IV infiltration leads to $700K negligence award

Conn. judge and jury find that Good Samaritan immunity protects paramedics, not employers

By Margaret Keavney

A Connecticut Superior Court awarded a patient over $700,000 as a result of an infiltrated intravenous line on an emergency call. One issue in the November 2016 case was whether the defendant ambulance company was entitled to immunity from liability because of the state’s Good Samaritan statute.

The paramedics themselves were not named as defendants in the lawsuit. However, they did testify in depositions before the trial and at trial. The court found that they were negligent in the treatment of the patient, and that the Good Samaritan immunity did not extend to their employer (the defendant).

Dextrose 50% preparation, pre-filled AbboJect package for IV administration.
Dextrose 50% preparation, pre-filled AbboJect package for IV administration. (Wikimedia Photo)

Differing accounts
In June of 2012, the paramedics responded to a diabetic emergency in a private residence. Upon assessment, they found the patient to have a Glasgow Coma Scale score of 6 and a blood glucose level of 49 mg/dL. Accordingly, they started an intravenous line to administer glucose.

This is where the plaintiff’s version of facts and the medic’s diverge. The medic testified that the patient’s girlfriend put the patient’s baby on the bed with the patient and he had to move the baby, which probably dislodged the intravenous line. The plaintiff’s girlfriend denied ever putting the baby on the bed. The girlfriend, who was a home health aide, noted that the patient was a "hard stick" and that the IV catheter did not appear to have been inserted correctly from the start.

Credibility of the witnesses
The judge had a lot to say about the believability of these two witnesses. Specifically, she said: "In evaluating the credibility of the witnesses, this court considered their appearance and demeanor on the witness stand, the consistency or inconsistency of their testimony, their memory or lack thereof of certain events, their manner in responding to questions and whether they were candid and forthright or evasive and incomplete, their interest or lack of interest in the case, and the consistency or inconsistency of their testimony in relation to other evidence, including exhibits in the case."

She did not find the paramedic credible. The paramedic said in his deposition that the patient’s girlfriend was on the bed when she put the baby on the bed with the patient, but testified at trial that the patient's girlfriend walked over to the playpen to lift the baby out and put him in the bed. The judge seriously doubted the paramedic’s truthfulness about how the intravenous line became dislodged and even about whether it was correctly inserted in the first place.

Standard of care
The parties used expert witnesses to establish the standard of care, which this judge stated is "the level of care, skill in treatment which, in light of all relevant and surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent EMS providers."

After noting that a poor medical result is not usually evidence of a breach of the standard of care, the judge found that the paramedic had failed to meet the following standards:

  • Adequately securing the intravenous catheter
  • Monitoring the intravenous line after insertion
  • Paying attention while injecting the dextrose
  • Restraining the patient so that he did not dislodge the intravenous line (in case he became combative)

The Good Samaritan statute
The defendant ambulance service argued that Connecticut’s Good Samaritan statute protected it from liability, because although the paramedics were negligent, it was only ordinary negligence, not gross, willful or wanton negligence. Under the state law, EMS personnel are not liable for ordinary negligence.

However, the judge was not swayed by this argument, finding that the law only protected the individuals. The employer was vicariously liable for their negligence, but did not enjoy vicarious immunity. She cited two other states whose laws had been interpreted that way, as well as other parts of the Connecticut law which did explicitly grant immunity to organizations, but did not include companies like the defendant.

Damages to the patient
In determining how much money to award the plaintiff, the judge considered what happened to the patient after the IV infiltrated. After his emergency fasciotomy, he stayed in the hospital for four days, requiring morphine for pain relief. Over the following few weeks, he had three more emergency department visits to follow up on wound care and control pain. He endured four surgeries, including a skin graft and a procedure to release scar tissue, followed by months of occupational and physical therapy and wound care. After all of that, he still has weakness and pain in his arm, reduced range of motion and grip strength, and problems in his activities of daily living. He has a 15 percent residual impairment. The award was categorized as follows:

Past economic damages: $72,290.99
Past noneconomic damages: $350,000.00
Future noneconomic damages: $300,000.00
Total damages: $722,290.99

Takeaways for EMS providers
Here are three top takeaways from this case for EMS providers.

1. Details matter
It was two years after the events in the patient’s house when the medic testified at trial. It’s not unusual to forget details like how the baby got into the bed. But that’s a large part of what convinced the judge not to believe the medic’s explanation of events.

2. Judge and jury decides who to believe
Two experts are going to tell the judge or jury what the standard of care is, and they probably will not agree. It is the judge or jury who decides which of them to believe.

3. Be ready to testify
Even if you are not named as a defendant in the lawsuit, you may still need to testify and put your professional reputation at stake.

The defendant may appeal this case, and if so, the appeals court may uphold or overturn the decision. Although this case does not have any precedential value, it is a good example of the courts’ application of a Good Samaritan statute to an EMS case. However, as EMS providers, it is more important to focus on providing good patient care, documenting it well and maintaining our skills and competencies than to place too much weight on liability determinations and litigation.

About the author
Margaret Keavney, JD, MHA, NAAC Certified Ambulance Compliance Officer, is a founding member of the New Jersey law firm of Keavney & Streger, providing counsel to EMS agencies on employment law issues, compliance, HIPAA, and regulatory issues. For more information, visit the website, connect with Ms. Keavney on Facebook, or follow her on Twitter @keavneylaw.

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