The High Court determines a paramedic’s standard of care

Proceedings were commenced in the Queensland Supreme Court (QSC) against the State of Queensland in which it was alleged that there was a failure by an Intensive Care Paramedic (ICP) to promptly administer adrenalin to the plaintiff who was a chronic asthmatic suffering from a severe asthma attack. Although the QSC found in favour of the State, taking into account the clinical context of the plaintiff and the ICP's skills, experience and training, the Court of Appeal (QCA) overturned that decision and found the State negligent on the basis the ICP's treatment fell below the standard of care. The High Court has overturned the decision of the QCA and found that intensive care paramedics are subject to a lesser standard of care than that of a medical specialist in emergency medicine, even though intensive care paramedics are expected to exercise clinical judgment.

 

Author: Nina Abangan
Judgment date: 13 August 2020
Citation: Queensland v Masson [2020] HCA 28
Jurisdiction: High Court

Principles


  • The High Court recently overturned a decision of the Queensland Court of Appeal in finding that the standard of care to be applied for an intensive care paramedic is less than that of a medical specialist in emergency medicine even though intensive care paramedics are still expected to exercise clinical judgment.
  • The High Court took into consideration the circumstances in which such paramedics are expected to make reasonable judgments and held that they could not be expected to make fine, professional judgments of a kind that require the education, training and experience of a medical specialist.

Background

On 21 July 2002, Jennifer Masson, a 25-year-old chronic asthmatic, suffered a severe asthma attack whilst visiting friends in Cairns. Queensland Ambulance Service (QAS) officers, including an Intensive Care Paramedic (ICP) treated Ms Masson at the scene prior to conveying her to Cairns Base Hospital.  As part of Ms Masson's initial treatment, the ICP administered IV Salbutamol.

Prior to her arrival at hospital, Ms Masson sustained severe and irreversible brain damage as a result of deprivation of oxygen.  She lived in a vegetative state for the next 13.5 years while being cared for at home by her parents and unfortunately, passed in 2016.

Supreme Court & Court of Appeal Proceedings

Proceedings were commenced in the Queensland Supreme Court (QSC) against the State (the Applicant) prior to Ms Masson's death, and had been continued on by her estate (the Respondent).

It was alleged there was a failure to promptly administer Ms Masson with Adrenalin which constituted a negligent omission for which the State was vicariously liable.  It was alleged the failure was contrary to the instructions of the QAS Clinical Practice Manual (the Manual).  In the alternative, should the QAS officers not be negligent, the training and instruction given by QAS was inadequate such that the State was directly liable for the failure to administer the Adrenaline earlier.

The trial judge held at first instance that the ICP acted with reasonable care and had "considered" the use of IV adrenaline, but opted for the administration of IV Salbutamol considering Ms Masson's clinical context of high blood pressure and high heart rate.  The trial judge also held this course of treatment was supported by a responsible body of opinion within the medical profession.

The Respondent appealed to the Queensland Court of Appeal (QCA). Contrary to the trial judge's finding, the QCA found that the ICP failed to consider the use of adrenaline and was negligent for failing to administer same to Ms Masson at the outset.

This was inconsistent with the exercise of reasonable care and skill for QAS officer to depart from the guidance of the Manual, even if following such guidance would have entailed risk in the circumstances.  The Manual provided guidance that, where a patient presents with symptoms such as that of Ms Masson, to "consider" administering adrenaline.

Decision

It was held by the High Court that the ICP did not act negligently as he did consider the option of administration of IV Adrenaline, however, in the circumstance, opted for IV Salbutamol in the context of Ms Masson's high blood pressure and heart rate.

The High Court formed the view that the QCA correctly observed that intensive care paramedics cannot be expected to make fine, professional judgments of a kind that require the education, training and experience of a medical specialist.  The High Court said that an intensive care paramedic is still expected to exercise clinical judgment but the standard of care that was expected of the ICP was that of the ordinary skilled intensive care paramedic operating in the field in circumstances of injury, which is a less exacting standard than expected of specialists in emergency medicine.

Why this case is important

The case serves as a reminder that a different standard of care will be applied to different circumstances based on skill level, qualifications and expertise.

When considering the liability of a party, consideration ought to be given not just to whether there is specialist knowledge but the reasonableness of the response in the circumstances.

 

Contributors

Nina Abangan Law Graduate