The key issues
The case concerned two issues:
- Whether the treating officer had considered the administration of adrenaline in accordance with the Practice Manual; and
- Whether a responsible body of opinion supported the treating officer’s decision to administer salbutamol given the associated risk factors.
On 21 July 2002, Jennifer Masson, a chronic asthmatic, suffered a severe asthma attack and emergency services were called.
On arrival, Mr Peters, an intensive care paramedic, observed that Ms Masson was in respiratory arrest with high blood pressure and a very high heart rate. He administered intravenous salbutamol instead of adrenaline because of these risk factors. During the journey to Cairns Base Hospital, Ms Masson’s condition worsened and she suffered severe, irreversible brain damage due to oxygen deprivation.
On behalf of Ms Masson, proceedings were commenced claiming damages in negligence against the State of Queensland, as the provider of ambulance services. The negligence claim alleged that the ambulance officer’s failure to promptly administer adrenaline to Ms Masson was a negligent omission for which the State was vicariously liable. This failure was said to be contrary to a Practice Manual (Manual) published by the Queensland Ambulance Service.
The trial judge found the following:
- Mr Peters had considered administering adrenaline but decided against because of the risks associated with using adrenaline on a patient with a high heart rate and blood pressure; and
- A responsible body of opinion within the medical profession at the time supported the view that those risk factors provided a sound basis for the administration of salbutamol rather than adrenaline.
On appeal, the Queensland Court of Appeal held that Mr Peters had failed to consider the administration of adrenaline because of a mistaken belief that the Manual prevented him from doing so. Additionally, the court held that the body of opinion finding was not supported by the evidence, and even if it were, departing from the Manual would nonetheless have been below the standard of reasonable care.
The State of Queensland was granted special leave to appeal to the High Court.
The High Court allowed the appeal, holding that the State of Queensland was not liable in negligence (either vicariously or directly) by reason of the failure of its ambulance officer to administer adrenaline.
The Court held:
- The clinical judgment to administer salbutamol was “neither contrary to compelling inferences nor glaringly improbable” and as such, the trial judge’s conclusion should not have been overturned; and
- The decision not to administer adrenaline was not in contravention of the Manual and was not negligent as it conformed with a responsible body of professional opinion.
Kiefel CJ, Bell and Keane JJ
- The standard of care expected was that of the ordinary skilled intensive care paramedic operating in the context of an emergency and not that of a medical specialist in emergency medicine;
- The Court of Appeal should not have accepted that there was no evidential basis for concluding that where an asthmatic patient is in imminent arrest, that consideration of adrenaline in accordance with the Manual was not to be informed by a paramedic’s clinical judgment;
- There was ample evidence to the effect that a responsible body of opinion within the medical profession favoured the administration of salbutamol for a patient with a high heart rate and high blood pressure.
Nettle and Gordon JJ
- Guidelines and policies are not to be construed as a lawyer might construe a statute. Here, the Manual was intended to guide and assist decision making not proscribe treatment;
- The standard of care of an ordinary skilled person exercising a special skill is informed, but not determined, by reference to a responsible body of opinion;
- Where a body of professional opinion is relied upon, it will be regarded as reasonable provided it has a logical basis;
- A body of professional opinion does not need to align with the majority opinion to be a responsible body of opinion. Nor does it need to be based on the assumptions which underscore that majority opinion; and
- The fact that the majority may have chosen adrenaline at first instance, does not mean the minority who would have chosen salbutamol were negligent.
The case reinforces that although a medical practitioner needs to act in a manner which is in accordance with a responsible body of opinion, or one that is widely accepted as stated in s 5PB of the Civil Liability Act (WA), there is no requirement to prove that the opinion was held by a majority of practitioners in the field. It also reiterates that the standard of care expected of a health practitioner will be determined according to the circumstances, specifically, the qualifications and expertise of the practitioner’s field.
The decision in Queensland v Masson  HCA 28 can be read here.