SIA could face legal action over heart attack incident

[Gunnar Smithsen]

Perhaps a temp closure of this thread until more light can be shed of the incident in question

Jus'sayin...

[kelvgoh]

On the slightly OT topic of liability for doctors who step up on board and help, I read recently that many major airlines like LH have or are considering buying general indemnity insurance to cover any liabilities or law suits for such persons arising from controversial cases. The reasoning is that otherwise no one will step up to help any longer if they risk getting sued into oblivion.

I would hope that airlines have to have such policies accross the board as a standard asap.

From a legal point of view, having an indemnity simply means that if you are found liable and are asked to pay up, it is the party which is providing the indemnity has to pay up on your behalf.

Still doesn't quite deal with the possibility that someone can still take you through the entire court process and the damage which your professional reputation could suffer, even if you are exonerated in the end. Quite unfortunate really.

[SilverChris]

He survived but with permanent effects from it.

Would you be happy with that result given that it could have been avoided?

I'm not happy to hear that at all. Let's wait for more details before pointing fingers. But at present, the fact that they didn't divert just doesn't make sense if the passenger needed immediate medical attention.

[fuu99]

I do agree with everyone here that perhaps there is more to the story than what has been published. I really find it silly that an airline would NOT divert on the basis of a suspected acute coronary syndrome. So perhaps we are missing some facts.

Mere suspicion of an acute coronary event (ACS) is a very powerful term in medicine and certainly in any emergency room.

Meanwhile, allow me to clarify some points previously raised...

A heart attack can present itself in many ways. In this instance, I wonder whether the diagnosis (or suspicion) of a heart attack was even considered during the flight as there was no means to accurately do so.

The doctor on board may have told the pilot that it may (or may not) be a heart attack and that it may be just a case of indigestion. He may also appear to be quite comfortable and "stable".

If this was the case, it'd be a difficult call for the pilot or ground authorities to authorise a diversion.

Could it be that the diagnosis was only made at the hospital?

An abdominal complaint in an adult male, especially for one who may have diagnosed or undiagnosed Diabetes (I'm not saying the man on the SQ plane did), is termed as a "cardiac equivalent." In other words, it is an ACS until proven otherwise. Diabetes contributes to a dysfunction in the autonomic nerves that allow the patient to "distinguish" between a chest and an abdominal event.

Walk into any ER and an abdominal complaint plus any one risk factor in favor of a heart condition will merit a cardiac workup until an ACS is finally ruled out. Yes, a heart attack, as you say may present in many ways. All the more reason to be assiduous in ascertaining the cause of the discomfort. Doctors are always taught to err on the side of caution.

So who could be sued? The airline for not stopping, or the doctor for a mis-placed diagnosis?

Anybody standing up on board a flight and shouting 'Yes, i'm a doctor' looking for the glory and admiration of fellow passengers might also have to soon think twice about the consequences of doing so if they go beyond their qualification.

There is what they call the "Good Samaritan Law" which has various interpretations in different countries. Basically for most places, this means it is difficult or even close to impossible to find fault in any individual who responds to or aids in an emergency. Of course, this presupposes the responder follows basic standards of care.

In the event of an emergency, doctors do not need the patient's consent and it is understood that the doctor is acting in the best interest of the patient.

Yes, a dermatologist may not hold a current Advanced Cardiac Life Support (ACLS) certificate but he definitely knows a whole lot more than say the purser.

There is also that thing they call the Hippocratic oath. It is easy for a doctor to turn around and avoid the site of an accident, but inside a metal tube at 39,000 feet? His license may even be at risk of revocation if he allowed the patient to die. Pain by itself is considered immoral in medical practice.

It will definitely be interesting how this story ends up.

[KC*]

An abdominal complaint in an adult male, especially for one who may have diagnosed or undiagnosed Diabetes (I'm not saying the man on the SQ plane did), is termed as a "cardiac equivalent." In other words, it is an ACS until proven otherwise. Diabetes contributes to a dysfunction in the autonomic nerves that allow the patient to "distinguish" between a chest and an abdominal event.

Walk into any ER and an abdominal complaint plus any one risk factor in favor of a heart condition will merit a cardiac workup until an ACS is finally ruled out. Yes, a heart attack, as you say may present in many ways. All the more reason to be assiduous in ascertaining the cause of the discomfort. Doctors are always taught to err on the side of caution.

I don't think you can compare this scenario to somebody presenting at an ER. The doctor attending to the passenger is not likely to be the one who makes the decision whether to divert the flight or not.

If I were in his shoes, I would certainly treat the passenger as a worse case scenario situation. But depending on the symptoms and signs at the time, a difficult judgement call had to be made on how likely he may actually be having a MI that would determine whether to divert the aircraft.

Could it be a gastro-oesophageal reflux? Could it be a Myocardial Infarction? Or maybe just a muscular strain? With no diagnostic tool at hand, only an educated guess can be made.

Not an easy decision.

[fuu99]

I don't think you can compare this scenario to somebody presenting at an ER. The doctor attending to the passenger is not likely to be the one who makes the decision whether to divert the flight or not.

If I were in his shoes, I would certainly treat the passenger as a worse case scenario situation. But depending on the symptoms and signs at the time, a difficult judgement call had to be made on how likely he may actually be having a MI that would determine whether to divert the aircraft.

Could it be a gastro-oesophageal reflux? Could it be a Myocardial Infarction? Or maybe just a muscular strain? With no diagnostic tool at hand, only an educated guess can be made.

Not an easy decision.

Myocardial infarction = chest heaviness; may be associated with respiratory symptoms; usually accompanied by diaphoresis; distribution of pain is vague and usually involves the entire chest.

GERD = burning sensation in the mid-chest; usually leaving a sour taste in the mouth.

Costochondritis = pain that could be localized, and the patient is usually able to point out the location.

An ECG and cardiac enzyme panel is usually on order.

60 - 80 % of the diagnosis is made based on History and PE alone. Tests are only confirmatory.

[KC*]

What you have described are classical signs and it would be so easy if things were always like that. I am sure your experience will bear out that exceptions often occur.

I suspect that if it had been a obvious case of MI, it would not be difficult to make a decision to divert the flight.

However, an MI can be silent or present itself in a less than obvoius manner. That is where difficulty may arise on whether to divert the flight so that the necessary tests may be done to confirm or exclude an MI.

And I'd like to stress again. The facts are not on the table right now and I suspect that unless we were on the flight itself witnessing the incident with our own eyes, we may not be in a good position to pass any judgement.

[fuu99]

What you have described are classical signs and it would be so easy if things were always like that. I am sure your experience will bear out that exceptions often occur.

I suspect that if it had been a obvious case of MI, it would not be difficult to make a decision to divert the flight.

However, an MI can be silent or present itself in a less than obvoius manner. That is where difficulty may arise on whether to divert the flight so that the necessary tests may be done to confirm or exclude an MI.

And I'd like to stress again. The facts are not on the table right now and I suspect that unless we were on the flight itself witnessing the incident with our own eyes, we may not be in a good position to pass any judgement.

As mentioned earlier, it is always best to err on the side of caution.