California Firefighters Not Liable in RAMA case

The California Court of Appeals has upheld a trial court ruling concluding that the City of Petaluma and two of its firefighter-paramedics cannot be held liable for the medical injuries of a patient who repeatedly decline medical aid. Marites Murphy filed suit after she suffered a stroke following a car crash.

The facts are explained in the appellate court ruling as follows:

• Marites Murphy sued the City of Petaluma and fire department paramedics Jude Prokop and Shay Burke for medical negligence after the two paramedics responded to the scene of a head-on automobile collision in which Murphy was involved.
• As we shall discuss, the distinctive feature of this case is that Murphy repeatedly told the paramedics she was not injured and did not want or need medical assistance, and she said so even after being warned she might have suffered a serious injury that was not yet symptomatic and being urged to accept transport to a hospital for examination by a physician.
• Accordingly, after concluding Murphy had the capacity to refuse medical treatment, the paramedics left the scene.
• Unfortunately, hours later, Murphy suffered a serious debilitating stroke attributable to a hypertensive crisis triggered by the collision.
• She subsequently filed this lawsuit alleging the paramedics owed her a duty of care, which they breached through gross negligence, to assess her medical condition and to arrange transport to a hospital.
• The trial court granted the defendants’ motion for summary judgment, ruling the paramedics did not assume a duty of care to provide Murphy with the medical assistance she claims was owed.

Murphy appealed the trial court decision, claiming that the firefighters owed her a duty of care. The Court of Appeals disagreed in a very length decision that analyzed several important California cases. The court’s analysis of those cases has been omitted, but here is the reasoning underlying the ruling:

• Murphy maintains the paramedics, by virtue of their interactions with her at the scene of the accident, assumed a duty to provide her with appropriate medical care which, according to her allegations, included taking her vital signs, and specifically her blood pressure, and transporting her to a hospital for examination by a physician.
• Murphy does not dispute she repeatedly told the paramedics she did not want or need medical assistance or transport to a hospital, including after she was advised she might have suffered a serious injury, indeed a life- threatening injury, the symptoms of which had not yet manifested themselves and was urged to accept transport to a hospital for examination by a physician.
• She maintains this is irrelevant, however, to the threshold issue of duty and the fact the paramedics interacted with her at all, i.e., to ask whether she was injured and assess whether she had the capacity to exercise her right to refuse medical assistance and transport to a hospital, sufficed to give rise to a duty to provide medical assistance meeting the applicable standard of care.
• She variously asserts the paramedics “actually examined [her,]” “[b]y their own admission” they “conducted a visual and interactive assessment of [her] condition to look for signs of injury and/or cognitive impairment, and determine her Glasgow Coma Scale score,” “they undertook to ‘perform[] a visual and cognitive assessment” of her, and “the evidence readily supports a finding that [they] voluntarily undertook to examine [her] at the scene of the collision” and “therefore, owed [her] a duty of care under [Health and Safety Code] section 1799.106.”
• According to Murphy, her refusals of medical assistance and transport to a hospital are relevant only to the issues of breach and whether the paramedics were “grossly negligent” in carrying out the duty to provide medical assistance they assertedly assumed on interacting with her.
• Defendants maintain they never had the opportunity to provide medical assistance and thus never assumed a duty to render such assistance consistent with the applicable standard of care-because Murphy repeatedly stated she did not want or need such assistance.
• Rather, as defendants see it, the extent of their interaction with Murphy-given her repeated refusals of medical assistance and transport to a hospital-was to assess whether she had, at that time, the cognitive capacity to exercise her right to refuse such assistance.
• Murphy makes no claim that assessment was performed negligently; indeed, she makes no claim that, at that time, she lacked the capacity to refuse medical assistance.
• While Murphy does not dispute the paramedics’ testimony she seemed “annoyed” when they continued to ask whether she wanted medical assistance or transport to a hospital, she argues she did not expressly refuse to be medically examined by Burke.
• She claims this fact, combined with the fact she participated in the exchange with Burke wherein he assessed her capacity to refuse medical assistance, suggests a trier of fact “could readily infer that Murphy would have allowed the Paramedics to conduct a more thorough examination-including taking her vital signs-had they attempted to do so.”
• This argument misses the salient point-after Murphy stated, repeatedly, that she did not want or need medical assistance, Burke did not undertake a medical examination and therefore did not, under the negligent undertaking doctrine, assume a duty to conduct such an examination meeting the applicable standard of care.
• The paramedics did not make Murphy any promises with respect to medical assistance, let alone fail to follow through on such promises.
• They did not ignore any requests for such assistance. To the contrary, they urged her to let them provide medical assistance and warned her that symptoms of a serious, even life threatening, injury could be delayed.
• She nevertheless reiterated she did not want medical assistance or transport to a hospital for examination.
• And while Murphy claims the paramedics failed to conduct a medical assessment sufficient to detect a potential brain injury or hypertensive crisis, the crisis she subsequently experienced was caused by the collision.
• We therefore conclude, given the undisputed facts in this case, the trial court correctly ruled the paramedics did not, under the negligent undertaking doctrine, have a duty to render medical assistance to Murphy in accordance with the standard of care applicable such assistance.

Here is a copy of the complaint: