Thursday, August 22, 2013

There is a huge scandal going on in the D.C. Fire and Emergency Medical Services Department, and nobody is really aware of it.

This is Part Two..............

Fire and EMS merger under Thompson

Adrian H. Thompson, a D.C. career firefighter, was named Fire Chief in July 2002. A stickler for regulations and discipline as well as firefighter, Thompson quickly restored morale. Initially hired at the same salary as Few, his pay rose by 18.8 percent to $158,000 a year in 2003.

Thompson discovered that recordkeeping under Few was so poor that the true extent of the paramedic and EMT vacancy issue could not be determined, although an internal DCFEMS study showed the agency had only 174 of the 335 emergency medical workers it needed to operate its 36 ambulances. The situation was worsening because improvements to fire safety throughout the years meant that the city had fewer than 100 fire alarms in a month but 8,000 to 9,000 calls for medical assistance. A three-month study by the D.C. Office of the Inspector General, released in October 2002, found that the department had no accurate way of measuring how long it took for an ambulance to reach the scene once a call for aid was received. But the time it took for ambulance crews to leave the stationhouse once they received an alert was double the national average (two minutes rather than one). In two-thirds of the days covered by the study, up to a fifth of all ambulances were out of service due to staffing shortages. All 14 of the ambulances were fully staff on just four days. The inspector general blamed part of the problem on employees who "are lazy or do not care", while the paramedic and EMT union attributed to the slow "turn-out time" to over-worked and under-staffed employees.

A number of equipment upgrades occurred during Thompson's tenures. The department began using a GPS locator on vehicles to enable dispatchers to identify which available vehicle was closest to an emergency (which the department hoped would speed up response times). Six new fire engines and six new ambulances (ordered in the waning days of Chief Few's tenure) arrived in January 2003, with another 14 fire engines, 16 ambulances, three ladder trucks, and seven command vehicles.

Leadership controversies

In August, D.C. emergency medical services officials breached confidential patient records by taking them home, a blatant violation of the federal Health Insurance Portability and Accountability Act. EMS Medical Director Dr. Fernando Daniels III was terminated, and city investigators said that many or most of the EMS division's 35 managers could be fired. Daniels' successor, Dr. Clifford H. Turen, resigned on March 1, 2005, after it was learned that he had not yet received a license to practice medicine in the District of Columbia and his speciality was not in emergency medicine.

Leadership problems occurred in the firefighting division as well. By July 2005, both assistant chief positions and five of the 12 deputy chief positions were vacant and being filled by acting officers. City personnel rules limited an individual to just 120 days in an acting position, and placement in an acting capacity could not be used in lieu of training or evaluation. In February 2004, Assistant Chief Pete Miller — who oversaw support personnel for the building inspection division, facilities maintenance, firefighter training division, health and safety, and vehicular maintenance — retired. Thompson appointed Deputy Chief Kenneth B. Ellerbe to the position, and Ellerbe was still there more than 17 months (510 days) later.

Ongoing grooming controversy

The ongoing grooming controversy erupted again in June 2005. District court judge James Robertson reaffirmed his "temporary" injunction against the department's short hair and short beard grooming policy. However, Robertson allowed the city to submit evidence at trial (to be held at a future date) to prove that longer hair and beards were a critical safety hazard. Rosenbaum controversy

Major problems with the DCFEMS department emerged on January 6, 2006. Retired New York Times reporter David Rosenbaum was assaulted in his home during a robbery. EMS personnel misdiagnosed Rosenbaum's severe wounds as drunkenness, and downgraded the incident to low-priority. Rosenbaum subsequently did not receive timely treatment, and died of his injuries. An after-action report severely criticized the DCFEMS department for its actions.

Thompson quickly implemented a number of changes to improve service. Five emergency medical services personnel were disciplined (which included terminating one and allowing another to retire). A new credentials and certifications tracking system was put in place to ensure that EMS administrators were properly certified to hold their jobs. New procedures were implemented to ensure EMS personnel understood the scope of their jobs and basic patient care protocols, and to better evaluate firefighters, paramedics, and EMTs. He also assigned an EMS supervisor to the dispatch center, and gave the supervisor the authority to reassign EMS crews to short-staffed parts of the city as needed. Ambulance crews were given more authority to determine which hospital a patient should be driven to, and procedural improvements were made to improve communication between dispatchers and EMS crews on the scene. New equipment was also added to emergency medical vehicles to allow GPS tracking of them. This allowed dispatchers to identify which EMS vehicle was closest to a call, and reduced response times further. Nonetheless, Thompson felt the Rosenbaum case "was an aberration" which did not require major changes to DCFEMS procedures or staffing.

In October 2006, the Washington Times reported that the investigation into the Rosenbaum incident was fatally bungled when evidence pointing to gross negligence in the case was not promptly reported to the D.C. Inspector General's office. One element of this evidence was a report which provided first-hand evidence that Rosenbaum's condition was much more severe than reported by EMS personnel earlier in the inspector general's investigation. Investigators said they believed the evidence showed that DCFEMS medical director Dr. Amit Wadhwa "may not have been fully responsive" to investigators and "may have made misleading statements during an official investigation". Wadhaw resigned in August 2006. A departmental spokesman said Assistant Chief of Operations Douglas Smith simply overlooked the evidence, and failed to pass it on. Chief Thompson said he independently reviewed all the key documents in the case, and realized the reports' importance. But the D.C. Inspector General's office said it was forced to send a letter to Thompson demanding the reports. City Council member Phil Mendelson alleged the department withheld the reports from him after he requested them in January 2006. Although the evidence had now been found, the mayor's office declined to pursue any further investigation of negligence in the Rosenbaum case.

Merger of firefighting and EMS divisions

With staffing problems in the EMS division continuing, response times still slow, tension between EMS and firefighting personnel still strong, and stung by criticism in the Rosenbaum case, Thompson implemented a plan in 2006 that began merging the EMS and firefighting divisions into a single unit. Some firefighters were cross-trained in limited emergency medical care, improved emergency services staffing by assigning EMS-trained firefighters to ambulances and by pairing a paramedic with an EMS-trained firefighter during periods when fewer calls came in. (The previous model staffed an ambulance with two paramedics at all times.) Since fire companies were often the first to respond to a medical emergency, he also placed a single parademic at 18 of the fire companies. Response times for EMS services fell by three minutes.

While campaigning for mayor in 2006, Adrian Fenty pledged to undo the merger of fire and emergency medical services. Fenty reneged on his promise, and the merger remained intact throughout his tenure as mayor of the District of Columbia (2007 to 2011).

Thompson resignation

After winning the D.C. Democratic primary in August 2006, Adrian Fenty pledged to fire Fire Chief Adrian Thompson. "The fire department needs a new chief; there's no question about it," Fenty said. "The whole system is broken, from fire to EMS."

Thompson resigned as fire chief in December 2006. Despite Fenty's criticism, the Washington Post described Thompson's tenure a success. The Washington Times described his chieftancy as one of "steady leadership", and concluded he "restored stability" to the agency.

In 2010, Thompson declared the merger of the EMS and firefighting departments a failure. He blamed racial issues in part, noting that firefighters are primarily white and EMS personnel mostly African American and that white firefighters have little respect for the mostly black and poor people they provide emergency care to. Kenneth Lyons, president of the paramedics' union, agreed but also emphasized that management failures and budgetary problems played a role. Fire Chief Dennis L. Rubin dismissed Thompson's conclusions.

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