2024 03 Monumental Mistakes in EMS BAD EMS v0.2.pdf

(note: This presentation contained videos not included in this slide deck)
Describe the elements of Negligence
Describe the concept of vicarious liability
Describe the role of anchor bias, fatigue, anger and fear in EMS decision making
Review the case of Kyle Vess
Review the case of Paul Tarashuk
Review the case of Crystal Galloway

1. Monumental
Mistakes in
EMS

2. Disclaimer
•I
•AM
•Not
•A
•LAWYER

3. Hanlon’s Razor and Clark’s Law
•Hanlon’s Razor: “Never attribute to malice that
which is adequately explained by stupidity.” -
Robert J. Hanlon
•Clarks Law: "Any sufficiently advanced
incompetence is indistinguishable from malice.”
–Fred Clark

4. It all started back in 2006
“pervasive culture of deliberate
indifference” to EMS

5. Times are
changing

6. Times are
changing

7. Times are
changing

8. Objectives
•Describe the elements of Negligence
•Describe the concept of vicarious liability
•Describe the role of anchor bias, fatigue, anger and fear in EMS
decision making
•Review the case of Kyle Vess
•Review the case of Paul Tarashuk
•Review the case of Crystal Galloway

9. “Negligence” and Malpractice?
Negligence
•a professional duty owed to the patient
•breach of such duty
•injury caused by the breach
•resulting damages.
Medical Malpractice
•Medical malpractice is defined as any act or omission by a physician during treatment of
a patient that deviates from accepted norms of practice in the medical community and
causes an injury to the patient.

10. Common Sense
•Res ipsaloquitur:
•The Thing speaks for itself.
•Essentially bypasses the 4 elements of
negligence
•The “Sniff Test” /The
“Newspaper Test”

11. RespondeatSuperior
•Vicarious Liability: “Known or should have known” an incident or problem
could, or would occur
•Negligent Hiring
•Negligent Supervision
•Negligent Training
•Negligent Retention
•Negligent Termination

12. “Willful Indifference”
•Willful indifferenceto the safety of others
means that someone intentionally disregards
the safety of others and doesn't take proper
care to prevent harm.

13. Some important terms: “Normalization of
Deviance”

14. Some important terms -Bias
•Cognitive biases in health care: Cognitive biases are flaws or
distortions in judgment and decision-making.
•More than 100 cognitive biases have been identified
•The big ones:
•Anchoring
•Diagnostic Momentum
•Framing
•Availability
•Confirmation

15. The Case of the Freeway
Firestarter
August, 2019

16. Kyle Vess Brian Cox

17. Background
•Dallas TX
•DFD Responds to a grass
fire on the interstate
•DFD arrives to find a
mostly extinguished grass
fire and Kyle Vesswalking
nearby

19. Discussion

21. Discussion

23. Does “Negligence” apply?
•(1) a professional duty owed to the patient
•Was on duty
•(2) breach of such duty
•Allegedly assaulted the patient outside of legal parameters
•(3) injury caused by the breach
•Facial Trauma
•(4) resulting damages.
•Pain, Injuries, etc

24. RespondeatSuperior?
•Vicarious Liability: “Known or should have known” an incident or
problem could, or would occur
•Negligent Hiring
•Negligent Training (and retraining)
•Negligent Retention
•Prior incident(s)
•Included falsification of documentation
•Negligent Termination?

25. Res ipsaloquitur:
•Kicking patient on the ground
•Taunting the patient
•Incriminating txt/SM Messages after the
fact.

26. The “Aftermath”
•Initially no action
•After body cam released (Sept. 2021):
•Mr. Cox was terminated (Oct, 2021)
•Mr. Cox Paramedic license was suspended ( Oct,2021)
•Mr. Cox was reinstated to DFD (Sept. ’23) on appeal
•Civil Case still pending

27. The Case of the Midnight
Rider

28. Paul Tarashuk Allison Harmon and Jamie Givens

29. Background
•Orangeburg County, SC
•OCSO and OCEMS respond to
a “Naked Man” jumping on a
Semi truck.
•OCSO arrives just before
midnight.

31. Discussion

33. Discussion

35. Discussion

36. Does “Negligence” apply?
•(1) a professional duty owed to the patient
•Was on duty
•(2) breach of such duty
•Failure to assess for /recognize potential life threats (AMS)
•Failure to transport
•(3) injury caused by the breach
•Released to LE when should have been transported
•(4) resulting damages.
•Death

37. Res ipsaloquitur:
•Inappropriate use of Ammonia Inhalants
•Inappropriate Demeaner
•Falsification of ePCR
•Described as A and Ox4
•Described as refusing to sign ePCR
refusal

38. RespondeatSuperior?
•Vicarious Liability: “Known or should have known” an incident or
problem could, or would occur
•Negligent Hiring
•Poor background checks on Harmon
•Falsification/Omissions on application
•Negligent Training (and retraining)
•Negligent Retention
•Negligent Termination

39. The “Aftermath”
•Initially no action
•After body cam released (May, 2019):
•State Law Enforcement Division (SLED) opened investigation
•Paramedic Alison Harmon terminated for unrelated incident
•OCSO Deputy Clifford Doroskistill on duty.
•Civil Case still pending

40. The Case of the Misdiagnosed
Mother
July, 2018

41. Crystal Galloway Lt. M Morris

42. Background
•Hillsborough County, FL
•HCSO dispatched
•Rescue 43 and SQ 1 dispatched
•4 paramedics total
•2 LT’s
•1 “Acting” LT
•1 FF/Paramedic

43. HCSO arrives
•Arrived shortly before HCFR
•Finds Galloway on the floor with a
complaint of “Headache and
sensitivity to light and sound” and
had a C-section recently
•HCSO advises R43 and SQ1 of this
information on their arrival

44. HCFR Arrives
•Patient now “hysterically crying” in pain.
•Vomited in presence of HCFR
•Unable to stand and walk.

45. HCFR On Scene
•HCFR Lt. Morris reports that the
patient “looked like she had a little
too much to drink” and “there was
no reason for them to transport her
to the hospital.”
•Advised the mother that if she
wanted to take her to the hospital
she could take her herself
•Did use the stair chair to help get
pt. into car for POV transport

46. POV Transport
•Mother began to
transport Galloway to
local free-standing ED
•Galloway began to have
seizure enroute

47. Possible contributing Factor
•Area of response
•Time of day
•Run volume

48. Does “Negligence” apply?
•(1) a professional duty owed to the patient
•Was on duty
•(2) breach of such duty
•Did not take vital signs
•Did not assess
•Did not recognize potentially life-threatening issue
•(3) injury caused by the breach
•Death
•(4) resulting damages.
•Loss of a mother, Loss of income, impact to the family

49. Res ipsaloquitur:
•No documented vital signs
•Left after 13 minutes
•Documented as:
•(R43) “Non Transport/No Patient Found”.
•(SQ1) ““Non-Transport/Cancel”

50. RespondeatSuperior?
•Vicarious Liability: “Known or should have known” an incident or
problem could, or would occur
•Negligent Hiring
•Negligent Supervision
•Failure to follow established policies
•Negligent Training (and retraining)
•Negligent Retention
•Negligent Termination

51. The “Aftermath”
•Responders placed on leave during 3 month investigation
•Found to be “grossly negligent” based on lack of assessment
•"[They showed a] lack of remorse," and "In some cases, even outright
arrogance.“
•Lt. Morris was terminated
•"The fact that he said he would do it again, the same way, and that he can
tell, by looking at a patient, what they need, I think is horrendous,“
•Other responders suspended 30 days w/o pay and demoted.
•Lt. Morris was later reinstates after union arbitration
•Settlement for 2.75 million (2020)

52. What have we learned?