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Appreciation for Medical or Health Assistance?

Appreciation for Medical or Health Assistance?

Old Sep 1, 2006, 11:54 am
  #1  
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Appreciation for Medical or Health Assistance?

Haven't seen a recent post on this topic - though there was a comprehensive one in 2004
here. This was titled "award for medical assistance."

Anyways, I'm an MD, and during a recent flight on AA, there was a patient who was shaking/having tremors. Call for medical help went overhead, and I was the only health professional on board. In examining and talking to the passenger, it seemed like he was dehydrated (luckily AA was well stocked with water and beverages, since he couldn't bring any on board). Anyways, no need to divert, and I stayed with him for a bit to make sure he was ok. End of story. No award, no appreciation offered from crew after the incident.

Here's my question to fellow MD's and health professionals... have you noticed a decline of appreciation for onboard medical assistance? Prior threads have addressed "awards" for service - I'm merely talking about a few "thank you's." Perhaps even these are hard to come by these days?

I would have expected at least a thank you from the FA's on my way out the plane. I don't expect any remuneration or miles or award - just a nice "thank you." Nope. I was up in the aisle for at least a good 15-20 minutes and the only Asian guy on the plane (i.e. couldn't be confused for anyone).

No gripes (it makes the day more pleasant when I don't expect anything from patients) - just curiosity at what others are experiencing.
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Old Sep 1, 2006, 1:20 pm
  #2  
 
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I am an MD as well. This spring I took care of a young men with and asthma attack and tachycardia on a red eye from PDX to IAH on CO. He was slightly overdosed with a salbutamol aerosol and there was no need to divert, but I spent quite some time with that patient.
The crew was very nice and all flight attendants thanked me after the flight. After I didnt hear anything from CO for three month I email and shortly after they gave me 5000 bonus miles and a nice but generic letter.
I havent been an MD for too long, so I hadnt had the chance to help before. But from what I here from some more senior MDs here in Germany is that LH, AF and SAS sent them nice presents (e.g. Champange or some nice wine) and miles. So I was a little disappointed with that.
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Old Sep 1, 2006, 2:18 pm
  #3  
 
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I applaud both of you. You are putting yourself in a no win situation. If you are asked if a divert is needed, so no, and the passenger crumps, there will be 3 malpractice lawyers for every 1 paramedic waiting for you when the plane lands
P
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Old Sep 1, 2006, 3:40 pm
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Originally Posted by pgrin
I applaud both of you. You are putting yourself in a no win situation. If you are asked if a divert is needed, so no, and the passenger crumps, there will be 3 malpractice lawyers for every 1 paramedic waiting for you when the plane lands
P
Thanks for your applause. But your comment made me think about providing medical care on an US Airplane. I did not even think of not helping. But your remarks give me the impression that that might be hazardous for me.
I work and was trained mostly in Germany. In our legal system the likelihood that any malpractice claims get through any court especially in the situation of a Good Samaritan are extremely low unless someone can proof that I intentionally did anything against better knowledge. At the same time everyone is required by law to provide first help or more if higher expertise is available. The helping person is immune from prosecution if assistance given in good faith turns out to be harmful. As I want to survive as an MD, I of course have malpractice insurance that also covers activities as a Good Samaritan outside of Germany.
But I would like to know which regulations and laws apply in this situation in the US.

Can I refuse to get involved if I am the only MD or health professional onboard?
What if my decision that the patient doesnt need to be treated right away and an emergency landing is necessary turns out to be wrong?
Can the airline sue me for causing an unnecessary emergency landing?

I only found is this:
49 USC 44701
(b) Liability of individuals.--An individual shall not be liable for damages in any action brought in a Federal or State court arising out of the acts or omissions of the individual in providing or attempting to provide assistance in the case of an in-flight medical emergency unless the individual, while rendering such assistance, is guilty of gross negligence or willful misconduct.
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Old Sep 1, 2006, 3:52 pm
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Well, what I got was a ride in the cockpit while talking on the radio (pre 9/11, obviously), a bag full of little airline alcohol bottles, and thank yous from the FAs and pilots.

I was helping a guy with what seemed quite clearly to be a kidney stone. I'm a specialist in a very specialized field, so my general medicine is not all that automatic. I wasn't absolutely, 100% certain. Ruptured aortic aneurysm would be pretty unlikely in a 30-year-old.

They asked me whether they should divert, and I said, "I'm not qualified to make a decision as to whether an airplane should divert." They patched me though on the radio to a central airline medical service (hence the cockpit). I described the symptoms and my thoughts to the MD on the radio, and he made the decision that we did not need to divert.

I guess the only thanks I would hope for is not to be sued. If I had had to make the decision, I would have said to divert in order to cover my a$$.
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Old Sep 1, 2006, 4:03 pm
  #6  
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Originally Posted by jannis
Can I refuse to get involved if I am the only MD or health professional onboard?
What if my decision that the patient doesnt need to be treated right away and an emergency landing is necessary turns out to be wrong?
Can the airline sue me for causing an unnecessary emergency landing?

I only found is this:
49 USC 44701
(b) Liability of individuals.--An individual shall not be liable for damages in any action brought in a Federal or State court arising out of the acts or omissions of the individual in providing or attempting to provide assistance in the case of an in-flight medical emergency unless the individual, while rendering such assistance, is guilty of gross negligence or willful misconduct.
While I am not a lawyer, I have read other threads where some MD's have refused to touch the passenger. There is always an airline doctor accessible by phone (as the other poster used) who can assist in these cases, as thus defer any "blame."

I don't think there is any harm in assessing the situation as an MD, and saying that we are unable to manage it properly. Once we start to manage a patient, we are actually bound to manage a patient at a level appropriate to our training. If there is gross negligence or we omit anything in standard of care, then we're in deep trouble. If it is too risky (too apt to get into a lawsuit) or above our means of managing a patient -- then I think there is nothing wrong with saying this to the pilot/crew that we are unable to treat the patient.

It is definitely a tough situation, since I'm sure "gross negligence" can be very subjective.
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Old Sep 2, 2006, 1:09 am
  #7  
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My husband is a physician and has never hesitated to help a sick passenger.
He takes his Hippocratic Oath quite seriously. I honestly don't recall if he has ever received any compensation other than appreciation for a job well done by the airline crew and the families of the ill passenger It was enough for him.
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Old Sep 2, 2006, 2:12 am
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Originally Posted by jannis
Can I refuse to get involved if I am the only MD or health professional onboard?
Your own professional and ethical standards are the same wherever you might be in the world, regardless of jurisdiction. If they are at all similar to mine, then these would ensure that you always become involved, to a level consistent with your experience. (Possible exception, if too much ethanol consumed?)

On a similar note, I don't think being on an aircraft is ever a good enough reason for me to take decisions that I am not adequately qualified to take elsewhere. This would include the decision to divert -- surely the captain has the final call, once he has enough information about the degree of urgency.
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Old Sep 2, 2006, 3:43 pm
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Originally Posted by jannis
As I want to survive as an MD, I of course have malpractice insurance that also covers activities as a Good Samaritan outside of Germany.
But I would like to know which regulations and laws apply in this situation in the US.

Can I refuse to get involved if I am the only MD or health professional onboard?
What if my decision that the patient doesnt need to be treated right away and an emergency landing is necessary turns out to be wrong?
Can the airline sue me for causing an unnecessary emergency landing?

I only found is this:
49 USC 44701
(b) Liability of individuals.--An individual shall not be liable for damages in any action brought in a Federal or State court arising out of the acts or omissions of the individual in providing or attempting to provide assistance in the case of an in-flight medical emergency unless the individual, while rendering such assistance, is guilty of gross negligence or willful misconduct.
This statute covers only non-medical individuals. If you are a doctor, you can be sued for alledged malpractice even if you are a Good Samaritan.

I don't think an airline will sue for an unnecessary landing. Consider leaving the decision to the captain by advising him, not trying to order him around. One could say that the passenger's medical condition is such he/she has a reasonable likelihood of survival without an unscheduled landing but that there is a likelihood of a bad outcome, possibly small, as a result of not landing. I have seen a sick (and coherent) passenger who did not want to divert which made the decision for the captain easy.

Airlines vary as far as compensation. Often, they will compensate other passengers for a delay more than the doctor. Northwest has a 5,000 frequent flyer miles certificate that they give. A Northwest FA has also supplemented this with another 1,500 mi. certificate. Delta has written a letter of thanks. FA will sometimes give a bottle of wine to the MD.

I've found that MD have a sense of compassion and are not so tricky and calculative like lawyers that they will volunteer and give assistance.
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Old Sep 2, 2006, 10:42 pm
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Originally Posted by Skylink USA
This statute covers only non-medical individuals. If you are a doctor, you can be sued for alledged malpractice even if you are a Good Samaritan.
IMHO, this is a very sad commentary on the legal-medical ongoing battle that continues to rage in the US.
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Old Sep 3, 2006, 4:04 am
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Yes, it is both worrying and reassuring (depending on which side of the professional divide you fall) that a doctor can always be sued for malpractice.

It seems to me that people everywhere can bring a case against a doctor at any time, but that the chances of the plaintiff winning vary according to several factors (not least of all being whether or not the doctor was actually negligent or incompetent!). This ought to apply equally whether the doctor is practising in the rooms or in public.

My indemnity insurance / protection society does not protect me from malpractice, or indeed from patient complaints or suits. It does (I hope) aim to defend me should I ever end up in this situation. Then it is up to the justice system to decide the outcome.

The really 'sad commentary' here is that this state of affairs tends to make us all more likely to advise the captain to divert, and less likely to intervene to a level consistent with our skills.
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Old Sep 3, 2006, 10:47 am
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Originally Posted by LZ-HMI
Yes, it is both worrying and reassuring (depending on which side of the professional divide you fall) that a doctor can always be sued for malpractice.

It seems to me that people everywhere can bring a case against a doctor at any time, but that the chances of the plaintiff winning vary according to several factors (not least of all being whether or not the doctor was actually negligent or incompetent!). This ought to apply equally whether the doctor is practising in the rooms or in public.

My indemnity insurance / protection society does not protect me from malpractice, or indeed from patient complaints or suits. It does (I hope) aim to defend me should I ever end up in this situation. Then it is up to the justice system to decide the outcome.

The really 'sad commentary' here is that this state of affairs tends to make us all more likely to advise the captain to divert, and less likely to intervene to a level consistent with our skills.
Well stated LZ-HMI

IMO, the "really sad comjmentary here is the effort of such actions/inactions on the health of the patient.
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Old Sep 6, 2006, 5:13 pm
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My mother (Emergency Medicine MD) seems to semi-routinely get caught in these types of situations. Especially since the other MD(s) on board seem to all be radiologists or pathologists.

As recently as 10 years ago, she and my sister (travel companion) were upgraded to 1st class for the rest of their trip and the return on a flight to Egypt.

On NW, she recieved 5,000 miles and a thank you.

Your mileage may vary -- but in some cases there is no other option.

Also -- even though they have doctor's on call (via airphone), flight attendents cannot start IV's or give any drugs. So esp. in an emergency, having a doctor (or an RN who can take the on call doctor's orders) on hand becomes vital.
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Old Sep 6, 2006, 7:58 pm
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Originally Posted by rubindj
Also -- even though they have doctor's on call (via airphone), flight attendents cannot start IV's or give any drugs. So esp. in an emergency, having a doctor (or an RN who can take the on call doctor's orders) on hand becomes vital.
Sad but true.
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Old Sep 7, 2006, 7:09 am
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I have helped out several times on several different airlines. US provided me with 5,000 bonus miles (I think) and a nice, personalized letter from an executive, and BA provided me with nada! It doesn't matter to me whether I get compensation or not, it is more about helping out to insure that the person in need of assistance is evaluated quickly. I always think of it from this perspective: what if the person in need of aid was a friend or relative of mine and none of the trained professionals stepped forward to help.

As I understand it from several attorneys, Good Samaratin laws may not be applicable but, if I act in a reasonably prudent fashion and am not grossly negligent (I know, I know this can be subjective), and I assist when I did not have a duty to act (e.g., I was not "on call" or "working" at the time) I am protected.

It is, as other posters have stated, a sad commentary that when decided whether to use training that we have to assist others, we have to factor in the fear of lawsuit before acting. It should occur reflexively, like drooling to a bell in Pavlov's dog, but it sure ain't...

Edited to add: I was on VS Upper Class 2 months ago and we had an interesting situation - we had been told that we were 30 mins from JFK, but were in a holding pattern due to traffic. Five minutes later we were told that we were given priority clearance and that all pax should stay in their seats when we landed to allow paramedics on board. Non announcement was made, nothing was evident in the aisles of the plane. When we landed, the paramedics and police went right to the cockpit! We then deplaned so I don't know what the outcome was, but I wonder if someone up front wound up flying solo, and I wonder if security concerns stopped them from making an annoucement requesting help.
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