On the night of December 14, 2007, a 14 year old Illinois girl named Laura Montero ruptured her appendix and fell gravely ill while aboard the Dawn Princess cruise ship. At the time, the ship was located in open water off the coast of Baja California, and hundreds of miles from a hospital. Recognizing the dire situation, the captain sent out a distress call.

The call was answered by the closest surgical facility, the U.S.S. Ronald Reagan, which was on training maneuvers 500 miles away. The aircraft carrier changed course, closed the distance between the two ships, and then launched a helicopter to cover the remaining 175 miles. Montero, who was receiving an antibiotic drip, was loaded into a litter basket, lifted into the helicopter and flown back to the Reagan for an emergency appendectomy. And, at last report, she was making a good recovery.

In the aftermath, a Navy spokesperson offered the following summary: "Where the ship was, where the land was, and the fact that the Ronald Reagan had a surgical facility on board were all factors that came into play. The option is to go to the nearest medical facility that can treat the patient."

There was no comment from the Navy, the cruise line, or the involved doctors as to any concern about medical-legal issues, nor was any comment needed. But, had this scenario been played out within range of prevailing risk management theory, one might have envisioned significant delays while the following issues were fully analyzed:

HIPAA: Will the girl's name be mentioned during radio communication between the two ships or will she be given an alias? How will the cruise ship know that it is the Reagan answering the distress call and not an imposter ship posing as the Reagan? When will the girl be notified of the Reagan's HIPAA policies? Should the policies be lowered with the rescue basket so that her mother can review them?

Informed Consent: How does the ship's presence in international waters affect the issue of informed consent? In that the girl's mother stayed behind on the cruise ship, who will give consent? Should the discussion of risks and benefits include the risks associated with being pulled off of a ship in a basket?

Documentation: Have past medical records been obtained and reviewed? Have everyone's thoughts, feelings, intuitions and reasoning with respect to all of the available options been thoroughly documented in a legible, organized and sequentially numbered manner? Has anyone used an improper abbreviation?

Fortunately, the men and women involved in this inspiring story instinctively recognized that the medical-legal issues meant nothing when compared to the value of a young girl's life, and they proceeded accordingly.

Taking care of the patient always takes priority over any and every medical-legal consideration. This principle is so important that it should serve as both the starting point and the conclusion any time the issues are discussed. "The option is to go to the nearest medical facility that can treat the patient," was all that was needed to change the course of a nuclear powered aircraft carrier.

It is unfortunate that we are regularly misled into believing that medical-legal considerations are more important than proper patient care. This type of advice is a terrible disservice to our patients and our profession. When searching for a solution to a medical-legal dilemma, we must keep in mind that "the best interest of the patient" turned the U.S.S. Ronald Reagan. And, it should have a similar effect on all of us.