SAN ANTONIO -- Facing assertions that a critically injured car wreck victim still was breathing, paramedics nonetheless ignored police officers and argued with a medical examiner's investigator, insisting that Erica Nicole Smith was dead, according to a medical examiner's investigation report.
Paramedics then begrudgingly consented to take her to a hospital hours after the Dec. 16 collision, the report said.
Smith, 23, whose injuries were so severe, the report stated, that her brain was exposed and gray matter was "coming out of the ears," died about 34 hours later.
In the days after the incident, San Antonio Fire Chief Charles Hood incensed some in the community with statements that paramedics had not erred at the scene. He also told the San Antonio Express-News that they'd sought Smith's pulse but could not find one.
Weeks later, Hood revealed that no one had checked for Smith's pulse and that at least one paramedic had violated the Fire Department's written protocol by judging Smith dead merely by looking. Reached early Monday, Hood said he could not immediately comment on the medical examiner's report. He could not be reached later in the day.
Completed last month, the medical examiner's report provides a detailed account of the emotionally charged events that followed the fatal wreck.
Just before 4 a.m., a Pontiac GS driven by Jenny Ann Ybarra of Seguin veered into a lane of oncoming traffic on Loop 410 near Rigsby Road and collided head-on with a Honda Accord in which Smith was the front-seat passenger, police said.
Ybarra, 28, has been charged with intoxication manslaughter.
The first paramedics to arrive at the collision were Michael Collins, 39, and Mike Gardner, 35.
Collins treated Ybarra, who was complaining of back pain, while Gardner tended to two other victims in the Accord: Sabrina Shaner, the driver, who police said was intoxicated, and Amber Wilson, a passenger in the back seat. Both had suffered minor injuries that included a facial laceration, a twisted ankle and three slipped discs, according to Lisa Smith, Erica Smith's mother.
Erica Smith, her brain exposed and blood streaked down her face, was left untreated in the Accord. Gardner, a paramedic with nearly six years of experience, told someone to place a yellow tarp over her body at 4 a.m., the report stated.
About 30 minutes later, police called for a medical examiner's investigator, who arrived at 5:14 a.m. As the investigator walked toward the Accord, a police detective and an evidence technician told her that "EMS had come to the scene, pronounced the victim dead after seeing her condition, then left the scene despite police having pointed out to the paramedics that the victim continued to take breaths," according to the report.
When the detective lifted the tarp, the investigator "could hear and see that (Erica Smith) was breathing short, shallow breaths," the report stated.
The investigator asked police to request that paramedics return to the crash site. Around 5:45 a.m., paramedics William Bullock, 33, and Jeremy Huntsman, 30, arrived at the scene, where the investigator told them that Smith still was breathing.
Huntsman "advised me that the victim was dead, and that Dr. (Donald) Gordon would be upset if they hooked up the monitor to a dead body," the report stated.
Gordon, a professor of medicine at the University of Texas Health Science Center who has authorized the standard medical operating procedure for the Fire Department, did not respond Monday to messages via phone and e-mail for an interview.
At the scene, the medical examiner's investigator repeated that Erica Smith still was breathing. After calling a supervisor, Huntsman agreed to "check the victim out" and later told the investigator that he'd call the Fire Department to free Smith from the car, "but if at any time during this process she stopped breathing, they would halt the process," according to the report.
Huntsman, Bullock and Collins were de-authorized as paramedics for an indeterminate length of time and transferred to the firefighting division. Gardner was permanently barred from working as a paramedic in San Antonio and also moved to the firefighting division.
Chris Steele, who heads the San Antonio Professional Firefighters Association, could not be reached for comment Monday. But in a previous Express-News article, Steele emphasized the severity of Smith's injuries when speaking about paramedics' actions that night. "If people see what we saw, they will understand what we did," he said.
All four paramedics were in the 21st hour of a 24-hour shift that began at 7 a.m. the previous day.
The additional firefighters arrived at the scene around 5:55 a.m. and pulled Erica Smith from the car using the Jaws of Life -- a resource that should have arrived with the first wave of paramedics but did not because a Fire/EMS dispatcher miscoded the call as a non-high-speed auto accident.
Hooked up to an electrocardiogram, Erica Smith "continued to have vital signs" that included a heartbeat and blood pressure, the report stated. Emergency responders placed her on a gurney and loaded her into an ambulance.
According to the report, when the medical examiner's investigator left the scene at 6:19 a.m. nearly 21/2 hours after the collision the ambulance in which Erica Smith lay still had not departed.
Erica Smith's Case
Dec. 16, 3:50 a.m.: Erica Smith and two friends are involved in a crash on Loop 410. The friends are taken to hospitals, as is the other car's driver. Smith is left for dead.
Dec. 16, 5:14 a.m.: A medical examiner's investigator arrives after being called. Smith is still breathing.
Dec. 16, 5:44 a.m.: Another group of paramedics arrives to treat Smith.Dec. 17, 2 p.m.: Smith is pronounced dead at Brooke Army Medical Center.