SPECIAL REPORT

Liability Risks Vary in Emergency Physicians' Response to Code Blue Alerts

By William M. McDonnell, MD, JD, Assistant Professor, Pediatric Emergency Medicine, Adjunct Professor, S.J. Quinney College of Law, University of Utah, Salt Lake City, member of the American Academy of Pediatrics National Committee on Medical Liability and Risk Management

By nature of their training, skills, and in some hospitals, based on their job descriptions, emergency physicians often respond to hospital "Code Blue" alerts. Not surprisingly, many patients involved in Code Blue situations have poor outcomes, and patients or their families may elect to bring medical malpractice claims against the physicians involved in the resuscitation attempts. Emergency physicians' potential malpractice liability in such cases may be affected by several factors.

Good Samaritan Statutes

All states have enacted some form of Good Samaritan statute that is designed to encourage prompt emergency care by granting health care providers immunity from civil damages and removing the fear of liability. Generally, when an individual with no pre-existing duty to do so voluntarily provides emergency assistance to a victim, the volunteer is shielded from claims of negligence. However, there is wide variation in states' application of Good Samaritan protections to physicians.

Of primary importance in determining whether an emergency physician will be protected by a Good Samaritan law is whether the physician had an obligation to provide the emergency care. When the hospital's rules or the physician's job description require that the physician respond to the Code Blue, courts have found a pre-existing duty to provide the emergency care, and have determined that the physician is not a volunteer entitled to the protections of the Good Samaritan laws. In such cases, physicians may be held liable for any negligent care.

When the physician has no obligation to respond to the Code Blue, but rather does so as a volunteer, some states have provided Good Samaritan protection from claims of medical malpractice.1 For example, in Hirpa v. IHC Hospitals, Inc., an emergency physician responded to a Code Blue in the labor and delivery suite, and assumed control of the resuscitation at the request of the patient's obstetrician.2 The Court noted that because the emergency physician had no "particular employment duty to aid the patient," Good Samaritan protection from malpractice claims was appropriate in order to "encourag[e] humanitarian acts by licensed medical providers."3

Other states, however, have determined that Good Samaritan immunity from malpractice claims is not available to emergency physicians treating individuals in a hospital. In Texas, Good Samaritan protection is not available to a physician in a hospital if he or she "regularly administers care in a hospital emergency room."4 A number of states have determined that no Good Samaritan immunity is available to any physician providing care in a hospital, even without a pre-existing relationship to the patient or any obligation to provide such care.5

EMTALA Effects on Good Samaritan Immunity

The Emergency Medical Treatment and Labor Act (EMTALA) imposes a general obligation on emergency physicians to evaluate, and if necessary, stabilize all patients who present to the emergency department complaining of a medical condition.6 As such, it establishes a duty on the part of the physician to the emergency department patient, and will generally eliminate any Good Samaritan immunity for care provided in the ED.

Rescue Team Statutes

California and Hawaii specifically shield from medical malpractice liability physicians who are part of the hospital's rescue teams, and those who are directed by hospital policies to respond to Code Blue activations.7 In Lowry v. Henry Mayo Newhall Memorial Hosp., the patient suffered a cardiac arrest while an inpatient at the hospital.8 The defendant physician, a member of the hospital's Code Blue team responded to the patient's room, and allegedly departed from Advanced Cardiac Life Support (ACLS) guidelines in her choice of resuscitation medications. The California Court of Appeals rejected the plaintiff's malpractice and wrongful death claims, ruling that as a trained physician "designated by the health facility to attempt ... to resuscitate persons who are in immediate danger of loss of life," the defendant was immune to claims of negligence.9

Minimizing the Risks

As in any other setting, emergency physicians providing care in Code Blue situations should endeavor to provide care in accordance with prevailing practice standards and should appropriately document their care. They should understand their relevant state Good Samaritan laws. In states that allow Good Samaritan immunity for physicians providing volunteer emergency care in the hospital, emergency physicians will be well-served by clear hospital policies regarding Code Blue responses. Hospital policies and employment contracts that clearly state that emergency physicians are not required to respond to Code Blue alerts, but rather that they are encouraged to do so as volunteers, might allow Good Samaritan immunity to some emergency physicians. In states with rescue team immunity laws, on the other hand, physicians who respond to Code Blue alerts should be formally designated (and trained) as part of the hospital's rescue team.

References

1. E.g., Hirpa v. IHC Hospitals, Inc., 948 P.2d 785 (Utah 1997); Clayton v. Kelly, 357 S.E.2d 865 (Ga.App. 1987); Johnson v. Matiuw, 531 N.E.2d 970 (Ill.App. 1988).

2. Hirpa, 948 P.2d at 789-790.

3. Id.

4. Tex. Civ. Prac. & Rem. Code § 74.001(b).

5. E.g., Velazquez v. Jiminez, 789 A.2d 51 (N.J. 2002); Guerrero v. Copper Queen Hosp., 537 P.2d 1329 (Ariz. 1975); Steffey v. King, 614 N.E.2d 615 (Ind.App. 1993); see also Jackson v. Mercy Health Ctr., Inc., 864 P.2d 839 (Okla. 1993) ("no hospital is ever a Good Samaritan vis-a-vis its own patient")

6. Pub L No. 99-272, Title IX, Section 9121(b), 100 Stat 82 (1986) (codified at Title 42, United States Code, Section 1395dd).

7. Cal. Health & Safety Code § 1317; Hawaii Rev. Stat. § 663-1.5.

8. 185 Cal.App.3d 188 (1986).

9. Id at 192-193.