Critical care bypass in emergency rooms

In January 2000, 18-year-old Joshua Fleuelling died following an asthma attack. He had experienced cardiac arrest while being transported by ambulance to hospital, although not the nearest hospital because that institution was on “critical care bypass.” In this issue of CMAJ, Anne Walker examines the policies of critical care bypass in a legal framework, reviewing the concept of duty to care as it relates to emergency physicians. She discusses the legal dilemmas that arise when the physician’s duty to care confronts real-world problems of staff and equipment shortages and emergency room overcrowding.

Walker says existing judicial and academic opinions seem to suggest that the standard of care for physicians is sufficiently flexible to accommodate any reasonable medical decisions made in response to overcrowding. However, she also warns that liability issues may be more complex for hospitals than physicians.

In a related commentary, Jane Upfold provides an emergency physician’s perspective on the challenges of weighing the potential harms of having patients diverted to another hospital against those of accepting critically ill patients and possibly jeopardizing the care of patients already in the overcrowded emergency department.

p. 445 Emergency department overcrowding: patient diversion and the legal duty to care

— J. Upfold

p. 465 The legal duty of physicians and hospitals to provide emergency care

— A.F. Walker

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