Fears of Legal Risk From Bystander CPR Are Overblown

November 11, 2019

It's a fallacy that a witness to an out-of-hospital cardiac arrest who performs cardiopulmonary resuscitation (CPR) is likely to be held legally liable for any associated injuries, a new analysis suggests.

Indeed, researchers found that delays in acting or failure to act in such cases is far more likely to lead to a lawsuit or other litigation.

A review of 30 years of legal cases in the United States identified only three instances of an action against a person, business, or school for delivering CPR. In only one of the three did the defendant lose the case.

Legal actions for delay or failure to deliver CPR were more than 50 times more common. Still, only 170 cases overall were identified, suggesting that such court cases are rare.

Dr Travis Murphy

The "widespread sense of potential legal ramifications is really unfounded, looking at the numbers," said Travis Murphy, MD, an emergency medicine attending at the University of Florida in Gainesville, who led the study.

"We didn't find any cases of someone who was not formally trained having a case decided against them, at all. So our message would be, if someone doesn't feel comfortable doing chest compressions themselves, they should get help and find someone who can," Murphy told theheart.org | Medscape Cardiology.

Murphy is slated to present the analysis November 17 at the American Heart Association (AHA) Scientific Sessions 2019.

Concern over potential litigation is a common barrier to the delivery of CPR by witnesses to cardiac arrest, agreed Comilla Sasson, MD, PhD, an emergency medicine attending at the University of Colorado, Aurora, who was not involved in the analysis.

The current study "provides some counterbalance" to the idea that a bystander is likely to be sued if they "do something wrong" during CPR, she observed.

On the other hand, the study also suggests that one is more likely to be sued for inaction, agreed Sasson, who is AHA vice president for science and innovation.

"I think that really changes the conversation, and in my mind maybe changes the way in which people perceive their role in helping someone," she said.

"At the end of the day, you're better off acting, because you could save a life. There are Good Samaritan laws just for this purpose ― if you're doing what you think is the right thing, then you will have some legal protection."

All 50 of the United States have such laws. Their specifics vary state to state, but all provide a degree of legal protection for persons who in good faith deliver care for someone who is injured or incapacitated.

Murphy and his colleagues scoured US court cases from 1989 to 2019 in the Westlaw legal database for personal injury or wrongful death suits that centered on the delivery of or the failure to deliver CPR.

The database doesn't cover all US states, and that's one of the study's big limitations, Murphy acknowledged. The 170 cases that were identified came from 37 geographically diverse states and included many of the most populous.

Three of the cases alleged battery, that is, injury resulting from CPR; the other 167 alleged negligence, or delay in providing or failure to provide CPR.

In 82 of the cases, the defendant was "trained," which the database defined as being a paramedic, registered nurse, physician, or similarly certified medical professional. Of those cases, 39% were decided in favor of the trained bystander.

The other 88 defendants were "untrained" bystanders. Of those, 12 were "lay bystanders" who may or may not have received any formal CPR training. The other 76 defendants were businesses or schools. Rulings favored the bystander in 49% of cases.

Overall, rulings were for the defendant in 76 cases and were for the plaintiff in 47 cases. The remaining 47 cases were settled.

Total payments in settlements or punitive damages for failing to provide CPR or delaying action exceeded $620 million, but such payments associated with a defendant who delivered CPR amounted to only $121,250. It was one award for pain and suffering.

"The only case in which someone was found guilty of battery was where nursing home staff provided CPR to a patient who had a 'do not resuscitate' order. That patient was resuscitated and lived for 23 more days," Murphy said.

Murphy and Sasson have disclosed no relevant financial relationships.

American Heart Association (AHA) Scientific Sessions 2019: Abstract 241, presented November 17, 2019.

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