Massachusetts FAIL

[Dustdevil]

Unacceptable.

http://www.telegram.com/article/20090426/N...1116/NEWSREWIND

Sunday, April 26, 2009

Paramedics accused of lying in Worcester death

STATE CITES UMASS MEMORIAL EMS

By Thomas Caywood TELEGRAM & GAZETTE STAFF

WORCESTER

— It was Mother’s Day last year, and Joan S. Rondeau was at work caring for elderly residents of a local nursing home when she got a telephone call that filled her with dread.

It was her daughter on the line. Mrs. Rondeau’s husband, Charles, wasn’t feeling well but was reluctant to go to the hospital. He had broken out in a sweat and was short of breath.

“Ignore what he said. Hang up and call an ambulance,” Mrs. Rondeau instructed her daughter.

A colleague gave her a ride home from work. She dashed up the front staircase of the Winfield Street three-decker and found two UMass Memorial EMS paramedics steadying her stricken husband as they walked him down the three flights of stairs — a violation of state standards of care that was later left out of their written report.

Half an hour later, Charles F. Rondeau was pronounced dead by an emergency room doctor at St. Vincent Hospital at 2:34 p.m. on May 11, 2008. The 48-year-old parking lot attendant had suffered an “extensive anterior wall myocardial infarction,” a massive heart attack, according to medical records.

After his burial in Hope Cemetery, as the initial numbing shock wore off, the grieving family began to question why a man complaining of chest pains and so clearly in distress would be made to exert himself by descending three flights of steep stairs. It didn’t make sense to them.

“Even a little kid knows that when you’re having a heart attack, any movement is going to make your heart beat faster,” said Mrs. Rondeau’s son, Shamus Waller.

Mrs. Rondeau’s daughter, Aisha A. Waller, noticed in the medical records a handwritten report from the ambulance service indicating Mr. Rondeau had been carried down the steps by the paramedics. She said she called in June to question the discrepancy and spoke to the chief of UMass Memorial EMS, Stephen Haynes.

“I told him that was not true. He asked me how I knew that, and I told him I was there. He said he’d check and that he’d get back to me,” Ms. Waller said. “While I was talking to him, I didn’t feel like he was taking me seriously.”

Mr. Haynes never called back, she said.

The family contacted a Boston law firm and in late December, on the advice of their lawyer, complained to state regulators, triggering a state Department of Public Health investigation that began in January.

The four-month investigation uncovered serious, widespread and persistent problems within the ambulance service that extend beyond what happened to Mr. Rondeau, according to a stinging Notice of Serious Deficiency issued by the DPH earlier this month.

The state notice and investigation report did not identify the patient, nor did UMass Memorial Medical Center officials in interviews, but the Telegram & Gazette learned his name through other means.

Among the more troubling findings of the investigation was the written report of the medical call, the “trip record,” had been falsified by one of the paramedics to show that Mr. Rondeau was carried down from the third floor in an extrication device called a stair chair.

When pressed by the state investigator, the paramedics later admitted that Mr. Rondeau in fact had been walked down the stairs, as the family had said. The paramedics, Seth Peters of Worcester and Jonathan C. Hanson of Princeton, told the investigator that they walked Mr. Rondeau down the stairs because Worcester firefighters hadn’t yet arrived to help them carry the stair chair, according to the state investigation report.

That turned out to be another lie.

The state investigator, Renee D. Lake, determined through dispatch records that Worcester Fire had arrived at the home at 1:47 p.m. — five minutes before the UMass ambulance.

What’s more, Worcester Fire Department audio recordings showed that Capt. John Horan of Engine 4 had radioed the ambulance from the Rondeau’s apartment to notify the paramedics en route that the patient was experiencing severe chest pains, difficulty breathing, profuse sweating and had a history of heart disease. On the audiotape, one of the paramedics can be heard acknowledging receipt of the transmission, according to the report.

In 2007, the city signed a five-year contract with UMass Memorial Medical Center to provide ambulance service for city residents over the objections of fire officials, who had sought to take over responsibility for EMS services in Worcester.

The investigation report by the DPH’s Office of Emergency Medical Services faulted UMass Memorial EMS and the two paramedics for failing to provide care for a patient in accordance with state treatment protocols and for knowingly making false statements in a trip record as well as in interviews with the investigator.

The apparent cover-up attempt prompted the agency to refer the two paramedics, Mr. Peters and Mr. Hanson, to the DPH’s Office of General Counsel for suspension of their EMT certifications. The suspensions were pending as of late last week, but both men were fired by UMass Memorial EMS this month after the state report was issued, a spokeswoman said.

“We don’t often see falsification of documents,” said Abdullah Rehayem, director of the DPH’s Office of Emergency Medical Services. “What the EMTs had done was severe enough for us to make the recommendation we made in the report.”

Mr. Peters, who wrote the trip record, did not respond to a call requesting an interview for this story. Mr. Hanson, who has an unlisted telephone number, did not respond to a note left at his home.

According to the state report, Mr. Peters told the investigator that he mistakenly wrote that Mr. Rondeau had been carried down the stairs out of force of habit, because the practice is so common, and because he was in a hurry to get the paperwork to hospital staff.

But the problems uncovered in the investigation went beyond the actions of the two paramedics, both of whom had no previous record of state disciplinary action.

The notice of deficiency lays out a list of serious problems, including failure to ensure personnel meet state regulations, failure to comply with state laws, failure to provide personnel with appropriate policies and failure to maintain an effective quality assurance program.

The ambulance service also was criticized for not ensuring that its paramedics consistently begin advanced life support on first contact with a patient, rather that waiting until he or she is extricated to an ambulance.

All of the shortcomings outlined in the report had been previously identified during an annual licensing inspection in April 2008 and were supposed to have been corrected, according to DPH.

“In summary, the Department, through this investigation, has discovered that as a result of UMass Memorial EMS not adhering to it previously submitted Plan of Correction, it cannot ensure that its personnel are in compliance with the Statewide Treatment Protocol,” the notice of deficiency concludes.

As a result of the doubts raised by the investigation, the DPH suspended the ambulance service’s permission to perform rapid sequence intubation, an advanced medical procedure to quickly insert a breathing tube in the field. Although the procedure wasn’t necessary in Mr. Rondeau’s case, the deficiencies uncovered in the resulting investigation prompted the suspension, officials said.

“That step was taken because we were unable to determine that quality assurance measures were in place,” DPH’s Mr. Rehayem said. “We found it necessary to terminate the project temporarily. That project has since been reinstated for UMass Memorial EMS.”

After the T&G began inquiring about the case, and nearly a year after Mr. Rondeau died, UMass Memorial Medical Center e-mailed a memo about the incident and the state report to its physicians and staff on Wednesday evening. The memo, sent under the name of Dr. Walter Ettinger, the Medical Center’s president, praised the hospital’s paramedics but acknowledged an “isolated incident not in keeping with our standards of care.”

The note to staff did not address the broader lack of compliance with standards, regulations and treatment protocols detailed in the state report.

In an interview, Dr. Ettinger expressed his deep sympathy for the Rondeau family’s loss, but he disputed the state’s claim that the ambulance service was beset with problems and had failed to comply with its earlier correction plan. Dr. Ettinger said UMass Memorial EMS officials didn’t get a chance to speak with the investigator before she filed her report and could have clarified many of the issues she raised.

“We believe it was an isolated incident. We have no evidence that this at all reflects the care we deliver or the standards our professionals are asked to meet,” Dr. Ettinger said. “When we found out about this, those paramedics were terminated.”

Dr. Ettinger said hospital officials only learned of the incident after the state issued the notice of serious deficiency earlier this month.

But the Rondeau family maintains UMass Memorial Medical Center would have known about it last year had Mr. Haynes, the ambulance service chief, followed up on their complaints.

Mr. Haynes told the state investigator that he did not have enough information from the family to investigate the call any further and that he did not speak to either of the paramedics or take any other steps to address the family’s concerns, according to the report.

“The impression we had here, and we looked into this thoroughly, we did not know about this particular incident from the family. The impression was that somebody had called and just asked what our policies and procedures were,” Dr. Ettinger said.

Aisha Waller said that characterization is not true.

Dr. Ettinger said he couldn’t discuss whether Mr. Haynes or any other supervisors had been reprimanded or disciplined as a result of the incident.

“I can assure you we have done everything to prevent this in the future, and that everybody who is accountable is being held accountable,” he said.

The DPH’s Mr. Rehayem said that, as of last week, the ambulance service was in the final stages of finalizing a new plan of correction to address the issues raised by the investigation. By coincidence, its annual license inspection was scheduled to begin this week as well.

Mr. Rehayem said the service need not have corrected all the problems detailed in the report to get its license renewed, but must show satisfactory progress toward full compliance with the various laws, regulations and treatment protocols.

Meanwhile, with the first anniversary of Mr. Rondeau’s death looming three weeks away, the Rondeau family remains tormented by one final question: What if the paramedics had followed the proper protocol and carried him down the stairs in a special chair?

“It seems like to me my father would still be alive if they had done their jobs right,” Mr. Waller said.

“It makes you wonder how many others?” Mrs. Rondeau reflected. “Not saying that they do this all the time, but when people call saying they’re having chest pains, you have to take that seriously. It can be a matter of life and death — as we found out.”

Nearly a year later, rows of sympathy cards remain neatly lined up on a kitchen counter in the family’s third-floor apartment. Mrs. Rondeau said she has no plans to put them away any time soon. The family’s lawyer, Andrew Meyer of the Boston firm Lubin & Meyer, said he expects to file a medical malpractice lawsuit in Worcester Superior Court within the next two months.

Mrs. Rondeau, who is struggling to hold the family together on her modest salary as a certified nursing assistant at Parsons Hill Nursing and Rehabilitation Center, said she’s dreading Mother’s Day next month.

“Mother’s Day is going to be a very difficult hump to get over because it’s going to be a year since he’s been gone,” she said.

“I don’t want to go into the depressed mode I was in when it first happened,” Mrs. Rondeau said. “I’m not saying I want to just get over it fast, but I have to earn a living by myself now. I have to function.”

Contact Thomas Caywood by e-mail at tcaywood@telegram.com.

[JPINFV]

Epic fail on the title. Massachusetts has a hard on for using Mass____ for their government offices (MassHealth, MassHighway, etc). Title should be MassFail.

[Dustdevil]

I actually started to write it that way, but I was excited to show off the fact that, at age 52, I finally learned how to spell Massachusetts.

[itku2er]

I actually started to write it that way, but I was excited to show off the fact that, at age 52, I finally learned how to spell Massachusetts.

Rock on Dust Rock on.....

We discussed this subject briefly last night in chat. But like Mike said a few apples ruin the bunch. But like every other news story posted on here there are two sides to it.

[tskstorm]

It's just as stated .. This is just a failure on the part of laziness. If the patient didn't want to sit in the chair, and wanted to walk which does happen despite how much you try to talk a patient into a stair chair or other device every now and again, I wonder why they didn't have the patient sign an RMA for it.

Reminds me of why I like having a signature on the RMA line for even the simplest of things. "Oh you just want an ice pack? No problem, but I just need some basic information and a signature"

[fireflymedic]

He wrote they carried him down the stairs out of force of habit? Riiiiiight. I suspect it was the other way around and they thought no one would object or make a comment otherwise. It's amazing how many lazy ones out there walk the patients to the truck just because they don't want to put forth a little effort. Sad - maybe the outcome would have been the same, maybe not, but at least he would have had a better chance otherwise. Also - doesn't say, but I would imagine they didn't put oxygen on him and then walk him down three flights of stairs - not sure, but just going hmmm

As far as the state board - I think immediate temporary order of suspension would serve them well - that's what falsification of records gets you here and a revocation of license usually follows shortly thereafter. I wouldn't want anyone who does things on "force of habit" treating me. Sorry - you boys are in for a rough road ahead I hope. Maybe it will make more stop and think before walking that next patient.

[Canadian Caesar]

In 2007, the city signed a five-year contract with UMass Memorial Medical Center to provide ambulance service for city residents over the objections of fire officials, who had sought to take over responsibility for EMS services in Worcester.

Great Job Guys, Way to give the IAFF more ammo. Now you know they are gonna say this wouldn't have happened if the "superior" services of Integrated EMS/Fire had been utilized.

Maybe they will feature this event in their next PSA Video...

[tskstorm]

Great Job Guys, Way to give the IAFF more ammo. Now you know they are gonna say this wouldn't have happened if the "superior" services of Integrated EMS/Fire had been utilized.

Maybe they will feature this event in their next PSA Video...

My question here is if the FD is so superior ... why did they leave the crew alone knowing there was a 3 floor walk down?... and knowing the size(weight) of the patient? Who told them they could clear the scene? FDNY FF's have a bad habit of clearing themselves off the job once we arrive.

[Richard B the EMT]

There are some amongst us who adhere to the "ABCs": Ambulate Before Carrying. There are others who would put into the carry chair, a patient with a hangnail of the pinkey.

Having said that, I'd personally kick the butt of any EMT working with me, or Paramedic, tries walking any patient exhibiting S/S of breathing difficulties or chest pain.

Edited April 27, 2009 by Richard B the EMT

[JPINFV]

Oh, sure, ABC means ambulate before carry. That doesn't mean that it's the rule for every patient with two good legs or the ability to hop.