# Two leg amputations after 'incomplete' assessment by paramedic



## DrParasite (May 18, 2021)

A Paramedic and EMT team arrived at the scene and assessed the man's leg but did not remove his sock. They decided not to transfer him to hospital. The next day, the man awoke with severe pain, a blue foot, and required two amputations to his leg. "this incident was adversely affected because of challenges in the inter-professional relationship of the personnel who attended"









						Two leg amputations after 'incomplete' assessment by paramedic
					

A man in his late 80s who ran 10km a week had to have his leg amputated after an ambulance failed to take him to hospital.




					www.rnz.co.nz


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## Tigger (May 18, 2021)

DrParasite said:


> A Paramedic and EMT team arrived at the scene and assessed the man's leg but did not remove his sock. They decided not to transfer him to hospital. The next day, the man awoke with severe pain, a blue foot, and required two amputations to his leg. "this incident was adversely affected because of challenges in the inter-professional relationship of the personnel who attended"
> 
> 
> 
> ...


Rough. The NZ system has several provisions for provider initiated non-transport, most commonly arranging an "urgent" visit to the patient's physician. Different education as well (base level paramedic has a bachelor's degree), but kind of tough to fall back on education when you don't actually assess the patient's complaint and are apparently fighting with your partner.


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## BobBarker (May 19, 2021)

The paramedic wrote the man a written apology? That would almost never happen in the US


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## GMCmedic (May 19, 2021)

BobBarker said:


> The paramedic wrote the man a written apology? That would almost never happen in the US


We're smart enough to not admit guilt prior to the lawsuit.


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## CCCSD (May 19, 2021)

So much for other EMS that’s reputed to be MUCH better than the US...


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## E tank (May 19, 2021)

Doctors' New Tool To Fight Lawsuits: Saying 'I'm Sorry' - WSJ
					

Malpractice Insurers Find




					www.wsj.com
				












						Study: Apologizing To Patients Reduces Hospital Defense And Liability Costs - Georgia State University News - Andrew Young School of Policy Studies, Press Releases, University Research - Academic Unit News
					

ATLANTA—Hospital staff and physicians who are willing to explain, apologize for and resolve adverse medical events significantly reduce legal defense and liability costs, according to a study led by Dr. Florence R. LeCraw, an Atlanta anesthesiologist and adjunct professor at Georgia State...




					news.gsu.edu


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## BobBarker (May 19, 2021)

I


GMCmedic said:


> We're smart enough to not admit guilt prior to the lawsuit.


Oh I get it but the fact that that’s standard practice is ****ty. Sometimes a simple heartfelt apology from a government entity or employee is enough to avoid a hefty lawsuit


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## E tank (May 19, 2021)

BobBarker said:


> I
> 
> Oh I get it but the fact that that’s standard practice is ****ty. Sometimes a simple heartfelt apology from a government entity or employee is enough to avoid a hefty lawsuit


...and when truly merited, just the right thing to do...


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## GMCmedic (May 19, 2021)

BobBarker said:


> I
> 
> Oh I get it but the fact that that’s standard practice is ****ty. Sometimes a simple heartfelt apology from a government entity or employee is enough to avoid a hefty lawsuit


You're not wrong.


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## Tigger (May 20, 2021)

GMCmedic said:


> We're smart enough to not admit guilt prior to the lawsuit.


My understanding is that tort laws are very very different in australasia. 



CCCSD said:


> So much for other EMS that’s reputed to be MUCH better than the US...


I think one case is hardly something to draw sweeping conclusions from.


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## EpiEMS (May 20, 2021)

Tigger said:


> My understanding is that tort laws are very very different in australasia.


I never knew this!

Fascinating concept:


> In New Zealand, patients seek compensation for medical injuries not through malpractice suits as in the United States, but rather through a no-fault compensation system. Injured patients receive government-funded compensation, in turn relinquishing the right to sue for damages arising from personal injury except in rare cases of reckless conduct. - Commonwealth Fund, 2006


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## RedBlanketRunner (May 20, 2021)

"Australian Negligence cases use a 'salient features' framework to determine whether a duty of care was owed by the defendant to the plaintiff."

According to an Aus. associate of mine, expression of care, concern or condolences is normally not a salient feature and does not constitute admission of responsibility or culpability. The onus is on the wronged party to establish otherwise.


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## CarSevenFour (May 29, 2021)

I always, ALWAYS, get called a liar with this story of a simple professional apology. It was back in 1992 and Labor Day was fast approaching, after having gone to the dentist for a root canal. The next morning I was really sick, huge fever, aching all over, my face is swollen, pus coming out my eye, difficulty breathing, and rushed off for emergency maxillo-facial surgery in the O.R. Even at that, the O.R. was full and they couldn't get me in right away, so I lay on an isolation bed with pain so bad it didn't hurt much anymore and I was beginning to feel like I was floating away, wondering at what point my face was going to split open from the heavy swelling. The doctor finally came in and said they were ready. On the way to the O.R., he was telling my wife that she had to prepare herself because survival wasn't likely. Never forget that the patient you think is too far gone to hear, actually can. I didn't freak out at his words, I just thought, "You're wrong, tonight's not my night to die." I just knew it. The IV anesthesia was a godsend and I was soon in the world of black, until I heard a voice, far off, but becoming clearer. Waking up, I thought, "Thank you, God, it's over..."

Well, it wasn't. The anesthesiologist was saying, "I can't find my landmarks, everything's shifted. I can't intubate..." I opened my eyes and his face was betraying extreme distress. This was a man who was helping me very late in his career and had seen a lot of emergencies in his time. He's got the tube in his hand, right in front of my face and I had this thought pop into my head, like someone was inside, telling me, "Go! Just breathe in the tube! Don't swallow it or it will go in the wrong way!" So I did and thank God he had a good grip on the ET tube and it just seemed to pop right in and everything shortly went black again. When I woke up afterward, the anesthesiologist was waiting at the bedside and offered an abject apology for not being able to complete the intubation. He told me had never seen anything like that happen where the patient took control and got it done. I told him it was ok; it worked out well in the end and I'd have a hell of a story to tell my wife! Later, my colleagues told me I should have sued both him and the dentist. But, jeez, in that instant of apologizing, I saw a distraught human being, knowing that he was losing me and would have had to start cutting because we were at the point of no return. I've had medics laugh me out of the room saying that, "It's impossible! You can't intubate yourself, physically impossible." Think outside the box, or die. I knew the procedure, what needed to be done and I was tanked up real good on Fentanyl and Versed. After he apologized, there was no way I would ever think of suing him or the hospital. Even at that, I had to take a second mortgage on my house to pay the medical bills totaling 14 grand because the insurance company refused to pay a penny due to my distress being secondary to a "dental mishap" that was not covered. 

That must be human nature, to let bygones be. These were just guys doing the best they could under extreme circumstances and the apology brought him down from the level of a detached medical expert and scientific professional to a sweating man wracked with guilt because he couldn't do something he normally could perform 'in his sleep'. One thing I do know is the old saw they repeat in EMT classes a lot, is true, "The life you save may be your own."


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## CCCSD (May 30, 2021)

How ‘bout those Bears?


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## CarSevenFour (May 31, 2021)

CCCSD said:


> How ‘bout those Bears?


If you have a point, make it. I see you have a little "flying monkey" there who loves you very much.


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## ffemt8978 (Jun 1, 2021)

Knock it off or become the focus of my complete and undivided attention.


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## MrBrown (May 23, 2022)

G'day folks ... your friendly neighbourhood Brown here, just happened to be looking for this very decision of the Health and Disability Commissioner when lo-and-behold I came across this post.

I cannot disagree with the findings of the Commissioner.  They were quite clinically reasonable.  It is pointless and lazy to assess something through clothing.  For example, I have seen many people listen for breath sounds through clothing.  I cannot myself say I have never done this, but I do not believe I ever did.  Some people may be surprised by the findings about working together and crew resource management.  It is not uncommon for the more junior person to say, "ah, but I am the junior person, I have no responsibility here whatsoever," and that is absolutely untrue.  Even the most junior person has a responsibility to ensure they speak up, and conversely, senior people have a responsibility to make sure this can occur.  All personnel also have equal responsibility for ensuring documentation is adequately completed.

For our American readers, here is some background.  Long ago, New Zealand decided we would legislate for a statutory scheme of compensation for accidents, including what is called "treatment injury," or what is commonly known as medical misadventure.  For this statutory scheme, we gave up the right to sue in tortious negligence for personal injuries.  We look to the scheme, not the courts.  Introduced on 1 April 1974, the scheme worked wonderfully up until 1 July 1992, when those nasty Tory pols got involved and decided to get their mitts into it.  That aside, all-in-all, despite significant problems, the scheme still on balance works very well.  The scheme is comprehensive and provides for treatment, rehabilitation, and compensation on a nearly entirely no-fault basis.  It is not based on premiums or any sort of insurance qualifications.  If you pass the various legal tests of causation, then you come within it.  The only time fault is de-facto required is in one particular part of treatment injury called "failure to treat." This requires showing another course of treatment was available and should have been taken.  It is similar, but not the same, as showing negligence.  Mere carelessness or inattention is enough, you do not have to make out the complicated, multi-step test of negligence.  This scheme is truly unique in the world, although I understand something similar exists in some parts of Australia for road crash (TAC).  Some of you will have seen the Whakare/White Island stuff and silly American lawyers screaming on TV about suing the tour company, obviously not realising they could not do so.

This bloke would have no-doubt received treatment injury cover.  He will be entitled to, for example, having a prosthetic limb fitted, having a wheelchair or walker or other assistive devices, to having ongoing rehabilitation paid for, transport to appointments or other places to maximise his independence (for example, shopping), to having house or vehicle modifications, having an in-home carer pop in to help with whatever he needs, and cha-ching, compensation for permanent injury.  The maximum lump sum is $184,000, but you have to be basically dead to get that.  I estimate he would get a goodly number of tens of thousands of dollars.  Oh, and no, there are no fees for any of these services, they are all provided free of charge by the scheme.  Some outpatient providers can charge a small surcharge, but most do not.  Even if there is a surcharge, low income people can get a subsidy to cover that too.

The lack of "being sued" is why it is very common for health practitioners to apologise to patients when things, even minor things, go wrong.  There is no liability attached to said apology because any monetary compensation for injury is covered by the Accident Compensation Act.  Even if the injury falls outside the various legal tests for coverage (not uncommon for treatment injuries; the test is multi-layered and recently made more complex by a Court of Appeal decision in _Accident Compensation Corporation v Ng & ors_), the patient and their family are still prohibited from suing.  The only exception to the bar on suit is for what is called exemplary damages (punitive damages).  These are very hard to get and the Supreme Court in _Couch v Attorney-General (No 2)_ set an extremely high test, only a slight departure downward from deliberate action that the person knew was wrong.

It would also surprise me greatly if an apology amounts to an admission of a duty of care or mistake.  In the standard tests of negligence, these are objectively assessed and particularly relating to the breach of duty of care, with reference to accepted common standards.  Just because someone subjectively feels due to apologise, I would think is irrelevant.  I would be greatly surprised if such was the case, but I am happy to be shown some on point precedent on the matter.

So, for all its problems, I would much rather have a statutory, no-fault scheme rather than rely on having to prove tortious negligence.  It also means the legal profession does not flood the consciousness of the general population with sleazy billboards, TV ads, signs on bus benches or church bullitens and the like trolling for injured clients in the hopes of hitting the big one.  There are a small number who do take on the terribly interesting medicolegal disputes that the scheme generates and it sure is terribly interesting work.


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## PotatoMedic (May 23, 2022)

Is it bad that anywhere MrBrown said something in the first person I subconsciously switched it to the third person?


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## MrBrown (Jun 10, 2022)

PotatoMedic said:


> Is it bad that anywhere MrBrown said something in the first person I subconsciously switched it to the third person?



Yes.  Because Brown must be referred to in the *fourth person*.  Come on mate, keep up.  Brown does not actually exist and was a bit of a figment of my imagination (certain _parts _of Brown's persona do exist, however) so it is not actually possible to speak of Brown in the first, second, or third person since Brown is not, in totality, real.  The distinction is important.  

I also wonder if such a statutory scheme of accident compensation would fix much of the medicolegal problems in the US.  I cannot see if being popular however, because y'all hate the government.  That's a bit of a problem.


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## CCCSD (Jun 10, 2022)

MrBrown said:


> Yes.  Because Brown must be referred to in the *fourth person*.  Come on mate, keep up.  Brown does not actually exist and was a bit of a figment of my imagination (certain _parts _of Brown's persona do exist, however) so it is not actually possible to speak of Brown in the first, second, or third person since Brown is not, in totality, real.  The distinction is important.
> 
> I also wonder if such a statutory scheme of accident compensation would fix much of the medicolegal problems in the US.  I cannot see if being popular however, because y'all hate the government.  That's a bit of a problem.


Everything is a figment with you…


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