Florida Fire Chief In Hot Water Over EMS Transport
The fire chief in Edgewater, Florida has gotten himself in hot water with the county EMS coordinator for ordering a patient to be transported to the hospital in a fire department vehicle rather than waiting for a private ambulance to arrive from South Daytona.
Dr. Peter Springer, the medical director for Volusia Emergency Medical Services, has suspended the right of Fire Chief Stephen Cousins to practice as a paramedic.
The chief claims his actions were motivated by an incident that occurred on January 8, 2010 when a 32-year-old woman with asthma died waiting for a delayed EVAC ambulance to arrive. In that case the Edgewater Fire Department arrived on scene within 5 minutes of the 911 call, and repeatedly asked for permission from EVAC to transport Joell Cianfrocca, but were denied. The original EVAC ambulance diverted to another run, and a backup arrived 32 minutes later.
Not surprisingly, Cianfrocca’s family filed suit against EVAC. The complaint includes the following allegation: “EVAC’s conduct in failing to timely transport, or to arrange for a timely transport of Joell when her life depended on it, was outrageous and beyond all possible bounds of decency.”
EVAC is the same provider that settled a case for $5 million last year over the handling of the birth of a premature infant.
Local officials in Edgewater are standing firmly behind their fire chief. Mayor Mike Thomas was quoted as saying “I am tired of this… We have got lives on the line.”
My question is, was this a true “load and go” situation? Yes, timely transport is essential. However, a large percent of patients can be effectivly managed for a short time. I think a suspension sounds extreme. But, like I said. We don’t know how severe the patient was.
Are you sure the medical director of EVAC can “suspend” the license of the fire chief?? In most states the medical director does not have that authority.
He took patient care as a priority over politics. I say good job chief!
Jason
She was at a doctor’s office so I assume if she was stable someone there might have objected to her being transported as opposed to waiting for an ambulance.
Sounds like there’s more going on here than meets the eye… or the headline.
Lungs
My understanding is that the doctor does not work for EVAC, EVAC works for him – under contract.
He is the county EMS director and EVAC has the contract to do all EMS transport work in the county. Florida state law gives alot of autonomy to the counties to organize EMS.
That is CRAZY I bet the med control would think diffrent had this been HIS family member! Since when is it wrong to act in the best intrest of your pt?! Way to go Chief!
Obviously there is more to the story that we are not seeing – and my suspicion is that politic is involved. With that said, I think there is prima-facia evidence that the system itself is broken there. A good set of protocols and a well run system would all but eliminate the need for anyone to have to make this type of decision!
Unfortunately, this is all about politics. But, in any case the medical director is ultimately responsible by extendinghis powers of med ctrl to us as medics without him or her we can not administer meds and this is law in every state. As for pulling his license, its his call and within the medical directors authority in every state. The thing to look at is why the license got pulled, if he did not put the patient in any harms way then this is a bit extreme, wheather there is a sole contract for transport or not and could prolly be challenged. We need the whole story. From a former state ems represntative
Sounds to me that the Chief made the correct call. I think we are having a breakdown on what’s important here, patient care. Politics need to stay the hell out of the field. I say “good job” Chief. I would have made the same choice. Hell, looks like he saved EVAC another lawsuit.
mapquest lists south daytona to edgewater as a 24 min trip. So Evac transport was 24 mins out if that makes a difference to you guys
Medical directors cannot suspend your Paramedic license…they can only take your credentials away from practicing under THEIR (MD’s) license. A medic license is given by the state of Florida, not a specific doctor; the medical directors have the ultimate authority to deny someone from practicing under their license as a Paramedic, or an EMT
I was deeply involved in this issues for the last seven years.
This is a political mess. What many of you do not know is that the medical director works for the County who just took over control of EVAC. While the Medical Director has professed to be a pro fire transport advocate he has not been strong in his support.
Volusia County has fought fire based transport for over 25 years and this is just another bad decision by a County with a history of bad decisions when it comes to emergency medical issues. All FDs were allowed to apply for Contingency Transport permits to transport patients that met qualifying protocol after the death in January 2010. It is now June 2011 and the County has and still continues to hold up the application process for any FDs that are prepared to transport. Under the agreed upon permit language the Fire transport would have been allowed because of the distance of the EVAC unit. So the Chief did follow protocol only the county refuses to acknowledge that protocol. In reality the County has created this controversy by holding up the “Contingency Transport Policy” for FDs to transport.
But! Now the County is collecting the revenue for transports so the picture gets even more clouded. There is much more to this story.
Curt you will appreciate this. Volusia County took over EVAC just to provide them with immunity coverage under the County which is capped by state law after the 5 million settlement and pending suit from last year. This county has wasted millions of tax payer dollars protecting EVAC and providing a very poor medical transportation system.
Chief
Thank you for the insight. I almost called you this morning to gain the inside story – but I appreciate you sharing it here. For those of you who don’t know Chief Weber – he recently retired from Port Orange FD, next door to Edgewater.
He was Florida Fire Chief of the Year last year and President of the Florida Fire Chiefs.
Tom – privatized EMS sounds like such a wonderful deal to the politicans – its too good to pass up. I guess the dream is coming unraveled down there. The fact that the mayor and council of Edgewater are standing behind Chief Counsins says alot.
Gotchya – I edited my phrasing from suspended his license to suspended his right to practice.
Thanks MM
Sounds like somebody wants his FD to transport and was looking to pick a fight to get it.
If the patient wasn’t dead after 32 minutes of waiting, I feel confident in saying that she as in no immediate danger. If the DOCTOR in the DOCTOR’S office felt she needed life-sustaining treatment while awaiting EMS, wouldn’t he have given it?
Just when I thought we had gotten past the “The best treatment for any problem is racing off to the hospital as fast as the ambulance will take us” days, a FIRE chief comes along to prove that dinosaurs still roam the Earth.
BH
I’ll let someone else handle you – it wouldn’t be fair.
He can certainly refuse to allow his standing orders nor protocols to apply to this paramedic..
BH
I just have to reply. First of all, contrary to what many people think or is shown on tv or in movies, most doctor’s offices are NOT equipped to handle true medical emergencies… they dial 911. Most have little more than and AED and basic first aid items.
Second, ask anyone in the EMS community and they will tell you, the HOSPITAL is not only the BEST but the ONLY place for you to be when having a true medical emergency.
Third, 32 minutes to wait on an Ambulance is unacceptable to anyone. This “dinosaur” aka WISE CHIEF made the right call by getting the patient to the hospital ASAP.
I am gonna go out a limb here and say that there was much more than meets the eye to this. But let me add a wee twist: let’s say the person was transported in the FD vehicle and the vehicle got into an accident or didn’t get to the hospital “fast enough”. Wouldn’t the FD the be on the hook? Being that they transported in a vehicle that was NOT licensed as such? Having said that I actually would say the Chief made the right call.
It’s the Med director for the county not for the private company
@ BH I think you need to read the story AGAIN. The lady did die because of the original unit being re-routed and waiting on another unit 32 min away(if i have read it right as well) Dont think this is one of those situations. I think the Fire Chief did what he was suppose to do, shame on the MD for Volusia County for suspending his license. Great job Chief
I work for a private ambulance service and this is a good topic. There is contention as to whether a sending facility is a higher level of care just because there is someone of higher training present. ie; Md or Rn. Can they dictate the priority of response and or transport. When the patients safety is in question who does the responsibility fall on? If there was a Md on scene and he approved the transport method then whats the issue? However, on the same note. We don’t know what their protocols dictate. This may have been a violation of protocol issue. I believe pt safety should always prevail.
Sorry, I missed an earlier comment. So it is a protocol issue. That sucks. pt care should always prevail. When you allow government polotics to dictate pt. care this is the types of problems that will always arise.
In my stretch of the woods, in Northern NJ, a woman died after waiting 45 min for an ambulance, the EMS chief (who incidently has zero medical certification, was powerless to do anything to help the woman. If there is no Bus available, and someone’s life is in danger, screw the system! A life is worth more then protocol! Beside, if you save one life, its like you’ve saved the world -Jewish scripts.
PGS – good point. There certainly is the potential for liability if the FD vehicle gets in an accident transporting the patient, or the patient codes, etc. etc. etc. No doubt. I am not sure that is enough to change the decision one way or the other but clearly it is an issue.
As I was reading your post – alot ran through my mind – and Alameda was one of the things. If you act when you’re legally not supposed to (Edgewater) you get in trouble, and if you don’t act when you morally should but legally your not supposed to (Alameda) you get in trouble. You can’t win.
Would the chief have been better off to allow the woman’s daughter or husband to drive her to the ER? Again, shades of Alameda where a civilian can do what a trained professional cannot….
Do we have too many bureaucratic strings – all well intentioned – but strings none the less – trying us in knots?
This pt was transported fairly quickly no 32 min wait… That pt did die upon arrival at the hospital. The chief said the previous 32 min wait and death influenced his decision. The transport unit was en route from 24 mins away. The county changed the protocol after the death last year but all the paperwork actually approving contingency fire transport is not out of the way yet.
Bottom line is Evac is a county run entity and the don’t want to lose out on funds generated by transport. They have sandbagged the process. The MD is the VP on evacs board. Conflict of interest? The county chairman is also on the evac board. The monopoly must stop and this Chief may be the one to finally say enough is enough. Good job chief!
If our medical directors wanted us to do nothing more than run people into the ER real fast, I have a hard time believing they’d give us 30-40 medications and $25,000 monitors, but that’s just me. The research doesn’t even support rapid transport for trauma, nevermind your average diff breather. Stroke and MI is pretty much it for the Pick Up/Haul Ass model.
As for the doctor’s office issue, I’m not suggesting they can or should be doing surgery or running codes, I’m not a moron- but I’m willing to bet they’ve got a box of albuterol and a couple amps of epi 1:1000 around somewhere. I responded to my own PCP’s office one day to find them starting an IV and drawing up Lasix. I’m pretty sure they could have managed if we were delayed.
Here’s my questions:
Why would a doctor allow a patient to leave his/her care in a fire department vehicle and risk his/her liability if the patient could wait? To help the firefighters prove a point? To make EVAC look bad? Does that make sense on any level? Would you risk it? Let me rephrase – under what circumstances would you risk it? Certainly not to prove someone else’s point! It would have to be pretty dire.
Why would the fire chief risk his career and run the liability risk for him and his department if the patient could wait? To prove a point? Think of the things that could go wrong if he plays that card unnecessarily – an accident, the patient codes enroute…
Why are the mayor and council squarely behind the fire chief and not distancing themselves from his “reckless” decision?
Why won’t the county address the concerns that local officials have about EMS? It didn’t happen overnight. The lawsuits against EVAC are not the problem – they are a symptom of the problem. Money and power have trumped lives – and that is a shame. We all bring our biases into this discussion – but at some point you have to admit something is not right here.
As for a paramedic thinking he’s God’s gift to the world, capable of saving anyone anytime – that the ER can wait til he’s good and ready to deliver his patient, that attitude will catch up to you. Call it karma, call it what ever you like, but it will catch up to you. And for you I would suggest good liability coverage along with Prepaid Legal Insurance – see the sidebar (how’s that Tim!!!!)
livesb4politics
This Edgewater situation may prove to be a valuable case study for fire and EMS leaders to pay attention to. There’s money issues, power issues – and you are right, serious conflict of interest issues. My recollection is Florida has some no-nonsense confict of interest laws, and one would think a high ranking county employee would have to be attentive to them.
BH,
Your thoughts are very misguided. I was wondering if you knew how many primary care physicians actually have medications to treat severe respiratory problems or cardiac issues in there office. It is not common practice and that is why they call 911. As to your reference of the patient not passing away in 32 minutes, I can only say that you are not firefighter or an EMS provider. Not with a heartless comment like that or maybe just new to the field. I can tell you have never had to work a patient in cardiac arrest with the family watching hoping for a miracle. I am close to both of these calls and others not mentioned. You only have a small portion of what the EMS system is in this county.
Curt you don’t know the half of it when it comes to conflicts. The medical director is currently the Vice President of Evac. The current county manager, assistant county manager, County Director of Ems, and county council chair are all on the board of directors of Evac. The medical director and ems director are the ones who are currently responsible for investigating these types of situations. The ems director never notified the state about the 32 minute response whetting patient died. This time the patient stabilized and transported with a good out come and a letter is fired off to the state by the ems director in no time. This is what fire medics are dealing with in Volusia County. Most of us are afraid that we are going to be singled out for that reason.
I agree, I bet Evac charged them anyway, they charged my father for just showing up at his house. Edgewater fire rescue worked on my father and he was not transported, Evac never touched my father but sent a bill for over $500.00 anyway. I asked for an appeal and was denied. My father passed away shortly after, so needless to say, they were told to go to the grave and collect.
Sounds they they should have been defendants in the Joell Cianfrocca lawsuit. Perhaps they would have gotten the message, because it certainly does not appear they get it now.
As others have mentioned, way more than meets the eye here. I also believe that some of the posters are confusing two separate but similar incidents.
The pt. of the most recent incident (according to the articles) was having an MI and ultimately underwent open heart surgery a day or so later. The FD vehicle was also an ALS transport-equipped unit (for contingincies as Chief Weber mentioned), not an engine/ladder/etc.
I don’t have an solid opinion either way, as I wasn’t there and only know what I’ve read (who knows how accurate that is?), but liked the discussion and wanted to share regarding your above considerations.
Regarding the doctor risking liability letting the pt. leave in an FD vehicle, she had a pt. having an event, requested help, and made a decision based on the info. at hand. I don’t think she had any motive other than to get her pt. further care.
Regarding the fire chief taking on the risk and potential consequences, regardless of motives, I think it was smart on his part to assume pt. care for two reasons. First, he put the responsibility where it belonged, at the top (“I’m the Chief, I did it, talk to me.”) Second, him losing his ability to practice in that county has little effect on his community or service delivery. Think about it…if a line member had recieved that consequence, his community would have one less medic on the streets. With the chief being an administrator, daily operations stay the same…no dropping a unit, no OT costs, etc.
It will definitely be interesting from a legal standpoint to see how this all plays out.
Thanks for the input Nate
BH, if that is the case, then it would not have hurt to let the FD transport the patient as a simple customer service.
You are making a huge unfounded assumption here. There is no evidence that the fire chief believes that the best treatment for ANY patient is “racing off to the hospital”, let alone this patient. However, there is no evidence that letting a patient sit on the scene waiting on Ambulance B when Ambulance A is already there is a good thing for any patient or for the system as a whole.
EMS is supposed to be about the evidence. You have none to support your generalizations and unfounded assumptions. I’m throwing the B.S. flag on this one.
And now the FD has apparently taken this incident and used it as cause to buy the most ridiculous fire apparatus ever devised:
http://www.braunambulances.com/Showroom/RecentDeliveries/2011VolusiaCountyDelivery.aspx
No matter what side of the issue you were on before, you have to admit that this is a crime against nature.
I believe those rigs were purchased by the county not the Edgewater Fire Department.
They are…. different. Even though they have pumps they won’t meet NFPA 1901 as engines.
Actually – thinking about it – what do they do if they arrive first at a fire with people injured? Deploy hose lines and forego transport??? Stop a block away so they don’t get blocked in???
Heck – why didn’t they throw a small aerial device on the roof????
You medical director can remove your ability to practice as a Paramedic under his direction. This can be for failing to meet his training requirements or for whatever reason if he feels you are meeting his standards. Getting a Paramedic certification with a state is an easy process and it is up to the medical director to ensure quality care is provided. This guy could still work as a Paramedic under another medical director somewhere else even while he is suspended here.
He Transported the patient – now he is in trouble…
If he sat there for 30 minutes, and didnt transport the patient, he would have been in trouble.
Politics – County Politics !
Don’t now the whole story but sounds like the chief made the right decision. There is no reason you should have to wait 32 min for a ambl. If it takes a fire unit that long to respond they are in trouble. The chief made the right call maybe they should look in to the ambl instead of trying to hang the chief.