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Case Note: Masson v State of Queensland Print E-mail

Masson_case_note_intro.jpg[2019] QCA 80 (10 May 2019)

Fraser and McMurdo JJA and Boddice J

The plaintiff appellant suffered a severe asthma attack at a friend’s house in 2002. An ambulance was called which arrived a few minutes later. Ambulance officers administered salbutamol. About 20 minutes later, en route to hospital, the officers administered adrenaline. Tragically the appellant suffered irreversible brain damage from oxygen deprivation. Had adrenaline been administered immediately, brain damage would have been avoided. The State was sued in negligence. The appeal turned on the alleged negligence of the attending ambulance officers.

There was considerable divergence in the medical opinion evidence at trial as to the advantages or otherwise of one drug over the other, and their respective risks in cases such as the plaintiff’s. On that basis, the trial judge considered that there existed a responsible body of opinion in the medical profession in support of the view that in a case such as the appellant’s, there was a medically sound basis to prefer the administration of salbutamol to adrenaline at the time of initial treatment. [1] The trial judge therefore found that the ambulance officers were not negligent in electing to administer salbutamol in preference to adrenaline and in not subsequently administering adrenaline until they did.

The reasons of McMurdo JA (with whom Fraser JA and Boddice J agreed) include an analysis of the role of the Queensland Ambulance Service Clinical Practice Manual (CPM) which the QAS provided to its officers for use in the field, the standard of care of an ambulance officer and the relevance of to that standard of the responsible body of medical opinion in the field of emergency medicine.

The trial judge found that the CPM required, in the appellant’s case, the ambulance officers to consider the use of adrenaline at the time when salbutamol was first applied. [2] The finding was upheld on appeal. [3] There was an evidential dispute as to whether the senior ambulance officer did consider adrenaline and made a conscious decision not to administer it. McMurdo JA disagreed with the trial judge’s assessment in this regard. [4] More importantly however, McMurdo JA considered that if adrenaline had been considered, it had not been considered in a manner consistent with the CPM. [5] The CPM, McMurdo JA found, was not ambiguous, required the consideration of adrenaline, and required that consideration to proceed in accordance with particular guidelines in the CPM. [6] Had that consideration proceeded as required, adrenaline would have been administered because the CPM made clear that adrenaline was the preferred drug in the circumstances. [7]

It was significant, McMurdo JA held, that the standard of care expected of an ambulance officer is not as high as that expected of a medical practitioner or an emergency physician in the hospital setting. McMurdo JA said:

[148] The difference between the care and skill to be expected of an ambulance officer and that to be expected from a specialist in emergency medicine is significant in a number of ways. The first is that, notwithstanding their training, ambulance officers cannot be expected to make the fine professional judgments which would require the education, training and experience of a medical specialist. That limitation is recognised by the fact that ambulance officers are provided with the instructions and guidance of something such as the CPM. As the trial judge said in the above passage, the CPM (or as he called it, the QAS guidelines) was significant as evidence of a relevant standard of conduct.

This limitation meant that the exercise of reasonable care required the ambulance officers to be guided by the CPM. [8]

It followed that even “had there been a body of medical opinion that adrenaline should not be used in a case such as this, and had Mr Peters [the senior officer] been aware of it, and followed that opinion, where adrenaline was the indicated drug according to the CPM, that would have involved a failure to take reasonable care.” [9]

Consequently there was no basis consistent with the exercise of reasonable care and skill by the ambulance officer to use salbutamol, and he, and the State as his employer, were liable in negligence.

Footnotes

[1] Expert from the primary judgment, replicated at [59] on appeal.

[2] At [22]; [39].

[3] At [23]; [39].

[4] At [65]; [66].

[5] At [156]

[6] At [34]; [35]; [60].

[7] At [156]; [162].

[8] At [162].

[9] At [163].


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