May 10 2013

Lufthansa Provides Benefits to Doctors for On-Board Medical Care

Published by at 5:02 pm under Healthcare Reform

How often do we hear the phrase – Is there a doctor on-board?

I recall hearing that phrase at least 4 times on flights – probably more.

Different doctors have different attitudes toward stepping in. In general, an uncompensated doctor is protected from liability via Good Samaritan Laws – as long as the intervention is not grossly negligent or intentionally harmful – a pretty high standard.

The legal literature is devoid of examples of doctors being sued because of their mile-high activities. Still doctors who have spent time with the medico-legal system are reluctant to participate.

Lufthansa recently announced a program to make it more inviting for doctors to step up. It’s called the Doctor On Board Program.

When you register, your name and your medical field will be stored at Miles & More so that in a medical emergency the flight attendants can locate you quickly and ask for your help. If several doctors are on board at the same time, a medical council of various fields is possible in serious cases. By that we save valuable time and render speedy help.

When you book flights in future simply give your Miles & More card number as usual. We shall then know that we can rely on your medical support on board.

Lufthansa assures participants they have your back.

Your legal situation as the doctor treating a patient on board is covered. You are covered personally, within the framework of third-party insurance that Deutsche Lufthansa AG has concluded for such cases, against possible claims of recourse by the passenger you have treated. Intent is of course excluded. This disclaimer of liability applies to doctors and skilled lay assistants.

The benefit: 5,000 frequent flyer miles on your first flight plus a free copy of The Handbook of Aviation Medicine and Inflight Medical Emergencies.

One wonders whether this benefit negates Good Samaritan immunity. Typically, Good Samaritan immunity is conditioned on no payment for services rendered. Arguably, by being a mere member in a program, you are not being paid for individual care, just for your identification as someone with potential skills. But, how is that different from being on a call schedule- and being paid for taking call (even if you never submit a bill to a patient in the ER)?

I applaud Lufthansa for making an effort to make flying safer for its passengers. Lufthansa based in Germany- a country with a different medico-legal system than ours. Perhaps the frequent flyer benefit should be adjusted for risk by country of origin.

Oh, one more thing. If Lufthansa has a list of who might be available to provide medical care, will they continue to serve alcoholic beverages to the volunteers? One can imagine this scenario – 4 drinks into the flight. Is there a doctor on board? The inebriated doctor steps up. The lawsuit against Lufthansa – the deep pocket – reads “the airline with wanton disregard for the welfare of the passenger proceeded to intoxicate the sole practitioner able to rend care.” I hate to be a pessimist.

24 responses so far

24 Responses to “Lufthansa Provides Benefits to Doctors for On-Board Medical Care”

  1. al jaffee md faapon 10 May 2013 at 5:41 pm

    On an international flight I responded to a call concerning a moderately ill German kinder who was unilingual.I combined my German learned @ Guilford with Yiddish and was able to converse with the young man………who was treated properly and admitted to a hospital upon landing………I was provided with some unsolicited miles….

    Enjoyed your message

  2. Jeffrey Taffet MDon 10 May 2013 at 5:56 pm

    twice in the last year I have answered the call. Both pretty serious; one with resuscitation I did myself. Both on flights to Hawaii on Hawaiian Airlines. After; they asked for all my information. Not even a than you note. nothing.

  3. Charles Davanton 10 May 2013 at 6:03 pm

    I’ve stepped up a few times and never been thanked by the airline. On a USAIR flight to Philadelphia we hit an air pocket and there was a crash and scream as a drink cart came down on a flight attendant’s foot. ICE and ACE until landing, right?
    Had to open the small emergency kit to look for an ace. Not there. Opened the big kit. I could have done a trach, taken out an appendix, treated an MI but still no ace wrap. Wound up using her pantyhose.
    Then they insisted that since I had opened–but never touched anything inside–the packs I had to fill out several pages of paperwork. Thinking they might thank me for treating an employee who proved to have a FX foot with a few drinks, a few miles, maybe an upgrade I filled out the forms. Never heard a word, but they had my name, address, and so on.

    So I’ll answer a call, but it will be a cold day in hell before I do any more free paperwork. And I now carry a brand new 3″ in my bag I carrry on. You never know.

  4. Jeff Bressmanon 10 May 2013 at 6:34 pm

    On an El Al flight somewhere in the middle of flying over the Atlantic Ocean a call for anyone with medical training. I am an oral and Maxillofacial surgeon with substantial training and experience in anesthesia and medical emergencies, but nonetheless still a dentist. Nobody else on the flight responded so I offered my services to a passenger with a suspected acute MI. When we landed, I was offered a very nice bottle of wine by the purser on board. Much to my surprise I later received a call from El Al corporate, and was offered lifetime membership into their airport lounges.

    A few months later a passenger on an American Airlines flight that I was on passed out, likely due to a syncopal event. Again, I was the only person who responded and NOBODY including the passenger that I helped said thank you.

    Have responded a number of other times on various airlines and nobody has ever been as thankful as El Al was.

  5. Dr. Californiaon 10 May 2013 at 6:34 pm

    Lufthansa assures participating doctors, “Your legal situation as the doctor treating a patient on board is covered.” Your legal situation?

    Why on earth would any doctor knowingly put himself and his family in a position of jeopardy for no compensation? I think any doctor who jumps into a situation like this (and I have in the past) hasn’t thought through the consequences. So what if you think you will “win” a lawsuit? Do you have spare time to travel to another state to be pilloried in superior court? Will you feel great if a jury, after you’ve been deposed, accused, insulted, and bullied on the record, says you weren’t at fault? Will you consider the time well spent?

    Anybody has a medical emergency around me, I’ll help them if I know and trust them. Otherwise they can call their lawyer.

  6. Keith Denkler MDon 10 May 2013 at 6:38 pm

    Stepped in to help on a United Airlines flight. Needed to render aid, IV and take the plane down in Montreal. Flight had a great Banyan kit.
    Got letter from the airline for thanks and the flight attendants were very appreciative.

  7. Richard M. Lowenthal, MDon 10 May 2013 at 8:29 pm

    4 years ago, on an Alaska Airlines flight from Burbank to Portland, I responded to a pretty straightforward matter of a syncopal spell proceeding into a convulsion in an elderly man strapped in his seated position. As a neurologist, I felt very comfortable dealing with this, especially because his wife was able to give me a very good history. He was fine, and all that was necessary was oral hydration and following his vitals over the final one hour of the flight, thereby sparing the 100+ passengers the inconvenience (and the airline the expense) of a forced landing in San Francisco. Everybody was very grateful: patient, family, flight attendants, and captain. I was handed a certificate for 8000 miles on the spot, and I received a very nice letter of appreciation from the airline the next week.

    I would do the same thing again. Frankly, much of my motivation is imagining the tables turned, and it was I who needed the medical attention while a fellow-passenger medical colleague sat on his/her hands, frozen by the fear of the legal consequences of helping a stranger. Fie on him/her!

  8. David L. Mobley, MDon 11 May 2013 at 12:19 am

    If the airlines were really concerned about assuring that their customers had excellent medical care, why not put a paid MD on all overseas and/or long flights. Instead they would rather have the physicians who happen to be on board provide free medical care while pretending they have no control over whether medical care is available.

  9. Dr. Californiaon 11 May 2013 at 2:44 am

    Dr. Lowenthal, I used to have that attitude, too. Then reality struck.

  10. Michael M Rosenblatt,DPMon 11 May 2013 at 5:22 am

    As it happens, I am on a river boat excursion in Germany now. A couple of days ago a fellow 70 y/o passenger showed me his right elbow. A few days prior to the trip he had fallen outside in his garden and rather severely skinned his arm, taking off a 3 by 4″ section of skin. His wife had been applying dressings with triple anti biotic ointment. While not very painful, his entire elbow was grossly fusiform swollen. I immediately thought MRSA, and suggested he be on antibiotics. I happen to carry Cipro with me, but I didn’t tell him.

    I would now NEVER dispense them. First of all, I am a DPM and I would not be licensed for that. Second, I am retired and no longer have any license. Third, Cipro would probably not work against MRSA, even though it probably would still help.

    But I did help him facilitate a doctor visit. (I speak conversational German).

    The German doctor didn’t prescribe anything. German medical practice allows their doctors “freedom” to do nothing. They are not hamstrung by defensive medicine.

    American physicians don’t have that freedom. If the elbow gets worse and infection invades neighboring fascia, the German doctor has no reason to worry. He can’t be touched.

    I stepped up on an airline emergency once, many years ago, which worked out OK. As a DPM I am marginally equipped to handle these, but if you are on a deserted island, I suppose you’re better off with me than nothing. I think that good policy is to offer advice, but also encourage licensed medical attention instead of doing it yourself.

    I think “standoffishness” is still a good idea even if you are a board certified trauma surgeon. But you can try to re-assure them and if possible help them with their travel insurance and get them to a doctor, especially if you speak the local language.

    Michael M Rosenblatt, DPM

  11. Charles Davanton 11 May 2013 at 8:19 am

    Reply above raises a question. If you are retired and no longer are a licensed, practicing physician could you be successfully sued for malpractice? You are no longer a physician in a legal sense and might no longer have the duty of due care, would you have any more liability than any one else practicing medicine without a license?

  12. Medical Justiceon 11 May 2013 at 8:31 am

    Almost anyone on a plane rendering care – whether a licensed professional or not – if sued, would attempt to defend under Good Samaritan Act. A retired doctor, who does not maintain an active license, would likely not send a bill, and unless grossly negligent, would be able to successfully defend as a Good Samaritan.

    A layperson can be sued for negligent actions. In one case in California, a layperson was successfully sued for gross negligence for removing an injured person from a wrecked car. The person had a spine injury and – the argument ran – the movement aggravated the spine fracture creating a cord injury. The person who yanked the plaintiff out of the car was not a doctor.

  13. DrBoneson 11 May 2013 at 9:31 am

    I was on a transatlantic flight with a kid behind me with febrile seizures. I helped cool the kid down and had to decide whether to have them abort the flight. We traveled on to London, and the kid did fine. My family was put into first class, but I elected to stay behind in coach to take care of the kid. I did go up front for breakfast…. The airline itself did nothing, but the crew was very grateful.

  14. Alan Schorron 11 May 2013 at 11:04 am

    Have had to “work” several times over the past 6 years on flights. On two of the flights, there were multiple “sick” passengers. Each time the attendants thank me over and over, helped me through the paperwork, which was not that sophisticated.

    Each time, I received a letter of thank you from the airline, several weeks later with an update on the passengers—no names or other personal information. Additionally, received miles in my account, (except the last time when it was put in my son’s account accidentally, but I refused to change it).

    I do not worry about a lawsuit due to the Good Samaritan Act. Most families and patients are grateful that someone is there, particularly on the long flights. Only 1 was belligerent, but he passed out due to 4 vodkas before 10 AM. The family however, did stop to thank me and my wife, who is a nurse.

  15. Never againon 11 May 2013 at 12:52 pm

    After 10 years of practice in a highly specialized, highly sued field, I was sued for a completely merit less case before Tort reform (filed just before the statute changed). Prior to this lawsuit I had responded to numerous “air emergencies” with no expectation of getting anything but a thanks from the individual and airline crew. Since realizing how easy it is to be sued, even in cases where the MD is well protected, I will no longer step forward. The stress, disruption of practice and family life, the persecution of you as a physician with blatant lies, during even a merit less lawsuit is no longer worth it. I wonder if all the “good samaritan” MDs who jump to assist have ever been sued. I would probably guess they have not.

  16. Eric M. Joseph, M.D.on 11 May 2013 at 1:05 pm

    I don’t know much about Lufthansa other than the heist in Good Fellas. I would stay out of the program and data base, and save a life prn.

  17. Dr.Philon 11 May 2013 at 2:51 pm

    To those of you who would not render care because of the virtually non-existent possibility that you would get sued,shame on you. I am currently and ER physician in practice for 37 years and live with threat of litigation every day I’m in the ED.Always do what’s right for the patient.How could you live with yourself if you didn’t

  18. ER MDon 11 May 2013 at 4:00 pm

    Anyone who thinks it unusual to not receive thanks (or to even be cursed at or assaulted) for life saving emergency care has never practiced Emergency Medicine! Twice as much free care as the next closest specialty. No whining now people, just do the right thing! It might be your loved-one next.

  19. Dr. Californiaon 12 May 2013 at 12:17 am

    Those who think it will never happen to them have no business flaunting a holier than thou attitude. Just be thankful you haven’t been abused. And why anyone thinks the good Samaritan laws provide any significant protection is beyond me. As the cop said, you may beat the rap, but you’re going to take the ride.

  20. Steve Teitelbaumon 12 May 2013 at 8:39 pm

    About a month before graduating medical school, my buddy was flying steerage to Paris. About 30 minutes into the flight they made an overhead request for “Any doctor to come to the first class cabin.” After they made this page three or four times with no response, he figured he would be as good as anyone.

    When he got there, the flight attendants and passengers were doing CPR on a big guy sitting upright in his seat, with the seat moving and head flailing with each chest compression. The patient was enormous, but my friend was an all-american athlete, so he picked him up and put him on the floor. But with his head to the tail and the plane descending, he realized that the patient was in reverse-Trendelenberg. So he again picked up this flaccid guy and turned him around in the narrow aisle so that his head would be to the cockpit in a quasi-Trendelenberg position.

    The guy was dead as a doornail, but he continued CPR seemingly forever because the plane had to dump fuel before it could land. No one wanted to call the code in the air, least of all him.

    What did my friend get? He got to sit in the guy’s otherwise empty seat first class to Paris. And one of the Paris-based flight attendants was so impressed with him that she took him out that evening and “showed him Paris.” I think that beats the hell out of the Lufthansa deal.

  21. Mike Deckeron 14 May 2013 at 12:58 pm

    Over the 40-plus years I have been a doctor, I have answered a number of these calls. On one transatlantic flight I spent an hour and a half calming down a passsenger having an acute psychotic break. On another transatlantic flight I assisted a diabetic with a new insulin dispensing device. She was about to give herself ten times her ususal dose. (Not bad for a guy who spends a lot of time in the OR) There have been a handful of times that speaking in a calm voice and and taking a limited history either ressolved the problem or came up with a plan to rectify the situation once we landed. I have not been concerned with being sued nor have I expected any recognition other than a,”thank you”. Certainly I was much more comfortable knowing that each passenger had received the limited care one can give on an airplane. I certainly hope that I would be given the same courtesy should I have an inflight emergency. I feel very privileged to have a career practicing medicine and feel that that privilege carries a responsibility to think of my fellow man first and not deny someone care on an airliner just because I might be sued.

  22. malcolm lesavoy,mdon 15 May 2013 at 12:43 pm

    sign me up.

  23. Michael M. Rosenblatton 16 May 2013 at 9:26 am

    I agree with Dr. Decker that “talking with a calm voice, taking a brief history and reviewing medications” can do a great deal to help defuse an otherwise uncontrolled medical situation.

    When I stepped up on a call for a doctor on a plane, the patient was an elderly, barely communicative lady who was complaining of chest pain. The crew wanted to know if they should turn back. This was kind of a large load for a DPM.

    But there was nobody else aboard to answer the call.

    She was not in acute distress when I saw her. When I introduced myself, she visibly relaxed. She already had her medications (which she had with her). I calmly reviewed them with her one by one and asked if she had taken them before she left, which she assured me she had. Her vital signs were essentially normal, excluding my ability to take a BP. Among her meds were nitroglycerine, which suggested that chest pain was a more or less common feature for her. By the time I was finished talking to her, she stated her chest pain was gone. After staying with her for about an hour, she fell into a relaxed sleep. There was no need to give her another dose of it, which I might have done if her angina got worse. Thankfully, it did not.

    I could see no compelling reason to return to the originating city. To be on the safe side, I stayed with her for the rest of the flight and ordered an immediate post-flight EMT contact. I admitted to being a DPM and did not “apologize” for it. If they would have had an EMT or an MD who was more qualified, I would have gladly demurred. I don’t want to leave the impression here that DPM’s are qualified for things they were not trained in. Most MDs would be surprised by our training, and many MDs who work with our residents agree. We do have our place; but it is NOT generally in emergency medical care.

    I filled out the report forms (with thanks from the crew), but never heard anything about this after. If my elderly father or mother would have faced a similar circumstance, I’m sure I would be grateful to whomever stood up to take the call, even if a dentist or another DPM.

    But I would not have expected or demanded any type of “heroic” response. I find this discussion helpful, because the odds of having medically trained people who are not medical doctors on board is greater than only MDs.

    Michael M. Rosenblatt, DPM

  24. David B. Gilberton 19 May 2013 at 8:05 am

    Last year on a Delta flight to London I was called upon to treat two passengers for most of the night. The first was simple syncope. The second, probably a ruptured diverticuli. I managed both without having to abort the flight or dump fuel. It probably saved Delta a quarter million dollars. They thanked me and gave me miles but I think El Al’s approach is the better offer. It costs the airline very little to give lifetime Club benefits. I sent their president some suggestions. Get an automated bp cuffs. The attendant can take bp’s while you are doing other things. The captain should have morphine under lock and key. It is the one thing you have to offer a patient with a kidney stone or an infarct. Screaming and moaning is not useful on a transatlantic flight. There should be a card available to give to a physician that tells him what is available and where the iv supplies and defibrillator is located. I now have the AliveCor attachment to my iPhone that allows me to view an ekg. It amazes me that these simple solutions are not standard on long flights. The money saved on this flight could equip Detla’s entire fleet. The airlines should offer a discount to any physician who purchases a long distance flight if he agrees to help out in an emergency. I’ll bet their attorneys have advised against it.