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 12^th 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 20^th, 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.

So, this morning, my Facebook feed subjected me to a post from a fellow EMS provider who shared a maudlin post from a Facebook EMS group about how important it is to be nice to patients on nursing home transfers because, OMG, you’re like the only person in their life.  Or something like that.

Ok, here’s the deal.  Be nice.  It’s simple.  It’s easy.  Honestly, it’s probably even part of the job, despite the number of people who think that a t-shirt with the tagline “EMS: Here to save your ass, not kiss it” is perfectly appropriate.  And studies show that nice medical providers get sued less often.

BUT…. Don’t give me some made-up, tear-jerker story or Facebook post to shame me into being nice.  I don’t need that kind of juvenile coaching.  (This kind of stuff is why I hate so many of the customer service and/or ethics speeches, articles, and presentations in EMS.) And if you do need that kind of reminder to actually be nice, I saw a couple of fast food places that are hiring.

I fully admit that EMS doesn’t pay the bills for me.  Never has and most likely never will, unless I get that killer job offer to be an EMS director somewhere or an overpaid (really, I’m worth it) EMS consultant.

I volunteer my skills as a paramedic and am often flexible with my rates to instruct class, especially for smaller EMS services.  I’m ok with that, really. While I’ve heard some people say that EMS will never pay well until we stop volunteering, I disagree — and to me, it’s a form of service for me to give back a little.

Here’s what I’m not OK with.  I refuse to volunteer as an event medic.  In the past, I’ve volunteered for two very large events (a biker party/rally and college football games).  Both experiences were bad in so many ways.  Both events went with relatively unprofessional event medical groups who were obviously either free or extremely low cost. Both events had bare bones protocols and equipment.  The football game EMTs were literally equipped with first aid kits and the “paramedic teams” were equipped at the BLS level with small EMT jump kits and an AED.  In fact, one time, the oxygen tank was empty when I checked out my bag.  I reported that to the supply person who told me that most people don’t check the bags.  And the protocols…. for the unnamed college in Austin with a Division I football progam…. one page.  Most of the instructions were EMT level protocols with directives to move the patient to a first aid room staffed by RNs and a doctor.

And how they treat volunteers….  When I first started at the college games, we had to carpool in and got $8 in food vouchers.  That would buy a snack at best.  As time went on, they stopped providing the food vouchers even.  They started selling a box lunch.  Oh, and you needed to be at the game early and stay late. 

So, what really brought on my gripe about volunteering for events was a post from a Facebook friend today asking for volunteers for the Houston Rodeo.  I’ve looked into it before.  What’s not to like?  One of the largest rodeos around, BBQ cookoffs, great country music concerts, and did I mention BBQ?  So, I did some research — and before you can be selected as a volunteer for the safety committee, you have to join the rodeo.  That’s at least $50.  That doesn’t count the vest that you have to buy.  And the volunteers don’t appear to get parking either.  So, for around $100 (my rough guess), you can pay for the privilege of volunteering as an EMT or paramedic for a very financially sound non-profit.   For a little over $100, I can guaran-damn-tee you that I can go to the Houston rodeo, not volunteer as a medic, and see the concert and get BBQ.

I’m tired of events shortchanging civic-minded medics by making them lose money for the “privilege” of being an event and shortchanging the public by skimping on proper medical services.

I keep reminding myself of what Chief Buddy Crain told me when I started volunteering with his fire department. “You shouldn’t have to pay to volunteer.”  That’s still sound advice from Chief Crain.  I encourage each of you to follow such advice.