In California, there’s no guarantee that they or emergency medical technicians will be reported, investigated or disciplined.
By Rich Connell and Robert J. Lopez, Times Staff Writers
May 6, 2007
A Mustang broadsided Kathy Schroeder’s Hyundai sports coupe in a Palmdale intersection, knocking her unconscious. She woke up wedged against the console, covered with an oily film.
“I just remember my eyes and face burning,” she said, “like bacon sizzling.”
She recalled telling the Los Angeles County Fire Department rescuers at the scene but said they didn’t flush her eyes. After being rolled into a private ambulance, she told the attendants too. They didn’t flush her eyes, either, explaining that it would get their floor wet, she said.
By the time the hospital did the flushing, the damage was done. Battery acid and other chemicals had burned her corneas, according to her subsequent lawsuit against her rescuers. Even now, after five eye surgeries in five years, life on a good day is a blurry video. Unable to resume her job as an advocate for the disabled, Schroeder, now 47, received a $400,000 settlement from the ambulance company.
The people who regulate medical rescuers in Los Angeles County, however, heard nothing about this incident.
County policy requires fire and ambulance officials to report potentially serious medical lapses by paramedics and emergency medical technicians to regulators. But those officials saw no problem with Schroeder’s care. Even after the 2004 settlement, neither rescue provider came forward.
It was not the only such case to escape regulatory scrutiny in recent years. A Times investigation found that oversight of paramedics and EMTs in California is haphazard at best, with nothing to ensure that potentially problematic cases are reported and investigated, or that errant rescuers are held to account.
Countless lives have been spared and injuries relieved by the state’s medical rescuers, often the frontline caregivers in a crisis. To many people, they are heroes. Their competence, often, is assumed.
But when things go wrong, The Times found, California is not set up to consistently weed out poor performers or dangerous patterns — raising the risk of harm to unsuspecting patients.
With little clout, regulators essentially rely on rescue providers to report on themselves, making it nearly impossible to get a realistic picture of where the system is breaking down or how it is performing overall.
The bureaucracy is fragmented. In contrast to other populous states — such as Texas, Massachusetts and New York — California has no overarching agency to oversee the state’s 15,000 paramedics and 70,000 EMTs.
Paramedics are licensed by and ultimately accountable to the state Emergency Medical Services Authority, which has limited enforcement powers. EMTs, who receive less training and whose duties are more limited, answer to any one of dozens of regional authorities.
“There’s a lack of accountability,” said Dr. David Persse, a former Los Angeles County regulator who left to become the Houston Fire Department’s medical director, partly because the centralized oversight system in Texas was stronger. He cited that state’s ability — lacking in California — to levy steep fines to bring rescue providers into line. “You got to have some teeth,” he said.
The Times reviewed all regulatory actions taken against paramedics and EMTs in California from 2000 to 2006. It examined incident logs, patient complaints and assorted legal claims; it interviewed regulators, rescuers and patients. Among the findings:
There is no coherent system for reporting problems or processing complaints that could lead to discipline.
Los Angeles County regulators, for instance, specifically require fire and ambulance officials to report suspected cases of gross negligence or substance abuse by paramedics and EMTs, but Sacramento and Orange counties have no similar policy.
Even when a policy exists, as in L.A. County, “the interpretation of what fits in there may be different from person to person,” said Carol Meyer, director of the county’s Emergency Medical Services Agency from 2003 until last week.
Without legal authority to penalize anyone for failing to report problems, state officials admit they are stymied. New state laws are needed “to address some of the shortfalls in reporting requirements, so we can get a better picture of what’s happening out there in the field,” said Dr. Cesar A. Aristeiguieta, director of the California Emergency Medical Services Authority.
For the public, there is no single, obvious place to go to register a complaint. Even when someone files a legal action, as in Schroeder’s case, regulators are not necessarily alerted to malpractice awards or settlements.
The numbers and types of disciplinary actions across regions are strikingly inconsistent.
In six years, the Orange County Emergency Services Agency, with about 2,500 EMTs, revoked two certificates and put one rescuer on probation. Sacramento County took no disciplinary action against its 1,500 EMTs — not even putting anyone on probation.
But in tiny San Luis Obispo County, with about 550 EMTs, 48 were disciplined, including six suspensions and six revocations.
For its part, Los Angeles County takes pride in its oversight of its 15,000 EMTs and by far took the most disciplinary actions statewide. But the vast majority of these actions involve probation, which allows people to continue working under certain conditions. In six years, just one rescuer’s certificate was revoked. Two were suspended.
Former County EMS director Meyer said probation is an effective tool, adding that almost no one who had been disciplined that way had subsequent problems. But she acknowledged that the regional disparities show the need for centralized certification or licensure of EMTs.
Communication breakdowns repeatedly occur among regulators and even within fire departments.
EMTs in trouble in one jurisdiction can sometimes start with a clean slate in another. One technician was suspended by Kern County for allegedly impersonating a paramedic, then managed to work and renew her EMT credential in an adjacent jurisdiction.
Paramedics have been suspended or fired by fire departments for patient-care lapses without anyone telling state regulators, as required by law.
Within the city of Los Angeles Fire Department, officials failed to alert their own medical director to instances of alleged medical lapses resulting in death.
When errant rescuers are identified, regulators don’t always move fast enough to protect the public.
A San Francisco paramedic, placed on probation after being found negligent in caring for an elderly patient who died in 1996, was later accused of improperly treating two other elderly patients who died. The state finally revoked his license last year. By then he had left for Colorado, where he now works.
Two months ago he returned to the Golden State. The reason: to teach about caring for the elderly at a continuing-education conference for rescuers. (”News to me,” said Harvey Eisner, director of the conference, of the rescuer’s record. He said he’d look into it.)
An Imperial County paramedic was accused of fraud and incompetence in patient deaths in 1999 and 2001 before he lost his license in 2004. The final straw: He was caught repeatedly falsifying a car crash victim’s vital signs. According to a state report, he told his supervisor that everyone does it.
Aristeiguieta said one reason the two cases took so long to resolve was that fire departments and regional agencies were slow to alert the state to the initial incidents. Since his arrival 18 months ago, he said, reporting has improved.
But there still “are instances when we learn of a case many months after the incident by reading a newspaper report,” he said. “That’s troubling.”
Close monitoring of medical rescuers is crucial, experts say, because they have less training than many other medical professionals. Though paramedics often receive instructions from doctors or nurses by telephone while treating a patient, records show that they can make dangerous mistakes: administering the wrong drugs, ending resuscitation efforts prematurely or failing to transport seriously ill or injured patients.
Aristeiguieta, who sits on the Medical Board of California, said oversight of medical rescuers needs to be brought more in line with that of physicians and nurses. One example: Doctors who pay medical malpractice awards and settlements of more than $30,000 must be reported to state regulators. That requirement “doesn’t exist for EMTs and paramedics,” he said.
Problems with rescuers may or may not be conveyed to fire department or ambulance officials, who may or may not report them to regional regulators, who suffer no penalty if they don’t pass them on to state officials for investigation.
“There are holes in the system,” said Glenn Melnick, a USC healthcare researcher who has studied California’s emergency system. “There’s very likely big gaps in performance that we just don’t know about.”
Times staff writer Doug Smith and researcher John Jackson contributed to this report.
