Good Samaritan Act & Code Blues

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April 9, 2014
Carmel Cosgrave
SmithAmundsen Health Care Alert

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When the emergency room doctor responds to a Code Blue page at his hospital, is he entitled to immunity from a negligence claim under the Illinois Good Samaritan Act? The Illinois Supreme Court in Home Star Bank v. Emergency Care held that an emergency medicine physician who responds to a Code Blue as part of his or her normal course of practice is not entitled to immunity under the act even though the patient was not charged a fee for the physician’s services. In reaching its result, the Illinois Supreme Court resolved a controversy that had developed between two competing lines of authority construing the Good Samaritan Act: the appellate courts of the State of Illinois and federal courts construing the same act. The Court ultimately adopted the reasoning of the federal courts which had considered the issue. The Illinois Supreme Court agreed with federal decisions which noted that the Good Samaritan Act was designed to encourage volunteers and was not intended to shield the acts of those physicians who treat patients within the scope of their employment.

Dr. Michael T. Murphy was working in the emergency room of a hospital when he responded to a Code Blue. The patient had been admitted to the ICU with a diagnosis of epiglottitis. Murphy attempted to intubate the patient who ultimately suffered a severe and permanent brain injury. When a lawsuit was filed, Murphy claimed immunity under Section 25 of the Good Samaritan Act. The act provides in pertinent part:

“Any person licensed…[as a physician] … who in good faith provides emergency care without a fee to person, shall not, as a result of his or her acts or omissions except willful or want misconduct on the part of the person, in providing the care, be liable for civil damages.” 745 ILCS 49/25 (West 2010).

Dr. Murphy had an independent contractor agreement with Emergency Care and Health Organization, Ltd. (ECHO). ECHO had an exclusive contract with the hospital to provide emergency room services. Murphy was paid hourly by ECHO for services he provided to ER patients at the hospital and for services he provided “in dire emergencies, i.e., cardio respiratory (or impending) arrest.” The hospital had a Code Blue and Cardiac Arrest Team Policy which provided that the ER physician “responds to all Code Blues” and directs the team. Murphy admitted at his deposition that responding to Code Blues was part of his job.

The trial court granted a motion for summary judgment on behalf of Dr. Murphy and ECHO on the basis of the Good Samaritan Act. The trial court based its decision on the fact that ECHO never sent a bill to the patient or his insurance company. The trial court rejected the reasoning of federal court cases that reached a contrary result. The appellate court however reversed the trial court’s findings in favor of the defendants.

The Supreme Court agreed with the appellate court and with the line of cases from the federal courts “that the purpose of the Act is to promote volunteerism and that Section 25 was never meant to apply to a physician who responds to an emergency because he or she is paid to do so.” In arriving at this decision, the Supreme Court noted that the fee section of the act was ambiguous and thus the issue was to be resolved as a matter of statutory construction. The immunity was originally provided to those licensed medical personnel “who in good faith provide[d] emergency care without fee at the scene of a motor vehicle accident or in case of nuclear attack…”

Over time the statute evolved, but the state courts repeatedly turned the focus of analysis to the “without a fee” language. This led multiple courts to apply the immunity of the Good Samaritan Act to physicians who responded to emergencies in hospital or medical centers without regard to whether the physician had a preexisting duty to respond. Eventually the state courts started to focus on whether the decision not to bill the patient was made “in good faith.”

The Illinois Supreme Court noted that several federal courts which had considered the Good Samaritan Act raised concerns that the immunity could be “engineered” by physicians who decide to decline to bill for services in order to avoid liability. The state court line of cases, which focused on the term “fee,” “thwarted unmistakably obvious legislative intent.” The legislative intent was to promote volunteerism. It was not intended to immunize physicians who respond to emergencies. While the state court line of cases in considering the issue of a fee looked only toward whether the patient was billed, the broader interpretation is whether the physician is paid to render the services. Here Dr. Murphy was indeed paid for the time he spent at the hospital, including the time he spent responding to the Code Blue. Accordingly, he was not acting as a volunteer and was not entitled to immunity protection under the Good Samaritan Act.