By Daniel Beekman
The Seattle Times
SEATTLE — Seattle’s mayor is interested in questions raised by a Seattle Times investigation of the city’s 911 medical system, and the City Council’s public safety chair plans to delve into how the system is working, they said this week.
Their remarks came after reporting by The Times about 911 callers routed to an out-of-state nurse line provided by Seattle’s ambulance contractor. The city has exempted nurse-ordered ambulance rides from wait-time standards and tracking, among other changes. That means patients may suffer hours-long delays without clear accountability. Experts and watchdogs have said the setup should be reviewed.
| EARLIER: Seattle patient’s 10-hour wait for ambulance raises concerns about 911 triage systems
“It’s a serious issue. We need to look at it,” Councilmember Bob Kettle told reporters during a media briefing Monday before making similar comments during a Tuesday meeting of the public safety committee he chairs.
I was not happy going through that,” he said about a Times story that described one caller’s ordeal. “The nurse line helps in so many ways, but we can’t have the situation as described in the article.”
Meanwhile, a former council member who supported the addition of the nurse line in 2022 said she’s concerned about details that weren’t made clear at that time. Also, a union official said he hopes Seattle leaders boost spending on the city’s strained 911 medical system, which is managed by the Fire Department.
“We’ve created an expectation for the people of Seattle that they’re going to get this excellent, high-quality service when they call 911,” said Kenny Stuart, president of IAFF Local 27 , the union that represents Seattle firefighters. “But we need to have an administration invest in those resources.”
Mayor Katie Wilson declined to comment on the specifics of the Times’ reporting, citing an active lawsuit against the city and its ambulance contractor by the estate of 911 caller Pamela Hogan; Hogan waited more than 10 hours for an ambulance, allegedly never got care and was later found dead.
Wilson said she’s “intensely interested in this topic,” however, and also interested in “exploring what it would look like” for the city to provide more 911 ambulance transports directly rather than through its contractor, American Medical Response.
AMR currently handles most rides, but Local 27 is interested in expanding the Fire Department’s role, Stuart said.
“From a high level, I’m interested in building state capacity,” Wilson said. “How can we not contract out to companies that provide service of questionable quality? I think there are a lot of documented problems with AMR.”
Although most people who call 911 with medical problems assume an ambulance is supposed to arrive quickly, that’s no longer always the case in Seattle, which started using AMR’s nurse line program four years ago.
For callers routed to the nurse line — thousands annually — the city’s expectations have shifted. Their ambulances aren’t subject to penalties for delays, and some people are taken to hospitals in Ubers rather than ambulances.
In the past week, The Times has spotlighted those changes and Hogan’s nightmarish experience, which was allowed under contract terms still in place.
Although Hogan’s wait could be an aberration, Seattle isn’t collecting the relevant data from AMR, so city officials have no way to know.
The city and AMR have denied the allegations in the Hogan lawsuit partly because it’s unclear exactly when she died and whether her ambulance wait is what killed her. They’ve said the nurse line is generally helping less-acute patients as intended and allowing the system to better prioritize and respond more quickly to true emergencies.
When the triage program launched, the Fire Department and AMR said it would reduce strain on busy ambulances and clogged emergency rooms by directing low-level patients to other options, like telemedicine and community clinics.
Then-Councilmember Lisa Herbold supported the nurse line for that reason, she said this week. But Herbold, who chaired the council’s public safety committee at the time, didn’t know all the details, she said.
She didn’t know that the nurses would be located in Texas, that a majority of callers routed to the nurse line would still be sent to hospitals in ambulances or that nurse-ordered ambulance rides would have less oversight, she said.
Emergency health care experts say 911 nurse lines make sense and can work but should be implemented with guardrails for patient safety. Some other cities with nurse lines have more protections against long waits and bad outcomes. For example, some have kept response-time standards for nurse-recommended ambulances and designed automatic upgrades for delayed responses.
Herbold now wishes she had known more and wonders why the relevant changes to AMR’s contract in 2022 weren’t subject to formal council review, she said. Had she known the city was going to stop tracking wait times for thousands of ambulance responses, she would have objected, she said.
The city signed a new five-year contract with AMR this past September. According to the Fire Department, long-term “blanket” contracts like AMR’s don’t normally require council approval. Herbold questioned that and said she hopes current council members will now revisit the matter.
“It just seems like you’d want that accountability and oversight because there are lifesaving services being provided,” Herbold said, describing Hogan’s experience with the 911 system as heartbreaking.
On Friday, former Deputy Mayor Tim Burgess, who served with then-Mayor Bruce Harrell from 2022 to 2025, said he believes it was a mistake to stop tracking ambulance wait times for some 911 patients. Like Herbold, he said he was unaware such contract changes had been made.
Kettle said he supports the nurse line concept because triaging is necessary and he generally has confidence in the city’s 911 medical system, including the Fire Department dispatchers who answer calls.
Still, Kettle said he was “not happy” reading about Hogan’s experience and thinks his committee has a responsibility to follow up on such concerns, the city’s relationship with AMR and how the entire 911 system is operating.
The intent would be “to ensure the pieces are all working as one would think and if there’s any tweaks needed we could go ahead and look to make those adjustments,” Kettle said in an interview Wednesday, adding, “I think it’s important to understand who knew what when. And, were there gaps?”
He spoke to Fire Chief Harold Scoggins about the issue Monday and wants to learn more, he said, adding: “We have to have a lessons-learned mentality.”
No other council members made public remarks this week about the city’s 911 health care policies.
Gov. Bob Ferguson joined AMR representatives Wednesday to sign a state bill related to Medicaid reimbursements for ambulance rides. His office didn’t respond Thursday when asked about patient safety in Seattle.
Matt Zavadsky, a nationally recognized health care administrator who managed a 911 system in Fort Worth, said industry experts reacting to the scrutiny of Seattle’s setup have emphasized the need for strong local oversight and clear expectations when nurse lines are used. They’ve said response times for nurse-ordered ambulances should be disclosed and Uber drivers transporting 911 patients should be trained for that, according to Zavadsky.
Some experts worry 911 systems like Seattle’s will likely see even more strain as patients lose health insurance due to federal policy changes.
“The reality is that we’re going to see more calls to 911 and pressure from all the players in the health care system to shunt patients elsewhere,” said Emily Brice, co-executive director of Northwest Health Law Advocates, warning about cost-saving promises made by for-profit companies.
“What happened to (Hogan) is a sobering reminder about what can happen when we believe those companies, without oversight and accountability,” she said. “There’s no quick fix to the problems that are growing in our health care system — what we need is leadership from every level of government.”
AMR didn’t reply to an additional request for comment this week.
Currently, Fire Department paramedics in red Medic One ambulances handle most “advanced life support” emergency transports in Seattle. AMR emergency medical technicians in white ambulances handle most “basic life support” rides, which are more common.
However, the council passed a new law in 2024 allowing the Fire Department to start billing patients for basic life support rides. More funding could help expand the Fire Department’s ambulance duties, Stuart said.
“We can provide the best care,” he said. “But it’s a cost decision.
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