Nurse Directories
Nursing Clinical Case of the Week

Good Samaritan Laws & Acts.
Do They Cover Nurses Volunteering Nursing Care
When A Citizen Goes Anaphylactic.
Boccasile v. Cajun Music Ltd. 694 A 2d 686 - RI (1997)

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Summary:  "Off-duty" healthcare professionals rendering
Emergency aid are in most cases "covered" by the Good
Samaritan Acts.  These are laws enacted in each state
that provide some degree of immunity from liability for
good faith efforts in giving emergency care.  In this
case, a nurse and physician were sued for providing
assistance in a volunteer function at a "first-aid" station.
Good Samaritan "immunity" was not recognized by the
courts.

A nurse, physician and several others volunteered to help
out with a first-aid station at a food festival being held locally.
 During the festivities one attendee would suffer an anaphylactic
attack.

The man had a known allergy to fish and helped himself to a
"gumbo" mix that contained the allergen.  He proceeded to experience
an anaphylactic allergic reaction.  The event "first aid squad" was
notified only of a "problem" and the person's location.

"Anaphylactic Shock

is the most severe form of allergy which is a medical emergency,
is a type I reaction in Gell And Coombs Classification .An often
severe and sometimes fatal systemic reaction in a susceptible
individual upon exposure to a specific antigen (as wasp venom
or penicillin) after previous sensitization that is characterized
especially by respiratory symptoms, fainting, itching, urticaria,
swelling of the throat or other mucous membranes and a sudden
decline in blood pressure."2

Of those present, all but a nurse remained at the station.  With the
physician and others on the way to assist the victim, clearly someone
had to stay at the station in case there were other emergencies.  The
question would arise of whether or not their actions were covered
under existing Good Samaritan Laws.  A key consideration is whether
or not a legal "duty to assist" the victim was created when the
responsibility to "volunteer" was accepted.

"Flynn v. United States, 681 F. Supp. 1500, 1506 (D. Utah 1988),
modified in part, 902 F.2d 1524 (10th Cir. 1990). Good Samaritan
laws responded to the common law rule that made one liable for
negligently rendering voluntary emergency assistance by extending
immunity from suit, thereby encouraging humanitarian acts by
licensed medical providers."3

Arriving on the scene, not knowing what to expect, they found
the person symptomatic, still conscious and standing on his own.
He indicated that he'd had a reaction and was in need of "a shot."

"Symptoms of anaphylactic shock include dizziness, loss of
consiousness, labored breathing, swelling of the tongue and
breathing tubes, blueness of the skin, low blood pressure, and
death bronchospasm"1

The physician recognizing the anaphylactic nature of the situation
requested one of the others obtain "epinephrine," while she stayed
with the patient.

When the other member of the squad returned with a single "Epi pen."
 The physician administered a dose.  The patient claimed to not have
obtained any relief.  A second shot was requested.  The pen was a
single dose unit only.  Having already used the available dose, the
physician explained it would be nearly empty.  There was no other
immediate source of epinephrine available at the time.  Unable to
offer an alternative, the physician gave the patient a second shot with
the same injector hoping it might still contain "some" medication.

Again the patient did not obtain relief.  With symptoms persisting,
the patient's condition deteriorated.  At this point an ambulance was
on the way, the nurse had been relieved at the station and came up
to assist, still unaware of what the problem had been.

When she came upon the patient, the best she could do was stay
with him until the emergency medical personnel arrived.  The
patient would complain of increasing shortness of breath.  En route
to the hospital, he would slip into a coma.  He would die the next day.

A lawsuit was filed naming both the physician and the nurse alleging
a "wrongful death."  Both the nurse and physician fought this in court.
 In the initial trial, the complaint was dismissed.

They argued for protection under the Good Samaritan Acts of the state.
  This legislation was enacted to encourage health professionals to
render aid at the roadside.  Previously, professionals had and still do
hesitate to assist for fear of being sued by the injured party.

"Because of the pervasive myth of liability in the medical professions,
most states have enacted some form of Good Samaritan law prohibiting
a patient from suing a physician or other health care professional for
injuries from a Good Samaritan act. To trigger the protection of such
an act, two conditions must be satisfied: it must be a volunteer act, and
the actions must be a good-faith effort to help. Displacing a neck fracture
in an effort to do rescue breathing might be malpractice in the Emergency
Room, but it is not bad faith on the roadside."4

While a Good Samaritan Act may protect you in state-specific circumstances
from being found and held liable, it will not protect you (nor will an
employer's malpractice insurance policy) from being sued in the first place.

In most states there is no obligation for a bystander to render aid or
legislation to penalize those that do not decide to get involved.
Minnesota, Vermont and Wisconsin are exceptions to this rule.
Minnesota statutes follow:

"A person at the scene of an emergency who knows that another person
is exposed to or has suffered grave physical harm shall, to the extent
that the person can do so without danger or peril to self or others, give
reasonable assistance to the exposed person. Reasonable assistance
may include obtaining or attempting to obtain aid from law enforcement
or medical personnel. A person who violates this subdivision is guilty
of a petty misdemeanor. "5

A common thread in each of the Good Samaritan laws is that no
immunity will be afforded for specific exceptions.

"The most commonly stated exception to immunity is for conduct that
is willful and wanton. Many jurisdictions also exclude other categories
of conduct, such as conduct that is grossly negligent, reckless, malicious,
in bad faith, fraudulent, or intentionally tortious or that is a knowing
violation of law. A few even included ordinary negligence, which arguably
negates the protection afforded."6

In the state of Rhode Island, in which this event occurred, there are
no specific laws requiring that a bystander give assistance.

Interestingly, immunity by the state laws is granted in the following
which do not specify volunteer medical and first aid activities.

"Rhode Island law also grants immunity from civil damages to:

(1) Persons rendering service as, or assisting, a manager, coach, instructor,
umpire, referee or official in certain interscholastic or intramural
sports programs;

(2) Any uncompensated person voluntarily serving as or assisting a
manager, coach, instructor, umpire, referee or official in a youth
sports program organized and conducted by or under the auspices
of a nonprofit corporation; or

(3) Directors, officers, trustees or employees of any nonprofit
organization, authorized to do business in the state, that organizes,
conducts or sponsors a youth sports program.208"6

It is debatable whether the initial trial led to a dismissal on grounds
of protection under existing Good Samaritan laws, or simply a lack
of evidence to prove negligence.  Of these, the latter is more likely.

With the complaint initially dismissed, the patient's estate appealed.

Questions to be answered.

1. In rendering care to the patient in a state of anaphylaxis, did
both the nurse and physician perform to the best of their abilities
with the resources available to them.

2. In rendering emergency aid to the patient, were they covered by
the state's existing "Good Samaritan" laws.

The plaintiff's attorneys would argue that negligence had been
a factor in the patient's death.  They accused the physician and
nurse of arriving on the scene "unprepared" to deal with the situation.

Interestingly, the plaintiff could offer no expert witness testimony
to support this.

In deciding the second question, the court explicitly stated that
"it assumed the defendants were not covered under Good Samaritan Laws."

This is alarming in that if the plaintiff had been able to produce
sufficient expert testimony to prove negligence, the nurse and
physician may well have been held liable.

In light of these circumstances,  the ruling of the lower court was
affirmed.

It sends a frightening message to nurses, medical and health care
personnel who chose to "volunteer" their expertise in times of need.
Some state laws do require action in specific circumstances:

It is unclear whether this opinion was offered because the assistance
was "organized."  Is an exception made to the Good Samaritan Acts
for First Aid Squads and Organized Emergency Medical Personnel
regardless of whether or not they charge the patient for their services?

Troubling questions for the individual when deciding whether or not
to render aid.  The answers and exceptions are defined in individual
state laws that vary widely.

Many nurses rely on malpractice insurance provided by their
employers to cover them at work.  It is highly unlikely that such
a policy would cover them while performing volunteer duties.

If you accept responsibility to perform expected duties either on
a paid or volunteer basis, for a profit or non-profit organization, you
may not be covered under otherwise applicable Good Samaritan Statutes.
If you chose to protect yourself by carrying malpractice insurance
policy, it would be wise to make sure this coverage is specifically included.

Related link Sections:

Direct Patient Care Links
http://www.nursefriendly.com/nursing/linksections/directpatientcarelinks.htm

Emergency Department Nurses on the Nurse Friendly:
http://www.nursefriendly.com/nursing/directory/spec/ed.html

Good Samaritan Laws & Acts:
http://www.legalnursingconsultant.org/legal.nurse.consultants.lnc/good.samaritan.laws.acts.htm

Ethics:
http://www.nursefriendly.com/nursing/directpatientcare/ethics.htm

Medical Legal Consulting Nurse Entrepreneurs:
http://www.nursefriendly.com/nursing/ymedlegal.htm

Sources:

1. 38 RRNL 4 (September 1997)

2. Health on The Net Foundation. July 2, 1998.  HON Allergy Glossary Anaphylactic Shock. Retrieved July 18, 1999 from the World Wide Web:  http://wolfgang.hcuge.ch/Library/Theme/Allergy/Glossary/shock.html

3. Utah State Courts. Filed November 14, 1997.  Hirpa v. IHC Hospitals, Inc., No. 960180.  Retrieved July 18, 1999 from the World Wide Web:  http://courtlink.utcourts.gov/opinions/supopin/hirpa.htm

4. Law and the Physician Homepage.  No Date Given.  Good Samaritan Laws. Retrieved July 18, 1999 from the World Wide Web:   http://plague.law.umkc.edu/Xfiles/x894.htm

5. LawGuide.  1998.  Minnesota Good Samaritan Law.  Retrieved July 18, 1999 from the World Wide Web:  http://www.lawstreet.com/lawguide/sigsgomn.HTML

6. Carter-Yamauchi, Charlotte A. 1996.  Volunteerism - A Risky Business? Retrieved July 18, 1999 from the World Wide Web:  http://www.hawaii.gov/lrb/vol/volchp3.html
 

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Created on July 14, 1999

Last updated by Andrew Lopez, RN on March 23, 2017


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