November 20, 2013. 6:06 PM. That’s a time that will live in my memory for a long time and that I will probably never be able to forget. You see, at that moment, my mom became an EMS patient and I simultaneously lost faith in my local EMS system.
It’s hard being a medical provider when your family is a patient. It’s even harder watching an EMS system you’ve always respected do everything it can to disappoint you.
I’ve always considered myself fortunate to live in Austin, Texas. Besides the great BBQ, we’ve always been proud of our EMS system. Until the early 2000’s, the local EMS department patch proudly proclaimed “System of the Year 1984.” And recently, Austin/Travis County EMS received accreditation from CAMTS, the Commission on Accreditation of Medical Transportation Systems. Surely, this system can’t disappoint, right? This isn’t one of those big city fire-based systems or one of those “eeeeevil” for-profit low bid contractors. This system is one of the best funded in the country. The medics are exceptionally well paid. In fact, both of the medics who came to “take care” of my mom made over $80,000 last year.
This is the system that I grew up in as an EMT-B, first responding with one of the county fire departments and riding as a third on their ambulances. This is the system that has a new hire academy that’s several months long and then an extensive field training process that lasts several months as well. Not to mention a full-time “Professional Practices and Standards Division” and two full-time physician medical directors and several part-time associate medical directors. If you believe their PR machine, this is the best EMS system in Texas, if not the United States. In other words: Bad. Things. Do. Not. Happen. Here. Period.
So, here’s what happened. Just before 6:00 PM that evening, my mom had an episode where she couldn’t remember the last two hours of her life. This episode ended up lasting a total of about 20-25 minutes. During that time, I called 911 for EMS help. (And we know that when her paramedic son insists on an ambulance, she’s sick.) The firefighter/EMTs who showed up from the Austin Fire Department did a great job of getting a set of baseline vitals, ruling out the possibility of a stroke, and reassuring everyone. Then, the responding EMS crew showed up. Two paramedics, each with over ten years experience in the local EMS system. You know – one of the elite EMS systems in the country.
Well, the treating medic comes up to my mom, who’s laying on the couch. He sets his $25,000 LifePak 12 cardiac monitor down in front of the couch. What does he do with it? He uses it as a stool to sit on. No. I am NOT making this sh-t up. He asks her a few questions and then says, “You’re not having a stroke and your symptoms are clearing up. If you want to go to the hospital, I guess we can take you.” Me, being the concerned son, I said that she definitely wanted to go to the hospital. Here’s the next shocker. The same medic says, “You’ve got a steep driveway and we can’t get the stretcher up the driveway. You think you can walk down to the ambulance if we help?” Did I mention that my mom has aortic stenosis? You know, that’s a heart condition. Me? I was too shocked to say anything. So, the medics walk a cardiac patient to the ambulance – in the cold rain. They were “nice” enough to allow me to ride in the back with mom. During the transport, the medic kept his nose buried in his laptop and the only thing he “did” for mom was to put her on an automatic blood pressure cuff. Because, yeah, that’s what you do for a cardiac patient. I almost forgot to mention that they knew I’m a medic. One of them asked the firefighters, “Is this guy riding with you?” The firefighters said I was the patient’s son and a paramedic. So, they knew they were being watched by someone who knows what the drill is. Think what they’re doing when they aren’t being watched.
So, Mom got admitted to the hospital for a couple days worth of diagnostics where they finally determined she had inadequate cerebral perfusion due to her aortic stenosis. She was scheduled for a heart catheterization and valve replacement. She ended up having a single vessel bypass and an aortic valve replacement on December 12th and is recovering remarkably well. So, at this point, we’ve more than determined her EMS care way missed the mark.
On the way home from the hospital on the night of the 20th, I began to have more and more concerns about the EMS care she received. One thing that Austin/Travis County EMS is also proud of is a 24-hour customer service line that rings to the on-duty field supervisors. You’re supposed to receive a return phone call within 30 minutes. So, when I hadn’t received a phone call by the next morning, I shot off an email to the EMS Director and the EMS Medical Director. Part of becoming an attorney means losing any and all fear in upsetting the apple cart. Besides, it’s my mom. And somewhere during EMT and paramedic training, I learned we’re supposed to treat every patient like we’d want our mom treated.
So, eventually, they had a field supervisor (district commander in the Austin/Travis County EMS lexicon) call me. He acted concerned and mouthed the customer service phrases just like someone would if you called in a complaint to the cable company or the phone company. He also promised that a “duty medical officer” would call me to discuss the clinical aspects of her care. As promised, the duty medical officer called me back. He too mouthed the customer service catch phrases and told me that I would never find out what happened as a result of his investigation because of certain statutory provisions mandating confidentiality of clinical reviews of EMS providers.
After a couple of weeks, I began to wonder what happened to my initial complaint. I spoke to the district commander again who told me that “they” made the decision that the concerns I had were clinical, not operational, and that the complaint had been closed. As this didn’t make any sense to me, I talked to one of my many contacts at EMS. That person told me there wasn’t even any record of the complaint being taken. When I heard this, I turned lawyer. Full-on lawyer. I sent what only be described as an attorney demand letter via email to the EMS Director, the EMS Medical Director, the deputy EMS Director, as well as the city manager, assistant city manager for public safety, the city attorney, and the city auditor. I explained my very real concerns as well as my mom’s fear to call EMS again. I demanded a meeting and that it was my very intention to file a formal complaint. I got my meeting. I met with the EMS Director, deputy EMS Director, the deputy EMS Medical Director, and the assistant chiefs for operations and professional practices. During that meeting, my email was turned into a formal civil service complaint against both the responding medics as well as the district commander who “deep-sixed” my complaint. I also got the opportunity to discuss the call in-depth with the deputy EMS Medical Director who seemed concerned and said that the events warranted investigation. I left at least semi-reassured.
After my mom’s successful surgery and as her recovery continued to progress well, I turned my attention back to the care she received. With a HIPAA release in hand, I got a copy of her EMS report. Not only was the report’s narrative full of misspellings, grammatical errors, and incorrect capitalizations, it was remarkably incomplete in describing what the EMS crew observed and heard from the patient – and her family. As an adjunct to my legal and EMS careers, I’ve presented several times on EMS documentation. Based on my expert opinion (Yeah, I’m arrogant that way.), I can, without a doubt, say that this is some of the worst documentation I’ve had the misfortune of running across. Surely the deputy EMS Medical Director would want to know about this. After all, he told me to call with any concerns I had.
So, I called him. And yes, he had seen it. And yes, he agreed it “wasn’t good.” However, he also told me that the clinical review was complete. He also went on to tell me that the clinical review process wasn’t about discipline, but about educating the crew. Ok, I can almost go along with that. Nevertheless, at some point, one has to wonder at what point education and remediation cease to work and discipline may be warranted.
So, the doctor told me that he “talked to the crew and this won’t happen again.” Wow. I feel better. Especially when the same day, the local news reports that Austin/Travis County EMS suspended a paramedic for two 12-hour shifts for making inappropriate posts on Facebook. However a combination of clinical errors that could well have had a negative patient outcome gets a “talking to.” Hell, they might have even been sent to bed without cookies. Maybe at their next shift at a slow “vacation station,” they’ll have to give up their Xbox time. I should also mention that the treating paramedic has a disciplinary record including two negligent collisions and failing to follow a directive from a district commander. So, there’s a documented history of laziness and an unwillingness to abide by department policies.
Fortunately, I did file a complaint with the state on the responding medics. Here’s hoping that the state recognizes this substandard care for what I believe to violate multiple state administrative rules relating to EMS. What amazes me is the number of local medics who weren’t surprised by the treatment from this crew. Ignorant, lazy, and arrogant were among the nicer words I heard to describe these two paramedics. Yet, our supposedly elite local EMS system allows these two to continue on providing slipshod, lazy, complacent, minimal standards of prehospital care while paying each of them over $80,000 a year. For $80,000 a year, I’m more than happy to put a patient on a cardiac monitor and schlep a stretcher, stair-chair, backboard, or scoop stretcher to the patient’s side. Wait. I do that most weekends. For free. Yep. I’m a volunteer paramedic. I provide compassionate, clinically competent medical care almost every weekend. So, there’s another take-away from this incident: paycheck status does not correlate to professionalism.
As I finish this blog entry, I am seriously doubtful that much more will be done to any of the personnel who I’ve mentioned here. So, I’ll close it here with a thank you. Thank you to the two responding paramedics, the district commander in question, and the deputy EMS Medical Director. Y’all have succeeded in ruining my opinion of a supposedly elite EMS system. You’ve shattered the years of PR about a “great” EMS system – and you’ve convinced a 66-year-old mom with heart disease that there’s no reason to call an ambulance. The worst part is, based on the lack of care that she received, I have a hard time arguing otherwise. Well done, y’all.
Yep, same the world over, I’m an EMT in the private sector in the UK, exNHS. Two weeks after a cesarean my partner woke in the early hours (4am) with a pain score of 10, she’s had three by natural child birth. Central chest pain radiating right to left, pale clammy, SOB, and a reduced LOC. I called 999, our fast response car arrived in 35mins, the para came in with his lifepack12 and did a three lead, result – didn’t know what was going on so would arrange a ambulance to transport to hospital, ambulance with para & EMT arrive got handover and traveled with no further intervention, all three knew I am in the job, always do my best but make sure I do it we’ll when other health care PROFESSIONALS are involved.
The first para had to return to his car to call for backup and had a cigarette while he was outside, instead of using his personal radio on his jacket, which he left in the house and we could hear him requesting a cold response which takes him less than 30sec but left his patient for almost 5mins for a cigarette! Ambulance takes an hour and fifteen mins to arrive. Appalled at the system and my peers in the UK, rant over, Merry Christmas to all of you in the US
Well said Wes. You are absolutely right in all regards. Too many times we (EMS) have let bureaucracy reign at the expense of patient care. But here I take myself out of the pronoun “We”. That is not what I represent. It is not what my paramedics represent. When bureaucracy reigns — mediocrity flourishes and the mission of our noble profession gets lost in middle management, electronic records, committees, tenure, politics, policies, procedures and yes, dispensed by lazy, uncaring personnel. What is that noble mission? Hummmm!
I return to the example of the first paramedic, the good Samaritan (Luke 10:24). He knew his mission. Regardless of culture differences or economic circumstance he felt compassion and acted as if the injured man was his brother. He cleaned his wounds, dressed them and carried him by the best transportation he had to a place where the injured man could recover. Then he paid for his patient’s treatment! How far have “We” digressed from treating every patient as if they were our neighbor or our family?
I am proud to have you as one of my extraordinary paramedics. Keep the torch lit and may your mission continue to guide you. You, and those like you, are my heroes.
Larry Miller MD
Wow. While I know this can happen, even in top-notch systems, it is still stunning to read the play-by-play. I agree 100% that our focus must be on that customer, all the time, and their family by extension. We preach it in the service I am with. But there are a few who seem to find their way, and it is the job of people like me to root them out. There is NO excuse for a lack of compassion. I won’t say I’ve always been charming with people who behave like jerks to us (nothing like a drunk with an obvious head injury shouting that he’s going to sue me and my crew if we don’t stop trying to treat him), but, if anything, we treat the patient, and try as best as possible to bite our tongue. Because when it all comes down to it, if you distill it to its most basic value, it’s what we are called to do. Great post; sorry you had to go through so much to be inspired to write it.
Excellent article and I couldn’t agree more. I’ve been in EMS close to thirty years and I see the same crap you described by “professional” paramedics every day. I see them picking up patients who are on a ventilator in the ICU and BVM them to the ambulance without a heart monitor attached. Walking cardiac patients to the ambulance is the norm. Don’t expect to hear much from the state, they are grossly undermanned due to budget cuts and unless someone dies they very rarely follow up on complaints. I’ve turned in a couple within the last year and have yet to hear anything back. I wasn’t shocked to read that Austin EMS, who many feel is an elite outfit, is not what you expected. I know many of their medics and to tell you the truth wouldn’t trust most of them with me or a family member.
Don’t worry, your experience is not unique to your agency.
If you knew better, why didn’t you demand what was appropriate? I see this in hospitals all the time – unfortunately, patients need an advocate to ensure appropriate care.
Why is the culture such that this ignorance was started by one PM, but allowed by the other? It’s impossible for officers or the medical staff to observe every run, so it is incumbent on the member’s sense of pride and basic human dignity to ensure someone else having a shit day, does nothing to compromise the medical care.
You experienced an issue that no amount of officers or medical directors can fix by themselves. The field crews must. The tarnish of 9/11 hero worship is wearing off and the reality is becoming apparent. If field crews want the respect they feel they are entitled to, they should act like true medical professionals and ensure they and their partners behave as professionals.
And I’ll always regret not speaking up on scene. I should have, but the combination of the stress of the events and the shock at the care. Plus, this EMS system is very unwelcoming of involvement from providers from outside agencies.
Damn Wes, I’m so sorry all this happened to y’all. NO one should ever have to feel that they can’t call 911 because of the lack of professionalism on the responders part.
I’m glad your mom is doing better though. Blessings to y’all 🙂
Wes I think you’ve hit on a core issue in EMS. I live in a small town of about 700 people. I like you am a volunteer. I am just an EMT and relatively new at this (less than one year). I do have considerable experience elsewhere in the private sector managing.
Due to the size of our town whenever I’m near or in town I’m on call, 24/7. And as I’ve seen other departments care for patients I’ve noticed one significant difference between caregivers; the presence or lack of passion for what we do.
So while the metrics show that Austin/Travis will deliver excellent service metrics don’t measure desire on the part of the caregiver to, as your doctor friend has stated “treat the paitent as family or friend”. I don’t believe that passion can be trained. I think with some accuracy it can be discerned during an interview process; but I doubt that screening for a desire to help, is part of the process.
I think in the case of any department individuals see a career with a potential of making 60 -80K. They pass the intellectual hurdles but are never tested on their commitment to understanding that the patient determines the importance of the call; not the caregiver. The patient has called for a reason – they have enough anxiety about what is happening to call an ambulance. No call is routine; but the caregivers settle into “Oh God, another hang nail, I just want to get this over and go back to my nice, warm, comfortable station.
Sounds judgemental as I read this and I guess it is. On the other hand I’ve seen “care” delivered without passion. EMS as a system needs to reevaluate the critical attributes of a proficient, caring, provider which should be extant in an interview.
Hoping you and your family have a great holiday season.
Alex
I’m shocked and appalled; I’m sorry that you and your mom had to experience that. I was a medic, and am now a nurse.
I have one philosophy regarding everyone that provides patient care: if you can’t give every patient the very best you have to give, every day, then it’s time to find a new job.
Someone mentioned it in an earlier post – patient advocacy. Being an advocate for a patient in any environment is so critical. Whether it is asking questions, or pushing just a little more, that may be the difference between a positive and negative outcome. Sadly the day has come where patients, and their families, must do their own research regarding pertinent conditions and disease processes.
My thoughts go out to you and your family. Wishing your mom a speedy recovery.
Katie.
Wow. I am sorry you had to experience this. I recently lost my mom to a medical error, so I know what it’s like to be faced with incompetent providers when you are a provider yourself. I’ve witnessed medics talking patients out of transport, but not like this. While I am not exactly surprised that this happened in Austin, I don’t believe this problem is limited to ATCEMS. Medics are becoming jaded and are often quick to write off patients with altered mentation. I experienced this with my mom, too. I have always been of your mindset, treating each patient how I would want my mom treated. Glad to hear your mom is doing well. Hopefully your little conversation with district command actually results in changes out here.