Fraud taints paramedic licensing process in Calif.
With state oversight lagging, finding cheaters is often a matter of luck
By Andrew McIntosh
Sacramento Bee (California)
Copyright 2007 McClatchy Newspapers, Inc.
All Rights Reserved
Before Richard Clarence Brown became a paramedic helping people in distress, he engaged in a few distressing activities himself, including stealing a car in Stockton and conspiring to kidnap a child for ransom.
He was convicted of a felony, jailed and ordered to get counseling. But Brown didn't breathe a word about his dark past when he first applied for a license in 1994 from the state agency that regulates California's 16,000 paramedics.
When Brown did disclose some of his history while seeking to renew his license in 2000 — for the third time — state officials took a closer look at his training records and found they were a lie as well.
Most paramedics work hard to earn and keep their licenses by studying the latest advances in emergency medicine, taking refresher courses and disclosing past legal trouble. But others cut dangerous corners — and nobody knows just how many of them are out there in ambulances.
These unqualified paramedics hide their background and lack of qualifications in myriad ways to land and keep their jobs, The Bee found in a review of thousands of pages of state documents obtained under the California Public Records Act. They embellish training records, manufacture classes never attended, or even claim someone else's license number.
The detection of certification fraud is spotty at best because the Emergency Medical Services Authority, the 50-person state agency that oversees paramedics, says it doesn't have the resources to scrutinize an estimated 500 license applications and renewals each month.
A paramedic program coordinator at a Southern California college who caught one of the fraud perpetrators called the practice appalling.
"If he's willing to make up a document, what's he willing to do to a patient who may be my mom, your friend or a member of your family?" said Phil Rawlings, of Riverside Community College. "We're talking about protecting the public here."
Such certification fraud hit close to home last year. David Jose Martinez, who worked six years as an area paramedic — even training rookies — resigned from the Galt Fire Department last fall after authorities say they discovered he had used another paramedic's license number to manufacture a state license card.
His alleged fraud was caught only when Galt merged with Elk Grove's Fire Department, and Elk Grove officials conducted routine background checks on all of their new paramedics.
Martinez, who confirmed his resignation but declined further comment, now faces criminal forgery and counterfeiting charges. Sacramento Fire Department officials said no patients had ever complained about poor care by Martinez during the five years he worked for them.
As such fraud arises, some employers adjust their screening practices. In the Martinez case, the state also acted quickly.
EMSA Director Dr. Cesar Aristeiguieta issued a statewide alert, urging employers to check licensing records and to prosecute locally since the state can take action only against legitimately licensed paramedics. Aristeiguieta said the state's subsequent investigation indicated the Sacramento and Galt fire departments did not ask for originals of Martinez's credentials but accepted photocopies he made using a store-bought labeler.
Both the state's rapid response and the criminal charges make the Martinez case unusual, The Bee's three-month investigation found. More typical are delays in state licensing penalties and no criminal prosecution.
Aristeiguieta maintains that license fraud is not a large problem in California. Yet, despite various state safeguards on paper, responsibility for unearthing the fraud usually falls to local public health agencies, fire departments and private ambulance companies.
There, The Bee found, it tends to be uncovered almost by accident - an employer makes a background check or someone reports a colleague — suggesting that the fraud may be more extensive and the risk to patients far greater than the state believes.
Larry Karsteadt, a manager of public emergency medical services on the North Coast who uncovered a serious case of fraud and forgery after a chance remark, wonders how great.
"Is there more? I'm not sure," Karsteadt said. "But who's really looking?"
Not the state, according to former EMSA licensing technician Kevin Koroush, who said the agency is doing a poor job of policing and checking paramedic license applications.
Koroush characterized his tiny, four-person unit as swamped and said checks of paramedics' paperwork were rare. "I was overwhelmed with license renewals every day," he said.
State statistics are out of date. In the only three-year period for which official EMSA tallies were available, 1998-2000, the state discovered 60 cases of licensing and certification fraud, plus seven more cases where people unlawfully impersonated a paramedic.
In a spot review of state enforcement records involving certification fraud cases between 2000 and 2006, The Bee identified at least 17 additional cases. Many involved failures to disclose past crimes and falsified training records.
Vital training sidestepped
The required training — ranging from classroom instruction to hospital internships — is designed to help rescuers make quick life or death decisions. It includes courses in advanced life support, offering emergency care to injured children and the effects of weapons of mass destruction.
Paramedics who have engaged in fraud often blame inadequate time to get the 40 hours of continuing education required every two years, saying their heavy workloads and odd hours make scheduling classes difficult.
Brown, the Stockton felon, said he found himself working so many hours for private ambulance companies that he couldn't squeeze in the classes he needed to renew his license in 2000.
"I had heard about a lot of people falsifying their CE's (continuing education) all the time and getting away with it," he said. "That's why I tried it."
Others chalk it up to errors in judgment. David Lanning, a paramedic on the North Coast, forged signatures and submitted phony records of hours he purportedly spent doing hospital emergency room internships.
"It was bad judgment on my part," Lanning said. "I lost my whole career."
Even when the lies are caught by employers and reported to the state, retribution rolls out slowly.
EMSA's Aristeiguieta acknowledges his agency has been slow, blaming scarce investigative resources and the lack of an internal legal counsel. Until recently, EMSA was forced to rely on lawyers from the also-stretched state attorney general's office.
In late 2004, EMSA hired its own attorney, Rae DeLong, who also is a registered nurse. She is trying to eliminate a 200-case backlog, streamline investigations and accelerate the filing of professional misconduct charges.
Brown said he never expected to be caught and he did get away with it — for more than a year — until July 2001. The state asked to see proof of his course work. Brown whipped some up and mailed it in, buying himself time.
After the lie was exposed during a random check of records by EMSA, Brown's employer, American Medical Response, asked him to resign. Yet he kept his license until it lapsed in June 2002. EMSA did not start proceedings to revoke his license for two more months, finally yanking it in January 2003, state enforcement records show.
EMSA also took months to revoke the license of Lanning, once a promising employee with Del Norte Ambulance in Crescent City, just south of the Oregon border. Even then, Lanning's fraud was discovered due to a remark made by Lanning himself.
In May 2005, Lanning, then a lower-level emergency medical technician, was honored by the North Coast Emergency Medical Services Agency for helping rescue a man caught inside a commercial freezer, an award noted in the Eureka Times-Standard.
Lanning aspired for something more — to become a paramedic, enabling him to perform additional medical procedures and make more money. He got his license the following November, a day after submitting his course completion record and application to the state, enforcement records show.
But Lanning had not completed the minimum 160 hours of emergency care training in a hospital. In June 2005, just after winning his award, Lanning had started forging signatures on his internship time sheet.
Had he not mentioned it to a classmate, Lanning might still be a paramedic today, according to Karsteadt, the executive director of the North Coast EMS agency, a regional oversight body.
Prompted by the classmate's tip, North Coast officials took a second look at Lanning's time sheets and realized half of the signatures were illegible. Karsteadt said when they asked Lanning to identify who had signed his time sheets, "he copped."
On Christmas Eve 2005, Lanning's paramedic license was suspended by the state, but it wasn't revoked for seven months. Del Norte immediately demoted Lanning to an ambulance driver's job before firing him in early 2006.
Firm cleans house after fraud
Paramedic certification fraud is not entirely new. Possibly the worst California case The Bee uncovered in state records occurred in the Mojave Desert at a private company: Borax Inc., now Rio Tinto Minerals North America Inc.
In 1997, EMSA revoked the licenses of four Borax paramedics, one of them an instructor and boss, for certification fraud at the mine, which employs 600 people.
Three of the paramedics signed phony attendance records for six continuing education classes they purportedly took in 1994 and 1995, state documents show. Phony class rosters were drawn up by the paramedic instructor and submitted to Kern County for county credential renewals.
A Borax paramedic blew the whistle, triggering an internal company investigation and audit. Its findings were reported to local and state authorities, said Robert Stegall, the director of health and safety at Rio Tinto.
The mining company fired all six paramedics it employed at the time, Stegall said, adding that, "management wanted to start over." But the state didn't file certification fraud charges against the four paramedics until 1996 and it didn't revoke their licenses until Aug. 27, 1997.
At the mine, new paramedics were hired — the company now also uses paramedics from a private company — and an external medical director was retained to improve oversight. "The important thing for us was to understand what happened and make sure we had systems in place to prevent it from happening again," Stegall said.
In the best scenario, the fraud is caught before the unqualified paramedic arrives at an accident scene.
That was the case with Christopher M. Freeman of Riverside, who received a state paramedic's license in April 2004 after submitting a course completion record from Riverside Community College. State enforcement records indicate EMSA officials did not catch that Freeman's course record was a photocopied and altered version of a classmate's.
In October, the newly licensed Freeman landed a job at Emergency Ambulance in Brea. Four days later, before Freeman was assigned to an ambulance, his fraud was discovered, said Chad Druten, human resources director at the private company.
Rawlings, the community college coordinator, said he spotted Freeman's fraud after the ambulance firm called to verify he had completed the program. Freeman did take his 240 hours of classes and he passed a national paramedic certification exam, but he failed his field internship at the college, disqualifying him from graduating and getting a state license.
Covering that up "was behavior unbecoming a paramedic," Rawlings said. "It was fraudulent. It was illegal."
Rawlings reported his discovery to EMSA, which suspended Freeman's paramedic license. But Rawlings points out that he caught the lie only because of an unusual chain of events.
"It's not that common for a company to call and check on whether somebody really completed course work," he said.
When EMSA notified Freeman of the fraud allegations, he returned his paramedic's license card in the mail.
Agency finally cracks down
EMSA had been shaken by a similar credential fraud scandal that began two years earlier, one that prompted the agency to quietly enact new regulations in October 2004 requiring paramedic schools and colleges to issue course completion records that were harder to falsify.
The certificate indicated they had completed mobile intensive care paramedic training at the Sacramento-based Northern California Training Institute, owned by ambulance company American Medical Response.
Both received state paramedic licenses. Alvarez used his to land a job at the Sycuan Fire Department on an Indian reservation near El Cajon. Briceno got hired at a Sonoma fire department.
The ruse did not become apparent until Briceno applied for another job and submitted a second bogus certificate, which the prospective employer — American Medical Response in Livermore — figured out was not real.
When the company reported the forgery to the state, EMSA reviewed other certificates from the Northern California Training Institute and turned up one from Alvarez.
On Sept. 26, 2003, EMSA formally revoked both licenses. Matthew C. Freeman, Briceno's lawyer, said in a letter to the state that his client realized his actions were "inexcusable."
Though the two had exposed patients to peril and their employers to liability with what the state described as "fraudulent, dishonest and corrupt acts," no reports of harm emerged. Neither was investigated by police.
Reached by phone at his home in San Lorenzo, Alvarez said he had passed his courses but couldn't get a course completion certificate because he owed the training program money.
"I was unemployed for a year, so I took a shortcut," he said. "Hopefully the next group of people considering a shortcut will realize it's not worth it."
Alvarez even got back into the emergency medical services business, becoming a probationary emergency medical technician in Alameda County in November 2004 after initially being denied an EMT license by that county for "commission of fraudulent acts," county records show.
Alvarez's Alameda County certification expired in December 2006, said John Vonhof, a county emergency medical official. The county doesn't know if Alvarez ever worked as an EMT there, Vonhof said, because, "that's something we don't track."
Meanwhile, the Northern California Training Institute took additional steps to protect its certificates from counterfeiting, said company spokesman Jason Sorrick. The state also improved its document checks.
Out-of-state violations missed
Checking credentials across state lines is another area where problems have arisen — and where the state has been tardy in responding.
Take the case of James Campbell, who lost his Arizona paramedic license in that state in 1989. Campbell didn't mention his past career when he applied for a California license in 1995. And with good reason.
Campbell was a felon, who had stolen wallets from three patients and a colleague's credit card. Using the credit cards to rack up $8,588 in debts earned him six months in jail.
It's unclear if Campbell ended up working in California. He let his California license lapse in May 1997. California officials accused him of fraud four months later and officially revoked his license on Nov. 21 of that year.
The state did adopt policies to catch paramedics with pending criminal cases from in or out of state, including more rigorous background checks and fingerprint scans. But it did not do so until April 2004. Those more stringent background checks came too late to stop Richard Clarence Brown from getting into the business.
Brown told The Bee that he deserved to lose his license. If anything, he felt lucky to get off so easy. "Technically, the state could have taken more legal action against me," he said.
Brown now tends to broken machines, instead of people, having started a computer repair business in Stockton.
"It was all for the good," he said of the end to his career.
The Bee's Andrew McIntosh can be reached at (916) 321-1215 or email@example.com.