Falsification of EMS records is nothing less than a deadly sin. A single incident can end employment, jeopardize continued certification and licensure, and potentially lead to civil lawsuits and criminal charges.
What exactly is falsification of records? How prevalent is it? Given the risks, why do people do it? This article will explore these questions and provide specific cases.
What is Record Falsification?
Let’s first discuss what we mean by falsifying records, as it comes in a number of formats. It can be writing down vital signs you didn’t take, claiming a patient wasn’t ambulatory when they were, checking off the equipment checklist when you didn’t check the equipment or documenting a refusal that was “EMS initiated.”
Consider the interaction EMS has with a patient who isn’t critically ill or injured, but who is “on the fence” about consenting to EMS transport to the hospital. Too often, EMS personnel get out of their ambulance with the refusal form already on the clipboard. With minimal discussion or truly informed consent, EMS quickly gets a signature on the refusal form and moves on.
Was this truly an informed refusal, or did you talk the patient out of being transported to the hospital?
Consider the unit checklist. When EMS personnel are questioned in a deposition, one of the first things a plaintiff’s lawyer will ask is whether the provider simply checked the boxes on the form, or if the provider actually checked the equipment.
The same applies to a provider documenting a normal set of vital signs when theydidn’t really measure a blood pressure, pulse rate or respiratory rate. Did theycheck the box or did they really do the task? Were two sets of vital signs really taken, and both blood pressures 120/80? Finally, did the provider document two sets of respiratory rates when they really only took one?
How Prevalent is it?
Unfortunately, there’s no way to really know. Unless the falsification is detected, it may go unnoticed, and there’s no way to know how often EMS personnel are involved. Though EMS personnel think it happens very infrequently, in a poll taken by EMT life, 18% of the respondents thought over 75% of EMS personnel falsified EMS documents.1
Case 1: Moving a Patient
In 2008, Worcester, Mass., paramedics were accused of lying in a situation that ultimately resulted in termination, criminal charges, civil litigation and a hefty verdict against EMS.2
48 year-old Charles Rondeau called EMS due to chest pain. On arrival, he was found short of breath and diaphoretic. Paramedics walked him down three flights of stairs–a clear violation of state standards of care. Their report, however, stated that he was carried down in a stair chair. What the paramedics didn’t realize was that his daughter and wife had arrived, and saw him being walked downstairs. He died half an hour later of an extensive anterior wall myocardial infarction.
After Rondeau’s daughter read the EMS report and found that it said he had been carried, she filed a complaint and a four-month investigation followed. She called the service to question the discrepancy, but never got a return call from the chief of EMS, Stephen Haynes.
Her next call was to an attorney, who initially advised her to contact the state EMS office. That office issued a Notice of Serious Deficiency.
Ultimately, the paramedics admitted walking Mr. Rondeau down the stairs, but said it was because firefighters hadn’t yet arrived to assist in carrying him down. That turned out to be another lie, because when the dispatch logs were reviewed, it turned out that firefighters had actually arrived at the scene five minutes before the paramedics.
Both paramedics were fired. As a result of doubts raised by the investigation, the State of Massachusetts suspended the service’s RSI certification. It found that the service couldn’t ensure that personnel were in compliance with the Statewide Treatment Protocols, and that it was unclear whether quality assurance measures were in place.
In addition, Mrs. Rondeau filed a medical negligence lawsuit which was settled for $1M.
Case 2: DNR Documentation
FDNY paramedics were accused of faking reports about a patient’s death after confusion over a DNR order.3 Two paramedics were called to a 71 year-old male patient complaining of difficulty breathing. They arrived to find CPR in progress and the man’s wife insisting that he had a DNR order.
She was unable to locate the paperwork. She did, however, have health care proxy paperwork but the paramedics said they were not allowed to accept it.
The EMS report stated they had intubated and administered IV medications when, according to a criminal complaint filed against them, they actually withheld resuscitation. The patient was pronounced dead and a supervisor came to the scene.
When the supervisor reviewed the paperwork, he realized that something was amiss. When he questioned the discrepancy, the paramedics admitted it, saying they sympathized with the wife. The supervisor reported the incident and criminal charges resulted.
The charges included offering a false instrument for filing and falsifying business records, with the top charge being a felony.
Case 3: Patient Refusal
In a third matter, Albuquerque (N.M.) Fire Department paramedic Brad Tate was fired after the City’s personnel board found that he provided substandard care and falsified records to show that patients had refused care and transportation.
In response, Tate mounted a multipronged battle, suing the City for wrongful termination and violation of his civil rights. The City ultimately settled the lawsuit for $300,000 in 2016 to prevent him from getting his job back.4
A ‘Deadly Sin’
Ed Racht, MD, the chief medical officer for American Medical Response (AMR), believes that falsification of EMS reports is one of the “deadly sins” that are serious enough to warrant withdrawal of medical ovrersight by the medical director. At the January 2018 meeting of the National Association of EMS Medical Directors in San Diego, Racht explained why.
“There’s a big difference between an honest error versus a conscious decision to deceive,” Racht said. “Any kind of deceit or lying can harm a patient by creating an illusion of something there that is not”¦and the provider completely loses credibility.” In his entire career, Racht has only withdrawn medical supervision 16 times, but five of those were for falsification of records.
“In one significant case, an entire run form was completed. We found out from the partner that they never even accessed the patient.”
The penalties for falsification of records can be significant. The potential for loss of credibility, losing medical supervision, termination and licensure action should be obvious. But there’s more to it than that.
For example, charting that a patient wasn’t ambulatory to justify Medicare reimbursement, when, in fact, the patient was walked to the transport unit, can be considered Medicare fraud. If the insurer is private, it may be insurance fraud. These are not minor charges and can ruin an EMS career.
Falsification of records is dishonest and unprofessional conduct. Though some of these incidents may seem minor, even a small infraction can have major implications.
- What % of your coworkers falsify EMS documents? (Jan. 12, 2009.) EMT Life. Retrieved March 20, 2018, from https://emtlife.com/threads/what-of-your-coworkers-falsify-ems-documents.10290/.
- EMT malpractice settlement: $1Million. (2012.) Lubin & Meyer PC Verdicts and Settlements. Retrieved March 20, 2018, from http://www.lubinandmeyer.com/cases/EMT-lawsuit.html.
- Annese JM. (May 22, 2015.) FDNY paramedics accused of faking reports about patient’s death after DNR confusion. Staten Island Real-Time News. Retrieved March 20, 2018, from http://www.silive.com/news/2015/05/fdny_paramedics_accused_of_fak.html.
- Heild C. (April 2, 2016.) $300K settlement keeps paramedic from getting job back. Albuquerque Journal. Retrieved March 20, 2018, from https://www.abqjournal.com/750602/paramedic-wont-get-job-back.html.