This was originally written for my EMS friends, but the basic concepts still apply: duty, breech, causation, and damages.
Setting the stage: It’s 3am (of course), and you just laid down after watching a Star Trek – The Next Generation marathon when the tones go off, and the dispatcher announces another of a long line of winter vehicle rollovers. Blah, blah, blah, icy roads and drunk drivers. Wind and snow, minor extrication, neck pain and minor bleeding from the head, the patient intoxicated but friendly. C-collar, the requisite uncomfortable backboard, and couple of big IVs just because, and a quick drop off at the local ER. The next afternoon you hear the patient began seizing shortly after you left the ER, and died a short time later from a massive subdural. Three years later you get the summons and complaint, naming you, your partner, your duty supervisor, your service, the hospital, the ER Doc, the radiologist, and the high school janitor as defendants in a lawsuit claiming negligence.
First, let’s dispense with the Good Samaritan defense. You were on duty and paid a decent hourly wage. Therefore, you’re not covered under the statute.
Negligence in the common parlance simply means you screwed up and you should have known better. However, in legal terms, “negligence” has a very specific meaning, and very specific elements that require evidence to reach the conclusion that someone is “legally” negligent. If the plaintiff is unable to prove each element of negligence, then the defendant cannot be found liable.
In order to be legally negligent, the plaintiff must show that the defendant had a duty to act (duty), that the defendant failed to follow the standard of required conduct (breach), that the failure was the cause of harm to the victim (causation), and that actual harm resulted (damages.) These four elements: duty, breach, causation, and damages, must all be proven in order to prevail. The Good Samaritan statute, which all EMTs seem to consider when thinking of negligence, speaks to two levels of negligence – simple negligence and gross negligence. Outside of this narrow statute, however, the level of egregiousness is relevant only in the amount of punishment given.
Let’s flesh out this discussion a bit. “Duty” is the easy one – did you have a duty to provide care to the patient. Yes or no. In the above case, for example, you were on duty and being paid to respond. Therefore, yes, you had a duty. This is the easiest of the four elements to prove, or to defend. You’re off duty and drive past an accident scene which already has numerous responders present. No duty, no negligence claim. Volunteers can sometime have a bit more difficult time, but the standard becomes whether you in any way held yourself out at the time of the event to be available to respond. If you were “on call,” duty attaches, if not, duty likely does not attach.
“Breach” is slightly more difficult to prove, but still often relatively easy. Did you do (or not do) something beyond or outside the industry standard? In other words, did you breach your duty to treat a particular illness or injury in an appropriate manner? This is gross simplification, of course, because evidence would be required at trial about what, exactly, was the “standard of care” required in the given circumstance. This makes this particular element the most wishy-washy, as dueling experts vie for the attention of the judge or jury.
“Causation” is the often missed elements by the lay public. This means that your actions, or inactions, actually caused the harm being alleged. If your patient was hit in the head by a pipe wrench, and you later drop him injuring his knee, you’re only responsible for the knee injury, not the whole shebang. This can often be difficult to determine. For example, a COPD patient presents with severe respiratory distress. You provide high flow oxygen, but not CPAP; when the patient continues to deteriorate you elect to sedate and intubate, causing dental trauma, increased swelling to the throat and worsening of the distress. The patient eventually arrests due to extreme hypoxemia. How much was your fault, if any? Would she have continued to deteriorate regardless of your actions?
“Damages” is reasonably straight forward, if the above elements have been met and determined. First, were there actual injuries that caused harm to the patient? It’s the “no harm, no foul” rule of negligence. You should have given Amiodarone, not lidocaine, for an SVT according to your medical standing orders. But the patient persevered and lived despite your best efforts. You had a duty to act, you breached that duty, but you did not cause compensable harm. While you may be on the soup line because you dangerously violated your standing orders, at least you won’t end up in court. However, if actual harm was caused by you, then you are responsible for those damages.
One can be negligent in the common sense but not be legally negligent. While this may be of little real comfort, EMTs should have a basic understanding of the general concepts of legal negligence. As for the scenario mentioned above? A good attorney will bring in a lot of questions. Was the alcohol masking signs and symptoms of head trauma the EMTs and hospital should have recognized earlier? Should the patient have been taken to a trauma center rather than just the local ER? Did the EMTs adequately describe for the ER staff the circumstances surrounding the crash such that the physician and staff could better assess the totality of the patient’s potential injuries? Obviously there aren’t enough details to make any reasoned response, and in the end it may take a judge or jury to flesh out all the answers. Such is the nature of the legal world.
