Witnesses: Training on newly deceased patients is 'widespread practice'

Witnesses told investigators that “tube checks” on deceased patients were “a widespread prior practice of paramedics” of the Bellingham Fire Department

For more on this topic, read EMS1 columnist David Givot's expert take on training for first responders while following the letter of the law. 

By David Rasbach
The Bellingham Herald

BELLINGHAM, Wash. — Bellingham Fire Department personnel made 15 training attempts to intubate a dead man as he lay in a body bag on the floor of the apparatus bay at Station 1, according to an investigation into the incident submitted Sept. 4 by a Seattle law group and released by the city Wednesday to The Bellingham Herald.

The report also said witnesses told investigators that “tube checks” — additional intubations on a patient after life-saving efforts have ended — were “a widespread prior practice of paramedics” of the Bellingham Fire Department.

Bellingham Fire Department personnel made 15 training attempts to intubate a dead man as he lay in a body bag on the floor of the apparatus bay at Station 1, according to an investigation.
Bellingham Fire Department personnel made 15 training attempts to intubate a dead man as he lay in a body bag on the floor of the apparatus bay at Station 1, according to an investigation. (Photo/BFD)

Sarah I. Hale, a partner at Summit Law Group interviewed 20 people — most of them in person between Aug. 15 and 16 — in connection with the investigation and reviewed documents, including training records, a redacted patient record and job descriptions before submitting her report to Bellingham Assistant City Attorney James Erb.

Hale’s report said evidence supported the allegation that eleven employees performed 11 successful intubations on an unidentified deceased patient on an undisclosed morning.

“The intubations on this patient occurred on the floor of the apparatus bay at Station 1, where a reserve aid unit normally parks,” Hale wrote in the report. “These procedures provided no medical purpose to the patient on (redacted date), as he was already deceased. Consent from the patient, a family member or anyone else connected with the patient was never requested and none was ever received.”

Steve Larsen and Aaron Wolven were the responding paramedics on the call to a nursing home for a report of abnormal breathing, according to the report. The patient had a “do not resuscitate” order that Larsen and Wolven knew about, according to the report, and the patient stopped breathing on the way to the hospital.

Witnesses reportedly told Hale that once the body was taken to Station 1 to await pick up by a funeral home, Medical Services Officer/Division Chief Mannix McDonnell gave oral approval for EMT Hunter Elliott and office employee Olivia Sund to intubate the deceased patient, even though the intubations were outside the job duties of both.

Eleven people in all admitted to having intubated the patient, according to the report: McDonnell, Elliott, Sund, Larsen, Wolven, Captain/Community Paramedic Jeffrey Brubaker, paramedic/firefighter Matthew Cook, EMS Captain Scott Farlow, accounting assistant Kristia Peschka, paramedic/firefighter Micah Quintrall and paramedic/firefighter Derik Scott.

Chief McDonnell reportedly told Hale he believed the intubations to be a “training opportunity,” and he hoped it would help him “gain information about how a newer intubation device was functioning for paramedics.”

Witnesses also told Hale that historically “tube checks” are used by paramedics to remain proficient in intubations and to meet requirements for certification. Witnesses told Hale the checks “involved withdrawing the original tube and then a second paramedic places the intubation tube again.”  The process, which is usually done two to four times, is generally quick and occurs immediately after a patient dies, Hale said. 

“These intubations are not intended to benefit the patient, but instead are a mechanism for the paramedic to practice their intubation skills and to acquire ‘tubes’ for purposes of license certification,” Hale wrote.

Hale said paramedics must perform 12 intubations within a three-year cycle, four of which may be performed on a mannequin. Intubations also are performed as part of life-saving efforts in response to aid calls, but of the paramedics interviewed, only Scott reported having sufficient intubations through call responses for certification processes.

Paramedics can practice intubations by scheduling opportunities in the hospital, the report said, or under the supervision of an anesthesiologist.

Dr. Marvin Wayne, who serves as the medical program director for Whatcom County and establishes EMS protocols for the county and ensures EMTs and paramedics are trained in accordance with the state Department of Health, reportedly told Hale he advocates for “tube checks” in certain circumstances, including deaths unlikely to be reviewed by the medical examiner and where the setting is private, such as in the back of an ambulance.

Wayne reportedly told Hale that he asks for family consent to perform “tube checks” in a hospital setting, but said it “is not otherwise routine.” Hale reported that none of those interviewed believed consent was necessary or had a practice of seeking consent prior to performing “tube checks.”

Instead, Hale reported, several witnesses said they took steps to make sure the family of the patient did not see them while attempting “tube checks.”

Dr. Wayne reportedly said that the practice of tube checking has been going on for at least 25 years and that he believes they’re important for paramedics to remain competent, saying “if someone is caring for you, you want them to be highly skilled.” Dr. Wayne said he believes other counties also engage in “tube checking.”

“Dr. Wayne’s advocacy of tube checks, and a long-standing tenure at the department, have contributed to a culture of paramedics placing a high emphasis on training,” Hale wrote.

But Hale said the intubations done in Station 1 diverged from the historic “tube checking” practice by:

  • The inclusion of two civilian office employees and an EMT/firefighter performing intubations.
  • The use of a prospective paramedic instructor to teach civilian employees and an EMT/firefighter how to perform an intubation.
  • The location and privacy given to the deceased patient.
  • The total number of intubations attempted (15) was more than the two to four (including one in lifesaving efforts) historically attempted in “tube checking.”
  • The patient was not initially intubated for medical reasons.
  • The amount of time transpired between lifesaving efforts ending and the intubations being performed.
  • The inclusion of “feedback” and discussion between participants about the intubation.
  • The use of the intubations on a deceased patient to evaluate equipment.

Two longtime officers who were involved in the incident retired or resigned, and the other nine members who admitted to intubating the patient received suspensions without pay or letters in their personnel files, depending on their involvement. One other unidentified person was also disciplined related to the incident. 

The Washington State Department of Health Center for Public Affairs Communication Consultant Sharon Moysiuk on Tuesday told The Herald in an email that the health department has opened a complaint to see if there is reason to open an investigation into the incident.

Moysiuk said Wednesday that she couldn’t comment on an ongoing investigation, even to say if performing intubations on a recently deceased “do not resuscitate” patient is standard practice throughout the fire and EMS services. Moysiuk said that until an investigation is complete, she could only provide the state requirements for paramedic recertification, listed under Table B of WAC 246-976-162 Table B.  

Several members of the Whatcom County EMS and Trauma Care Council said such actions are not part of the Whatcom County protocols for basic or advanced life support among other local fire departments.

City of Bellingham communications director Vanessa Blackburn, in an email to The Herald Tuesday, said the city is not aware of any criminal investigations at this time.

Whatcom County Prosecuting Attorney Dave McEachran told The Herald Wednesday that his office has not received a referral on the incident, but he has had a phone call about it. 

The Washington State Attorney General’s Office also hasn’t begun a criminal investigation, according to an email Wednesday to The Herald from communications consultant Dan Jackson.

“The Attorney General’s Office cannot initiate a criminal investigation on its own,” Jackson said. “It must be asked to by an agency with original criminal jurisdiction.”

Copyright 2018 The Bellingham Herald

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