Paramedic sits up front on transfer, patient dies

[EMS49393]

I can't even start the discussion on this article, since I'm still in bewildered awe.

http://www.nlrtimes.com/articles/2008/03/14/news/nws02.txt

Family blames ambulance company for death

By D.J. Smith Staff Writer djsmith@nlrtimes.com

Thursday, March 13, 2008 3:07 PM CDT

This is the ambulance used to transfer Frances Kiehl from Rebsamen Medical Center in Jacksonville to Baptist Health Medical Center in North Little Rock on Aug. 17. (Photo courtesy of Arkansas Department of Health)

On Aug. 17, 2007, Eben Kiehl signed a consent form that said he understood the risks and benefits of transferring his wife of 46 years, Frances Kiehl, from a Jacksonville hospital to another hospital for doctor-prescribed dialysis treatment for a kidney infection.

Six days later, 66-year-old Frances Kiehl’s family buried her.

Kiehl died of cardiac arrest from an inability to breathe properly and subsequent oxygen deprivation to her brain, her daughter said; the family blames the ambulance company that transported her.

After a state agency conducted an investigation, it recommended that the company, Arkansas Emergency Transport (AET) of Jacksonville, be put on probation for a year and that one of its employees, basic emergency medical technician (EMT) Mandy Sollock, be put on probation for two years. It also recommended that the company suspend EMT-paramedic Jerry Tharp and the state revoke his certification.

As of press time, a representative of the Arkansas Department of Health had not returned a phone call asking whether the probations, the suspension and the license revocation had been carried out.

The Arkansas Department of Health’s Section of Emergency Medical Services and Trauma Systems received the paperwork on Kiehl’s transfer from the Jacksonville-based Arkansas Emergency Transport on Aug. 22. That normally would have been the end of it, said Larry New, a section regulatory administrator with Emergency Medical Services and Trauma Systems.

Because the department is “complaint driven,” New said Monday, the incident became a full investigation once Frances Kiehl’s daughter Diane Chism of Sherwood called his office Aug. 24. Chism made six more calls and sent many e-mails to New during the investigation.

In late February, the investigation run by New was completed and Emergency Medical Services and Trauma Systems recommended that AET ambulance service be put on probation for a year and basic emergency medical technician (EMT) Mandy Sollock for two years.

It also recommended that Tharp, the primary medical person in the ambulance, be suspended immediately from his job at the Brinkley-based Southern Care Ambulance unit in Clarendon, where he went to work after being terminated at AET. And it directed the Arkansas Health Department “to seek permanent revocation of his Arkansas EMT Paramedic certification.”

After the termination, Tharp went to Emergency Ambulance Service Inc. (EASI) in Pine Bluff looking for a job, but EASI wouldn’t hire him until the investigation was complete, he told New on Aug. 27.

Gary Padget, chief executive officer of Southern Care Ambulance, said Monday that Tharp was fired from his job in Clarendon after Emergency Medical Services and Trauma Systems called Padget during the last week of February.

Under confidentiality regulations, Padget said, when an ambulance company hires an EMT, the state will disclose only that he is certified. Whether a person is under investigation is not disclosed until the investigation is complete, he added, because “everbody gets their day in court.”

“It is set up to protect the innocent,” Padget said. “But as an employer, I would like to know these things at times.”

AET supervisor Lance Hinds told New that AET had terminated Tharp on Aug. 24 for failure to “meet employer’s standards.” This was after an in-house investigation, but AET previously had fired Tharp once in Izard County, operations director Shawn Collins said Feb. 18.

The Izard County firing was for multiple incidents of Tharp’s acting “against medical advice,” in which he did not transport a patient who was hypotensive (exhibiting abnormally low blood pressure), Collins said.

AET hired Tharp the second time after he completed his orientation June 4, 2007, because, “We thought his skills got better,” Collins said.

The 11- to 12-mile trip for the Sherwood resident from Jacksonville’s Rebsamen Medical Center (now North Metro Medical Center) — which didn’t have dialysis equipment — to Baptist Health Medical Center-North Little Rock would have taken 12 to 15 minutes at the speed limit, according to Internet research.

But when Chism, driving her own car, arrived at the North Little Rock hospital, she discovered that the AET dispatcher had sent Tharp and Sollock to Baptist Health Medical Center in Little Rock with Kiehl, another 15 minutes away.

The transfer paperwork given to the crew had the North Little Rock hospital listed as “BMMC” (Baptist Memorial Medical Center, the hospital’s old name), with “BMC” (Baptist Medical Center, the Little Rock hospital’s old name) crossed out.

Chism, waiting at Baptist Health Medical Center-North Little Rock on Springhill Drive, was nervous when the ambulance transferring her mother took more than an hour to arrive, she said Friday. She said that when the ambulance arrived, she, her father, her daughter and her mother’s sister saw two people in the cab (the front of the ambulance). She assumed another EMT was in the back with her mother.

She then saw Sollock walk slowly toward the back door and turn back to get something from the cab. When Sollock went toward the back again, Chism’s daughter Shannon Horton, 26, went to help her with the back door. Sollock later denied to New that Horton helped her.

When the back door of the ambulance was opened, Chism was horrified to see her mother’s face visibly blue with her head and shoulder hanging off the gurney — and that there was no paramedic with her.

Chism said Sollock then ran to the emergency door, hit the outside intercom and said, “I have a code out here; I need help.”

In the report, Sollock said Tharp was in the cab, called her in, told her to close the door so the family couldn’t see and said he couldn’t find a pulse. Sollock said Tharp then told her she should summon hospital emergency staff.

“I saw what I saw,” Chism said, “and I started screaming, ‘Mom’s gone, Mom’s gone,’ ” when she saw Sollock run to the emergency room door.

“I think I went into some kind of shock,” she said.

Kiehl’s sister, Sue McHolan, who was coming out of the emergency room, told her she saw Tharp get out of the ambulance through the passenger door, “just stand there,” then move to the back of the ambulance and place his hand on Frances Kiehl’s chest.

The 61-page report said that, even if the investigators accepted as truth Tharp’s statement “I am 200 percent sure I remained in the patient compartment during the entire transport,” he was not free of culpability.

“He did not provide adequate patient care as expected by an Arkansas certified Emergency Medical Technician-Paramedic,” the report concluded.

In her interview with New, Sollock said she was the only person in the front of the ambulance when it arrived at the North Little Rock hospital. New asked her twice whether she knew the implications of falsifying information.

“I understand that, and I would never cover for anyone jeopardizing my EMT certification. It was too hard to get,” Sollock said after New said several people had reported seeing two people in the cab.

Sollock told New in person that on Sept. 17, “once at Baptist Medical Center in Little Rock, Jerry [Tharp] entered the emergency room.” The hospital staff reportedly told Tharp he was at the wrong emergency room, she said.

But in Sollock’s handwritten report of Aug. 28, she said Tharp informed the Little Rock hospital by radio that they were about five minutes from arriving there.

As they pulled up and she got out, Sollock heard the Little Rock hospital respond by radio that the ambulance crew should check its destination. Sollock said Tharp already had pulled the gurney from the ambulance, but the two reloaded it after Tharp talked to AET’s dispatcher to confirm that they were at the wrong hospital.

Tharp told New on Feb. 11, “The patient was never removed from [the] ambulance, as far as I remember.”

On Dec. 5, New again interviewed Sollock, who said this time that upon arriving at Little Rock, “neither of us went into the emergency room.”

Tharp told New that the trip from Little Rock to North Little Rock took 15 minutes. He said Frances Kiehl started to foam at the mouth as they drove up the street to Baptist-Springhill and was in “code” as they backed up to the emergency door. Sollock said she noticed a flat line on the cardiac monitor in the ambulance, indicating that Frances Kiehl had gone into cardiac arrest.

Emergency room personnel got her heart started shortly after she was taken into the North Little Rock hospital, but she never regained consciousness. Five minutes of hypoxia, or oxygen deprivation, can cause irreversible brain damage, according to the National Institute of Neurological Disorders and Stroke.

Chism and Eben Kiehl took Frances Kiehl off life support Aug. 20 after the neurological testing that Chism requested showed no indication of brain activity. Frances Kiehl died five to 10 minutes later, Chism said.

According to the state’s report, when Daniel Furr, the emergency room nurse, entered the ambulance to help Tharp, he noticed that the tube to the ventilator was “twisted and kinked.” Once this problem was corrected, Furr said, “Ms. Kiehl’s color began to improve.”

AET’s record shows that the ventilator was working before the transfer run, according to AET fleet manager Robert Cole, but it was sent out to be reconditioned the next week. New said no record of Tharp’s training on the ventilator could be found in his AET file.

Another problem was electrocardiogram strips from the cardiac monitor were missing from AET’s files. The one attached to the bill for Frances Kiehl’s transfer was found to be another patient’s electrocardiogram strip from four days earlier. When asked, Tharp said he had placed Kiehl’s two strips in his shirt pocket and inadvertently washed and dried them at the office.

The AET office didn’t have a dryer hooked up until two months after Tharp was fired, Cole said. Tharp later said he must have hung the shirt up to dry.

Tharp said the cardiac monitor fell from a chair in the emergency room that day and the batteries fell out. Cole said that without batteries the monitor loses its information after five minutes. Neither Sollock nor the ER nurse could attest to seeing the monitor fall.

The monitor has a safety clip to hold batteries in, and an attempt by investigators to open it was extremely difficult, according to the report.

The invoice AET sent for Frances Kiehl’s transfer had a charge for a pulse oximeter, which sounds an alarm if a patient goes into hypoxia, though this unit was never on the ambulance, the report indicates.

Chism said she had trouble over the five months of the investigation. She said she got only two to four hours of sleep a night for three to four months. Sleep still is difficult on some nights, because, “I think this [report] has opened it all back up,” said Chism. But she said the report was worth the wait.

“Oh, I was pleased with the fact that they were so thorough,” she said.

Her dad still has a hard time, too, and can’t even clean out his wife’s clothes closet, said Chism. She said she stands in the closet when she visits her father, “because it smells like her.”

Chism said she wanted to tell her mother’s story so people know that “just because you think you can trust [that] people are doing their jobs, it isn’t always true.” She later found out that, even though she was told she couldn’t ride in the back of the ambulance, a person is allowed to ride in the front seat with the driver.

[mailmantech82]

Once again another blot against the profession...where do these people come from?

[JPINFV]

Wow. How about just revoking that company's license to run paramedics?

[EMS49393]

How about revoking the license of the company, period? Notice how they thought it would be a bright idea to re-hire this sub-standard paramedic because they "thought his kills had improved." Wow, what a slip... that is "his skills had improved." That was really unintentional, really, I swear it.

I might add to this story, this is not the first time AET has gotten themselves in hot water over their practices and paramedics.

No mercy.

Guinness,

K.

[mobey]

Hmm ...fire him and revoke certs. Negligence? Abandonment? Something must fit.

But I have to wonder if he was maybe kneeling in the "alley" at the front of the box. I think this may be more common than we care to think it is within transfer companies. My sister-in law was recently transfered between 2 hospitals for a C-Section, my brother said the medic sat in the airway seat, rotated to face the front and chatted up his partner for the majority of the 1.5hr transfer. He did however do a couple sets of vitals and ask about pain along the way.

I am not going to say I have never slipped to the front of the alley for a sip of my coffee on a 6:00 am prescheduled transfer. But I am never away from my patients side for more than a minute or two.

I believe this medic was a little too complacent and maybe even "burned out".

[Ridryder 911]

Write the check... Get the orange suit out for the so called Paramedic.

R/r 911

[wbgraidermom]

Just got done reading this story and all I have to say is "WHAT THE HELL WAS THIS COMPANY THINKING WHEN THEY HIRED HIM BACK?" This guy should have never have passed his cert test in the first place. That is one bad medic. You are to check vitals every fifteen minutes and the monitor every few minutes, if he would have done that she would still be alive. When we transport vent patient's we alway check the pulse ox to make sure the o2 levels are good, if they are not we check the o2 lines and the vent itself to see if something happened.

The company should pay for what they did. It is just as much their fault as it is his. Looking at the truck in the picture. WHERE ARE THE LIGHTS ON IT? The company should just close its doors and get out of the business.

As for the emt-b, she should not be allowed on a truck until she can prove she knows what she is doing, but taking the emt-b class over again and taking the cert test again, too. That is just how I feel about this.

I just don't get why people are like that.

As for letting a family member ride in the front seat, Daughter should have spoke up and she would have been told that she could. I let family members ride all the time in my truck with me.

I 'm getting down from my soap box now. I would like to hear more from y'all about this.

Things like this happen everyday and this is the one that made the news.

[Scaramedic]

I don't see what the big deal is. They do it all the time on TV. :wink:

[Dustdevil]

I am not, by any means, defending this guy or the company. The events of this incident, and the subsequent obfuscation, are inexcusable. But I'm not sure the part about hiring him back is what it sounds like. The info they give is pretty vague. He was fired over "skills"? That's the last thing I would ever fire somebody for. Skills always get better with experience. If you aren't capable, as an employer, of giving your employees the necessary supervised experience and training to function competently, then you are the reason they suck. So exactly how was this guy's skills supposed to get better in a few short months while working at some other non-EMS transfer service anyhow? And exactly what "skills" are they talking about anyhow? How often does this transfer jockey use anything that we consider to be "skills" on his job? I have a feeling that "skills" isn't what this was all about. I think the guy just plain sucked, regardless of skills.

If he had inadequate skills, I think the list of those skills was something like interpersonal skills, assessment skills, critical thinking skills, and communications skills, as well as a laundry list of personal shortcomings, including apathy, immaturity, and stupidity. But when they say "skills" it sounds more like they're saying he can't hit an IV, which is something this transfer jockey probably does only once a year anyhow. The transfer company is just hoping nobody else will pick up on that.

And do these losers even run emergencies anywhere? If not, it seems like writing "EMERGENCY" on the side of your transfer trucks is akin to writing "POLICE" on the side of your security guard car.

[spenac]

I am surprised that no one has asked is it possible that the family in their hysterical state is wrong about what they thought they saw. Is it not possible that they saw him exit the passenger side door of the box and just assumed it was the front passenger door? Is it not possible that he was in the back of the box? Is it not possible that the hose got kinked with him trying to position her for CPR? Is it not possible that stories change because as days go by the many different calls they got started running together? Is it not possible that the Basic and the paramedic had different stories because of different perspectives based on different positions in ambulance and different education?

I agree based on that article it sounds like they suck but what if it was really just that one nightmare call where everything went wrong? Just saying what if?