Recently, the City of Phoenix agreed to pay $605,000 to settle a wrongful death lawsuit stemming from a patient transport incident. According to the lawsuit, firefighters responded to assist an individual who was unable to stand and required medical transport. Rather than using a stretcher, stair chair, or other patient-moving device, the patient was reportedly transported down exterior stairs while seated in a rolling office chair. During the movement, the chair allegedly tipped backward, causing the patient to fall onto the concrete below. He later died from the injuries sustained in the fall.
The case quickly generated headlines throughout the fire and EMS community, with many asking the same question:
“Was this negligence?”
The answer isn’t as simple as many people think.
Because the case settled before trial, there was never a judicial finding that the firefighters or the City of Phoenix were negligent. However, the allegations in the lawsuit provide an excellent opportunity to understand how negligence is evaluated in civil court and why every EMS provider should understand its elements.
A Settlement Is Not an Admission of Guilt
One of the biggest misconceptions surrounding civil lawsuits is that a settlement equals an admission of wrongdoing.
It doesn’t.
In fact, settlement agreements almost always contain language stating that the defendant does not admit liability or negligence.
Cities, hospitals, ambulance services, and insurance companies settle lawsuits for many reasons, including:
- Avoiding the uncertainty of a jury trial
- Limiting the cost of prolonged litigation
- Reducing attorney fees and expert witness expenses
- Avoiding the possibility of a much larger verdict
- Bringing closure to everyone involved
In other words, a settlement is often a business decision, not a legal determination that someone acted negligently.
So while the Phoenix settlement resolved the lawsuit, it does not prove that the firefighters violated the standard of care.
What it does provide is a valuable teaching opportunity. As a person guilty of using a patient’s chair myself because in all honesty I was too lazy to go to the truck, this is an eye opener.
If this case had gone to trial, the plaintiff would have been required to prove every element of negligence.
Understanding the Five Elements of Negligence
Many EMT and paramedic programs teach negligence using four elements:
- Duty
- Breach of Duty
- Causation
- Damages
While that’s not incorrect, I prefer teaching negligence as five elements because it separates the two different types of causation that must often be established.
The five elements are:
- Duty
- Breach of Duty
- Actual Cause
- Proximate Cause
- Damages
Let’s look at how each element could have been argued in this case.
1. Duty
Duty is usually the easiest element to establish.
Once firefighters or EMS providers accept responsibility for a patient, they owe that patient a duty to provide care consistent with what a reasonably prudent provider with similar education, training, and experience would provide under similar circumstances.
In this case, firefighters responded to the patient’s home, evaluated him, and began transporting him.
By accepting responsibility for his care, they established a legal duty.
There likely would have been very little dispute over this element.
2. Breach of Duty
This is often where negligence cases are won or lost.
A breach occurs when someone’s actions fall below the accepted standard of care.
Notice that the legal question is not whether the providers intended to help.
Nor is it whether they had successfully used a similar technique before.
Instead, the question becomes:
Did their actions meet the standard of care expected of a reasonably prudent EMS provider under similar circumstances?
According to the lawsuit, the patient was transported down stairs in a rolling office chair instead of using appropriate patient-moving equipment.
Today, most fire departments and transporting EMS agencies carry stair chairs or evacuation chairs specifically designed for removing patients from homes and navigating stairways safely. These devices incorporate secure patient restraints, controlled descent systems or tracks, multiple lifting handles, and are engineered specifically to reduce the risk of patient and provider injury during stairway operations.
Stairways are among the most hazardous environments EMS providers encounter. That’s exactly why these devices were developed.
The plaintiff would likely have argued that purpose-built patient movement equipment existed and that using a rolling office chair unnecessarily increased the risk to the patient, falling below the accepted standard of care.
The defense, on the other hand, may have argued there were unique circumstances influencing the crew’s decision—such as the patient’s condition, the home’s layout, equipment availability, or other scene-specific factors. Because the case settled before trial, those arguments were never fully presented to a jury.
3. Actual Cause
Actual cause is also known as cause in fact.
The legal test is simple:
But for the alleged breach, would the injury have occurred?
The plaintiff would likely argue:
“But for transporting the patient in the office chair, he would not have fallen down the stairs.”
If a jury agreed with that argument, actual cause would likely be established.
Actual cause is often the easiest portion of causation to prove when the injury occurs immediately after the alleged negligent act.
4. Proximate Cause
This is where many providers become confused.
While actual cause asks what caused the injury, proximate cause asks whether the injury was a reasonably foreseeable result of the alleged breach.
In this case, the plaintiff would likely argue that transporting a patient down a flight of stairs in a rolling office chair creates a foreseeable risk that the chair could tip or lose control.
If that occurred, a serious fall resulting in fractures, spinal injuries, or even death could also be considered foreseeable consequences.
The defense may have argued that an unexpected event or intervening factor caused the accident rather than the transport method itself.
Again, because the case settled, we never learned how a jury would have viewed those competing arguments.
5. Damages
The final element is damages.
Without actual harm, there is no negligence claim.
According to the lawsuit, the patient allegedly suffered severe cervical and spinal injuries before later dying from those injuries.
The lawsuit sought compensation for medical expenses, pain and suffering, and wrongful death damages.
This element likely would not have been heavily disputed.
The Right Tool for the Job
One of the greatest advances in patient movement over the past several decades has been the widespread adoption of stair chairs.
Nearly every transporting fire department and EMS agency carries one because they are specifically designed for one of the highest-risk tasks we perform: moving patients safely on stairs.
No piece of equipment eliminates every hazard, but stair chairs dramatically improve patient stability, provider ergonomics, and control during ascent and descent.
EMS providers frequently encounter situations where they must adapt to confined spaces, bariatric patients, narrow hallways, spiral staircases, or other challenging environments. Improvisation is sometimes unavoidable.
However, whenever purpose-built equipment is available, it should be the first choice whenever practical.
These devices exist because years of experience—and unfortunately, previous injuries—have demonstrated safer ways to move patients.
Why This Case Matters
This article isn’t about criticizing another department.
Every firefighter and paramedic has faced difficult patient removals.
We’ve all encountered cramped apartments, winding staircases, icy porches, oversized patients, or scenes where nothing seems straightforward.
The lesson isn’t that improvisation is always wrong.
The lesson is recognizing when convenience begins replacing sound risk management.
Whenever you find yourself deviating from normal patient movement procedures, pause for a moment and ask yourself:
- Is there a safer option?
- Do we need additional personnel?
- Should we retrieve different equipment?
- If I had to explain this decision to a jury five years from now, could I articulate why this was the safest reasonable option under the circumstances?
Those few extra minutes may prevent an injury that changes a patient’s life—and your career.
The Takeaway
The City of Phoenix settled this lawsuit, but that settlement is not an admission of negligence or wrongdoing.
A jury never determined whether the firefighters breached the standard of care.
Nevertheless, the allegations provide an excellent real-world example of how negligence is analyzed in civil court.
Whenever you read about an EMS lawsuit, don’t immediately ask,
“Who was at fault?”
Instead, work through the legal framework:
- Duty: Did the provider owe the patient a duty of care?
- Breach: Did the provider’s actions fall below the accepted standard of care?
- Actual Cause: Did the alleged breach actually cause the injury?
- Proximate Cause: Was the injury a foreseeable consequence of the alleged breach?
- Damages: Did the patient suffer measurable harm?
If the plaintiff cannot prove every one of these elements, the negligence claim generally fails.
Understanding these principles isn’t about practicing defensive medicine or avoiding lawsuits. It’s about making thoughtful, evidence-based decisions that protect our patients, our crews, and the profession we all serve.
The next difficult patient movement you encounter probably won’t make national headlines.
But the decisions you make in those few critical minutes should always be guided by the same question:
“What is the safest reasonable option for my patient?”
Because at the end of the day, that’s the standard every EMS provider should strive to meet.