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How Do We Stop Dangerous Paramedics From Harming Patients?

 

What is dangerous?

How about looking at a clearly sick patient and saying You aren’t sick enough to get a ride in my ambulance based on I don’t know.
 

“He came in and said, ‘This is another attention-grabber; she’s faking it; there’s nothing wrong with her,’ ” Chavez said. After Tate continued to balk at authorizing her transport to the hospital, despite her vomiting and other symptoms, she said her family used a car with bad brakes to drive her themselves. She was hospitalized for the next seven days.[1]

 

This does not appear to be a good example of assessment skills.

This may be an example of a lack of assessment, but we do not know what was done, assessment-wise.
 

Her treatment by Tate became part of the Albuquerque Fire Department’s basis for firing the 10-year paramedic lieutenant last January. A five-month internal investigation of Tate’s conduct turned up so many serious instances of misconduct that AFD Chief James Breen testified this week that he didn’t consider rehabilitation, suspensions or other type of lesser discipline.[1]

 

He has been doing such a bad job that management considers him to be irredeemable?

It seems that the problem is a lack of oversight.

He has been a medic for ten years.

He is a lieutenant.

As an officer, he is in a position where he is supposed to have demonstrated more than the usual amount of responsibility. After ten years, the officers above him should already have an idea of what kind of assessment and treatment he provides, or fails to provide. If this is a sudden departure from the assessment and treatment he has been providing, then there should be a consideration of possible causes, such as PTSD (Post-Traumatic Stress Disorder).
 

The AFD undertook an investigation that included a review of 18 months of 911 calls that involved Tate.

Of the 300 or so reports Tate filed on those calls, about two-thirds raised red flags or showed some type of problems, according to testimony from now-retired fire department EMS commander Jon Sigurdson.[1]

 

I would expect to hear about problems the same week I wrote the charts, especially if this involved most of my calls. If I could write 200 problem charts without negative feedback, then that would suggest that the problems were not detected by the QA/QI/CYA department until after a specific complaint.
 

One call was labeled cancelled by Tate in a report, even though the patient showed abnormal heart rhythms at the scene and wasn’t transported.[1]

 

Maybe they have different rules there, but a cancel is a call where I never even begin to assess the patient, never mind hooking up the heart monitor (or was the patient on some other heart monitor?).
 

Some 911 calls appeared to be dismissed as “anxiety attacks,” even though paramedics aren’t supposed to diagnose patients, testimony showed.[1]

 

We do diagnose.

I have had plenty of patients who were hyperventilating, but were able to be calmed to the point where they no longer wanted to go to the hospital. All of these patients were advised to call 911 again if their symptoms returned. If a patient wants to go to the hospital for anxiety symptoms, I take them.
 

Many of Tate’s reports “were so grossly inadequate it was virtually negligence,” Sigurdson said.[1]

 

I see that as a failure of oversight.

This appears to be a response to a complaint that resulted in recognition of serious problems that had not previously been seen as serious.

Remediation is almost always the first step, but recognition of the problem before it becomes overwhelming is important.
 

He also said his report writing improved after the records management section notified him about incomplete reports.[1]

 

What message does management seem to have been sending?

You are doing a good enough job to be one of our officers, even though some of your charts are not complete. Were other problems mentioned?
 

Testimony showed that Tate’s “bedside manner” provoked complaints from patients and their families in the past, but not until another AFD lieutenant complained about Tate’s treatment of his 16-year-old daughter last year did AFD officials look at his standard of medical care to patients.[1]

 

And there are other examples of complaints.

Why has it taken so long to address these? Has remediation already been attempted several times?

There is an article from 2012 that describes several other problems over the past decade for a Brad Tate that works for Albuquerque Fire Department.[2]
 


Image credit.
 

He does look intimidating in this picture, so maybe management is was intimidated by him.

Footnotes:

[1] Most of paramedic’s reports raised flags
Albuquerque Journal
By Colleen Heild / Journal Investigative Reporter
Thu, Oct 24, 2013
Article

[2] Firefighter in hot water – Family suing over accident
By Alex Tomlin
Updated: Thursday, March 21, 2013, 11:23 AM MDT
Published: Tuesday, October 2, 2012, 8:28 AM MDT
KRQE.com
Article

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Comments

  1. While it’s an obvious, glaring, example of lack of oversite, frankly it’s not surprising. Mostly the problem is his, followed by a lame FD QA/QC process, followed by an institutional practice of not legitimately scrutinizing officers.

    It doesn’t help that the cast majority of AFF medical call patients are transported by another agency. So the vast majority of reports end up being a “cancel” even though they should NOT.

    This guy was a well-known problem that should have been gone long ago. But as is often the case, AFD was more concerned with response times and buying more fire engines than ensuring proper patient care. Especially in the case of a problem officer/supervisor.

  2. There seems to be a false premise contructed here that proposes that it is either a case of a bad medic, or a case of bad oversight (with the likely culprit being bad oversight). This isn’t a case of either/or. They are both true, and neither the medic nor QA bear any more or any less burden than the other. They are both part of a singular system that is crippled by politics, fear of litigation, malaise, lack of motivation, and by the ability of actual skills as a medic being secondary to operational capabilities and just plain opportunity.

    • JDA,

      There seems to be a false premise contructed here that proposes that it is either a case of a bad medic, or a case of bad oversight (with the likely culprit being bad oversight).

      No.

      I did not wimp out with the term bad medic.

      I am very blunt about this being a dangerous medic.

      This isn’t a case of either/or.

      The medic is responsible for being dangerous, but the management is responsible for cultivating him.

      Did he promote himself to lieutenant?

      Did he refuse to demote himself? He probably did, but the responsibility is above his pay grade.

      They are both true, and neither the medic nor QA bear any more or any less burden than the other.

      That is politically correct nonsense.

      Management had a decade to deal with this dangerous medic, but they completely failed.

      Not only did they fail to deal with him, they set him up as an example for other medics.

      They are both part of a singular system that is crippled by politics, fear of litigation, malaise, lack of motivation, and by the ability of actual skills as a medic being secondary to operational capabilities and just plain opportunity.

      Management is supposed to be able to deal with that.

      If an employee is doing something wrong, it should be documented and discussed with the employee. If the problem does not keep happening, then it is just one note in an employee file and an example of being human, or an example of a disagreement.

      If the problems are not documented, then more fault is with management for incompetence.

      If it takes an investigation to find a problem that everyone is aware of, because it is too obvious to miss, then management has been horribly incompetent.

      Was there any attempt at remediation?

      Remediation is not going and sitting in a room and watching videos about how things are supposed to be. Remediation is being retrained so that the employee is aware of the problems and aware of the consequences of further bad behavior. Is there only one shot at remediation before termination, or is there a maximum of two, or three? All of that should be clear to everyone involved.

      At some point, management can say that there is no reason to keep trying to remediate, but it should not take a decade to get there and still be a lieutenant.

      The title of this was, How Do We Stop Dangerous Paramedics From Harming Patients? You did not answer that question.

      One way is to have management deal with dangerous medics quickly, not wait ten years and then call in outsiders to do it.

      .

      • You are right. I do understand the perspective you are coming from now. It originally seemed to me that perhaps the medic in questions seemed to be escaping judgement in your eyes in favor for attacking the institution. But I see that you are essentially using this medic’s situation as a means of facilitating discussion over how services like the one he was attached to can better prevent his situation from occurring to begin with.

        In my own service, there is an individual who is as dangerous, unskilled, and uncaring as any that we encounter in these cautionary tales. What is particularly troubling is that his capabilities, and more importantly, his failings, are a known quantity to the service. I am at a loss as much as you are for how these individuals are not being held to the screws when it comes to their performance.

        What is discouraging is to see others who partner with medics such as this become enraged at the poor patient care and lack of compassion displayed on calls when they are providing care, only to fold and clam up when given the opportunity to send it up the chain. There is a complete institutional failure at this point to be able to offer correction and/or termination when medics provide incompetent and dangerous care. No one wants to do it. They’ll wait until the employee in question shows up late too often. Then they can let the clock be a self-evident condemning force rather than taking up the burden of judgement through QA.

        • JDA,

          We do agree on the problem.

          There does need to be more done by coworkers, too.

          I have been fired from one job for criticizing an incompetent medic. I went to the medical director with my criticism and was told that I had gone outside of the department and that I was had violated policies that allowed them to terminate me and give my full-time position to that paramedic.

          The medic is dangerous.

          The management is also dangerous.

          The patients are the ones harmed the most.

          .

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