Do Good Samaritan laws protect you in the hospital?

An appeals court has made it harder for doctors in Texas to respond to inpatient emergencies, critics charge. Are they being alarmist?

By Wayne J. Guglielmo
Senior Editor

Ob/gyn Douglas K. McIntyre of Austin, TX, probably wishes he'd been out of town on April 23, 1998. On that day, McIntyre voluntarily responded to a "Dr. Stork" page at St. David's Medical Center in Austin. The delivery—in progress when he arrived and complicated by shoulder dystocia—resulted in permanent neurological damage to the baby. The parents sued McIntyre, among others, claiming he had exerted excessive traction during delivery.

McIntyre asked that the trial court grant him summary judgment based on the Texas Good Samaritan statute. His motion was granted, but in a 2-1 vote last October an appeals court reversed the ruling and tossed the case back to the lower court. In December, McIntyre petitioned the Texas Supreme Court for review. In April, the high court requested a briefing on the merits of the appeal.

The case has stirred interest in Texas, and beyond, because it raises questions about the circumstances under which doctors who voluntarily offer emergency assistance inside a hospital are protected as Good Samaritans—something state courts (including Texas') disagree on. Complicating the case further is the peculiar nature of the Texas law, which includes remuneration standards that most other state statutes don't.

We took a look at this interesting case to see what it could mean to you.

Doctors needn't sit on their hands, trial court says

In asking the trial court for Good Samaritan protection, McIntyre had to leap several legal hurdles set out in the state's statute. Among other things, he had to establish that he not only didn't charge for the emergency care he rendered—which he didn't—but that he had no "expectation of remuneration."

Expectation, of course, is a tricky standard, but Texas law offers some guidance. "A person who would ordinarily receive or be entitled to receive" some form of compensation in an emergency—a hospital emergency specialist, for example—would not be entitled to Good Samaritan protection, the statute points out.

In his motion for summary judgment, McIntyre explained that he was clearly not employed by the hospital in this capacity, and so was acting with no expectation of being paid.

The plaintiffs, in their response to the motion for summary judgment, never claimed McIntyre was an employee in the emergency department, but they insisted that he expected remuneration for his services, nevertheless. As evidence, they cited his "admission" in deposition that he physically could have sent the mother a bill if he'd wanted to.

They also pointed to the fact that he was at the hospital that day to see another patient, from whom he did expect payment. That expectation, they said, made him subject to another exception to the statute—the one disqualifying someone "at the scene of the emergency . . . seeking to perform a service for remuneration."

The trial judge disagreed with both arguments. First, he guessed McIntyre ordinarily wouldn't send a bill for a hospital emergency, given the custom among doctors in the county in which he practiced. Also, the fact that McIntyre was in the hospital seeing a paying patient didn't itself disqualify him from Good Samaritan protection.

If it did, the judge said, then "the only people who could step forward [in an emergency] and be protected are people not working for money at that location," which would likely exclude doctors and nurses. In fact, the judge said, "The only people that could help [under these circumstances], would be the very people you wouldn't want helping. And I don't think that's what the legislature intended."

Appeals court applies a two-pronged test

In reversing the lower-court judgment in favor of McIntyre, the appellate court was less interested in divining legislative intent than in parsing the plain meaning of the statute, as Southern Methodist University associate law professor Thomas William Mayo pointed out in the Nov. 5 issue of Texas Lawyer.

"Two distinct possibilities exist for when a person is deemed to be acting for or in expectation of remuneration," Chief Justice Marilyn Aboussie wrote in her majority opinion. "When the individual would ordinarily (1) receive remuneration for administering care, or (2) be entitled to receive remuneration for such services. While the first possibility speaks towards what is customary, the second possibility addresses legal entitlement [italics in original]."

McIntyre's testimony that neither he nor any other physician in the county would customarily charge for emergency services satisfies the first possibility, the Chief Justice wrote. But he failed to produce sufficient evidence to satisfy the second possibility—that he wasn't legally entitled to remuneration. Therefore, she concluded, his "summary judgment was erroneously granted."

In a strongly worded dissent, Justice Jan Patterson scolded the majority for parsing "the words [of the statute] beyond their intended meaning." She wrote, "If entitlement to remuneration under some unarticulated legal theory or multipronged requirement were the test, no doctor would ever render emergency care."

Will doctors think twice about jumping in?

The fallout following the appellate decision has been intense.

McIntyre's attorney, Jim Ewbank of Ewbank & Byrom in Austin, thinks the majority decision sends a chilling message. "Doctors should know what is expected of them in their community," he says.

They shouldn't have to sort through "possible legal theories that might entitle them to compensation" before offering emergency care. If they're forced to, says Ewbank, then specialists in particular will be discouraged "from coming to the rescue in their specialty, because those are the only people who might have an expectation of remuneration."

That would be unfortunate, he adds, echoing the trial judge, because "those are the very people you want to respond to the emergency. I want an obstetrician to feel free to jump in and save my baby without worrying." (In January, the Texas Medical Association filed a friend-of-the court brief in support of McIntyre's petition for review before the Texas Supreme Court.)

But plaintiffs' attorney Laurie M. Higginbotham, of Austin-based Whitehurst, Harkness, Ozmun & Archuleta, thinks the law as the appellate court interpreted it "doesn't discourage specialists from responding." Even if McIntyre had been called upon to deliver this baby in the hospital elevator, he would probably be acting as a Good Samaritan, says Higginbotham. "But because the birth took place in the labor and delivery room, where he always practices and where he makes his living, he stopped being a Good Samaritan"—and thus isn't entitled to a lower standard of care.

If the Texas high court takes up the case, justices will have to decide between these two very different interpretations of the law. Indeed, courts in other states (New Jersey and Utah are two) have struggled with the underlying dilemma—on the one hand, how to protect patients from substandard care, even in emergency situations; on the other hand, how to encourage doctors to respond voluntarily, without fear of liability.

As a guide to resolving the dilemma, the trial court judge's words may have some relevance: "People really don't volunteer without protection of Good Samaritan laws, but . . . anytime somebody actually undertakes care, the care's not influenced by what the liability standard is." In other words, prudent liability protections encourage involvement in times of distress—they don't promote shoddy or substandard care.

 

Wayne Guglielmo. Do Good Samaritan laws protect you in the hospital?. Medical Economics 2002;9:92.