Dodge, in a comment on an earlier post, drew my attention to a case involving Queensland ambulance which is reported in the Brisbane Times. He said:

My thoughts on this firstly on the point of faulty equipment if the equipment in question has been serviced routinely according to the manufacturer’s instructions and that the service and testing was undertaken by suitably qualified medical equipment technicians could a case for negligence be found in the event the equipment has a sudden failure. While on the question of a possible unnecessary delay of the ambulance to arrive at the call what would be considered unnecessary I would assume that Kent v Griffiths provides some insight to this question.

Finally could the officers themselves be held partly responsible for the undesirable patient outcome by deviating away from the hospital to go to a station to attempt to retrieve replacement equipment when it could have been more expedient to proceed to the nearest emergency department under lights and sirens thereby preventing any delay in specialist emergency medical treatment for his perceived heart attack. Also (according to the article) they allowed the patient to walk to the ambulance with a suspected heart attack, as with the service I am with forbids such patients to be allowed to walk as it places undue stress on their already injured heart muscle.

Your thoughts on this interesting case would be welcomed.

I’ll comment on these points in turn. First we have to recall we don’t know all the facts, but let us assume that the story, as reported in the Brisbane Times is correct. In that story it is reported that “… the defibrillator had malfunctioned in late February and then failed to pass an equipment check the day before Mr Corsie’s death”. If that is the case there may well be good grounds for a claim against Queensland Ambulance. This would not be a case where a paramedic has done the best they can and there has been an adverse outcome, or a decision had to be made that in retrospect, was not the best decision. This would be an issue where Queensland Ambulance is acting like any supplier and has to act as the ‘reasonable’ supplier/health service/ambulance service. A reasonable ambulance service, that is one that does a risk assessment and thinks about possible outcomes, would realise that equipment has to be checked and working and would appear to have equipment checks. A reasonable ambulance service should have in place a system were equipment that fails the check is taken off line until it can be repaired as the consequences of not doing that are obvious and severe. A system that requires crews to check equipment but gives not instruction on what to do if it fails is clearly not ‘reasonable’.

Dodge asked about a different scenario, that is “… if the equipment in question has been serviced routinely according to the manufacturer’s instructions and that the service and testing was undertaken by suitably qualified medical equipment technicians could a case for negligence be found in the event the equipment has a sudden failure.” That is a different scenario all together. The question is always what is reasonable. Whether the equipment was reasonably made for the purpose and did it have sufficient redundancy in it is one question. But let us assume that its ideal equipment, maintained properly and the like, then a sudden failure could hardly be negligent. What could one do to prevent it? That is always the critical question. If the failure was unpredicted and unpredictable, it’s not negligent for it to fail.

As for the delay in the ambulance arriving, the story says “… the ambulance took an unacceptable 19 minutes to arrive at their address after being called”. Whether that delay really was ‘unacceptable’ will depend on why it took that long. What else was happening etc. The law says that government agencies can’t be sued for not having more resources than they do, and that all the demands on their resources have to be taken into account, (Civil Liability Act 2003 (Qld) s 35) so the issue here will be why did they take 19 minutes and given all the circumstances was that a reasonable time. Kent v Griffiths wont provide any guidance. In that case there was no explanation as to the delay in responding and it was found that the officers lied in their evidence about their response. That case did not deal with what may constitute good reason for delay, as there was no reason to consider.

Dodge then asks “… could the officers themselves be held partly responsible for the undesirable patient outcome by deviating away from the hospital to go to a station to attempt to retrieve replacement equipment when it could have been more expedient to proceed to the nearest emergency department under lights and sirens thereby preventing any delay in specialist emergency medical treatment for his perceived heart attack”. The officers wont be personally liable, as employees of Queensland Ambulance the Service will be liable if that decision was negligent as they were acting as ‘Queensland Ambulance’. Whether that decision was reasonable or not will depend on clinical evidence as to what they should have done, and whether they were directed to do that by their coordination centre or acted on their own initiative. That wont make any difference to the outcome, as who ever made the decision would have been an employee of Queensland Ambulance so Queensland Ambulance will be liable (if anyone is).

The story tells us the patient “… was allowed to walk to the ambulance.” Dodge says “… the service I am with forbids such patients to be allowed to walk as it places undue stress on their already injured heart muscle.” It’s been over 20 years since I was an ambulance officer and we didn’t let people with this sort of condition walk to an ambulance either, and I know of at least one Intensive Care Paramedic whose skill qualifications were downgraded for doing that, so not letting heart attack patients walk would appear to have been standard or ‘reasonable’ practice for some time. I don’t want to rush to judgement here, of course, I don’t know if or why they did allow the patient to walk and there would need to be evidence on why that call was made, if it was in fact made, but prima facie that is at least a questionable decision if in fact that was the decision.

The difficult issue for the plaintiff in this case will be causation. The plaintiffs will have to prove that but for the delay, and the faulty equipment, the patient would have survived and that may be difficult. They may also bring an action in their own name, that is the distress and angst they have suffered was compounded by ambulance response. Proof of that would not require proof that the outcome would have been better for their loved one, but that they would not have been exposed to the trauma of a series of errors.

This case sounds similar to one that has occurred in the USA that you can read about here.

Michael Eburn