Is There a Doctor in the House?

The desire to help patients in need drives many people to enter the medical profession—so it can be hard for a physician to ignore an emergency medical situation, even if it happens outside of a medical facility or if it requires specialized training the physician may not have. However, these “bystander care” situations can pose significant risk for physicians. Being aware of the risks and implementing plans to mitigate them are essential.

Worth the Risk?

Before stepping in to help, it’s important for physicians to carefully evaluate the scenario at hand and understand the difference between urgent and emergency medical situations. Physicians should only ever provide care outside of a medical facility, offer medical assistance to non-patients, or perform services outside of their scope of expertise during a true emergency when a person’s health or life is in serious jeopardy and treatment cannot be delayed.

Let’s look at a couple of real-world scenarios that would warrant emergency intervention, and two more that would be better handled in an office setting with the proper specialist.

Low-Liability Risk:

• Dr. Smith is a primary care physician whose pregnant patient came in with an ear infection. While he was taking her vital signs, she suddenly went into labor, requiring an emergency delivery. In this situation, not only was the doctor untrained in obstetrics, but the office itself was ill-equipped to handle an emergency delivery. Nonetheless, this patient needed immediate care to save her and her child’s lives, so the physician had the nurse call 9-1-1 and stepped in to help. He provided care to keep the patient as comfortable and safe as possible until emergency services could arrive, and immediately deferred to their expertise.
• Dr. Lee is a general surgeon who was travelling with her husband and two children to Hawaii for their annual vacation. During the 10-hour flight, a man suddenly began to choke just a few rows away, so she rushed to his aid to perform the Heimlich maneuver and dislodge the object stuck in his windpipe. Once complete, Dr. Lee provided minor assistance to alleviate his discomfort until the plane landed and emergency services could tend to his urgent needs.

Higher-Liability Risk:

• Dr. Martinez is an orthopedic surgeon who spends much of his free time playing on the local men’s soccer team. His friend and teammate had slipped on the field recently and was experiencing worsening back pain. Wanting to be helpful, Dr. Martinez checked the man’s mobility and assessed his pain on the field after practice on multiple occasions, and prescribed pain relievers to help ease his immediate pain and discomfort. When a rare, life-threatening infection was discovered to be the undiagnosed culprit of his chronic pain, Dr. Martinez faced legal consequences, having inadvertently established a physician/patient relationship while treating a non-emergency issue.
• Dr. Gupta is a pediatrician with a small private practice. While performing an annual checkup on one of her patients, the child’s grandmother exhibited symptoms of a heart attack and collapsed on the examination room floor. Dr. Gupta immediately began performing CPR. Witnessing this scene, a nearby nurse immediately called emergency services, who arrived on scene within minutes. However, with more than two decades of experience, Dr. Gupta was confident in her CPR skills and felt that she was better equipped to handle the situation than the young EMTs that arrived. She insisted that she would continue managing the patient’s resuscitation in an effort to save the woman’s life rather than defer to the specialized skills and judgement of the EMS team.

When to Let Go

When assisting in a true emergency, providers will be happy to know they should not be held to the same standard of care as would be expected of the appropriate specialist in a medical setting. However, knowing their limitations as well as understanding when to pass the torch is critical to mitigating liability risks. While it may go against natural instincts, physicians must recognize and accept the fact that they are not trained and/or equipped to handle every possible situation and should defer to emergency services upon their arrival to reduce the risk of a malpractice lawsuit.

“Good Samaritan” laws in all 50 states and the District of Columbia protect physicians and other healthcare providers from punitive repercussions resulting from unintended consequences of basic medical care during emergency situations. However, this protection extends only to situations that occur outside of medical settings and has no authority should something go awry within a practicing physician’s medical facility. For emergency situations both in and out of the hospital or office, there are a few steps that any physician should take to protect themselves.

Recommended Steps 

To limit the risk associated with emergency care, Curi recommends a few steps that all physicians should take in any emergency situation:

• Call 9-1-1: In an emergency scenario, the physician, or the physician’s staff, must always contact emergency services as soon as reasonably possible. When emergency services arrive, the physician should then step back and allow the team to provide care.
• Use Common Sense: In these situations, it’s expected that the assisting physician base all decisions on their basic understanding of the scenario at hand. While no one expects them to know everything, healthcare providers should certainly use common sense to navigate the event.
• Follow the Golden Rule: “Treat others the way you want to be treated.” Most people agree that they would hope to receive attention from a medical professional when in distress or emergency. With this in mind, physicians should embrace the opportunity to help whenever it’s needed, by calling 9-1-1 and providing basic care to make the individual comfortable until emergency services arrive and can take over.
• Keep Proper Documentation: If the individual being helped in the emergency situation is already a patient at the provider’s site of care, the attending physician should document the incident in the patient’s chart. If the person in question is a non-patient, the physician should document the event on an incident form or provide information to help populate an outside report. If the situation occurs in a public area, the physician should write down everything that happened while it is still fresh in his or her mind to ensure they are able to provide a complete and accurate account of what happened.
• Practice: Physicians should establish policies and perform regular drills to help staff develop a sense of when it is appropriate to call on the doctor for help or to immediately dial 9-1-1.

Moving forward, it’s important for medical practices to review policies with staff so they are aware of these protections and can feel confident in emergency situations. Empowering physicians and medical staff to use common sense in response to emergencies not only saves lives, but when done right, preserves their reputation and prevents undue legal consequences.

For further guidance, Curi members are encouraged to reach out to our Claims and Risk Management Departments at 800.662.7917.