The Court of Appeal found the State of Queensland vicariously liable for the failure of an ambulance officer to administer adrenaline (instead of salbutamol), in contravention of a clinical practice manual, to a patient having a severe asthma attack.
It was accepted that the State of Queensland (the State) was vicariously liable for the acts of its ambulance officers, and owed an established duty of care to Ms Masson. The primary issue was whether or not the State had breached that duty of care.
On 21 July 2002 Jennifer Masson, a 25 year old chronic asthmatic, suffered a severe asthma attack. The Queensland Ambulance Service (QAS) responded to a call for assistance. On arrival Ms Masson was in respiratory arrest. Officers were given a brief history of Ms Masson’s asthma, her requests to be taken to hospital and her collapse. Officers were not advised, and did not know, that Ms Masson’s previous attacks had been successfully treated with the administration of adrenaline. She was administered salbutamol with some effect. The two frontline drugs in the treatment of asthma attacks at the time were adrenaline and salbutamol.
Ms Masson suffered hypoxic brain damage following this attack and remained in around-the- clock care for many years until her eventual death in 2016. An action was brought by her estate (the appellant) alleging that she would not have suffered catastrophic brain damage if the attending QAS officer had administered adrenaline instead of salbutamol.
The State contended that the administration of salbutamol was a reasonable response to the known circumstances at the time.
The Decision at Trial
The trial judge concluded that the treatment administered did not fall below the standard of care to be observed by ambulance officers and was not contrary to the QAS Clinical Practice Manual (CPM). No breach of duty was established and the claim failed. QAS appealed.
Issues on Appeal
While several allegations of negligence were raised at trial, only two were pressed on appeal including whether the ambulance officers ought to have administered adrenaline immediately, or at least within a couple of minutes, rather than 20 minutes later; and whether the ambulance officers were inadequately trained and instructed by the QAS to deal with an emergency such as this, with the consequence that they did not administer adrenaline earlier.
The Decision on Appeal
The Court of Appeal observed that the standard of care required by a person with some special skill or competence, such as an ambulance officer, is that of an ordinary skilled person exercising and professing to have that special skill. Importantly, that standard of care is not as high as that expected of a medical practitioner or emergency physician in a hospital setting, including because ambulance officers do not have the same education, training and experience as a medical practitioner. It was held as a consequence that it would not be consistent with the exercise of reasonable care and skill for an ambulance officer to depart from the guidance of a CPM, because such officers do not have the skills required to make their own professional judgement about the merits of competing views within a field of specialised medical practice.
In this case the treatment that was given, Salbutamol, did not comply with the guidelines in the CPM. In addition, the ambulance officer administered the alternative drug in dosages exceeding that prescribed in the Drug Data Sheet within the CPM. His decision to do so was not permitted by the CPM.
The Court of Appeal found that Ms Masson was not treated in accordance with the CPM. The use of adrenaline was not relevantly considered as was required by the CPM. Further, it was inconsistent with the CPM to administer twice the dose of the alternative drug in the hope that it would be as effective as adrenaline. The exercise of reasonable care required the ambulance officer to be guided by the CPM. The Court of Appeal held that the trial judge’s finding that there was a reasonable body of opinion in the medical profession supporting the administration of salbutamol, in the circumstances of Ms Masson’s high heart rate and blood pressure, was not supported by the evidence.
The Court of Appeal unanimously held that the State of Queensland was vicariously liable for the ambulance officer’s negligence. Damages were agreed at $3M
Implications for you
This case illustrates the importance of practice or guidance manuals for semi skilled health professionals and suggests that they ought not make individual judgements about the merits of competing treatment options when a course of action is detailed by an applicable manual. It highlights the need for employers to ensure that such guidance or practice manuals are written in a clear and unambiguous way.