Today’s correspondent is a:
… paramedic with St John Ambulance in West Australia.
Often we are ramped with patients at the government hospitals. These patients are triaged by the hospital nurse and then we are told to wait with the patient on our stretcher and sometimes the patient is placed onto a hospital bed and we are still told to wait with the patient until they are admitted into the ED.
The patient’s details are at this point have been typed into the hospital system and they have been given a triage score, and hospital paperwork printed out.
My two questions are:
- Suppose an elderly patient who is asleep on your stretcher quietly dies. Who is legally responsible for the patient?
- If you are looking after the ramped patient and decide to treat the patient under your guidelines and the hospital staff say they do not want you to do whatever treatment you are intending to carry out, do they have the authority as technically you are ramped and not yet admitted into an ED cubicle?
The answer to question 1 is that both the paramedics and the hospital are responsible. In Darnley v Croydon Health Services NHS Trust  UKSC 50 the Supreme Court of the United Kingdom said:
It has long been established that such a duty is owed by those who provide and run a casualty department to persons presenting themselves complaining of illness or injury and before they are treated or received into care in the hospital’s wards. The duty is one to take reasonable care not to cause physical injury to the patient (Barnett v Chelsea and Kensington Hospital Management Committee  1 QB 428, per Nield J at pp 435-436). In the present case, as soon as the appellant had attended at the respondent’s A & E department seeking medical attention for the injury he had sustained, had provided the information requested by the receptionist and had been “booked in”, he was accepted into the system and entered into a relationship with the respondent of patient and health care provider… This is a distinct and recognisable situation in which the law imposes a duty of care. Moreover, the scope of the duty to take reasonable care not to act in such a way as foreseeably to cause such a patient to sustain physical injury clearly extends to a duty to take reasonable care not to provide misleading information which may foreseeably cause physical injury.
(For a discussion on Darnley’s case see Advising patients who want to leave a hospital emergency department – UK and Australia (October 16, 2018)).
Where the patient has been seen by the triage nurse and their ‘details have been typed into the hospital system and they have been given a triage score, and hospital paperwork printed out’ then just as in Barnett v Chelsea and Kensington Hospital Management Committee the hospital has a duty ‘to take reasonable care not to cause physical injury to the patient’ and I would suggest to actually make efforts to admit and treat the patient.
The paramedics also owe a duty of care to their patient. (That is axiomatic but for legal authority see Kent v Griffiths  QB 36). So, both agencies have a duty to act reasonably. For the hospital that may be a duty to try and find a bed in accordance with the patient’s triage score. For the paramedics it has to be to continue to ‘treat’ their patient. If the patient’s condition deteriorates, it would be incumbent on the paramedics to notice that, bring it to the attention of the triage nurse, and if necessary, take appropriate action in accordance with their training and procedures.
As for question 2 and for further discussion on similar issues, see:
- Victorian Paramedics treating patients inside the A+E (June 12, 2015); and
- Treatment in a Victorian hospital carpark (August 19, 2015).