Should airlines pay for services they request a medical professional to perform?

[k_sheep]

It was QF and no, no details taken. All very casual.

 

[docjames]

I think I posted earlier in this thread but have had my details taken (they took my BP!) but no contact from Qantas after the event. Bit disappointed as was in J and spent pretty much the whole MEL-BNE flight in Y attending to unwell pax.

 

[drron]

I think I posted earlier in this thread but have had my details taken (they took my BP!) but no contact from Qantas after the event. Bit disappointed as was in J and spent pretty much the whole MEL-BNE flight in Y attending to unwell pax.

Thats my experience too.Though I was in J on the SIN-LHR run and spent half the time in Y.The crew did give us a bottle of wine and our choice from the duty free.But no follow up from QF management although they had my details-the CSM taking down my postal address as well.

 

[docjames]

Thats my experience too.Though I was in J on the SIN-LHR run and spent half the time in Y.The crew did give us a bottle of wine and our choice from the duty free.But no follow up from QF management although they had my details-the CSM taking down my postal address as well.

That's the bit that sticks - I'd just like to see a thank you letter from QF management.

Add that to the list of things i'd like to see from QF.

 

[mannej]

Should it not be a thank you letter from the sick pax instead?
They were the sick ones, not QF.

 

[QF WP]

Wow, I can't believe that I had missed this thread, so I have read it in full tonight. It is a fascinating subject to me (medical) but other than my First Aid Certificate and former training as a Lifesaver (where I had helped resuscitate a number of drowned/drowning swimmers and the usual bluebottle stings and surfboard fin cuts), I have never experienced major medical issues on board - yes, I've heard the call over the PA, but it's never been near me.

Thank you to all the doctors who have added their experiences, riveting reading.

 

[Princess Fiona]

I've had a couple of travel vouchers from QF for medical assistance.
I would always help if asked and would not expect or ask for anything in return.

 

[k_sheep]

I've had a couple of travel vouchers from QF for medical assistance.
I would always help if asked and would not expect or ask for anything in return.

And indeed, the Good Samaritan Act implies that you are free from blame as long as you are not grossly negligent, and do not ask for payment in return - I remember a case where a doctor stopped to assist at a car accident and ended up billing for his time (cannot remember if it was directly or through medicare) which opened a whole can of worms.

Sadly, I recall a conversation with a well respected anaesthetics/ICU consultant who strongly advised never offer your services on an american airline or for an american passenger due to an unacceptable litigation risk

 

[Princess Fiona]

Sadly, I recall a conversation with a well respected anaesthetics/ICU consultant who strongly advised never offer your services on an american airline or for an american passenger due to an unacceptable litigation risk

That's pretty sad really. Fortunately for me I've not yet had any requests in the LOTFAP but I seriously cannot imagine myself refusing to help and indeed I wouldn't contemplate it.

 

[rechoboam]

I've had a couple of travel vouchers from QF for medical assistance.
I would always help if asked and would not expect or ask for anything in return.

Funnily enough I have never been asked despite oh thirty? more? long-haul flights since graduating. I heard a call once in my sleep but by the time I roused myself it was sorted out. On Emirates once they asked me if I was a medical doctor as I came in, then said "great, you can help us out if anything happens on board" which really annoyed me as I had been up for 24 hours travelling, was delirious with sleep deprivation and neither able nor willing to do anything in those circumstances!

I think it's clear that expecting payment raises all kinds of problems. However we are effectively a "volunteer" force taken for granted by profit-making companies, helping airlines avoid diversions that presumably would cost well over a quarter mil each, only we aren't actually volunteering for the role. I do volunteer for various charitable medical endeavours such as bringing patients in from abroad, but that is in conditions when I have slept, am sober, and in a familiar environment. I have also given first aid many times at the roadside etc. What particularly concerns me is that based on the ABC article mentioned above, Vietnam Airlines which code-shares with QF (just to take an example) appears to have had substandard medical equipment based on doctors' accounts; not even simple equipment to help the patient breathe if CPR is needed (self-inflating bag and mask). If I am expected to be a volunteer medic on their plane, I (or rather my professional association) should be able to help determine what is carried in Australian airspace. If all they have in terms of pain medicine is paracetamol as per the show, there's really nothing I can do for severe distressing pain and I feel bad being in charge of that situation, which is completely avoidable.

I don't know what the solution is but it seems to me that there should be an urgent need for airlines to assume responsibility and liability for any medicolegal costs or actions providing that the practitioner is acting with their limits of expertise, in or out of the US, as a minimum. I can't see why this hasn't happened. And they should stop offering stupid gifts like a box of ballpoint pens (!). Obviously you don't want to "expect" anything as you are then not a volunteer, but the airline should replace the flight if appropriate, which would be less than 1% the cost of the diversion.

Lastly no-one has mentioned that a small minority of doctors in ED/Anaesthesia/etc can't think of anything more exciting than helping with emergencies on an airplane and relish the stories that result. If they end up put in a J seat they have even more fun!

 

[jb747]

Should the airlines pay for it, or perhaps the patient?

Over the years I've seen this scenario many times, and almost always there is a very willing doctor at the end of the call. Management never say thank you, but my crews have always done what they could to say thanks.

You do see some interesting variations though. On one occasion we had two doctors arguing away, whilst an ambo was doing all of the work...Medlink agreed with the ambo. On another, a young doctor responded, and after a few minutes told the cabin crew to go and get the bloke who had been sitting next to her...turned out he was an emergency specialist...but he wasn't intending to help.

If Medlink are involved, and their instructions followed, then my understanding is that they cover all of the legalities/liabilities.

The interaction with the crew is then another interesting part of all of this. If, for instance, the doctor thinks a person should be on the ground ASAP, but the weather or the alternates poor, then it becomes a balancing act. Do you place the entire aircraft at risk to look after one person...? That's my call.

You do meet some nice people this way too. Just recently I had a chat with a professor of thoracic surgery from the northern UK. Delightful bloke...who I'm sure was amused to try his skills on an alternative body part.

 

[drron]

Yes JB the QF crews have always been great in these situations.
Though i did prefer my experience with JAL.Was assigned my personal FA/translator,gifts on board and a follow up letter from the President of JAL.
But even better was running into the purser on 2 other JAL flights.Walked on in NRT to be greeted personally followed up by-"drron which seat would you prefer to be in?"Certainly had the rest of the cabin wondering who i was.

 

[rechoboam]

Jb is correct Medlink take on liability - but not all airlines use it. I should get a job with them actually...they have access to a lot of expertise.

Should the patients pay? I think they should in principle pay for my time, my ticket and some extra for the medico legal risk. But what can you do? Swipe a credit card before helping? Chase a debt from Mr Chan from rural Sichuan? My finance staff are good but I think they would hate me forever if I tried that on!

 

[docjames]

I'd prefer it to remain gratis per se. Billing etc implies liability....

 

[rechoboam]

I'd prefer it to remain gratis per se. Billing etc implies liability....

Playing devil's advocate- my whole practice carries liability, every single day. I would just give the patient a sheet of paper stating that I am giving them treatment to the best of my ability in difficult and suboptimal circumstances through no fault of my own. I'm called in the middle of the night anyway for life-threatening situations and if the patient turns out not to have insurance a bill will be sent out in due course, with an explanation. Now that I think about it why is anyone more scared of being sued in an airplane than anywhere else...and why can't someone launch a civil action against a doctor who preferred to sit down and watch 2 1/2 men instead of saving someone's life? (even if they end up losing)?

 

[docjames]

Playing devil's advocate- my whole practice carries liability, every single day. I would just give the patient a sheet of paper stating that I am giving them treatment to the best of my ability in difficult and suboptimal circumstances through no fault of my own. I'm called in the middle of the night anyway for life-threatening situations and if the patient turns out not to have insurance a bill will be sent out in due course, with an explanation. Now that I think about it why is anyone more scared of being sued in an airplane than anywhere else...and why can't someone launch a civil action against a doctor who preferred to sit down and watch 2 1/2 men instead of saving someone's life? (even if they end up losing)?

Certainly not volunteering could leave you open to potential liability too I suppose. In reality, it would be rare to be sued anyway, and you are covered by your medicolegal insurance for "good samaritan" work. It would not be considered "good samaritan" if you were charging, it would be professional services provided.

Thus if you bill the patient, you would have to ensure your medicolegal insurance covered you for practice overseas / in flight, in sub optimal situations. Which you'd need to arrange in advance. It's the lack of familiar environment that makes me uncomfortable - I know what to do, but do i have the equipment and appropriate assistance to achieve a good outcome.


There's also a blurry area around volunteering / providing professional service when highly sleep deprived or intoxicated in which neither case should you really be practicing, but you may be the best option in any case, but if you were you to make a mistake, if it went to court, it could get very messy around fitness to assist. Again in theory you should be covered by good samaritan, but not necessarily if billing.


If you are travelling overseas on a tourist visa, and you bill the patient, are you then working and in breach of visa?


It gets very messy.......

 

[Will]

Now that I think about it why is anyone more scared of being sued in an airplane than anywhere else...

Replying with the other side of the argument (whilst noting that most of us would, and do, assist): the principal issue with being sued for activities conducted on an aeroplane is jurisdictional. Some indemnity policies may not cover the actions, ie if it involves US jurisdiction, and the claim may be extremely expensive to defend (it may involve flying around the world for a hearing, and sourcing local representation).

The other reason, which isn't discussed much, is that doctors may be scared by a time-critical, life and death situation in an unfamiliar, suboptimal environment without appropriate equipment. Most doctors are a long time past their last emergency department shifts, and can honestly be very intimidating to attempt a resuscitation in cramped quarters without the usual aids.

and why can't someone launch a civil action against a doctor who preferred to sit down and watch 2 1/2 men instead of saving someone's life? (even if they end up losing)?

Of course someone could file a civil action. They would probably lose - as you note - due to multiple defences (duty to rescue not yet established in common law, easy to claim drunk/ tired) and they probably wouldn't even know who to sue (the airline won't give them a list of who is on the plane and what their qualifications are!).

 

[docjames]

Some indemnity policies may not cover the actions, ie if it involves US jurisdiction, and the claim may be extremely expensive to defend (it may involve flying around the world for a hearing, and sourcing local representation).

Most indemnity insurers will specify if they cover you throughout the world in event of good samaritan act. I've certainly confirmed with mine that this is the case.

 

[beardoc]

The other reason, which isn't discussed much, is that doctors may be scared by a time-critical, life and death situation in an unfamiliar, suboptimal environment without appropriate equipment. Most doctors are a long time past their last emergency department shifts, and can honestly be very intimidating to attempt a resuscitation in cramped quarters without the usual aids.

One reason I'm glad I'm still involved in medical retrieval!

Of course someone could file a civil action. They would probably lose - as you note - due to multiple defences (duty to rescue not yet established in common law, easy to claim drunk/ tired) and they probably wouldn't even know who to sue (the airline won't give them a list of who is on the plane and what their qualifications are!).

Actually, in Australia, there's is a clear duty to attend if you are currently able to and you have been identified as a medical practictioner because of the Woods vs Lowns case in NSW. It's a case where a child had an epileptic seizure and the mother sent her other child to go to a nearby doctor's surgery to summon help. There was dispute over whether a request was properly made (the sibling identified that she talked to Dr Lowns and that Dr Lowns refused to come, insisting that they should be brought to his surgery, but the doctor denied that he said this). The court deemed that the doctor had been requested and then had a duty to attend, and in not doing so, was negligent. If they know you're a medical doctor and you're in any condition to attend, and you refuse to do so, you can be sued. My MDO covers me for Good Samaritan acts anywhere in the world - it's my understanding that all Australian MDOs do, but you should check with yours if you're not sure.

 

[rechoboam]

One reason I'm glad I'm still involved in medical retrieval!



Actually, in Australia, there's is a clear duty to attend if you are currently able to and you have been identified as a medical practictioner because of the Woods vs Lowns case in NSW. It's a case where a child had an epileptic seizure and the mother sent her other child to go to a nearby doctor's surgery to summon help. There was dispute over whether a request was properly made (the sibling identified that she talked to Dr Lowns and that Dr Lowns refused to come, insisting that they should be brought to his surgery, but the doctor denied that he said this). The court deemed that the doctor had been requested and then had a duty to attend, and in not doing so, was negligent. If they know you're a medical doctor and you're in any condition to attend, and you refuse to do so, you can be sued. My MDO covers me for Good Samaritan acts anywhere in the world - it's my understanding that all Australian MDOs do, but you should check with yours if you're not sure.

I spend a good chunk of my time too resuscitating people in CT scanners etc due to the particular job I do, so I wouldn't be particularly stressed responding to this sort of situation. Lowns was a doctor, working in his medical practice, a doctor in the community and I don't think that is directly translatable to being in an airplane and potentially being asleep/affected by large doses of clonazepam etc (some doctors are obliged to use sedatives for flights if they themselves have medical conditions aggravated by lack of sleep). Of course i'm not a lawyer. My MDO covers me for GS acts, but not all do worldwide. In fact my MDO covers me for short periods of work abroad without having to make any particular provisions - I think.

Replying with the other side of the argument (whilst noting that most of us would, and do, assist): the principal issue with being sued for activities conducted on an aeroplane is jurisdictional. Some indemnity policies may not cover the actions, ie if it involves US jurisdiction, and the claim may be extremely expensive to defend (it may involve flying around the world for a hearing, and sourcing local representation).

The other reason, which isn't discussed much, is that doctors may be scared by a time-critical, life and death situation in an unfamiliar, suboptimal environment without appropriate equipment. Most doctors are a long time past their last emergency department shifts, and can honestly be very intimidating to attempt a resuscitation in cramped quarters without the usual aids.

Check out In-flight emergencies: playing The Good Samaritan - "A consultant psychiatrist who assisted with an on-board emergency in 1997 billed the airline for £540. It was felt that this case was only brought as a result of the lack of generosity of the airline in the first instance. When they refused to pay he took them to court, where he failed to win his case"