In Florida, health clubs' duty to stricken patrons doesn't go far beyond dialing 911.
The question of whether or not fitness centers have a legal duty to maintain an automated external defibrillator is still being decided on a state-by-state basis. In one recent case, Fowler v. Bally Total Fitness [Case No. 07 L 12258], Maryland's Cook County Circuit Court ruled that even though there was no legislative mandate requiring an AED, Bally Total Fitness acted with indifference to the welfare and safety of its patrons when it failed to have one on site. [See "Aftershocks," May 2008, p. 28.] Other jurisdictions have looked at clubs' duty of care differently. For example, as demonstrated by the Court of Appeal of Florida, Fourth District's decision in L.A. Fitness International v. Julianna Tringali Mayer [980 So. 2d 550 (Fla. App. 2008)], sometimes just promptly calling for medical assistance is enough to satisfy your legal duty. While working out on a stair-climber at L.A. Fitness in Oakland Park, Fla., Alessio Tringali suffered a heart attack. Hearing other gym patrons' shouts for help, two L.A. Fitness employees ran to render aid to Tringali. An employee certified in CPR observed Tringali lying on his back, bleeding from a cut on his head and shaking from small convulsions. When the employee knelt down beside Tringali to assess his condition, he felt a faint pulse, which to him indicated a heartbeat. He also noted the red color of Tringali's face and concluded that Tringali had an oxygen supply. He did not, however, put his face next to Tringali to feel if he was breathing. Based on his observations, the employee believed that Tringali was having a seizure or stroke, and therefore decided not to attempt CPR and possibly make matters worse. He testified that Tringali had just begun to turn blue when paramedics arrived. It is estimated that it took EMTs approximately three minutes after receiving a call from the front-desk receptionist (prompted by the second club employee) to arrive at L.A. Fitness, meaning four to six minutes had elapsed from the time the employees heard the initial calls for help. When they arrived, the EMTs found Tringali lying on his back, not breathing and without a pulse. While they quickly performed CPR and used a defibrillator to shock Tringali's heart, they were unable to reestablish a pulse, and Tringali was later pronounced dead at the hospital. As a result of his death, Tringali's estate filed a wrongful-death action against L.A. Fitness, alleging that the club breached its duty to render aid during a medical emergency when it: a) failed to administer CPR to him; b) failed to have an AED on its premises; and c) failed to properly train its employees how to handle medical emergencies. After a trial, the jury, under the theory of comparative negligence, found L.A. Fitness 85 percent negligent in Tringali's death. The final judgment against L.A. Fitness was $619,650. In its appeal of the verdict, L.A. Fitness argued that it satisfied its duty to render assistance to the victim as a matter of law when it promptly summoned professional medical assistance for him. In examining what legal duty L.A. Fitness owed Tringali, the court first recognized that a "special relationship" existed between L.A. Fitness and its members, and that L.A. Fitness had (as any business owner had) a duty to use reasonable care in rendering aid when a patron became ill or injured. The question, therefore, was whether failing to administer CPR meant that L.A. Fitness had breached its duty. Since neither party could find any statutory or case law in Florida that clearly delineated the duties health clubs owed their patrons facing a medical emergency, the court, citing Starling v. Fisherman's Pier Inc. [401 So. 2d 1136 (Fla. 4th DCA 1981)], held that the only duty a proprietor owes an ill or injured patron or guest is an ordinary duty of care to render aid. A facility owner and its employees, the court ruled, will seldom be required to do more than give such first aid as the employees reasonably can, and take reasonable steps to look after the injured person until medical assistance arrives. Using this standard, the court ruled that since L.A. Fitness immediately called 911 once it discovered Tringali needed help, and stayed with Tringali until paramedics arrived, the club had fulfilled its common-law duty to render aid and secure medical assistance for Tringali. In support of its ruling, the court found no precedent in Florida for imposing a duty upon health clubs to have CPR-trained employees on site at all times for medical emergencies, or to require such employees to perform CPR on injured patrons when such a procedure may be warranted. In addition, the court noted that other jurisdictions that have examined the issue of a business owner's duty to injured patrons have also generally held that a business satisfies its legal duty to come to the aid of a patron experiencing a medical emergency by summoning medical assistance within a reasonable time. Next, the court held that even if L.A. Fitness had an obligation to provide first aid to Tringali, its obligation did not extend to performing such skilled treatment as CPR. First aid, the court ruled, requires no more assistance than that which can be provided by an untrained person. Therefore, while the court acknowledged that CPR was a relatively simple and widely known technique for saving lives, it nonetheless concluded that since it required training and recertification, CPR was more than mere first aid. Having concluded that L.A. Fitness had no legal duty to have CPR-qualified employees on site, and that their employees were under no legal duty to administer CPR to their stricken patron, the court next rejected the Tringali estate's argument that L.A. Fitness had a duty to have an AED on its premises. In support of its conclusion, the court noted that the Florida Legislature had specifically adopted the "Cardiac Arrest Survival Act" [§ 768.1325, Fla. Stat.], which refused to impose any requirement that AEDs be placed in any building or location, or that facilities with an AED have anyone trained in their use. While the decision of the Court of Appeal of Florida, Fourth District in L.A. Fitness International may seem to lower the standard of care facility owners owe their patrons, such a reading could be dangerous. First, the decision was based on Florida statutory or case law, and only applies in Florida. Since other states have specifically modified their laws to require fitness facilities to have an AED, it is essential that club owners consider local laws when deciding whether to purchase AEDs for their facilities. Second, it should be noted that while Florida may be unwilling to impose a duty upon health clubs to have AEDs or CPR-trained employees on site at all times, the American College of Sports Medicine has developed industry standards of care that call for each facility to have a written emergency plan, employ CPR-qualified personnel for handling emergencies, and have an AED on its premises.