my name is Max Feinstein and I'm an anesthesia
resident at the Mount Sinai Hospital in New York City
I was recently driving down the highway and I found a man laying unconscious in the middle
of the highway, so I got out and started doing CPR. afterwards, I began to wonder:
what are the medico-legal implications of actually providing out of hospital care?
and to answer that question, I decided to ask a lawyer!
hi, I'm Jacob Appel. I am both an attorney and a physician,
and I'm the director of ethics education and Psychiatry here at Mount Sinai Hospital,
and I get asked questions like this a lot. and the first thing I tell people
is that in most states, you don't have to help anybody in a situation like this.
there are a handful of states that have rules called "duty to assist" laws that make anybody
have an obligation to help a stranger in need. but New York State, for example, is not one
of them. so you want to keep on driving? you want to wave goodbye? you can do that.
The only exception, by the way, is a "half rescue." so let's say you're walking by a pond and
you see someone drowning, and you swim out to save them, and then you realize that it's your boss,
and you don't like him, so you wave and you swim back. that you can't do, because you deterred
other people waiting along the side of the water from jumping in to save him. so other than a half
rescue, you are free to drive by in New York. that doesn't mean it's the right thing to do.
so there's another law in New York State - and most states - called the "Good Samaritan law"
that protects you if you do offer assistance to a stranger in need,
and it applies if you're a doctor or if you're a layperson. and this rule basically
says that if you engage in care with the best of intentions, meaning you're acting out of the
goodness of your heart, not an ulterior motive, you are protected from lawsuits for negligence.
so the exceptions are if you engage in intentional damage to the person, like you realize that's your
boss, and you don't like him, so then you stab him with your scalpel -- then you're not protected. or
if you engage in reckless conduct, or some might call it gross negligence, you don't uphold the
standard that an ordinary person would know is the standard to behave with. but beyond that,
you're protected from liability if you help a stranger in need. does not apply in the hospital
setting, does not apply if you're their doctor. but a stranger in public- you're protected.
interesting. one of the things that I started thinking about after this incident that I
described is wondering whether I should carry any sort of medical equipment in
my car. one of the things that I wish that I had had, for example, was at least a pair of
gloves. and then I started wondering "well, would it make sense for me to carry, say,
a bag-valve mask?" or you know - and I don't think that I would do this - but
carrying intubation equipment. this would not be something that I have ever thought about before
until I found myself in the situation. I'm curious what you would recommend?
I mean you certainly could carry equipment that is suitable to the kind of expertise you have
can only be a good thing, and you're going to be protected if you use that equipment in the
appropriate, or roughly appropriate, ways. I'm a psychiatrist - I don't carry a couch with me,
so there are limits, but I always say in a situation where you're helping a stranger,
there are three things you should do as a physician: first, you should announce that
you're a physician because that will deter people who are not physicians from intervening, and
they'll know why you're stepping forward. then you should explain what your specialty or expertise
is. so if I'm a psychiatrist and I step forward and say I'm a physician, I'm a psychiatrist,
and the chief resident anesthesia is standing behind me, they may be more suited to help in
a particular situation. they won't assume I know what I'm doing, and then finally you should turn
to someone, point them out specifically, and tell them get help or call 9-1-1.
because as I mentioned, you can't do a half rescue, so until EMS, or the police,
or someone else comes to intervene, you're going to be trapped in that situation once you start.
one of the questions that also came up - and I'm thinking about
this as you're describing laws varying state-by-state, what happens if you're
30,000 feet off the ground in a metal tube traveling at 500 miles an hour?
generally, state laws are not protective, but there are complex
rules governing aviation. what I always say is: if you help someone in a plane,
there are two principles to keep in mind. one: if you ever go before a jury or a State Medical
Board and you've tried to save someone's life in a plane and explain what they did,
they're not going to care what the technical rules of the law are. they're going to say you
were a doctor and did a good deed, and it's gonna go down to your advantage.
in contrast if you stand back and say I don't want to help you, and you're in a confined space like
a plane, if there's no other doctor, whatever the law says it's not going to turn out well for you.
on the other hand many Good Samaritan laws have an exception that says it doesn't apply if you do it
expecting compensation. so I always tell people, because everybody knows that airlines give you
frequent flyer miles, and a free drink, and all sorts of benefits if you help someone on a plane,
a malevolently intentioned plaintiff's lawyer might argue that you expected that. and therefore
you should turn down any free compensation they offer you for helping someone on a plane.
so would you generally recommend that you
turn down compensation if you provide care on an airplane?
I would say, in any setting, you want to do your good deed,
you want to specify so that nobody doubts it that you're not becoming the patient's doctor,
and you don't want to accept any compensation, whatever limited amount they give you. the 500
miles (frequent flyers), the free drink, isn't worth the hassle it could generate.
one of the questions that subsequently came up since this incident that I had: someone suggested
to me that if you are a physician and you assume care of a person outside of the hospital,
you should not relinquish that care until someone of an equal training or higher has
arrived. is that anything that you've heard of? is there any truth to that?
so there's some truth to that. I wouldn't say an equal level of training. I would say an adequate
level of training to manage the situation. so if you're an anesthesia resident turning
over care to a random passerby might not be appropriate, but turning over care to an EMT
who may not have the anesthesia training you do, but can manage the situation, is fine.
the other thing I always mention is there's no medical record for someone you see in a strange
place, someone comes up to you. if you're doing this, I would at least write down in a paragraph,
or an index card, or somewhere, document what you did so if it ever does become a legal issue,
you can say right afterwards "I wrote down what happened."
speaking of charting and thinking about privacy, is it inappropriate to discuss what has happened
out in public, say among colleagues, or on a YouTube channel? can I post the link to
the news article that related to this story that was written after the event happened?
so there are things that you legally can do, and things that you should do. so legally,
you probably can do all of that. you're not in a doctor-patient relationship,
it's not private health care information. from an ethical point of view, publicizing someone else's
medical issues probably isn't ideal. and from a practical matter, if you want to avoid the kind
of publicity that could generate litigation, far better off not to generate interest.
if you go home and tell your spouse what happened,
I think that's absolutely fine. if you share it on CBS News, you may generate a backlash.
one of the other concerns that I had was whether my being a resident has any bearing on what any
sort of untoward legal consequences that could unfold, say if something goes wrong. in your
opinion, is there any difference in the advice that you would give to someone who's either a
medical student, versus being a resident or a fellow, versus being an attending?
so the law is the same. but that doesn't mean that you're not more likely to be targeted if you fit
one of these categories rather than another one. so simply from a matter of discretion,
I probably would be more discreet about this if I were a doctor. if I were a random person and
I revived a stranger on the street, I might be thrilled at this and go tell CBS News,
and the odds of suing me are very low. if I am the chief of anesthesia I may be a larger
target. and I always remind people: just because you're not liable and going to win a lawsuit,
doesn't mean people can't sue you anyway. you probably want to avoid the hassle of
people suing you frivolously or mistakenly or filing a complaint with the medical board
that is rapidly dismissed, because it still costs you time and energy.
I understand that in addition to being a physician and an attorney, you are also a
book author. do you happen to have any place where my viewers could find books that you've written?
sure. so my latest book is "Who Says You're Dead?" which is actually a compendium of
ethical dilemmas about medicine and science both for doctors and for lay people. so they're fun,
and it addresses exactly the kind of questions we're talking about today,
and you can find it in most bookstores, on Amazon, or a lot of copies on my grandmother's shelf.
would it be advisable to put a link to that in this YouTube video?
sure, absolutely
I think we'll include that. and speaking of books,
I put this library back here. I realize we're in a simulated operating room, but I wanted to make
it feel a little more at home. it's a little kitschy, but that's the decor that I went for.
I am one of the judges for the National Book Critics Circle Awards this year,
so I get a crate full of books every day, so I feel right at home
I really appreciate your time, thank you very much for talking with me.
and just as a reminder to everyone, in this video: none of this is medical advice and..
..none of this is legal advice. if you need legal advice, either consult an attorney, or marry one.
thanks very much for watching. if you found this video helpful, I'd really appreciate
it if you liked it and subscribed to the channel. I'll see you next time.
thanks so much