As the state Department of Public Health and the attorney general's office continue investigations into widespread EMT training fraud, experts warn lawsuits could soon follow.
About 200 emergency medical technicians in Massachusetts and New Hampshire, including state-certified instructors who worked in Billerica and Lowell, allegedly bought and submitted false recertification records to their employers, according to DPH. The majority of cases under investigation stemmed from anonymous tips brought to the attention of DPH officials.
"These are just the cases we know about," said Jennifer Manley, a DPH spokeswoman. "We sent out a memo to municipalities asking them to give us any further information if they had any. We don't know when (the investigation) is going to end but we're very disturbed by this and we're going to keep going until we are satisfied the problem has been resolved."
But when looking at the high number of EMTs being scrutinized in the state's probe, some say a wave of lawsuits could be the next step. It is illegal to falsify EMT records in Massachusetts. Under state law, trainers and EMTs who awarded or received fake credentials could be held accountable.
From private ambulance companies to ambulance services run by municipal fire departments, administrators who might have known about employees falsifying records could face serious penalties, said Joe Devlin, a professor of corporate and contract law at the Massachusetts School of Law in Andover.
"We're looking at a widespread case of fraud," Devlin said. "It's a mess that's open to a whole host of possible legal cases. Since it's so widespread, it's hard for me to believe that some upper levels of management didn't know about it."
If the state's investigation reveals that the owners of ambulance services were aware of the fraud, but still let EMTs out on the road, then the company could be on the hook for anything that falls short in guaranteeing its employees had the proper licenses, Devlin said. But such a situation would also depend on contractual obligations, Devlin stressed.
The state can suspend or revoke licenses of individuals found in violation and can refer cases to prosecutors for criminal sanctions. That was the case in Hamilton last year, when former Police Chief Walter Cullen was among four people indicted on public corruption charges after a grand-jury investigation into falsified EMT training records.
Despite the jarring number of individuals under investigation for fraud, several local EMTs say the number of those who follow state guidelines is far greater.
Tewksbury Fire Chief Richard Mackey said the town's Fire Department-run ambulance reduces the risk of fraud by training EMTs in-house. Every two years, refresher courses are taught by a state-certified trainer at Tewksbury Public Library. Out of the Fire Department's 50 firefighters, 49 are EMT-certified.
"We take the courses together over three days, for eight hours each day," said Mackey, who has been a certified EMT since 1979. "Everybody sees everybody else in the classes and we take them seriously, because it's where you get some of the best hands-on training."
The state certified instructor will draw from actual emergency calls in Tewksbury and use them as a basis to go over the latest methods and techniques, Mackey added.
"There's always changes in CPR, different methods incorporated and protocols changed by the state," he said. "This is a time when those protocols are shown."
Since the state's investigation has revealed a large-scale problem with fake certification, Lowell-based PrideSTAR EMS has posted a message on its website stressing that all of the company's employees meet the state's requirements for licensing and have not been targeted in the probe.
"We just wanted to show transparency and stress that it's not an industry-wide issue," said David Daly, company president. "We conduct all of our training in-house to ensure compliance. Once you start using outside agencies, you can open yourself up to liability issues."
Emergency medical workers must renew their certification every two years through classroom hours and a practical exam. EMTs and paramedics are required to obtain that training on their own, through a number of state-certified instructors who offer classes at various colleges, schools and municipal buildings all year long.
But the honor system has failed in several cases where the state discovered instructors took payment for courses, then signed off on them along with the individuals, even though the individuals never attended or, in some cases, didn't complete the required classes.
Leo Nault, a state-certified instructor formerly employed at Trinity EMS, is one of 200 now being investigated. Trinity has about 30 employees involved in the probe, with five in Lowell and the majority in Haverhill.
John Chemaly, Trinity's president and co-founder, said yesterday that Nault has since been terminated from the company. Trinity also has other supervisors that are being looked at, Chemaly said.
All of the company's EMTs who are part of the probe were suspended from their duties until they were recertified, per orders of DPH. The Trinity employees received the proper licensing and were back on the job within a week, Chemaly said.
"We're not dealing with any disciplinary actions until the state finishes its investigation," Chemaly said.
Manley said representatives from Trinity did contact the state with concerns about false certificates. Chemaly said he was alarmed after learning that Mark Culleton, who owns and operates Life Saving Maneuvers of Billerica, was under investigation for giving firefighters and private ambulance workers CPR certificates without actually training them.
Chemaly said Trinity, which provides ambulance service in 10 communities, including Lowell and Chelmsford, could face liability depending on the outcome of the state's investigation.
The ambulance contracts in Chelmsford and Lowell both allow the municipality to terminate the contract if any part of the agreement is broken.
Chelmsford Town Manager Paul Cohen and Lowell City Manager Bernie Lynch each said they are satisfied that Trinity owners acted on their own to check every employee to make sure all were in compliance.
"It's disappointing to hear that there are EMTs who have falsified records," Cohen said. "But it doesn't appear to be a management deficiency. They were relying on the certifications people brought before them. We consider everything when we make a decision on a public-safety provider. Given the breadth of the issue, that it goes well beyond Trinity, I don't think this is a fatal flaw on the entire company."
Lynch said city officials will watch carefully as the investigation unfolds.
"We can't determine what action will be taken until the investigation is complete," he said.
DPH Commissioner John Auerbach said the state cannot suspend or terminate any licenses without going through due process.
"We are working to make sure these types of incidents don't happen again," Manley said.