SUBJECT: IMMUNITY APPLIED TO EMERGENCY DEPARTMENT ON-CALL PHYSICIANS

CASE NAME: BREAZAL V. HENRY MAYO NEWHALL MEMORIAL HOSPITAL

CASE CITE: 286 CAL. RPTR. 207 (CA. CT. OF APP., OCT. 2, 1991)

STATE: CALIFORNIA

FACTS OF CASE: An eight year old boy woke up with a headache, earache, and fever. By evening, he was having trouble breathing. His mother took him to an emergency department and a pediatrician was called. He diagnosed epiglottitis. The pediatrician requested an ENT specialist he called to assist in treating the patient.

The ENT specialist examined the patient and sent him to the operating room. An anesthesiologist inserted an endotracheal tube. The ENT specialist performed a tracheostomy, and patient was taken to the recovery room. When the ENT specialist returned to the recovery room he discovered that the patient's tracheostomy tube was out of position. He repositioned it and sutured it in place. He and the pediatrician left the hospital at about the same time. They gave instructions to call them if the tube dislodged and to suction the tube and keep it free from secretions.

The recovery room nurse suctioned a pink frothy sputum indicating the patient was suffering from pulmonary edema. The anesthesiologist, who was still in the hospital, ordered administration of a diuretic to relieve the pulmonary edema. About the same time the patient's tracheostomy tube again became dislodged. When the anesthesiologist was unable to ventilate the patient through a replacement tube, he concluded that both lungs were collapsed. The ENT specialist and the pediatrician were called, and they returned to the hospital.

Shortly afterward, the patient went into full cardiac arrest. The resuscitation team was called, and a pediatric emergency team from a Childrens' Hospital was contacted. By the time the life-flight team arrived, the patient was in electromechanical dissociation. The pediatric intensive care specialist and the life-flight team noted the patient's eyes were fixed and dilated and said he was brain dead. Nevertheless, he was transported on life support to the Childrens Hospital. A brain scan confirmed brain death. The patient was removed from life support systems and pronounced dead at the hospital.

The patient's mother filed suit for the wrongful death of her son and for negligent infliction of emotional distress. The hospital and the anesthesiologist settled the claims against them, and the case went to trial against the pediatrician and ENT physician. The trial court granted a nonsuit on the professional negligence claims on the grounds that the Good Samaritan statute applied to on-call physicians who rendered emergency care and immunized them from liability. The mother's claim for negligent infliction of emotional distress was dismissed before trial.

Affirming their decision, the appellate court said the emergency that the physicians treated continued as long as the patient reasonably required urgent care. The emergency the physicians were treating had continued throughout the entire time they were treating the patient. The Good Samaritan Statute shielded them from liability for any acts or admissions in treating the patient.

CASE COMMENTARY:

Good Samaritan protection has traditionally been applied in the out of hospital setting. It was created to protect the physician who stopped at the roadside to help an accident victim, or provided care to a collapsed pedestrian. In recent years, courts have applied Good Samaritan protection inside the hospital. This case is unusual in applying Good Samaritan immunity to physicians on-call for an emergency department.


SUBJECT: REPLACEMENT SURGEON RECEIVES GOOD SAMARITAN IMMUNITY

CASE NAME: PERKINS V. HOWARD

CASE CITE: NO. A049833, CALIFORNIA COURT OF APPEALS, 1ST APP. DIS., DIVISION 4

STATE: CALIFORNIA

FACTS OF CASE: Dr. John Lang, assisted by Dr. Clyde O'Neill performed hip replacement surgery on Ina Booth Perkins at Mt. Diablo Medical Center. On the day of the surgery, Dr. O'Neill was ill with the flu, and while the surgery was in process, he became so ill that he could not continue assisting with the operation. Therefore, the hospital contacted Dr. Timothy Howard, who was seeing patients in his office across the street from the hospital, and requested that he step in as assistant surgeon.

Perkins allegedly suffered an injury to her leg and foot as a result of the surgery, and sued Dr. Howard for malpractice. The trial court granted summary judgement for Dr. Howard on the ground that he was entitled to immunity under California's Good Samaritan Statutes, and Perkins appealed.

The Appeals Court, noting that California had "a good number of Good Samaritan statutes which protect designated classes of people from civil liability for their acts or omissions when rendering emergency assistance," focusing its analysis on Business and Professions Code §2396. That section confirms immunity from liability upon a physician whom, in good faith, renders emergency medical care to a person at the request of another physician. The court noted that case law had added an additional requirement that the physician claiming immunity did not have a pre-existing duty of professional care to the patient.

The court concluded that Dr. Howard had established the elements of the immunity defense. In so ruling, the court rejected Perkins contention that a physician defendant must also show "that the medical necessity requiring the assistance of another physician be caused by an unforeseen complexity." The court also rejected Perkins contention that Dr. Howard had a pre-existing duty to her because Dr. Howard had assisted Dr. Lang on a previous hip operation three years before the surgery at issue. Therefore, the Appeals Court affirmed the Trial Court's order.


SUBJECT: OBSTETRICIAN, RECEIVES IMMUNITY FOR IN-HOSPITAL DELIVERY.

CASE NAME: ROBERTS V. MYERS

CASE CITE: 569 N.E.2D 135

STATE: ILLINOIS

FACTS OF CASE: A mother was admitted to the hospital and was seen by her attending obstetricians, then cared for by hospital nurses and residents. One of the nurses in the labor room applied an electronic fetal monitor and began observing fetal heart tones. She recorded her observations on a labor progress record. Another nurse informed the obstetrician, who was at the hospital caring for his own patients, of decelerations in the fetal heart tones.

He performed the sterile vaginal examination; about ten minutes later, a resident deemed it necessary to obtain immediate assistance from another physician. A nurse saw the obstetrician in the physician's lounge and brought him into the delivery room. In his progress note, he characterized the fetal heart tone decelerations as type one dips. When the OB was unable to hear fetal heart tones, the patient was prepared for immediate delivery. A midforceps application was used to deliver an infant, who weighed 3000 grams and had quadraplegia and cerebral palsy.

A Trial Court entered summary judgement in favor of the physician on the ground that he was immune from liability under the Good Samaritan Statute. Affirming the decision, the Appellate Court said the physician was not liable. He delivered the infant of woman who was not his patient under emergency circumstances, and he did not receive a fee for his services. His actions met the criteria for immunity under the statute, the Court said.


SUBJECT: GOOD SAMARITAN PROTECTION FOR ON-CALL SURGEON

CASE NAME: GORDIN V. WILLIAM BEAUMONT HOSPITAL

CASE CITE: 447 N.W. 2ND 2D 793

STATE: MICHIGAN

FACTS OF CASE: The patient was admitted to the emergency department at 11:05 a.m. after sustaining injuries in an automobile accident. The staff emergency physician conducted an examination and determined that a surgeon was needed. The on-call surgeon, Dr. Villalva, was not available. Reportedly he was at a wedding and, he asserted, did have a beeper but was not called. Defendant Dr. Howard, not officially on-call, was contacted and agreed to come to the hospital. Howard arrived at 11:40 a.m. and immediately conducted a complete examination. The decision was made to operate. The patient was brought to the operating room at 1:57 p.m. Her condition was critical. She lost cardiac function and attempts to resuscitate her heart were not successful. She was pronounced dead at 2:40p.m.

Suit was filed against Dr. Howard and the William Beaumont Hospital. Dr. Howard moved for summary judgement based on the Michigan Good Samaritan Statute. The trial court granted the motion and the plaintiff appealed contending that the statute had been applied too broadly, i.e., that it should apply only when a person renders care outside their job or training. The appellate court rejected this argument noting that 1975 amendments to the law clearly made it applicable to medical professionals who are not under a duty to respond.

CASE COMMENTARY:

Cases over the last few years from around the country clearly indicate a trend toward protecting physicians who respond in emergencies when not "on duty".



SUBJECT: GOOD SAMARITAN PROTECTION FOR ON-CALL SURGEON

CASE NAME: GORDIN V. WILLIAM BEAUMONT HOSPITAL

CASE CITE: 447 N.W. 2ND 2D 793 (MICH. APP. 1989)

STATE: MICHIGAN

FACTS OF CASE: The patient was admitted to the emergency department at 11:05 a.m. after sustaining injuries in an automobile accident. The staff emergency physician conducted an examination and determined that a surgeon was needed. The on-call surgeon, Dr. Villalva, was not available. Reportedly he was at a wedding and, he asserted, did have a beeper but was not called. Defendant Dr. Howard, not officially on-call, was contacted and agreed to come to the hospital. Howard arrived at 11:40 a.m. and immediately conducted a complete examination. The decision was made to operate. The patient was brought to the operating room at 1:57 p.m. Her condition was critical. She lost cardiac function and attempts to resuscitate her heart were not successful. She was pronounced dead at 2:40p.m.

Suit was filed against Dr. Howard and the William Beaumont Hospital. Dr. Howard moved for summary judgement based on the Michigan Good Samaritan Statute. The trial court granted the motion and the plaintiff appealed contending that the statute had been applied too broadly, i.e., that it should apply only when a person renders care outside their job or training. The appellate court rejected this argument noting that 1975 amendments to the law clearly made it applicable to medical professionals who are not under a duty to respond.

CASE COMMENTARY:

Cases over the last few years from around the country clearly indicate a trend toward protecting physicians who respond in emergencies when not "on duty".