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Risks of being a 'Good Samaritan'

David Craik considers the legal and ethical issues for off-duty GPs giving emergency medical help.

Dr Nonye Agomo had to confirm the death of an elderly woman on a flight and then explain her findings over the aeroplane’s radio (Photograph: J Heath Lancy)
Dr Nonye Agomo had to confirm the death of an elderly woman on a flight and then explain her findings over the aeroplane’s radio (Photograph: J Heath Lancy)

Are you going on a holiday abroad this Christmas?

What if, as you settle back in your aeroplane seat and look forward to the beach or the ski-slope, you hear the emergency call: 'Is there a doctor on board?'

Anxious that the incident may require skills beyond your training or competence, you may feel reluctant to come forward, but your professional instincts will no doubt compel you to offer your help.

Good Samaritan act
A 'Good Samaritan act' is one in which medical assistance is given, free of charge, in a bona fide medical emergency on which you may chance, in a personal as opposed to a professional capacity.

Dr Emma Cuzner, medico-legal adviser at the Medical Defence Union (MDU), recognises the fear of claims against them that GPs have when making themselves available as Good Samaritans, including on flights abroad where there may be jurisdictional issues as to which country's law will be used.

There is no legal requirement to be a Good Samaritan.

However, if a doctor chooses to provide treatment, they will be entering into a doctor/patient relationship and will therefore owe a duty of care, such as they would do for any patient they treat.

That means there is a potential for a breach of that duty of care within the jurisdiction in which the treatment is carried out. There is therefore the chance of a complaint, claim or regulatory hearing arising.

So is it safer to remain in your seat, particularly in the light of society's increasingly litigious nature?

Expectation on GPs
There may be no legal requirement to help a stricken individual but there is an expectation and GMC professional obligation that GPs will offer their assistance.

The GMC's Good Medical Practice states in paragraph 11: 'In an emergency, wherever it arises, you must offer assistance, taking account of your own safety, your competence and the availability of other options for care.'

Dr Cuzner says: 'The general public is both reassured and grateful to know that doctors will offer their expertise as Good Samaritans.'

GPs who are members of the three UK medical defence organisations, MDU, Medical Protection Society (MPS) and Medical and Dental Defence Union of Scotland are covered for claims arising from Good Samaritan acts around the world.

A MPS spokesperson says its members would be entitled to apply for assistance, no matter in which country, if legal proceedings are commenced.

If your medical indemnity provider is not a medical defence body but an insurer, check if Good Samaritan acts are covered.

For example, insurer Towergate MIA does cover them although its standard indemnity policy on Good Samaritan acts excludes the US and Canada. 'They are particularly litigious,' says Towergate MIA's professional indemnity team manager Patricia Woodroff. 'If a policyholder is travelling to these countries the cover can be extended.'

The chances of a claim arising are remote as patients and their families generally welcome the help of a good samaritan. Both Dr Cuzner and Ms Woodroff, with 20 years of experience between them, say they have never had a claim arising from a Good Samaritan act.

But as long as it remains a possibility, GPs should tread carefully.

First of all check with your indemnity provider what protection you have before travelling abroad.

When assisting a patient, recognise and work within the limits of your competence.

MPS advice is to acknowledge the existence or otherwise of other help. For example, it might be more appropriate for paramedics to move patients in the case of a suspected neck injury.

In the absence of alternative expertise, the MPS advises that a doctor would be expected to perform as best he can, recognising his own limitations and, if possible, making the patient aware of these.

Consent should be obtained from the patient if they are able to give it and you should make a detailed record of the incident and the help you provided.

Case Study

London GP Dr Nonye Agomo has been a Good Samaritan four times

'On the first two occasions I was on flights when there was a call for a doctor,' she explains. 'In both cases, when I reached the passenger in need there were already doctors there with more experience.'

The third event occurred at Dr Agomo's local gym when a man was pulled out of the swimming pool by a lifeguard. 'I went to assist but the lifeguards said they were trained in the necessary resuscitation techniques.

'However, I stayed with the patient and gave him extra support until the ambulance arrived,' she says.

The fourth incident, this February, took place on a flight between the US and UK. Dr Agomo spotted a flight attendant and a group of passengers acting anxiously a few seat rows in front of her. She went over and found an 88-year old lady sitting motionless. 'She was not breathing. After a series of checks I confirmed her dead.'

Dr Agomo then had to explain the incident and her findings to the airline's US doctor via the plane's radio. During the flight she wrote a report of the case and on landing at Heathrow was interviewed by an the UK airport's doctor.

'I had to leave my contact details but I have heard nothing since,' she says. 'In cases such as these there is always the fear of litigation, especially as we were still in US airspace when I checked the old lady. You fear being targeted for being helpful but ethically you have to try to help.

'Look at the people who were not medically trained but who helped during the 7/7 bombs in London. Just tell people your limitations and do what you can.'

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