By Colbert I. King
Saturday, February 25, 2006
Now that tributes have been paid, mourners are back in their homes and offices, and the spotlight has shifted to other matters, let's return to that Friday night of Jan. 6 in Northwest Washington, when New York Times reporter David E. Rosenbaum was beaten, robbed and dispatched to his death.
But first consider three documents.
The first is a Jan. 11 news release from Adrian H. Thompson, chief of the D.C. Fire and Emergency Medical Services Department, on "the Gramercy Street, NW Incident" -- Gramercy Street being the location where Rosenbaum was found in medical distress.
Thompson said his staff "conducted four medical assessments on Mr. Rosenbaum. At no time did he present symptoms or detectable injuries that would cause first responders to request the addition of advanced life support resources." He concluded: "Our operational review indicates that appropriate measures were taken and EMS providers met all standards of care as outlined in our protocols."
The second item is an excerpt from a Jan. 13 report that Thompson submitted to Edward Reiskin, deputy mayor for public safety and justice. I received the report in response to a Jan. 17 Freedom of Information Act (FOIA) request.
Thompson wrote: "The initial and detailed assessments showed no indication that the patient's condition should be upgraded for advanced life support. Patient assessment continued while [Ambulance 18] was en route to the scene. Oxygen was administered at high concentrations. At no point did the patient's vital signs deteriorate.
"The patient was placed into the ambulance and the EMT provider riding in the back started another initial and detailed patient assessment. [Ambulance 18] began transport of a Priority 3 (stable) patient to Howard University Hospital at 21:58:42 and arrived at 22:18:24. During transport, patient assessment and care continued. . . ."
The third item, also received via my FOIA request, is a Jan. 11 report on the "Incident on Gramercy Street NW" to Douglas L. Smith Jr., assistant fire chief of operations, in which the writer states that "following their assessments, the patient was deemed a low priority and by protocol the patient was transported to Howard University Hospital. At no time was any suggestion given . . . as to what hospital the patient should be transported."
Now join me on the night of Jan. 6. An emergency medical technician on the scene has filled out Form 151, or Patient Care Report, on Rosenbaum. A copy is on my desk.
The patient is listed as John Doe, and the date of birth, address, home phone and Social Security number are unknown. "ETOH" (the chemical name for ethanol) is entered as an assessment of Rosenbaum's condition. The form also contains this entry: "ETOH consumption. PT [patient] fond [sic] on sidewalk by E-20. PT unable to speak . . . obvious trama [sic] chest, pelvis intact . . . removed Oz mask. PT vomited numerous times. PT transported to hospital 5 [Howard University] care transferred to ER STAFF without change or further incident."
ETOH, according to Fire and Emergency Medical Services protocol, means breath assessment: "possible alcohol usage."
The same technician, as part of the examination, gave Rosenbaum a Glasgow Coma Score, which is the means of quantifying the consciousness level of patients with head injuries. The GCS, according to medical sources, is tallied between 3 and 15, with 3 being the worst and 15 the best. Rosenbaum's evaluation was a GCS total "6." According to one trauma scoring source, a coma score of 8 or less correlates with a severe brain injury.
From items filled out on the form, the report indicated that his eyes didn't open spontaneously or in response to verbal or pain stimuli, that there was no verbal response, and in the box calling for a description of the patient's skin, "pale" rather than "normal" was checked.
What's the possible significance of this? According to the Fire and EMS protocols governing clinical priority and transport decisions, a patient who is unconscious or who has a GCS below 13 and does not respond to therapy should be designated as a "Priority 1: Unstable Patient."
Instead, Rosenbaum was designated, as Chief Thompson stated, as a "Priority 3: Stable Patient" (a classification usually assigned to uncomplicated fractures, minor burns and lacerations with bleeding controlled, or seizure patients with a GCS of 15).
Rosenbaum was described as being intoxicated, deemed a low priority and was left waiting for an ambulance that was located 23 minutes away and staffed with EMTs who had limited training, even as advanced life-support ambulances with better-trained paramedics were not only closer to the scene but available when the call went out.
Yesterday I asked Thompson, through D.C. Fire and EMS spokesman Alan Etter, "Why would a patient who has been given a GCS 6 be classified 'Priority-3 Stable' and not 'Priority-1 Unstable'?" In an e-mail, Etter replied: "This incident is still under investigation and Chief Thompson will decline comment."
Would a change in priorities, an upgrade in ambulance and paramedic care or a dispatch to a closer trauma care center -- one that would not have left Rosenbaum lying on a gurney for an hour until his vomiting drew a nurse's attention, as reportedly happened at Howard University -- have made any difference? I don't know. Maybe not.
But did his treatment by the Fire and Emergency Medical Services Department meet all standards of care as outlined in the department's protocols, as the fire chief claimed? Can a camel curtsy?
And this gets me to another bit of unpleasantness that has bubbled up to the surface since Rosenbaum's death: the complaint that too much attention has been paid to a New York Times reporter's death vs. people who are dying in the District every day.
Let's get something straight: The treatment received by that beaten and robbed man on Gramercy Street was not because he was a highly respected and apparently well-connected journalist. He was handled that way because he was a John Doe thought to be drunk.
Yes, it catches my attention when someone in my profession is in trouble. But readers of this column know that the voiceless or those who get stepped on, put down or overlooked by their government also get attention in this space. See last week's column.
If, through the investigation of David Rosenbaum's death, the public can be assured that D.C. Fire and EMS will give the proper care and treatment to all John Does lying on the District's streets, regardless of where they are found, then Rosenbaum's tragic and cruel final days on Earth may have rendered an invaluable service to people who live in or visit the nation's capital.