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Previous coverage of this story
Coverage from Curt Varone's FireLawBlog.com here and here
UPDATE: Read Friday statement from hospital CEO
Since we first reported the story on Sunday about a Nova Scotia man who was fatally injured in a skiing accident at Sugarloaf Ski Resort in Maine last week, like me, many of you have been waiting to hear the other side of the story. Some key information has been missing and it's possible some of those answers may come today.
So far, we only know the details provided by David Morse's widow Dana, a nurse practitioner, who says paramedics left her on the side of the road when she asked to be allowed in the patient compartment for what she believed were her husband's dying moments. In addition, Dana Morse has strongly criticized the care provided by the ambulance crew.
Franklin Memorial Hospital in Farmington, Maine, which runs Northstar Ambulance service, indicated it did not know about Dana Morse's complaint when contacted by the Chronicle Herald last weekend. Since then, the hospital has not been doing itself any favors by not releasing any information about the incident.
While determining the level and quality of care provided to the patient may take some time, it seems the key point of the story that has made it newsworthy, whether Dana Morse was abandoned by the side of the road, should be an easy one to figure out, along with any explanation for those actions.
Rather than provide those answers in a timely fashion, the hospital and ambulance service have stretched this reputation issue into a whole week of news stories. OnlineSentinel.com reports the wait for the rest of the story may end today after Jill Gray, community relations manager for Franklin Memorial Hospital, indicated there could be a statement released about the internal review.
Among the stories this week are the one above from NECN where the reporter talked by phone to Dana Morse's sister.
Bangor Daily News has done at least two stories. In the first, Dana Morse said the details of what happened are even worse than what she shared with the Chronicle Herald:
Dana Morse told the Bangor Daily News on Tuesday she believes an investigation into the handling of her husband’s case will reveal it was even worse than depicted in The Chronicle Herald story, which she said was otherwise “completely accurate.”
“I will file a formal complaint to ensure the details are available for their investigation, as the printed details in The Chronicle Herald are not even touching the surface,” she wrote to the BDN in an email, adding, “I will not provide further comments [as] my focus is my boys.”
In the second story, Bangor Daily News reporter Seth Koenig got in touch with my friend Curt Varone, who writes FireLawBlog.com:
"We’ve got to get down to the facts about what happened,” Varone told the BDN in a Wednesday evening telephone interview. “Did the transporting EMS unit en route to a hospital leave a patient’s family member by the side of the road? If that did happen, what were the grounds? As a fire service leader, I’m struggling to come up with grounds to justify that. I’m not saying they didn’t have grounds, but we’d need to know what those grounds were.”
Varone said before the public knows what the hospital’s internal review finds, “it’s not helpful to speculate.” But he said it will be important for the hospital to release its findings openly, a step medical facilities are not often required to take.
“This is something that has captured the public’s attention, and the hospital, just like any other entity, has an obligation to tell the public, ‘This is what happened — we did an investigation and, you might not like what happened, but here are the results,’” Varone said.
Excellent points, as always, by Curt. In fact, a good way to stop that speculating would have been for the hospital to provide the key facts well before now. If it is bad news for the hospital and the ambulance service, delaying the inevitable is just making it worse. If the hospital has a defensible position, they have lost a lot of opportunities to share it and possibly prevent further erosion of the ambulance service's reputation.
Those who think that just by saying "it's under investigation", or the old standby, "we can't talk because it's a personnel matter", are enough to quiet things down and give you time, can just look at this story to see what really happens. Not talking usually does little to solve a serious image problem like this one.
In addition, Curt made a good point to the Bangor Daily News, that echoes something I said in the comments section following our original post last weekend:
“How could a couple of medics have gone through this ordeal — especially if it happened the way the widow said it happened — and not report it to their supervisors?”
An early warning system, especially with bad news traveling at the speed of light in the digital age, is crucial to dealing with reputation issues. When those in charge and those responsible for addressing the press and the public have to find out the potentially bad news first from a reporter, responding properly and promptly will be even more difficult.
Stuff happens. Make sure your people know that keeping it a secret will always make things much worse.
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Also on STATter911 …
- Wife who asked to be beside her dying husband in ambulance says crew left her on side of road. Questions about care after Maine skiing accident. – January 15, 2012
- Maine’s Franklin Hospital/Northstar Ambulance issues a non-statement about dying man’s wife claim she was left on side of road. Another lesson in reputation mismanagement. – January 20, 2012
- Raw video: House fire in Bangor, NY. – February 26, 2013
- Controversy all around, DC’s Mayor says he has confidence in Fire Chief Ellerbe. Deputy Mayor wants to know why 10 ambulances were out of service when cop needed help. – March 7, 2013
Comments
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Dave, I agree 100%. The longer it takes for the hospital to release information, the more I think they are trying to find the right "spin". Something obviously happened and right now Dana Morse has ALL the credibility. I said in my original post that I don't think the "investigation" by the hospital is sufficient. I highly doubt they will be truly forthcoming if they were in the wrong. We'll see, maybe I'll be wrong, but that's not likely.
At our station, any call that goes outside of the normal has an incident report written up with the PCR, These reports are written by all staff on the call not just the attending Medic, this is then given directly to the supervisor. Who reviews it and puts into motion any action that may need to take place. This protects us as providers, the Organization, and ultimately the Public as well. Leaving someone on the side of the road would defiantly warrant such a report to be filled i can think of a few reasons why it may have been done. but without proper Documentation and reporting it may be a very bad day for that EMS organization.
I look forward to more information on this story. We need answers as a profession. I am concenred that we need to address this as an EMS community. The mesage boards revield a frighteningly all to common response among the EMS community. It seems that many Paramedics are totally untrained in dealingh with family. Or become combative or angry with even posing the question of how to handle this professionally. Everyone on scene is a potential patient and they had a DUTY TO CARE for her. Was she having a behaviorial emergency? Maybe, if she was then she needed help, no help was summoned, if she was not, then we have some very bad decisions made by some medics. The only reason for anger and fear in this matter is that you are not comfortable with another medical professional in the back.. At least for now thats the way it looks on the sidelines, I hope the hospital comes to the table with answers and not delayed spin. We as a profession need to know and need to talk about this nationwide!!
The issue here does sound like a combination of lack of training and hubris. We all know Paramedics who readily admit that they don't want to deal with family, or are too terratorial to accept unknown(especially higher level?!)HCP's on scene….Why?
If I have an NP or PA or MD on scene, they usually get roped into helping somehow because in rural Maine, sheer geographical distance means that most EMS and Fire-calls are 'short-handed' in those vital first few minutes…it is just a matter of resource utilization.
With an MCI, the more trained hands the better, because it often takes more than one or two people to stabilize a critical patient. It is a collaberative effort and there is always something to be done that does not 'violate protocols' even if it is just gophering or holding C-spine. Combine that with extended transport times-no lifeflight for whatever reason, and the fact that with an unstable patient you will need to do mutiple things simoultaneously en-route. If you have that luxury, it makes sense to have an extra provider in the back.
Even though this was not an MCI, in my experience the best way to calm a medically trained relative is to give them something to do. Sometimes people die, it's nobody's fault, but if my patient is in extremis,either in the hospital, in their home, or on the rig, I have a moral obligation to let their loved ones be present in their dying moments. To willfully prevent that is inexcusable
On any EMS call, regardless of license level, initial assessment includes rapidly establishing a baseline. After spinal r/o, it takes seconds to expose,visualize injuries, note skin color, work of breathing, auscultate LS, HS, palpate the thorax, check excursion, exclude JVD and/or tracheal deviation, do a quick 4 quadrant abdominal check, r/o pelvic instability and providing the c-spine is stable, quickly check the back . If no severe bleeding from extremities they can wait until after vitals are obtained, Start 02 and at least monitor limb leads. If ALS, obtain a history whilst establishing 2 large bore IV's. (active 41 yo previously healthy male patients usually have good veins).He was alert, with a known MOI ! Based on history of thoracic trauma, quick look/defib pads in situ and/or obtain 12 lead.
30 minutes shoud be ample time for these interventions, before or after initiating transport, based on the initial 'stay and play' or 'load and go' assessment That way at least you are closer to your receiving facility (ground: 50 mins FMH/80 mins CMMC.(In fair weather can ski patrol start Life-flight?) En-route you can perform a secondary survey, note trends and contact OLMC to give them a 'heads up' and consult. There had to be significant signs of deterioration…such as increasing dyspnea,pain, tachypnea, cool extremities, pallor, signs of pulmonary contusion??…indicators of developing tension pneumo? IV fluids can be titrated to keep systolic BP >80.
IMHO, prompt, appropriate (often non-invasive BLS) interventions at any point along the continuum can buy time. Even positioning (Full-Fowlers vs supine).
Unfortunately in order to train people correctly, they must first realize their knowledge deficit. Medicine is such a soft science that we are all learning every day…there is no shame in calling OLMC, or asking a more experienced or specialized provider for help.
My heartfelt condolences to the Morse family for their tragic loss, and to Davids friends and community.
He was lucky to have a loving and articulate wife who has the courage to pursue this, and perhaps catalyze a much needed paridigm shift in EMS. In some small measure, that might provide consolation to his loved ones.