By Daniel Beekman
The Seattle Times
A lawsuit that blamed Seattle’s emergency medical service for a 911 caller’s nightmarish wait for an ambulance and her subsequent death has been settled out of public view and before the case could reach trial.
Bitter Lake resident Pamela Hogan waited more than 10 hours for an ambulance in 2022 and died allegedly without ever receiving care. Her estate sued the city and its ambulance contractor last year on behalf of her son.
Hogan’s estate agreed to dismiss Seattle as a defendant last week and then immediately settled with the city’s contractor, American Medical Response.
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The terms of the settlement weren’t disclosed in court; lawyers for Hogan’s estate and AMR said the agreement was confidential; and Seattle City Attorney Erika Evans’ office said it had no information about the deal.
In addition to settling the case, AMR also paid for the city’s defense, Evans’ office said. The lawsuit won’t end up costing Seattle taxpayers.
But the way it was settled leaves the public in the dark about the end of a case that generated concerns about Seattle’s 911 medical system, including the use of a nurse line operated by AMR. Settlement details such as payout dollar amounts can indicate how significant or not a lawsuit’s allegations were and help policymakers determine whether changes might be wise.
Hogan’s long wait for an ambulance came after a Seattle Fire Department dispatcher transferred her initial 911 call to AMR’s nurse line. The city has exempted the line from standards requiring ambulances to respond promptly. National experts and watchdogs have said the setup should be reviewed.
Earlier this year, Mayor Katie Wilson said she was intensely interested” in the topic but declined to comment further, citing the active Hogan lawsuit.
Although the lawsuit has now been resolved, Wilson has yet to address questions about the city’s 911 nurse line and related issues. In response to an interview request last week, her office shared a written statement.
“The Mayor is grateful there has been a resolution in this case that will allow the family members of Pamela Hogan closure around this death,” the statement said. “The Mayor’s Office has followed this litigation and the media attention it has garnered. We regularly review our 9-1-1 systems and response data related to the City’s 9-1-1 services and make adjustments as needed.”
Secret settlement
It’s common for defendants in lawsuits to seek to include confidentiality clauses in their settlements, said Jason Epstein, a personal injury attorney and adjunct professor at the Seattle University School of Law .
“It really only benefits the larger player, the corporate entity,” Epstein said. “To get the ball over the line (and secure a monetary settlement for a plaintiff), we may have to agree, but it’s never something we want to do.”
Washington’s Public Records Act requires cities to disclose their lawsuit settlements. But Seattle exited the Hogan case a few hours before it settled.
That may have been “legal gamesmanship” designed to keep the settlement under wraps, said Peter Mullenix , adviser to the nonprofit Washington Advocates for Patient Safety and a medical malpractice attorney.
The possibility a city contractor could settle a wrongful death case related to a core public service without disclosure is unfortunate, Epstein said. Ideally, the courts should function to promote transparency and deter future harm when other systems fail to protect the public, he said.
“It does not serve the public in any way to have this be private,” Epstein said about the resolution of the Hogan case. “I think we deserve to know.”
There’s a delicate balance at play in the legal system, added Steve Calandrillo , a professor at the University of Washington School of Law .
“We want to allow two parties to settle privately, in order to compensate victims and avoid the prohibitive costs of trials,” Calandrillo wrote in an email. “But that also could work against the public interest by not letting everyone else know about a potential public safety risk that could/should be fixed (e.g. that ambulances might not arrive in time to save your life).”
911 nightmare
Filed last year, the lawsuit that settled last week stemmed from Hogan’s experience on April 8, 2022 , when she called 911 with debilitating knee pain.
Rather than sending an ambulance to her apartment right away, a Fire Department dispatcher transferred her to a nurse line operated by AMR.
Seattle had begun using the Texas -based nurse line in February 2022 , saying it would relieve pressure on busy ambulances and hospitals by connecting low-level 911 patients with options such as Uber rides, clinics and telehealth.
After Hogan told an AMR nurse she was trapped in bed with 10 out of 10 pain, unable to walk, eat, drink or get to the bathroom, the nurse ordered an ambulance and recommended the 71-year-old get care within four hours.
Hogan called 911 back four times that evening, but multiple Fire Department dispatchers told her to keep waiting and she never spoke to a nurse again. When she told a dispatcher she had congestive heart failure, he replied, “We are not going to play that game.”
By the time an ambulance arrived at Hogan’s apartment building, more than 10 hours had passed since her first call, it was the middle of the night and she was no longer answering her phone. The ambulance left without her, and her body was found six weeks later decomposing on the floor next to her bed.
Hogan’s lengthy wait was allowed under contract terms between Seattle and AMR that remain in place today. Until 2022, 911 ambulances had to respond within an hour. When the city began routing certain callers to AMR’s nurse line in 2022, it stopped capping and tracking their ambulance waits.
The Fire Department has said it believes the nurse line is working as intended. Elsewhere in Washington and across the country, some other cities and counties with 911 nurse lines have adopted more cautious approaches.
Contested case
This spring and summer, King County Superior Court Judge David Keenan heard requests by Seattle and AMR to dismiss the Hogan case as a whole and certain claims in particular. A jury trial was scheduled for September.
Lawyers for the city and AMR described the lawsuit as speculative, arguing there was insufficient evidence to show Hogan’s ambulance delay caused her death.
Phone records show a few outbound calls from Hogan’s phone (to customer-service and medical-clinic numbers) about two days after her calls to 911, suggesting she lived for a while after missing her ambulance ride, attorneys for the city and AMR said.
There was no autopsy and the medical examiner’s office reported the cause of death as probable heart disease, rather than the knee problem Hogan called 911 about.
Lawyers for Hogan’s estate pointed Keenan to other aspects of the story.
Hogan told the Fire Department it could break down her seventh-floor apartment door, if necessary. Instead, the ambulance crew sent to her building left the address after three minutes, apparently without seeing her.
The medical examiner’s office found receipts and food items in Hogan’s apartment dating to before she called 911 but none afterward.
Medical experts for Hogan’s estate said her immobilization during her ambulance wait likely exacerbated her heart problems and contributed to her death. Medical experts for the city and AMR pushed back, arguing the Fire Department and nurse line responded to Hogan’s knee pain appropriately.
Keenan declined to dismiss the case, saying factual issues were still under dispute. He later found the city owed Hogan a duty of care and declined to clear the city of potential responsibility for its contractor’s actions.
AI in the mix
Earlier this year, Seattle City Councilmember Bob Kettle expressed concern about Hogan’s experience and said his public safety committee would follow up by reviewing the 911 system. That hasn’t happened.
In the meantime, reporting by The Seattle Times in June revealed the Fire Department has been using artificial intelligence during 911 calls.
Since 2024, all 911 medical calls in Seattle have been screened by a Denmark -based company’s AI technology, and the AI has been prompting Fire Department dispatchers to send certain callers to AMR’s nurse line.
This happened without any disclosure to callers and without any public review until The Times reported on it, raising concerns among some legal and healthcare experts about transparency, privacy and accountability.
Wilson said her administration was working on a public framework for AI use and governance but didn’t comment on the Fire Department’s use of AI, in particular. Kettle said he needed to “do some due diligence.” He didn’t respond to a request for comment about the Hogan settlement last week.
The Hogan lawsuit highlighted “real deficits that could and should be addressed,” so its opaque resolution is frustrating, said Josephine Ensign , a professor emeritus at the University of Washington School of Nursing .
The gaps Hogan seemed to fall through could affect “any of us,” she said.
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