The Northern District of Texas recently added to a growing body of case law in holding that a crew’s imperfect response to a medical emergency on board an aircraft does not constitute an “accident” under Article 17 of the Montreal Convention.
Granting summary judgment in favor of the airline in Arzu v. American Airlines, Inc., No. 4:24-cv-00433-P, 2025 WL 1347329, at *1 (N.D. Tex. May 8, 2025), the district court held that the airline was not liable for the collapse of fourteen-year-old Kevin Greenidge during a flight from Honduras to Miami, which ultimately led to his death shortly after the plane was diverted to Cancun International Airport for medical assistance.
At the time Kevin boarded the flight, he weighed 319 pounds and suffered from asthma, sleep apnea and type II diabetes. After takeoff, he asked for his inhaler from his aunt, with whom he was travelling. His breathing nevertheless worsened and shortly after reaching altitude, he became unconscious. Kevin’s aunt called for assistance and when the flight attendants responded, Kevin was unresponsive. Accordingly, they called a Code Red and requested assistance from any medical professionals on board. A nurse and a general surgeon responded. Pursuant to the nurse’s direction, several people assisted in placing Kevin on the floor. The nurse, surgeon and a flight attendant administered CPR. Another flight attendant obtained the on board automated external defibrillator (“AED”) which was used by the nurse and surgeon on Kevin. At this point, the flight crew was alerted to the medical emergency and made an emergency descent into Cancun at 7:33 p.m. The plane arrived at the gate at 7:50 p.m. Emergency medical services transported Kevin to the hospital where he was pronounced dead at 8:45 p.m.
Condon & Forsyth’s readership is likely familiar with application of the Montreal Convention to international transportation and its Article 17 liability provision for death or injury to passengers, which requires proof that an “accident” caused death or bodily injury on board the aircraft or in the process of embarking or disembarking. The Supreme Court has defined an “accident” as an “unusual or unexpected event or happening that is external to the passenger.” Air France v. Saks, 470 U.S. 392, 395 (1985). The seminal case analyzing accident liability in the context of a crew’s response to a passenger medical condition is Olympic Airways v. Husain, 540 U.S. 644 (2004). In Husain, a passenger requested to be moved out of the aircraft’s smoking section due to his asthma. All three times the flight attendant responded that the flight was full, and she was too busy. On appeal, the Supreme Court held that the crew’s refusal to respond to a passenger’s medical request was “a link in the chain of causes” that led to the passenger’s death.
While Husain presented circumstances of a crew’s non-response to a medical situation on board, courts consistently hold that a crew’s imperfect response to a passenger’s medical emergency does not necessarily constitute an Article 17 “accident.” On that basis, Condon & Forsyth obtained a defense verdict in favor of the carrier in Singh v. Caribbean Airlines Ltd., 49 F. Supp. 3d 1108, 1111 (S.D. Fla. 2014), aff’d sub nom. Singh ex rel. Singh v. Caribbean Airlines Ltd., 798 F.3d 1355 (11th Cir. 2015), a case relied upon by American Airlines in seeking summary judgment in the Arzu case.
In Singh, a passenger on board a Caribbean Airlines flight from Trinidad to Miami suffered a stroke. The cabin crew provided oxygen and a nitroglycerin tablet to prevent cardiac arrest. The Purser of the flight notified the cockpit that there was an ill passenger on board, but she did not mention a possible stroke. Sometime later, the passenger slumped over in his seat and the Purser notified the cockpit that the situation had become serious. The Captain contacted MedLink, which provides the advice of a medical professional in case of emergencies on board aircraft, who recommended that the flight divert to Nassau, Bahamas. However, the Captain ultimately continued on to Miami, taking into consideration all relevant factors, including the fact ground staff in Nassau could not be reached to arrange for the diversion; whereas, emergency medical arrangements were available in Miami.
The Singh Court determined: “While there are certain deficiencies in how the flight and cockpit crew, including the Captain, responded to [the passenger’s] on-board medical emergency, those deficiencies, whether considered in isolation or collectively, do not support the basis of a claim under Article 17 of the Montreal Convention.” 49 F. Supp. 3d at 1118. Further, the airline did not disregard any “explicit health-based request,” as in Husain. Id. at 1120. Similarly, the Arzu Court held “that there may have been reactionary delays, confusion of roles, and departures from policy[;]” however, “the failure of American Airlines to follow all relevant procedures, ‘when evaluated in context . . . was not unusual or unexpected.’” 2025 WL 1347329, at *4 (citing White v. Emirates Airlines, Inc., 493 Fed. App’x 526, 534 (5th Cir. 2012).
A crucial distinction presented in Arzu and Singh, as opposed to Husain, is that any lapses in procedure are part of circumstances that “reflect concerted efforts by the crew to provide emergency assistance” to sick passengers. Arzu, 2025 WL 1347329, at *3. In evaluating passenger claims arising out of on board medical emergencies, it should be helpful for carriers and their insurers to bear in mind this crucial distinction, namely that a crew’s response need not be perfect to avoid liability under Article 17 of the Montreal Convention.
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