State of Queensland v Masson [2020] HCA 28
Ms Masson had suffered with asthma for years. In 2002, she suffered a severe attack and collapsed on her front lawn. An ambulance was called and paramedics arrived 6 minutes later. Ms Masson was unresponsive at that time. The QAS paramedic gave her salbutamol and initially it seemed to be working but on the way to the hospital, Ms Masson’s heart rate dropped and cardiac arrest was imminent. The QAS paramedic then gave her adrenaline which didn’t help and Ms Masson suffered pneumothoraxes which needed urgent thoracostomy on the side of the road. By the time Ms Masson had arrived at hospital, she had suffered severe hypoxic brain damage. Ms Masson lived in a vegetive state until 2016.
Ms Masson’s estate claimed she should have been given adrenaline immediately on QAS arrival because that is what the QAS Clinical Practice Manual, particularly the QAS asthma guideline, said should have happened and if she had been given adrenaline, she would not have suffered the respiratory arrest which led to her brain injury.
The State of Queensland, for the QAS, instead said that salbutamol was an equally effective option, particularly when Ms Masson’s high heart rate and high blood pressure contraindicated the administration of adrenaline. The Judge agreed with this, stating “there would have existed a responsible body of opinion in the medical profession in support of the view that Ms Masson’s high heart rate and high blood pressure, in the context of her overall condition, provided a medically sound basis to prefer the administration of salbutamol to the administration of adrenaline.” The Judge found that the manual did not mandate the administration of adrenaline but simply stated it should be considered. He found that it was considered but then rejected. Ms Masson’s estate therefore lost the trial.
The estate appealed the decision. The Court of Appeal found that that the QAS paramedic didn’t consider the administration of adrenaline because, in fact, he thought he was prohibited from administering it. The Court also found that his conduct was not in accordance with the manual, he used “a less effective drug for a patient in this critical condition” and he “was negligent in not administering adrenaline from the outset”. The appeal was allowed.
The State of Queensland appealed to the High Court of Australia which unanimously allowed the appeal and restored the original Judge’s decision: the administration of adrenaline was not mandated by the manual and many other paramedics in the same boat, using their own clinical judgment, would have used salbutamol too.