Which case won?

casea
The case for the patient
  • The paramedic failed to follow the instructions for treating asthmatic patients set out in the ambulance service’s clinical practice manual (“CPM”).
  • The CPM's asthma flowchart required that for patients in imminent arrest, such as this patient, the treating paramedic must "consider adrenaline".
  • According to the CPM glossary to “consider” means that an ambulance officer is to make a clinical judgement regarding application of treatment modalities based on potential benefits and adverse effects.
  • This paramedic failed to consider adrenaline. He misunderstood the asthma flowchart in the CPM, believing wrongly that he was precluded from administering adrenaline to a patient who was tachycardic, not bradycardic (i.e. did not have heartbeat of less than 60 beats per minute). This is clear from his 2009 statement where he said, “In view of the fact that [the patient] was tachycardic, that is she had a heart rate that was greater than 100 beats per minute and peripheral pulse were palpable, intravenous Adrenaline was not permitted under the Asthma protocol. I therefore elected to administer intravenous Salbutamol.”
  • The CPM also made it clear that adrenaline was the preferred drug to achieve a fast dilation of the bronchial passages to avoid death or irreversible brain injury. Adrenaline starts to work in 30 seconds, whereas Salbutamol takes one to three minutes to start working. Had the paramedic applied his clinical judgement on arrival at the scene, he would have concluded that he must give this patient adrenaline in the circumstances.
  • Further, the majority of specialist emergency physicians operating in hospital emergency rooms in 2002 would have chosen adrenaline from the outset.
  • The paramedic is therefore negligent in failing to meet the required standard of care, the state is vicariously liable and the appeal should be dismissed.
caseb
The case for the paramedic
  • I did “consider adrenaline.” I made a reasonable clinical judgement that adrenaline would have been unsafe given the patient’s high heart rate and high blood pressure.
  • A responsible body of medical opinion at the time supported the administration of Salbutamol in the circumstances. As my medical expert told the court: "You don't give adrenaline to somebody who has got a rapid pulse and a high blood pressure, because it is a dangerous drug that will cause, in the face of hypoxia, a dangerous arrhythmia … that's why Salbutamol is given."
  • I am a paramedic, not a medical practitioner specialising in emergency medicine. I operate in the field without the assistance and certitude of the facilities of an emergency room. It is irrelevant that emergency room practitioners may have chosen adrenaline from the outset.
  • I was not negligent, since I met the required standard of care, and therefore the appeal should be allowed.

So, which case won?

Cast your judgment below to find out
Case A Case B

Case B won. You were right!

How people voted
a14%
b86%

Expert commentary on the court's decision

Megan SaultAssociate
“This decision, while factually tragic, illustrates the application of the test applied when assessing the standard of care of professionals in negligence claims.

This test calls for wide acceptance of the professional’s conduct, which does not mean the majority of the profession has to make the same decision.

The decision also serves as a reminder that professionals are assessed against their peers. In this case, the court distinguished the standard expected at law of a paramedic from the standard expected of a specialist trained in emergency medicine, characterising it as a ‘less exacting standard than that expected of specialists in emergency medicine’.“
Court finds in favour of paramedic

In State of Queensland v The Estate of the Late Jennifer Leanne Masson [2020] HCA 28, the High Court of Australia granted the State of Queensland’s appeal.  

The court found that the paramedic, Mr Clinton Peters, was not negligent in treating the patient, Ms Jennifer Masson.  

Court considers standard of care for paramedic versus a doctor

In order to claim damages from the paramedic via the State of Queensland, Ms Masson’s estate was required to establish that the paramedic breached the duty of care that he owed to her as a patient.  

To determine whether there was a breach, the court had to look at the standard of care owed by a paramedic and whether the treatment provided fell below that standard. 

The High Court confirmed that the standard of care owed by a paramedic cannot be determined by consideration of the standard expected of specialists in emergency medicine.  

Their Honours described the standard expected as that of the ordinary skilled emergency care paramedic operating in the field in circumstances of urgency. The High Court endorsed the findings of the Court of Appeal in this respect, that paramedics cannot be expected to make “fine professional judgments of a kind that require the education, training and experience of a medical specialist”. 

Clinical practice manual only a guide

The court accepted that the CPM is not determinative of the standard of care for paramedics. The manual was a guide and assisted, rather than prescribed, decision making. It was not the law. 

Paramedic made reasonable clinical judgement

The issues on appeal related to whether the paramedic had in fact made a clinical judgement and whether the paramedic’s decision to administer Salbutamol was reasonable, having regard to the CPM and to medical opinion at the time.  

The court was satisfied that the paramedic had exercised clinical judgment and had not made a mistake about the interpretation of the CPM.  

Although in his 2009 statement, Mr Peters had favoured an interpretation of the asthma flowchart that precluded treatment with adrenaline if the patient was not bradycardic, the court agreed that this was not his understanding at the time he treated Ms Masson. Rather, his actions on the night demonstrated that he had “made a clinical judgment, involving consideration of administering adrenaline, but had rejected that course because of the risk of a serious adverse reaction given Ms Masson’s tachycardia and hypertension.”  

Administration of Salbutamol supported by body of medical opinion

The court found that the paramedic’s clinical judgment to administer Salbutamol was supported by a responsible body of medical opinion and was within the range of reasonable clinical judgments that an intensive care paramedic might make.  

The court observed: 

The Estate proved on the balance of probabilities that the majority of specialist emergency physicians operating in hospital emergency rooms in 2002 would have chosen adrenaline from the outset. But, as has been explained, the fact that the majority of specialist emergency practitioners may have chosen adrenaline from the outset does not mean that the minority who would have chosen salbutamol as first preference would have been regarded as negligent; still less that an emergency paramedic operating in the field without the assistance and certitude of the facilities of an emergency room would be so regarded 

…In the result, the overall effect of the evidence led before the primary judge was that a responsible body of opinion in the medical profession in 2002 supported the view that Ms Masson’s high heart rate and blood pressure in the context of her overall condition provided a medically sound basis to prefer salbutamol to adrenaline at the time of initial treatment… The reality was, as his Honour said, that this was a decision which could reasonably, in light of the competing risks, have gone either way. No breach of duty of care was established.  

Court rejects argument that adrenaline preferred due to faster effect

The court rejected the estate’s timing argument, that adrenaline was the superior drug due to its faster effect.  

This argument had been accepted by the Court of Appeal, notwithstanding that the trial judge’s attention had not been drawn to the parts of the CPM that referred to the timing of the effect of the drugs, nor had the expert witnesses been asked to address this issue.  

In the High Court’s view, the Court of Appeal should not have accepted this argument. 

Decision illustrates standard of care applicable to professionals

This decision, while factually tragic, illustrates the mechanism of the test applied when assessing the standard of care of professionals in negligence claims.  

This test calls for wide acceptance of the professional’s conduct, which does not mean the majority of the profession has to make the same decision. 

The decision also serves as a reminder that professionals are assessed against their peers. In this case, the court distinguished the standard expected at law of a paramedic from the standard expected of a specialist trained in emergency medicine, characterising it as a “less exacting standard than that expected of specialists in emergency medicine”. 

NOTICE: This article is accurate as at the time of publication and does not constitute legal advice. Please see our legal notices page for more information. Information related to coronavirus can be outdated very quickly.
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