At Medical Protection there are increasing calls to the medicolegal helpline and online requests for assistance from doctors who are unclear what exactly constitutes a Good Samaritan act, and whether they would be covered for some unusual scenarios that show an increasingly divergent practice of medicine.
Medical Protection members are reminded that a Good Samaritan act is defined as:
Recent requests from doctors have asked whether their Good Samaritan cover allows for scenarios where they are sought out to provide care in an emergency – rather than happening across the emergency when not at work. This may be in a situation where a doctor is known to live in a local area and someone goes to get them when there is an emergency locally or, where a recently retired doctor who maintains a license to practise is asked to provide a prescription. Other queries have related to situations where a Good Samaritan act evolves into an ongoing duty of care, or queries from those doctors who have committed to providing services using an app, for example the “GoodSAM” responder app.
Considering the above definition, those who are being sought to assist in an emergency through knowledge of their professional status may be considered to not be acting in a true Good Samaritan capacity as they have not happened across the situation in a personal capacity, and often there are other ways that emergency care can be sought – and faster. However, with increasing ambulance delays, these situations may conflict with the moral and ethical duty as a doctor, nurse or registered healthcare professional. In an emergency situation, there is no legal obligation on a doctor to assist but paragraph 26 of the GMC’s Good Medical Practice states:
Medical Protection considers that, provided a doctor is assisting in a genuine emergency, outside any working contract or existing professional relationship with a patient whilst waiting for additional medical care, it is likely to be considered a Good Samaritan act; however, doctors should ensure they are not promoting this as a service. Providing care that goes beyond providing immediately necessary emergency care, such as providing medical advice or writing prescriptions, would not be considered a Good Samaritan act and doctors are strongly advised to consider the medicolegal implications of this scenario, and seek further advice that is outside the scope of this article.
Those who are registered to provide a service via the GoodSAM responder app and act in accordance with the code of practice can be reassured that this does fall under the Good Samaritan act for Medical Protection members. Healthcare professionals who are registered with this app should advise their indemnity organisation that they are providing this service.
State indemnity and Good Samaritan acts
Doctors must have individual indemnity to ensure that they are covered to assist in a Good Samaritan act. State indemnity via the NHS schemes covers only for those scenarios that occur as a result of employment, including the GMS contract for GPs. Other healthcare professionals should check their indemnity requirements with their regulator.
Medical Protection experience of Good Samaritan cases
Since 2013 Medical Protection has assisted with more than 140 cases relating to Good Samaritan acts, with the most common case type being a request for a report, usually following involvement where a patient has subsequently died. Requests for reports in these circumstances should be treated in the same way as any other report, setting out the name and qualification of the doctor writing the report and importantly the circumstances under which they became involved in the patient care. Where a patient has died it is possible that a doctor may be called in their Good Samaritan capacity to give evidence at an inquest, which is likely to be as a factual witness, as outlined in the case below, available in full on the Medical Protection website:
Dr G and Dr B had been out walking down an icy country lane when they found a motorcyclist lying in a ditch next to his bike. They called 999 and were informed that an ambulance would be sent. While waiting for help to arrive, the patient’s condition deteriorated, and they became concerned about his airway and breathing. They tried to reposition the patient to enable assessment and intervention but encountered some difficulty due to the terrain. The patient suddenly arrested and sadly died despite prolonged resuscitation.
A few months later the coroner wrote to the doctors to request statements. When they contacted Medical Protection for help, we appointed a medicolegal consultant (MLC) who provided advice on the structure and content of the statements, bearing in mind that there would likely be an inquest in due course. The MLC talked them through the inquest process and advised the doctors to let her know if they were called to give evidence.
Dr B was subsequently asked to attend the inquest as a factual witness. Her MLC provided advice on giving evidence and what to expect on the day, resulting in the inquest passing uneventfully.
What about more unusual outcomes from Good Samaritan acts and how might a healthcare professional be supported?
In 2022 Dr C, a GP trainee, was attending a social event with a number of friends. She had been consuming alcohol when she became aware of a commotion and heard shouts for help. She attended the incident, where a person had fallen down the stairs and sustained a head injury. She attended the patient and undertook basic first aid; she also advised an ambulance should be called. She handed over to the paramedics on arrival.
Three days later her lead employer contacted her to advise they were undertaking local disciplinary procedures due to one of the paramedics reporting Dr C for a failure to contact the ambulance in a timely fashion. The paramedic reported the patient had sustained an intracranial bleed, which had required treatment.
Medical Protection assisted Dr C with providing a written statement of events to their employer and attending an initial disciplinary meeting with the lead employer. Dr C was able to provide a factual account of the events and explain she understood that an ambulance had been summoned as she requested. No further disciplinary action was taken, although this was a stressful period for Dr C at a critical time in her GP training.
It is possible that there may be circumstances when a Good Samaritan act goes beyond what should be expected in the circumstances and doctors should be mindful that there may be scenarios where a Good Samaritan act goes too far.
Take the case of Mr R, a retired orthopaedic surgeon without a license to practise, in a retired category of membership at Medical Protection. He was undertaking a ten-day trekking expedition in Ecuador with a group of friends. The group had radios and were able to seek support as required from local guides and experts.
During the expedition one of the group members sustained a serious injury to their foot when they stepped on a snare. Mr R had some medical kit available and treated the injury, advising his companion that they could seek medical support at the end of the trek. Over the course of the following days, the wound became increasingly painful and was discharging small amounts of pus. Mr R undertook daily washouts of the wound using saline and monitored his companion’s pulse rate for signs of sepsis.
At the end of the trek the injured party collapsed and was taken to hospital. He was advised that as a result of the penetrating injury and subsequent infection, he required a below knee amputation, which was performed.
Mr R received a letter of claim six months later, from an English firm of solicitors, alleging he had breached his duty of care to his trekking partner and looking for financial compensation.
Was this a Good Samaritan act?
Initially yes: Mr R happened upon an injury and assisted at the time, he also was in a retired category of membership which would allow assistance with a Good Samaritan act anywhere in the world. However, by undertaking daily wound reviews and not seeking independent medical care it could be considered he developed a duty of care to his companion beyond acting in a bona fide emergency.
Mr R should have considered providing initial first aid and then seeking independent medical advice, especially given that the group had access to local guides and experts.
The above hypothetical scenario sets out a situation where the care provided may not be considered to be a Good Samaritan act by virtue of the prolonged nature of the relationship. In this case it would be unlikely that Mr R would be able to get assistance from his indemnity organisation as he extended his care to beyond a reasonable Good Samaritan act, although each case is assessed on its own individual circumstances.
Fortunately in reality, the likelihood of a claim after a Good Samaritan act is extremely low and since 2015 the Social Action, Responsibility and Heroism Act offers protection for those involved in Good Samaritan acts. However, the law is clear that when considering the action it must have been performed in a responsible manner.