choking, you help; if you’re driving down the freeway and there’s an accident and no responders yet on scene, you help. We were, however, also taught that “help” could be just calling 911, or taking the role of lead until someone more qualified shows up (e.g., “you, call 911, you, find a first aid kit, you, do CPR” etc). We just kind of accepted this responsibility and moved on, but I have always wondered how much responsibility this really entails.

    I’m sure things must be a little bit different for an EMT, a health care professional who specializes in emergency medicine, than other health care professionals like pharmacists or any sort of technician who is trained in first aid but by no means an expert. I’m covered by the Good Samaritan law so long as I act within my training – I’d guess the EMTs have a different set of rules.

    But I’m not sure you can do the sentence “Every person in the United States should..” As health care professionals, we’ve set ourselves separate from “every person,” haven’t we?

    Definitely interested in the outcome of this.

  10. A Random Person says:

    Sorry for the multiple posts. I thought of more!

    I think too, we have different standards when we consider our medical personnel (sorry, guys!) I mean, if someone knew CPR and refused to help someone, they might be socially stigmatized, but if someone in an EMT uniform did not help without explanation and there is a bad out come – that EMT is representing their profession while in that uniform and what’s more, they’re representing the city and the government.

    Maybe a good comparison would be a police officer on break, who does not respond to shots heard and instead tells them to call 911. In the time it takes, someone is injured, killed or kidnapped or (insert bad thing here).

    EMTs, police officers, etc, have a social and public role in society, and when they’re in that uniform, right or wrong, they are immediately identified as that role. Therefore, failure to fulfill that role, with a bad outcome (which I still think is a major factor) is going to result in public outcry, not just toward them, but to the entire role, and to those who hire these people in that role.

    Unfortunately, I think that once you’re in the uniform, you, and the government who has hired you will be considered liable simply because of social expectations.

  11. Painless says:

    I don’t know WC. I seem to recall hearing something about “duty to act” when I was a medic. I’m pretty sure that in some states you can be prosecuted if you are medical personnel and you don’t stop and offer help at the scene of an emergency (I know, hard to prove.. but). Yes, you should be covered under good Samaritan act unless you are charging for your services – and as long as you aren’t negligent there shouldn’t be any issues. I think the EMT’s in this case were wrong. They had a duty to act in this situation. Just like I would have had a duty to act as a nurse if I had been there. Certainly – have someone call 911 and once the ambulance staff transfer care to them – but – I think the duty to act really was there. Who knows – if they had simply done nothing more than maintain an airway the woman and her baby might be alive today. They were in the wrong. They should be held accountable and liable for their non action. Where’s Matt when you need him? This would be one case I don’t think I would argue against prosecuting criminally and civilly.

  12. Katherine says:

    I agree with the “if you are in the uniform of one of the emergency services, you are legally expected to do what you would usually do in an emergency when in that uniform, even if on break”. Not in uniform means you are governed by the laws that cover the general public.

    Morally I’m disgusted that they did nothing, but then if you had to help everyone that might be in serious distress no-one would ever get anything else done. I hear yelling and screaming from my apartment all the time. I have no idea if it’s just verbal, or some kids having a good time, or someone that is being abused. Do I call the cops? No. I ignore it, because I figure it isn’t serious most of the time, and because I can’t tell the difference, I figure I should take the same action every time. I would expect emergency personnel would be able to tell pretty quickly whether someone that collapsed was in serious danger or not after a quick check though.

    • BK says:

      “Not in uniform means you are governed by the laws that cover the general public. ”

      this is not quite true for the most part. many states require that you act in accordance to your training. and EMT would be held to a higher standard as joe blow, a paramedic would be held to a higher standard and a physician held to yet a higher standard of care.

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  14. caz says:

    It is Ok for a technician to refuse, I don´t agree but since they are technicians they just react practically, they don´t really understand ( and they are not intended to do so) what they are doing. unfortunately, it is necessary step in the US health system. In europe prehospital care is done by doctors and you will probably not find a situation like this . doctors have a commitment they have taken o the first day they become MDs and then they cannot refuse to provide medical help.
    To me it is clear. Us prehospital care should not be run by EMT you have enough doctors to take care of it providing a safer and higher quality care as it is done in europe. What you face now is a consequence of having the second choice professional for this job…
    check SAMU in france and you may understand what this means…

  15. Ted says:

    This can get a little complicated. In the city where I work, EMTs accept a duty to act while on the clock as part of the requirements of local certification. That said, EMTs who aren’t locally certified are technically forbidden from responding to emergencies (in practice, this is waived for true emergencies and “Good Sam” situations).

    Speaking of Good Samaritan laws, I have been assured by a lawyer friend that most Good Sam statutes have loopholes in them big enough to drive a truck through. It may be unwise to rely on them for legal protection.

    None of this seems to apply in this situation, as the EMTs in question were apparently in their jurisdiction. The fact that they were identifiable indicates that they were in full uniform including nametags, or (more likely-those nametags can be hard to read) in a marked vehicle with a unit number. All of this implies “on duty”, which clearly mandates a duty to act. If no prearranged duty to act exists, then legally the potential responder cannot be held liable. It is unreasonable to insist that off-duty EMTs respond under all conditions as this requires EMTs to maintain a constant state of readiness (not feasible) or to respond in suboptimal readiness (do you really want a drunk Paramedic trying to intubate your loved ones?).

    The fact that the patient had a bad outcome is lamentable. As previously mentioned, if the EMTs had not acted and the patient had turned out to be fine, we probably wouldn’t be bothering to talk about this. Should the EMTs be more liable because the victim did poorly? Yes, because otherwise the door is opened for frivolous lawsuits against anyone who doesn’t act in a potential emergency (yes I’m fine after my car wreck, but I’m going to sue everyone who drove past me on the interstate).

    If the victim has a bad outcome, but it isn’t due to the EMTs failure to act, should they still be liable? No, because that limits the capacity for turnover of care (if the patient died because of an error in the hospital, it is unreasonable to hold the EMTs liable for that error).

    In short, “Every person in the United States should be legally liable for failing to help someone else when”: 1) a duty to act exists and is not fulfilled; 2) there is a bad outcome; 3) the bad outcome is DIRECTLY RELATED to the failure to act.

    Remember that there is a difference between moral and legal obligations. The off-duty nurse who sees me choking on my dinner at a restaurant has a moral obligation to help me. I do not wish to live in a place where s/he has a legal duty to do so.

  16. Anonymous says:

    In uniform or out of uniform, if you can provide some assistance, you should do so. Simply saying “call 911″ and walking out when you could at the minimum help assess the situation better than an average joe is irresponsible towards your career (aka find another one) and your humanity.

  17. NYEMT says:

    I can say for certain that if they were in uniform and on the clock (even if on break), that they are legally obligated to render aid unless already responding to another emergency. Also, if they were off duty, but in uniform, I seem to remember there being no legal duty to act, except maybe to call 911. That said, from a moral perspective, I believe they should be punished if they had the capability to render some aid (even if that means a physical exam, almost every EMT I know carries a stethoscope, gloves, and pen light on their person when in uniform, even if off-duty). And, considering the outcome was death, it seems likely CPR could have been done.

    Every EMT I’ve spoken to about this is apalled and it has already given us a bad name. I already had a nurse ask me if I “was on break” today, thinking she had told a hilarious joke, as if joking about someone death and the circumstances surrounding it is funny or appropriate. I hope their licenses are revoked.

  18. Nurse K says:

    McDreamy, you’re going a bit crayzee here. They are suspended without pay pending an investigation, which, I presume is allowable under their union contract. No one is saying they’re “liable” for anything.

    I’m guessing the theory is more behavior unbecoming a firefighter/EMT rather than failure to help. When you’re in your EMT uniform, and refuse to help a person obviously in need who’d collapsed while you’re in the same room/restaurant with them, you’re just making your employer and yourselves look really bad. It could just be that they didn’t think it was anything serious and could be handled through the usual channels by calling 9-1-1, especially if it was a young person.

    I once witnessed an elderly person trip and fall in the parking ramp on the way in to work. I helped her up and offered to go get her a wheelchair and bring her to the ER with me. She said that wasn’t necessary, that she felt fine and wasn’t injured, and would walk into her clinic like she’d planned. I wasn’t on the clock or anything, and this actually made me late to work, but it would just LOOK BAD if I just walked right by her, ya know? I could have theoretically been dinged on violating one of the organizational values if I didn’t offer to help since at that time, while not clocked in, I was clearly representing the organization with my scrubs and name badge like the firefighters were.

  19. just add fuel to this fire they were both dispatchers who had little field experience…still think the tenet of decent behavior holds water though.

  20. sleepyjosh says:

    A few more details to the story. The coffee shop in which this whole incident took place is actually in the same building as the FDNY Headquarters/call center.

    There are a few other (later) parts to the story that also make things look bad (e.g. the first responding ambulance EMTs leaving some equipment in the ambulance etc)

    On a moral level–I think that the EMTs should’ve done something more than say “call 911″ [and walk away]. That’s just my opinion.

    As for the legal said of things–I’m leaving that to the lawyers…

    • Don Miller says:

      Interesting that the coffee shop was in the FDNY headquarters.

      That leaves open the possibility that these EMTs weren’t there with an ambulance but maybe at HQ for some administrative function or training.

      They should have still taken charge of the scene and provided first aid, and helped the guys with the ambulance when it arrived.

      Has anyone mentioned what station they worked out of? Maybe they were no longer working as EMT’s but were assigned to HQ as staff.

      Sorry, still trying to figure out what was going through their heads. I am sure they thought they were making a rational decision.

      • Don Miller says:

        Just found the answer to my own question.

        According the AP, these two worked at HQ as emergency service dispatchers.

        It does say they are qualified EMTs, but that isn’t the same as working with patients day in and day out. No mention of how long it had been since they worked in field.

        They may have felt removed enough from the EMT experience that the duty to act didn’t cross their mind.

        If their jackets had said “Dispatcher” on it, instead of “EMT”, I think the family wouldn’t be so upset. But then, I have a low opinion of the quality of dispatchers in my area, so I am a little biased.

  21. SeaSpray says:

    *Why* DID they do that and not help in any way? Evidently their reasoning wasn’t good enough for the mayor.

    If they didn’t have much field experience, I can appreciate why they requested 911 be called… and is a good idea.

    But to walk away? Especially when a pregnant woman and both mother and baby at may be at risk?

    I don’t understand how anyone could turn their back on someone in need of help like that.

    This is a good ethics question.

    It would seem that *more* is expected of those in the medical field. I would extend it to emergency services as well (fire/police)

    I still come back to the WHY of their actions. Could there have been a justifiable reason that will later come out?

    Just because someone is suspended without pay from their job does NOT guarantee the suspended person is guilty of a violation.

    And just because the newspaper or any other media source report the situation does NOT mean the reported facts are accurate/true and not trumped up to sensationalize to get more readership.

    And just because the mayor comes out against them ..does not mean he isn’t concerned for other reasons… and yet ..he may very well be sincere.

    Hopefully… the truthful facts will come out in arbitration and/or court.

    I am not saying they were right.. not at all. Just saying we may not have all the facts.

    I don’t think you should force anyone to do anything like that. But if that medical person is the only thing between that person on the side of the road and death..I would *hope* they would opt to try to save a life…but they should NOT then be sued if things go south.

    WC,you said “Should we suspend people from their jobs for failing to do what is morally correct?”

    I think it depends on the individual situations ..again determined by the facts. You can’t say that across the board because in some cases there may be gray areas and other cases black and white.

    You can have guidelines but there could be extenuating circumstances.

  22. Katy says:

    In uniform? Wrong. If a cop on their way home witnessed a crime, they couldn’t walk straight past it while in uniform. Out of uniform, it’s as much their responsibility as anyone elses in the room.

  23. Social comments and analytics for this post…

    This post was mentioned on Twitter by rlbates: From WhiteCoat’s Call Room: Mandating medical care? http://bit.ly/6fyZxE

  24. Don Salva says:

    I’m sorry, but you can’t compare this to “off duty attorneys to provide free legal services in an emergency” or “forcing billionaire mayors to give money to people in financial emergencies”.

    Both of those are not potentially life threatening. So yes, EMTs should be forced to provide emergency medical care on spot, IF(!!) they aren’t being called to another emergency right this moment.

    Yes, taxi drivers should be forced to provide a free ride to the nearest emergency department IF that means the sick person can potentially be saved. Even said person dies, at least the taxi driver tried.

    • Ted says:

      This opens up a big can of worms. Cab drivers can’t realistically be expected to determine whether anyone who asks for medical care really needs it. So, if cab drivers have to take anyone in a life-threatening situation to the hospital, cab rides to the hospital are ALL now free. If you don’t think something like this is open to abuse, ask your local EMTS.

      • Don Salva says:

        No, I meant it more like other people see somebody in dire need of transportation to an emergency department and waving a taxi. This taxi and its drivers should be obligated to comply and transport the sick person to the nearest ED.

  25. gene saltzberg says:

    In uniform = on duty, therefore a legal and moral obligation to help. Sadly, she probably had a life rthreatening event that would not have responded to ALS measures (PE, Amniotic Fluid embolism, spleenic artery aneurysm rupture), but because they didn’t try they failed her and the reputation of the badge they wear!!

  26. Terry G says:

    If employees are to be terminated for not doing what is morally correct, then the U.S. Congress would no longer have 60 Democrat Senators, nor about 240 Democrat Representatives.

  27. jatmon997tt says:

    This is a very interesting discussion about pre-hospital care. However, it’s unfortunate that it involves a person asking for help, then collapses and dies, while trained professionals decide not to help.

    All EMTs have training in BLS (some even have ACLS and other critical care training). Two therapies pre-hospital that have been shown to help survival in cardiopulmonary arrest are rapid defibrillation/cardioversion, and effective (and un-interrupted) closed chest compressions. That is why use of the automated defibrillator (AED) and effective chest compressions (pediatric and adult) are covered so extensively in BLS classes.

    At a minimum, if you are trained in BLS, if someone collapses you have to assume they could be in pulseless arrest and evaluate/respond IMMEDIATELY. This is because even without any equipment (ie the AED), closed chest compressions and ventilation (ie BLS)can be initiated while “someone calls 911,” and you could SAVE THEIR LIFE (which is why I hope they chose EMT as their career). I’m not sure what the moral/legal obligations are (and that’s what makes the debate interesting). But as healthcare providers (whether your “on duty” or not), it was a bad MEDICAL decision on their part. Why they chose to make it, is what intrigues me the most….

  28. Jack A.H. says:

    What would we be discussing if the medics reached out and helped, did all they could, and the patient died anyway due to some catastrophic event? Medics, RNs and Physicians are held to higher medical standards by the legal system and public at large. You can be sure a lawsuit would follow, and plaintiff would most likely win.

    I carry no malpractice insurance since I am retired. I am very reluctant to stop and help anyone in medical need, so that I do not loose everything I worked for my entire life. Having said that, I did save the life of my neighbor across the street last Xmas when she coded (V.fib) at home; even without malpractice insurance, and her husband is an attorney. Sometimes I wonder what would have happened if she did not survive…..

    Fully agree with comment 26 above!!!

  29. Mysticheadlice says:

    Oh, so ALL Democratic politicians are immoral?? Now there is a well thought out position worthy of an intelligent discussion.
    Well, of course you do something if someone collapses in front of you. You do what you can based on your knowledge and experience while someone calls 911. When the cavalry arrives they take over and you go your merry way. Yeah, you can think of all sorts of hypothetical situations where you would choose not to intervene, but when it actually happens, if you aren’t a dermatologist or something, you do what you can. You don’t have to identify yourself as an expert, you just do what a bystander can do. Why do you think they have placed all those AED’s everywhere, so ONLY laymen will use them while the experts stand or walk by? If these EMT’s were off duty or out of district, then they do what they can (which ain’t much if you are an EMT) and wait for the paramedics to arrive, OR maybe they pick this lady up and take her to the nearest hospital, but you don’t ignore her.
    If you don’t automatically go into action when someone goes down and needs CPR or an airway, then there is something wrong with you.

  30. hawk says:

    as a MD, I WILL NOT stop and help. anybody. anytime. the legal consequences of helping are just too high. the risks are too great. my malpractice does not cover me if I am not at work, and good sam laws are full of loopholes, as the recent california rulings show. if it dont have an established duty of care, I just walk on by. Sorry, but my life, my possessions and the health and well being of my family take much higher priority than random acts of kindness and care.

    You may think this is cruel and brutal, but it is what it is, and given the liability and attorneys in this country, you have to take their ideas into account

    • Don Salva says:

      It’s not cruel, not by a long shot. It’s egoistical and understandably. But then again, you should not be a doctor in my opinion. It’s time for you to look for another profession OR look for a country more suitable for you to practice your profession to the fullest extend without fear of prosecution.

      I do understand the US justice system is a joke, I really do.

  31. Mysticheadlice says:

    To Hawk reply #30
    As far as I am concerned, you should turn in your license. I have been practicing ER medicine for over 30 years, and have had the occasion to administer aid in airports, on baseball fields, on soccer fields, on an airplane, and even in a court room once. I did what I had been trained to do, and have never regretted it, and would do it again. Every single time, regardless of outcome, I have felt good about what I did, and gotten a rush that I rarely get working in the ER.
    In the ER, almost everyone who answers the phone when someone calls with a question says, “All I can tell you is dial 911″ I don’t (Yes, I actually answer the phone when it rings and I am the closest one to it). I do my best to answer the question. People say, “Hey, we aren’t supposed to give out advice on the phone.” My answer, “No, we aren’t supposed to give out BAD advice on the phone.” There are risks in everything we do, but that is what I signed up for when I took my Hippocratic oath.

    • hawk says:

      Don and Mystic

      I thought I would get a couple of comments like this. I understand what you are saying, but I have known people who have been sued for rendering aid in an emergency, successfully, I might add. If you look at your malpractice, you will see that it likely does not cover you outside of work, and likely not outside of a shift.

      If you want to risk everything by rushing to aid somebody, be my guest, but dont judge me based on my desire to not be sued. If you have been in er for 30 years, your practice probably predates residency training, and even in residency we were told not to stop and aid, for the legal reasons more than anything else.

      On another note, what if you do stop and give aid, no protective measure, get hep C or AIDS. you are SOL in that case, as disability wont cover you for an injury or condition not sustained at work.

      My hope is that one day, we will move past the legal system in this country, to the point where somebody who is highly trained, and who does care (and believe me I do care) is aboe to give care when needed, in whatever circumstance, without the fear of jackpot jury lawsuits. It probably wont be in my lifetime.

  32. Val Kvool says:

    There are several simple things that should have been initiated in this case. First, a basic education standard in all EMT curriculums entails the 1974 “Duty to Act” law. You’re on duty, in service, come upon an emergency, scene safe, YOU ACT! Secondly, standard in the EMS industry, when you are in service and availbale and witness an emergency, you initiate what is called “self dispatch” and request for additional aid if needed while you attempt to stabilize. Knowing that these 2 EMT’s were dispatchers is even more concerning in that they for sure have had medic units call into them before and self dispatch upon witnessing a medical event before anyone called 911. As a veteran EMS provider, educator and manager, this case should be exrcised to the maximum allowable compensation, restitution and termination from employment. This case meets all 4 criteria for negligence; Duty to act, Breech of duty, results of further harm, standards neglected.

  33. G.K. Derebail says:

    Morally those two EMTs should have rendered help irrespective of what they were doing. Suspending them for inaction, if they are not one duty is going beyond the call of duty on Mayoral Part. In this country when legislators are condoning immorality and legislating as it is the right of the individual to pursue his action, like homosexuality, who are they to judge the morality of the EMT’s?

  34. gene s says:

    I’ve been in the ER x30 yrs. I have never heard of an EMT/ Paramedic being sued for initiating care in a cardiac arrest when either on or off duty. Maybe I am naive, but it’s their job.

  35. Francesca says:

    At first when viewed this article on EPMonthly, woman’s condition was not clear. Now the pregnant woman is dead. I initially thought to give EMT’s benefit of doubt and cut them some slack if they were on break. Then I saw that they were not en route to another call. These two EMT’s are a bit too desensitized for my taste. Most EMT’s and or others with similar skills in New York, would have at least called in the call and or provided BLS support until transfer of care. I’m certain FDNY would have not given them a bad rap for interrupting their donut break protocol if they were not presently engaged in another emergency. It’s called clocking in overtime overtime or getting another breaky… While we all agree some “emergency calls” are downright ridiculous and should have right to refuse stat care , what these two did does not qualify as such. If I had their crap attitude I’d deserve to be kicked to the curb. If you can’t take the stress of providing United States Health Care then get the hell out of the “business”. On a moral level, yes I do believe any compassionate Health Care provider have the duty to at least try to help. It’s a sad day when any person, none the less a Health Care provider doesn’t have the time to at least dial 911, do the basics within their scope while waiting as little as five minutes for the bus to arrive.

    I don’t know where this White Coat Doc hails from but with sympathy lying in favor of these two clown EMT’s I’ll be happy if never to need his care in an emergency situation. Pity…

    As a native New Yorker I’m saddened to see such press as I know there are many who would have made a better judgment call. Here’s one recent FDNY EMT Off-Duty and Off-Donut Break who did the right thing and saved a man’s life. No he didn’t have to do anything “just because” but he did.

    http://bit.ly/6yrRrz

    Thank God for those who do have some compassion and moral backbone.

    • AFellowWhoCanRead says:

      It is interesting to see how many people who are projecting upon WhiteCoat that which he specifically disavowed within his post. He says lay aside the moral arguments about what they should have done, is it OK to legally mandate and punish them for what they did. Half the posts argue exactly what he said the post was not about it. The most recent one above is siply one of the most egregious examples.

      • Francesca says:

        Dear “AfellowWhoCanRead”: You make a nice defense team member for Sir Whitecoat. Perhaps I and all others who have derived alternate understanding of Whitecoat’s post not know how to read! Please educate me by example of where exactly is specified Whitecoat’s post states morality in pre-hospital care protocol be spared the legal axe? Perhaps I have indeed projected that I would have hoped an intelligent Emergency Physician such as Sir Whitecoat, would think deeper before posing such a question. The fact that you state: “It is interesting to see how many people who are projecting upon WhiteCoat that which he specifically disavowed within his post.” might suggest that majority reaction is all dumb? I personally believe morals and integrity should not be put aside when it comes to legally mandating disciplinary action on this matter or many others. The fact is this case is based on deficit of moral substance of two EMT’s who did not react as many would have. Maybe I’m nuts but don’t all infractions like these have some foundation which can not set morals aside? I gather one would not have effect without the other. Oh well…just another crazy New Yorker talking so try not get your knickers all tied up in a twist! I talk straight and if someone disagrees, it’s OK. If they do agree that’s OK too! Pity really for Whitecoat or any other professional to have a public blog with comment section needing moderation for damage control on every move if they were unable to handle some back slap talk. Perhaps if Sir Whitecoat thinks I and others who have commented negatively are dumbos he might like to explain position himself. If my reaction is egregious, as you say it is, you “AfellowWhoCanRead”, defense team member of Sir Whitecoat, might submit claim for comment(s) to be removed by Comment Board of Directors. Apologize if have offended which was not my intention. I shoot straight from the hip, with little if any political correctness. Before lambasting my comments please take into consideration that I lack formal education, write run on sentences and dumb as nails. Hope knowing latter might get me some sympathy from a smart “AFellowWhoCanRead” like yourself. It’s Christmas and I wish all who celebrate a merry one.

        PS… I’ve written a nice comment before on Whitecoat’s so please know I’m not for or against any particular blog or person!

  36. alex21 says:

    I dug out an old article giving a good bird’s eye view of the law and its practice.
    The Good Samaritan- by Dr. Leonard Berlin
    http://www.ajronline.org/cgi/content/full/177/3/529

    • Francesca says:

      alex21 says:
      December 24, 2009 at 11:22 pm

      I dug out an old article giving a good bird’s eye view of the law and its practice.
      The Good Samaritan- by Dr. Leonard Berlin

      http://www.ajronline.org/cgi/content/full/177/3/529 Wouldn’t be a problem if it is old as much as it is subjective in favor of removing all moral and legal implications to coincide. Clearly this is a matter that Doctors and lay people will most likely never agree. It’s sad that a Doctor even if wanted to render “good samaritan” aid needs to first worry about getting sued. Pity.

  37. Silence Dogood says:

    Can a government mandate certain behavior from its citizens and punish them if they do not conform to the law? Yes and no.
    Forcing us to wear seat belts is a no brainer to most of us but there is a subset of the population who sees this as an infringement of their rights. Forcing us to wear clothes when in public is a good idea for most of us, however some people think that this should be their decision to make.
    Now, if the government passed an edict that said that all unmarried women who get pregnant will be forced to have abortions…………..now, would the government be right in this case. We tried legislating morality with constitutional prohibitions to the manufacture and consumption of alcohol……and we all know what happened to that bit of social engineering.
    So, my point is this……in some cases, government mandates for citizen actions is a good thing; for other government mandates, not so good. Forcing a doctor or a nurse or an EMT to act in a situation when they are not “on duty” would be one of those times where the government may have over reached its power. We can but hope that for the majority, the morality of their action or inaction would be much more determinate than the threat of government sanctions.

  38. Fred Bollhoffer says:

    everyone talks about the morally right or wrong, the legally right or wrong.
    ever had to defend yourself in court and win?
    you will still pay your lawyer, the more you make the more that lawyer costs.
    and we aren’t reforming the judicial system,
    morally right is lost in this country ,

  39. With a limited scope of practice, and no equipment, it’s unlikely that the two EMT’s could have changed the outcome. But the APPEARANCE of indifference makes them an easy target for criticism.

    They, correctly, identified the need for a 9-1-1 response, perhaps in the face of their own inadequacies, but failed to provide BLS support. It may have made no difference, but they should have at least tried.

    We make attempts to “save” individuals sometimes simply for the sake of family knowing that our efforts are futile. They, at least, should have done the same for the sake of the family. The failure to show a compassionate response is a moral and ethical violation. They should be fired.

  40. one__speed says:

    It was mentioned above that the two employees were at a coffee shop in the heaadquarters building where they worked as dispatchers for the FDNY.

    So we have two people presumeably trained in first aid who may or may not actually be current in the skills needed to assess the patient.

    When asked for assistance they recommended that 911 be called so an active crew can be dispatched to the scene. (very appropriate in my opinion)

    We don’t know what the patients condition was or even if the assistance of two bystanders (sure, they were wearing uniforms) would have made any difference in the eventual outcome.

    And really, how often does a 25 year old pregnant female with a non viable fetus die prehosptial where the intervention of bystanders make any difference what so ever ?

    Ian

  41. TireDoc says:

    Here’s reality people. This whole thing is an unfortunate consequence of our society “having it’s cake and eating it too”. You can’t say to anyone person that because of their training/social stature/moral station they are obliged to enter into a situation where they may later be second-guessed or otherwise held liable for a then unforseen outcome and expect widespread compliance. It’s simply myopic and unrealistic. And to those who would serve as “expert witnesses” on this or other cases you are singularly uninformed on the facts because you were simply NOT THERE, so you couldn’t know the mental state of the EMT’s, you couldn’t know whether other medical professionals were present and did or did not get involved, and you couldn’t know the patient’s state of health at the time of the “collapse”. All you have is hearsay and third person accounts. There are simply too many variables for the opinions of “experts” or anyone else who feels they know what “should have” happened to apply to rational thinking persons. That being said, our unfortunate reality is that we practice in a self-destructive environment where we retrospectively blame, incriminate and punish those whose role is to assist society during the most dire circumstances of our lives, (when the outcome is less than “desirable”- people don’t often say much if the result is neutral or good). The whole silly process is adjudicated by those least equipt to do so impartially, fairly and accurately. With such a horrible chimera of failings in our system, it would be surprising NOT to have individuals who refuse to participate in circumstances which carry the greatest liability. Why are they still part of the “illness management” machine? Had they known things were this messed up they likely would not have entered the field in the first place. The “high minded” in our profession need to wake up and realize our health care system is coding and events such as this are merely a symptom!

  42. Steve Pitschka says:

    Wow! Legal medicine lives on.

  43. Doc99 says:

    “Judge not, that ye be not judged.”
    Matt 7:1

    “The police acted stupidly.”
    President Obama

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