Mike Fish was driving for Uber 10 minutes outside of Boston when he picked up a second passenger in his Uber Pool who, he said, seemed “out of it, drowsy — almost sedated.”
When the drowsy passenger asked him if Boston’s Mass General hospital was the nearest emergency room, “that set off a red flag,” Fish told BuzzFeed News. “I said, ‘Do you need the ER?’ He said yes. It came out that, over the last few days, he’d been passing out and losing consciousness.”
But instead of calling an ambulance to get the urgent medical attention he needed, the sick passenger called an Uber Pool. The shared ride would save him a few bucks, but it meant he’d have to wait for Fish to drop off the first passenger before he’d get to the ER.
“I was a little nervous,” Fish said. “I didn’t know what was going to happen.”
Ride-hail drivers are, by and large, untrained, self-employed workers driving their own cars on a part-time basis. They’re not medical professionals. But as health care costs have risen and ride-hail has become more pervasive, people are increasingly relying on Uber and Lyft drivers to get them to the hospital when they need emergency care.
A recent (yet to be peer-reviewed) study found that, after Uber enters new markets, the rates of ambulance rides typically go down, meaning fewer people call professionals in favor of the cheaper option. People have always taken taxis to the hospital — there’s the classic example of the woman going into labor in the back of a cab — but ride-hail technology makes it much easier, especially in less densely populated cities. This money-saving tactic might make sense for people in noncritical condition, but it puts ride-hail drivers in an uncomfortable position. They’re forced to choose between assuming potential legal liability if something goes wrong, or dealing with a sense of guilt and the fear of getting a lower rating if they decline or cancel the ride.
Fish didn’t have much of a choice about taking the man to the emergency room — by the time he learned where the rider was going and why, they were already on their way. This happens frequently. But in another instance, Fish willingly agreed to take someone to the ER, a restaurant kitchen worker who’d sliced his hand open while working.
"I was torn between whether to call 911 or continue to the ER, but ... I figured I’d get there quicker than an ambulance."
“With Boston traffic, it was probably quicker than calling an ambulance. If you call an Uber, chances are there’s going to be one within a block or two. An ambulance won’t be as close,” Fish said. “I’m not recommending people do that, but in that case, it worked out pretty well. I got him there in six minutes, and he didn’t need attention from a paramedic, so that actually ended up being pretty efficient.”
But legal professor and gig economy observer Veena Dubal told BuzzFeed News that by allowing the injured man into his car and pressing the button to start the ride, Fish may have exposed himself to serious legal liability.
“You’re not liable if you refuse to take them,” Dubal said. “You’re under no legal obligation to care for them until they get in your car, and then you’re a proprietor conducting business.”
If Uber drivers were employees of Uber, then Uber would be liable if something bad happened to a passenger en route to the hospital. But because drivers are independent contractors, they could be held responsible for any failure to provide care during the business transaction.
“There have been cases where business owners haven't protected people from violence who walk onto their property, and the courts have said there's a special relationship between the business owner and customer, and the business owner acted negligently by not keeping the customer safe,” Dubal said. “In this case, the business owner would be the Uber driver, once the rider gets into the car.”
As independent contractors, Uber and Lyft drivers can turn down any ride that makes them uncomfortable. The companies also charge riders for cleaning fees and repay drivers for the expense, though drivers say this process is a major headache that can take weeks. Both companies said low ratings or demerits for canceling on a rider experiencing a medical emergency could be expunged from a driver’s record.
“Uber is not a substitute for law enforcement or medical professionals,” an Uber spokesperson told BuzzFeed News. “In the event of any medical emergency, we encourage people to call 911.”
Lyft said the same, adding, “If a driver encounters a passenger with an emergency situation, they should contact 911. After that, they should report the incident to our 24/7 critical response line so we can take appropriate action.”
But drivers told BuzzFeed News that neither Uber or Lyft have provided them with direct guidance about what they should do when a passenger expects to be taken to the ER. “As far as ambulances or medical emergencies, to my knowledge, Uber's never said anything about it,” said Russ Fisher, a ride-hail driver in Cedar Rapids, Iowa. “They just vaguely say any ride is your decision, use your common sense.”
When Fisher picked up a young woman whose destination was Mercy Hospital, he didn’t immediately suspect that her ride was urgent. In fact, he’d gotten a ping from her during surge pricing, only to have her cancel the ride and rebook it a few minutes later when the surge went away. So he was surprised when, a few minutes into the trip, she asked him to pull over so she could throw up on the side of the road. Later, she told him she could barely walk and was experiencing the worst pain of her life.
“I was a little nervous when she got out to vomit,” Fisher said. “I haven’t been in a situation like that. I haven’t trained for that. I was torn between whether to call 911 or continue to the ER, but since I was only two minutes away, I figured I’d get there quicker than an ambulance.”
An Uber might have been the speediest solution in that particular situation, but ambulances and the paramedics are prepared to handle emergencies, while ride-hail drivers aren’t. Sirens and lights allow emergency vehicles to bypass traffic and red lights, and the EMTs on board are trained and able to start providing medical care as soon as they arrive on the scene.
"I drive my kids in the car. I don't want deathly ill people in my car."
And it’s not just the patients who are put at risk when they opt to call a car rather than an ambulance. When drivers give rides to sick people, they’re exposed to germs and the possibility of infection. One driver remembered with horror picking a patient up at the hospital whose colostomy bag exploded on the way home. Another said he had to wipe down the backseat of his car after driving a woman in labor to the hospital. Experienced drivers recommend getting leather or plastic, never fabric, seats.
“If someone leaves bodily fluids, it's up to me to clean,” said an Uber driver named Jamie.
Jamie was driving Uber in Pittsburgh around 2 a.m. one morning when he picked up two riders headed to the hospital. One of them looked very sick. “I was nervous, but I didn’t say anything. He was in bad, bad shape,” Jamie said.
He dropped the couple off at the hospital without incident, but later he found out the sick rider had died of a long-term illness. Jamie was sympathetic, but he wondered why they didn’t call an ambulance.
“I drive my kids in the car,” he said. “I don’t want deathly ill people in my car, to be honest.”
Uber and Lyft didn’t create this problem. Emergency medical transportation is expensive, with ambulance rides costing patients hundreds or even thousands of dollars, even if they have health insurance. More than half of Americans say an unplanned $1,000 expense would put them in debt.
“What it says is something awful about the state of health insurance, that it's so expensive to get to the hospital via ambulance,” said Dubal, the law professor. “It means this is a new, weird, privatized way that people are dealing with emergencies, and the drivers aren't equipped to deal with those things, and they're taking on risks that they're unaware of.”
Dubal said it’s unlikely that an attorney would be willing to sue an individual ride-hail driver for failing to provide adequate medical care during a ride, largely because there’s no money in it. But what they might do, she said, is sue Uber, claiming the driver was acting as the company’s agent, even though they aren’t formally employees. The high likelihood that Uber would settle such a case would make such a lawsuit tempting.
“Uber is settling cases left and right because they don't want this issue of whether drivers are employees or independent contractors to be decided in a court,” Dubal said. “So they’re highly motivated to settle. I wouldn't be surprised if this lawsuit doesn’t already exist, or will exist soon.”