Substance abuse rises among paramedics in California, putting the public at risk
By Andrew McIntosh
Sacramento Bee (California)
Copyright 2007 McClatchy Newspapers, Inc.
All Rights Reserved
Paramedic Michael Carey, high on drugs and in desperate need of money, arrived at the accident scene on a highway near Modesto to find a 72-year-old woman in the car, bloody and unconscious.
Searching for identification in her purse, Carey came across the thousands Cleotilda Maria Arroyo had saved to purchase a house in Mexico — a powerful temptation for a man whose struggles with alcohol, pills and bills had left him bouncing checks, even for his state paramedic license.
Carey called for an air ambulance to fly Arroyo to the hospital and pocketed $6,100 of her cash.
With that brazen theft in June 2005, Carey joined a growing number of California paramedics, under stress with easy access to medication, who are abusing drugs and alcohol, statistics show, putting patients at risk.
In the worst cases, they are committing crimes, too: Driving drunk or high. Getting into hit-and-run accidents. Abusing patients. Stealing. Even injecting the powerful morphine they carry, replacing it with a saline solution and giving that to victims in pain.
Though the number of paramedics caught is not high, the stakes are because they treat people at their most vulnerable.
Margaret Ong, the recently retired emergency medical services manager for the Sacramento Fire Department, said cases like Carey's call for urgent action.
"We need to identify substance abusers and get them out of the system," said Ong, a former U.S. Navy nurse. "They are a danger to the public and a danger to society."
In the last two years, the state agency charged with monitoring and prosecuting substance abuse by paramedics has logged more than 65 drug and alcohol cases — up from only eight cases in 1999-2000, according to enforcement records obtained under the California Public Records Act.
The Bee's investigation included thousands of pages of California paramedic enforcement records, court and enforcement documents from other states, and dozens of interviews.
Yet official statistics represent a fraction of the cases because employers are not required to report paramedics who take medical leaves for substance abuse treatment. Others, The Bee found, are forced to resign and still more are never discovered.
The Sacramento Fire Department's months-long investigation of the theft of morphine from 43 sealed vials, for instance, ended in December with no perpetrator officially identified, though a captain retired rather than answer questions.
The 50-person state Emergency Medical Services Authority in Sacramento is struggling to keep up with the increased cases. A four-person unit there is responsible for enforcing all rules for the state's 16,000 licensed paramedics, who work for public agencies, private ambulance firms and even far-flung mining companies.
At the end of last year, 31 California paramedics were on probation for alcohol or drug problems, and another 18 with a history of substance abuse were working under provisional licenses. Yet before a recent internal shuffle at EMSA, a single state worker was responsible for overseeing such tricky cases — part-time.
Concerned about the trend, Dr. Cesar Aristeiguieta, EMSA director since 2005, recently began requiring paramedics arrested on suspicion of drug or alcohol-related offenses — even off-duty — to be evaluated by an addiction specialist. He wants to "intervene early on, try to salvage people's careers, and assure public safety."
These medical first responders — the heroes we count on to reach the scene first when we are at our most vulnerable — tend to be the last to seek help for themselves.
Former paramedic Richard Rolston recites a rescue professional's credo that turns dangerous for those with addictions — and those they rescue: "I can fix anything and everyone, including me."
Such bravado failed Rolston. During his 20-year career, he brought ambulance service to the 22,000 residents of the scenic Big Bear resort community in Southern California. He also suffered from pancreatitis and, for nearly a year, numbed his pain with at least 350 vials of morphine stolen from his fire department's safe, according to court records.
Strung out, Rolston, 47, turned himself in and recently completed a prison sentence for grand theft and forgery.
Growing problems unheeded
Michael Carey's case offered plenty of unheeded warning signs, state enforcement records show. A month before he responded to Arroyo's accident, Carey, then 42, could not be roused at work to answer an emergency call.
Three days after stealing Arroyo's money, Carey showed up for duty reeking of alcohol and his employer, Riggs Ambulance Service, called police to give him a Breathalyzer test. According to the state's enforcement files, he registered an alcohol level almost twice the legal limit.
Instead of being arrested or put on leave, however, Carey was sent to a hotel for the night. His license was not revoked for good until he was arrested for grand theft after a five-month police investigation. He was sentenced to six months in jail, but served just 10 weeks.
Carey told The Bee he was working 90 hours a week as a new Riggs employee when he stole Arroyo's money and that he was having marital difficulties and raising a premature baby with health problems. The day of the accident, he was abusing the anti-anxiety drug Librium — commonly prescribed for alcohol withdrawal. The alcohol and pills, he said, had become a form of escape.
"I was mentally, physically and emotionally exhausted," Carey said. "My addict thinking took over: One pill is good, 10 is better."
Rolston was addicted, too, but he managed to hide it by replacing the drug with saline and tap water and falsifying drug log books. Even his wife, Sonia, had no idea he was an addict.
"If my husband can become a morphine addict and thief without me even noticing, it can happen to anyone," she said.
Rolston agrees. "For every one you catch," he said, "there's probably another 100 out there."
Morphine theft by paramedics has become a perplexing problem across the country, with recent cases in at least 17 other states. A review of more than three dozen morphine theft cases by The Bee found that lax narcotics storage, tracking and security policies facilitated each of the crimes. The cases, two-thirds of which occurred in 2005-2006, were identified through public records requests, online searches of state enforcement records and news reports.
A fifth of the cases The Bee examined were never solved. As with Rolston, the stolen drugs usually were replaced with a saline solution to avoid detection. In several instances, such as that of a Fort Wayne, Ind., paramedic — charged with theft in December 2006 — patients were injected with saline instead of the genuine painkiller.
In one large case, New Jersey paramedic David Strous stole at least 10,521 milligrams of morphine — the equivalent of about 1,000 vials — before he was caught and stripped of his license in 2000, according to state paramedic disciplinary records. Reached at his home in Delaware, Strous declined to comment or discuss his case, other than to say he was never prosecuted for the theft.
A potential public threat
More so than other addicts, paramedics harboring addiction problems pose a threat not only to themselves and their families, but potentially to the public.
William and Arleen Yaley lost their 26-year-old daughter, Mollie, after a June 2002 diving accident at San Carlos Beach, a lick of sand near downtown Monterey. Today, they are haunted by the possibility that the two men dispatched to save her may have been high on drugs.
Mollie Yaley became separated from her diving partner after getting tangled in kelp, according to police reports.
Other divers found her limp body in 20 feet of frigid water and dragged her ashore. Problems with the county 911 system delayed the ambulance dispatch by 12 minutes, and paramedic Bruce Faucett and emergency medical technician Alfonso Martorella took another 10 minutes to reach the beach.
Neither took Yaley's temperature, according to records in her parents' subsequent lawsuit. The rescuers stopped trying to revive her after 20 minutes, though they had not received the required doctor's approval.
When Faucett did call in to the emergency room at the Community Hospital of the Monterey Peninsula, a doctor ordered him to restart his efforts and wrap Yaley in warm blankets. As Yaley warmed up, her heart began beating. But she lapsed into a coma and, four days later, her parents took her off life support.
The Yaleys' wrongful death suit against Faucett and Martorella's employer, American Medical Response, took an unexpected turn when Martorella alleged that the two shot heroin the morning of Mollie Yaley's diving accident, court documents show. Though Martorella later recanted his statement, and Faucett denied it, the two have had documented problems with drugs and erratic behavior.
Martorella was a cocaine user, court records showed, who was convicted of more drug-related crimes after Yaley's death. He and Faucett both took medical leaves to undergo drug addiction treatment in 2003, personnel records show.
A few months before the failed Yaley rescue, AMR suspended Faucett for a day for "erratic, irrational or otherwise inappropriate behavior," documents show, after a dispatcher complained he had threatened her.
In late 2005, the Yaleys accepted a $250,000 settlement from the ambulance company — the maximum available under state law. Neither the company nor its employees admitted any negligence, saying Monterey County did not then have a protocol for treating cold-water drowning victims.
The Yaleys created college scholarships in their daughter's name for high school students in Mariposa County, where they live. They have never publicly discussed Mollie's death and declined to do so for this story.
"For them, it's a pain that will never go away," said their Walnut Creek attorney, Brian Evans.
Evans said he is haunted by the state's handling of the case. A state EMSA investigator called him, he said, but asked only a few brief questions. The agency, he charged, has never fully investigated Yaley's death or drug abuse allegations.
EMSA director Aristeiguieta said the agency did examine the Monterey case, but the investigation proceeded slowly, in part because Faucett failed to respond to a written request for records.
After The Bee started asking questions about the Monterey case, however, EMSA filed professional misconduct charges against Faucett — who now works as a massage therapist — for drug and alcohol abuse and erratic behavior.
Kevin Koroush, who worked at the agency as a licensing technician during the probe into Yaley's death, described the enforcement unit as overloaded and understaffed.
"They can only catch so many cases because they are so short-handed," he said.
Meanwhile, the cases multiply because of job-related stress among paramedics. Over the past decade, an emerging body of research has shown paramedics face a higher risk of becoming drug abusers or alcoholics than ordinary citizens because of the life and death work they perform, erratic hours they work and horrors they witness.
Cheryl Regehr, a professor of social work at the University of Toronto, surveyed 86 veteran paramedics and found many deeply troubled by tragedies. One recounted his grief over a child whose throat was slit by his father. Another cited recurring nightmares of a suicidal woman diving off a building, again and again.
Ten of the paramedics Regehr studied reported abusing alcohol following such incidents, almost a third took mental health leave and one in 10 went on medication, according to her study, published in the American Journal of Orthopsychiatry.
Helping others, himself
Richard Rolston saw many horrors and saved many lives during his career in Big Bear. He ensured paramedics there had advanced training and modern equipment. He set up a low-cost ambulance insurance program for the poor. His work was recognized with a national award in 1996 for outstanding contribution to the development of rural health care.
Though in constant pain from pancreatitis triggered by a diseased gallbladder, he racked up $32,000 in unused sick leave. On one bad day, Rolston said he looked at the expired morphine in his work safe and thought, "I've helped a lot of people for 20 years. Now I can help myself and relieve this pain."
Fast addicted, Rolston began covering his tracks — both the missing morphine and the marks on his arms from daily injections. He refilled the morphine vials with saltwater and took to wearing sweaters.
"I thought I could control it and wean myself off it," said Rolston, who started injecting Benadryl from his fire department's ambulances to manage his withdrawal.
Rolston eventually fell apart and turned himself in, pleading no contest in February 2006 to charges of grand theft by embezzlement and forgery. What happened next divided his tight-knit community.
The sentencing report, filed by probation officer Mike Paganini, accused Rolston of playing Russian roulette with the lives of residents. Letter writers to the local newspaper, the Grizzly, agreed.
San Bernardino Superior Court Judge Robert E. Law sent Rolston to prison for 16 months, saying he had abused the public's trust.
A faction of Big Bear residents came to Rolston's defense. Pat Miller, who has lived there 12 years, called it a travesty of justice.
"He put himself on the line, day after day, week after week, month after month," she said. "For those who turned their backs on him when he became so ill, I don't understand it."
From his cell, Rolston blamed no one but himself and wishes he had sought help earlier. Now out of prison, after serving 10 months, he thinks tougher checks and balances are in order.
Rolston advocates random drug and alcohol testing of paramedics and annual training in managing stress and preventing substance abuse. He also wants the state to tighten narcotics control requirements for ambulance companies, cities and counties.
His wife, Sonia, wants that too, especially because two of the couple's sons have become paramedics.
"What I care about now is that all paramedics ... are safe and have the tools necessary to protect themselves," she said.
Drug tracking varies
Internal controls are far from uniform in California, The Bee found. The Sacramento Fire Department, for instance, upgraded its approach only after the contents of 43 vials disappeared from duffel bags on firetrucks. Its new system stores drugs in metal strongboxes that open with a personal identification number.
Like other agencies, Sacramento Fire initially was reluctant to acknowledge it had a problem. Officials suggested seals had been broken on its morphine vials by excessive handling or heat.
Such denial is familiar to the founders of Protelligent Inc., an Irvine-based technology firm that has found little interest in its system to help fire departments and ambulance firms keep track of their narcotics.
"The perfect solution has been developed for a problem that nobody wants to admit exists," said Roy Bettle, the company's operations director.
Potential clients have made clear, Bettle said, that an order would prompt a delicate question from their bosses: "Have we had a problem?"
State-of-the-art enforcement case-tracking systems at the state level would help keep problem paramedics out of ambulances. Yet EMSA's software cannot adequately monitor its own enforcement efforts, not to mention link up with those of other law enforcement agencies.
That lack of cross-referencing contributed to Michael Carey staying on the job long after he was under investigation for stealing Arroyo's money.
Following the June 2005 accident, Carey's paramedic license was temporarily suspended — but for his alcohol use, not because of the theft investigation. In July, Carey said, his estranged wife, Traci, reported his theft to police.
But EMSA didn't know. So, after Carey sought treatment, in August he signed an agreement with the state regulator that allowed him to return to work in October on probation as long as he agreed not to drink alcohol.
After a surprise Breathalyzer test at the start of a 6:30 a.m. shift on Oct. 24, 2005, detected a 0.03 blood alcohol level, the state suspended his license again and started revocation proceedings.
Aristeiguieta, the EMSA director, said it was not until mid-December that year — after Carey was arrested for the June theft by Merced County sheriff's deputies on suspicion of stealing Cleotilda Arroyo's money — that his agency became aware of his crime and yanked Carey's license for good.
The Bee's Andrew McIntosh can be reached at (916) 321-1215 or email@example.com.