State board cites 7 Kan. responders for failing to transport patient to hospital
Though injury was deemed "incompatible with survival," bodycam footage and records show patient was alive for hours before transport to hospice
The case of the seven Kansas EMS providers facing discipline after withholding treatment for a self-inflicted gunshot to the head is as troubling as it is frustrating. It is one of those cases that proves conclusively that, sometimes, EMS providers simply cannot win. Read more as EMS Attorney David Givot, Esq., analyzes the paramedics' actions in this case, "A no-win situation: When medical director orders violate policy."
Michael Stavola and Chance Swaim
The Wichita Eagle
SEDGWICK COUNTY, Kan. — A state board is calling for an investigation of Sedgwick County EMS Medical Director Dr. John Gallagher over his handling of a Wichita suicide call in 2019, according to records released last week.
The Kansas Board of Emergency Medical Services has proposed disciplining seven Wichita-area emergency responders for failing to take a suicide victim to a hospital five minutes away, even though he had a pulse and labored breathing.
Instead, the man — who had shot himself in the head — was covered with a white sheet and taken to hospice where he died more than 10 1/2 hours after the shooting.
Gallagher went to the man's downtown Wichita apartment and decided he was "unsalvageable" and should be left to die, the Kansas EMS Board Summary Proceeding Order says. The full report has not been released because the case is still pending.
The patient was left on the floor of his downtown Wichita apartment for five hours. At times, he appeared to be in pain, "moaning loudly," the order says.
The Wichita Eagle is not naming the man because he died by suicide.
A review by the Sedgwick County Medical Society found the patient was handled properly. Sedgwick County and Wichita government agencies have hired an attorney to defend their employees' conduct.
But the Kansas Board of Emergency Medical Services, which licenses EMTs and paramedics across the state, says the patient was not given proper care. If a patient is breathing or has a heart beat, EMS protocol is to transport the person to an emergency room.
Three Sedgwick County paramedics and four Wichita Fire Department employees could be suspended, fined or have their licenses revoked by the Kansas Board of EMS for their roles in responding to the call. They have filed an appeal and remain employed by the city and county, officials confirmed.
Charges include falsifying information, disregard for patient well-being and dignity, failing to provide patient care, unprofessional conduct and not following protocol.
Gallagher supervised the call that day along with Sedgwick County paramedic Timothy Popp. Gallagher is not facing disciplinary action.
Two months after the call, Sedgwick County consolidated its EMS services and the Office of the Medical Director, placing Gallagher, a physician, as the top official in the county's EMS system.
The Kansas Board of EMS is asking the Kansas Board of Healing Arts, which licenses physicians across the state, to launch an investigation into his conduct.
Gallagher declined to comment when contacted last week, referring calls to the county's spokesperson.
The 31-year-old man shot himself just before 12:30 p.m. on June 19, 2019. He was less than a mile away from Ascension Via Christi St. Francis.
A Wichita Fire Department crew was on the scene within two minutes. Sedgwick County EMS arrived two minutes later.
A Wichita Fire Department paramedic said the man had no pulse and was not breathing, despite signs of labored breathing, body camera footage would later reveal, according to the Kansas EMS Board's order.
After one round of CPR, they found a pulse.
"Body camera footage indicates Patient continued breathing for the duration of the incident," the order says.
Sedgwick County Paramedic Timothy Popp, the on-scene care team leader, started seeking advice from Gallagher by phone seven minutes after the shooting call.
Gallagher was told that the patient had "no pulse and with snoring respirations while still breathing."
After consulting with Gallagher, the care team stopped providing treatment.
"It was an injury incompatible with survival," Gallagher said in a 2019 interview with The Eagle. "And the paramedic correctly identified that there was going to be no change in outcome for transport to the hospital. ... I went through the scenario with him and confirmed that he was correct."
About 10 minutes later, Popp called Gallagher again, reporting the man had a "strong pulse."
Gallagher said although the patient would not survive his injuries, he could "theoretically find himself on a ventilator and going for organ donation."
At 12:45 p.m. the order says that "Popp indicated that per the Medical Director (Gallagher), the Patient was 'technically code black' as his injuries had been determined unsurvivable and notes the time as when treatment would thereafter be withheld."
"Code black" means dead. At the time, the man was moving his arms, vomiting and clearing his own airway. In police body camera footage reviewed by Kansas EMS investigators, the man "can be heard groaning loudly" as he moves his head.
"This continues for several minutes with members of the care team watching and doing nothing," the order says.
Popp, 22 minutes later, called Gallagher a third time.
"Popp expressed concern at the appearance that the Patient was suffering even though they knew he was not" and asked to give the man a 500 mg dose of ketamine. Gallagher approved the medication.
Gallagher showed up on the scene at 1:32 p.m. He decided the man was "unsalvageable" and it was a "matter of time" before patient's brain stem stopped functioning.
Gallagher told emergency responders to use 12:45 p.m. as the time of death, "since that was when they decided to wait with the Patient until his vital signs ceased."
At 2:10 p.m., about 1 1/2 hours after the shooting, Gallagher asked EMS and the Wichita Fire Department to leave the man with Wichita police and "gave instructions to call him when the Patient concluded dying."
Wichita Police officers "stated they were not comfortable doing so and returned to their vehicles," according to an investigation of the incident. Wichita Fire Department EMTs agreed to stay with the man.
Gallagher cleared the call at 2:20 p.m.
At 3:03 p.m. — nearly three hours after the fire department first arrived — the man's vital signs remained unchanged. Wichita Fire Department EMT Stephen Runyan called Gallagher and asked "when they were to begin to provide care." Gallagher told him to call back in an hour if the patient's condition didn't change.
Gallagher called in a hospice team that arrived at 4:05 p.m. But they couldn't treat the patient because they didn't have the family's permission — and they didn't have any treatments or medication with them.
The hospice team eventually got permission from the family. Sedgwick County EMS came back to the scene around 5 p.m.
At 5:11 p.m., a paramedic called Gallagher and said, "the Patient was again moaning loudly and that he worried the moaning would distress the audience outside." He asked to administer another 500 mg of ketamine "because the Patient was not being managed as far as pain control."
He was concerned because "[t]here [were] also several people standing outside and we wanted to make sure the patient was comfortable while in their presence," the order said.
After five hours, the patient was covered with a white sheet even though he was still alive and carried down the apartment stairs to the ambulance. He died at Harry Hynes Hospice at 11:05 p.m., according to his autopsy — 10 hours and 39 minutes after the 911 call.
A no-win situation: When medical director orders violate policy
Should Kansas providers face discipline for not transporting a patient who was breathing?
'A very clear case'
It's unclear what spurred the state investigation, but the handling of the man's 2019 death troubled multiple EMS staff members, past and present, who were interviewed by the Wichita Eagle.
The decision to leave the man to die, and not take him to the hospital, was the last straw for Leila Durch-Anderson, a former paramedic with Sedgwick County EMS. She said she ended her seven-year stint with the county a couple of months after the incident.
"For one, if the patient has a pulse and they're breathing, they should probably go to the hospital," Durch-Anderson said. "For two, you just don't leave someone there for hours until they die."
The Kansas Board of EMS said in its order that EMS providers should have taken the man to the hospital.
"If they have a pulse and/or are breathing on EMS arrival, it is expected that full resuscitative efforts will be provided and the patient expeditiously transported to a trauma center unless that is not physically possible due to entrapment," according to the EMS protocol cited in the Kansas EMS order.
All seven city and county employees were cited for unprofessional conduct, failing to provide adequate care and failing to follow protocol. The board said they "demonstrated a lack of ability, knowledge, or fitness to perform patient care according to applicable medical protocols."
The EMS board's decision includes a list of employees and violations of regulations:
— Timothy Popp, Sedgwick County paramedic — The order notes several aggravating factors that led to a harsher penalty for Popp than the others.
As the senior paramedic on the scene, Popp "failed to perform patient care according to applicable medical protocols" and provided medical information to Gallagher that was "incomplete and/or inaccurate." He falsified patient records by claiming to have provided care he did not provide, the order says.
He was also cited for "covering Patient with a sheet during this transport as though Patient was already deceased," which the board said "demonstrated a disregard for Patient's well-being and dignity."
The Kansas EMS board has moved to revoke Popp's paramedic certificate.
— Megan Holub, Sedgwick County paramedic — The Kansas EMS board recommended a 60-day suspension for Holub, noting that she failed to follow protocols and failed to self-report the incident. She would also need to take a review course of local protocols and pass an exam offered by the medical director before being re-instated.
— Amanda Morlan, Sedgwick County paramedic — The Kansas EMS board recommended a $200 fine and ordered her to take a course and pass a test on local protocols. Her punishment is lesser than Holub's because the board found several mitigating factors, including that she was in a probationary period and provided "no actual medical care" to the patient. "However, the Board notes Respondent (Morlan) had a duty to follow the protocols even in the face of a Supervising Paramedic or Medical Director's direction to the contrary."
— Brandon Maurer, Wichita Fire Department paramedic — The Kansas EMS board recommended a 90-day suspension and a class and exam on local protocols. The report says he incorrectly triaged the patient and then failed to provide care until after EMS arrived and re-triaged the patient.
"Respondent's failure to follow applicable medical protocols resulted in Patient inaccurately being triaged as code black and was a key cause of the subsequent events," the order says.
— Stephen Runyan, Abraham Kersting and Jonathan Weber, Wichita Fire Department EMTs — The Kansas EMS board recommended a 60-day suspension for all three Wichita Fire Department EMTs for failing to provide adequate care in the first few minutes they were on the scene, noting they had a duty as an EMTs to follow protocol even if his superiors directed them to do otherwise.
The city of Wichita and Sedgwick County disagree with the state board's decision and have hired lawyer David Cooper of Fisher Patterson Sayler Smith to appeal the decision.
Sedgwick County spokesperson Kate Flavin said in a news release last week that county officials believe "competent and appropriate care was provided to this patient."
The Sedgwick County Medical Society — a committee of physicians — found the same conclusion one month after the suicide.
"It was a very clear case," Executive Director Phillip Brownlee told the Eagle in 2019. "There was no doubt that proper medical care was provided."
Last week, he again defended the findings.
"The Medical Society's EMS Physicians Advisory Committee reviewed the case shortly after this tragic incident occurred," Brownlee said. "The committee of emergency medicine physicians unanimously concluded the EMS providers delivered appropriate care."
The state board would not comment on its decision, citing an open investigation.
"Typically, the person passes rapidly in their home, and the case is closed," Gallagher said in a 2019 interview with the Eagle. "This one took a little longer, and I felt it was appropriate to move to a traditional hospice center because of that timeline."
Contacted last week, he would not comment on the Kansas Board of EMS order, saying all questions should be run through the county's Strategic Communications team.
"I'm going to follow the directions I'm given," Gallagher said, and hung up the phone.
In the 2019 interview, Gallagher defended his decision not to take the man to the hospital.
"I don't think it would have been the right thing to do to simply load him up and throw him in the hospital," he said. "And they correctly believed that what he needed was end of life care."
(c)2021 The Wichita Eagle (Wichita, Kan.)