Maybe You Can't Go Home

EMS and the Law


 
 

W. Ann "Winnie" Maggiore, JD, NREMT-P | | Wednesday, June 27, 2007


For complicated reasons that I still cannot fully explain, after 10 years out of EMS field practice, I decided I wanted to go back. In addition to being a full-time firefighter and paramedic, I had given a great deal of time and effort to the local volunteer fire department I helped start in 1973. I left amidst a political sandstorm in 1992.

We had been a vibrant small town VFD, often called a model volunteer fire department by the state bureaucracy. Maybe I really just wanted to add some credibility to my national talks as well as my local teaching in the paramedic program. Or perhaps I needed a better way to try to keep my skills up. But, when I really searched my soul for why I would do such a thing, the real reason was simply because I missed taking care of patients and being part of the community. I wanted to go home.

Each day as I drove the local highway, I passed a sign that said Volunteers Needed for my old local volunteer fire department. I realized that I missed the patient care, the close contact with those in need, the ability to hold a hand and make it better. I missed community service that warm, fuzzy feeling you get from doing something for the good of the place where you live. I missed the firehouse atmosphere and being in the company of others who enjoyed community service. I thought maybe I could do some mentoring, help with some training and maybe even get my hands back into the action now and then.

A close friend was the current chief of our local VFD. Initially, I thought I d just do some teaching and maybe some grant writing, kind of ease in nice and slow. The chief gave me a uniform and a two-way radio, just in case I changed my mind about going on calls. The uniforms were different to me: soft T-shirts instead of the regulation blues, ball caps and windbreakers. My old friend knew me too well. It wasn t long before I was back in the swing of things sort of.

I started answering calls. Rusty as I was, I did seem to recall the basics of what to do out there, and I actually began thinking I might be somewhat useful as the lone paramedic on the squad. I was impressed with all the shiny new equipment the department had acquired in my 10-year absence and got a tour of the station that I had planned when I left. There were a lot of new gizmogadgets I had to figure out how to use, but I was holding my own. Then it all changed

On my very first post-retirement call, I was exposed to active tuberculosis. Yes, we still have that in New Mexico. We still have plague, too. Due to multiple system failures, no one on our non-transport crew had been notified through the health care system that our patient had died of active TB. Fortunately, we live in a small community, and a friend of the patient called to tell us that his friend had died and to thank us for being so kind to him when he was so ill. And, by the way, did you know he had tuberculosis?

So, we all trooped in to the county s selected health care provider for TB testing. I really didn t know exactly what was supposed to be done and presumed that the Occupational Medicine Center we went to did. Wrong. I came to find out that while half of us received the appropriate testing, the other half received misinformation. And our second test was done way too soon, necessitating a third test. Further, I found out that we were treated as new hires in a big hospital rather than acute EMS exposures. After several weeks of attempting to deal with the situation as Jane Q. Paramedic, I was still unable to convince the hospital to give me a copy of my own medical records, despite executed HIPAA releases and dozens of phone calls. Seems you have to get your medical records from somewhere six states away. Then, they sent me all of my medical records for the last 10 years, with the exception of the one for the exposure, which was the only one I requested. They also sent me a big bill for the copies.

After a month, disgusted, the lawyer hat went on. I made a call to our medical director and to the medical director of the Occ Med clinic, who I had represented once in a deposition. He remembered me and investigated what happened. It took another couple of months to figure out what went wrong, why and to obtain the appropriate testing for our EMTs. However, during the crisis, the state Department of Health had come into our community and used the local school to conduct free testing, since a large number of people had been exposed to the patient. There was absolutely no coordination between the local fire department and DOH, and our EMTs were unable to take advantage of the testing that was done in our back yard.

About a week after that call, I responded to an accident on the highway. The patient was the daughter of a close friend. Her vehicle had rolled and looked horrible, but fortunately she had been wearing her seat belt and escaped with minor injuries. I was very impressed with the initial handling of the call by one of our EMT-Basics, who did an excellent assessment. The patient s parents showed up at the scene, and I was able to calm her hysterical mother by letting her know that I promised to take very good care of her daughter. However, when I told the new county transport unit I would be going in with them, I caught serious attitude from an Intermediate EMT who was backed up by his paramedic partner who told me I could not go in with the transport unit because I knew the patient! I was literally told to get out of the transport unit. This came as a shock, since I knew the majority of my patients, or their families, in the 20 years I had previously been an EMS provider in this community. Transporting someone I knew had never been a problem, but apparently this was a new taboo I hadn t been warned about.

I went on a mutual aid call for a baby not breathing. The BLS unit on scene hadn t taken any vitals and confided to me that they really didn t know how. Who trained these people? Fortunately, the baby was now pink and howling, and I started teaching baby vitals right there on the scene. The baby s father described a frightening episode where the baby went limp and turned blue. When the ALS transport unit finally showed up from the big city, it became clear to me that the paramedics had no intention of transporting the baby in an ALS unit when she appeared to be fine now. Wrong answer. Another call to the medical director.

A couple of months later, elections were held in our small department. By a vote of 8-7, our chief, a highly skilled EMT-Intermediate with more than 30 years of experience as a volunteer firefighter, was voted out in favor of someone with minimal firefighting experience and a shiny new EMT-B, but who had been heavily campaigning for the position. The voting members waived the usual requirements for the chief s position in favor of a change of administration. Hmm.

The final blow for me came on a night when my local squad was asked to standby at a small outdoor concert in the community that was slated as a benefit for wildland firefighters. I was asked to cover the EMS unit. I came to the station in full uniform, ready to go. I had asked a new recruit if she wanted to come along, hoping to begin some much-needed mentoring. The new recruit appeared in a miniskirt, inappropriate footwear, dangly earrings and a large concho belt, topped with a fire department uniform T-shirt. When I commented that she needed to be appropriately attired for the job, she replied that the chief said it was fine to wear shorts (I will not engage the skirt/skort/shorts debate here). Reluctantly, she did change into a jumpsuit, and we proceeded to the event. There, I noticed another department member in a fire department uniform T-shirt drinking margaritas from a thermos. This was the same guy who told me that he didn t care about HIPAA, but HE was taking copies of run reports home in case he got sued. Yet another call to the medical director. I was rapidly turning into the department's official ratfink.

I reported the drinking to the new chief, but no disciplinary action was taken. The new chief was unclear about FD insignia, or what it meant, and really didn t think it was much of a problem. I later found out that the celebrity who labeled the concert as a fire department benefit and his band had gotten paid, but that there was nothing left for the fire department that was supposed to benefit. That was pretty much where I decided I should leave off. How had we gotten into that mess?

In the aftermath, I turned in my T-shirt uniform and my two-way radio, and once again said goodbye to field EMS. Nobody wanted to hear the voice of experience. No mentoring needed here. Experience not necessary; will train. Who cares about what goes on in national EMS? Things had changed, but not for the better. The shiny new trucks looked pretty on the outside, but there wasn t much left on the inside. With few exceptions, people were in it for all the wrong reasons.

Maybe you really can't go home.




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Related Topics: Administration and Leadership, Legal and Ethical

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W. Ann "Winnie" Maggiore, JD, NREMT-PWinnie Maggiore is an attorney and paramedic in Albuquerque. She is a shareholder at the law firm of Butt, Thornton & Baehr, PC where she defends physicians, dentists, oral surgeons, nurses, paramedics and other health care providers, as well as law enforcement officers, against lawsuits and administrative enforcement actions. She is an author of many EMS legal publications, a member of the JEMS editorial board, and holds a volunteer faculty position in the Department of Emergency Medicine at the University of New Mexico.

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