By Colbert I. King
Saturday, March 18, 2006
"0143-Per Dr. Wadhwa. A-18 placed oos due to very poor judgment & TX in Code # 1 Pt which was transported to Hosp # 5 as a code # 3. Per Medical Director unit placed oos members are ordered to type spec. report to Dr. Wadhwa & explanation EMS #5 Capt. Carter notified."
-- D.C. Fire and Emergency Medical Services log for Jan. 6, 2006
At 10:18 p.m. on Jan. 6, Ambulance 18, driven by Emergency Medical Technician Selena Walker, who was accompanied by Firefighter-EMT Michael Deems, arrived at Howard University Hospital with a robbed, beaten and soon-to-die "John Doe," later identified as New York Times reporter David E. Rosenbaum.
Amit Wadhwa, medical director of the D.C. Fire and Emergency Medical Services Department (FEMS), was working at Howard University Hospital on that Friday evening. At 1:43 a.m., more than three hours after Walker and Deems arrived with Rosenbaum, Wadhwa called the EMS senior duty officer, ordered Ambulance 18 taken out of service, and left word for Walker and Deems to send him individual written special reports on their handling of the patient.
The significance of the quoted entry above?
Within days of the Rosenbaum killing, FEMS Chief Adrian Thompson stated publicly that the department's "providers" -- the firefighters on Engine 20, which arrived first on the scene, and the two Ambulance 18 EMTs who transported Rosenbaum to the hospital -- had met all of the department's pre-hospital standards of medical care. As the entry indicates, on the night of the incident, Wadhwa had reached a contrary and decidedly less favorable conclusion.
He ordered Ambulance 18 taken out of service ("oos"), citing "very poor judgment & TX [treatment]" on the part of the ambulance's EMTs, Walker and Deems. They had, according to Wadhwa, transported Rosenbaum as a Code 3 (stable) patient when in fact he was a Code 1 (unstable) patient. Code 1 warranted a transfer of Rosenbaum from Ambulance 18 -- a basic life support unit -- to an advanced life support unit staffed with skilled paramedics. That didn't happen. Sadly, an advanced life support unit was only a few blocks away.
What went wrong?
I have copies of written statements that Walker and Deems submitted to Wadhwa and Thompson as well as written statements that Engine 20 firefighters -- Anthony Fields, Frelimo D. Simba, Reginald Chandler and Michael A. Roy -- provided to their superiors.
In summary: Engine 20 personnel found a patient lying face-up on the sidewalk, in an altered mental status. He was not able to speak. They claim to have examined and assessed the patient and found no signs of trauma. (Note to the D.C. inspector general: Sworn testimony on this point is most desirable.)
The ambulance with Deems and Walker arrived on the scene. In separate reports, the EMTs described Rosenbaum as "incoherent." Both Engine 20 and Ambulance 18 workers said that Rosenbaum vomited numerous times while on the ground. Deems said the vomiting episodes continued during transport to the hospital.
Despite Rosenbaum's altered mental status and the unknown reason for it, other than suspicion that he was drunk, the workers did not "collar and board" him -- that is, stabilize his neck with a cervical collar and immobilize him on a backboard. Instead they sat him up and placed him on an ambulance cot.
EMT Deems wrote: "I then asked the crew member [with Engine 20] if a collar or board was needed, he stated, no 'he is just drunk and only the cot is needed.' The cot was removed from the ambulance and placed next to the Pt [Rosenbaum]. With help from E-20, the Pt was placed on the cot sitting straight up."
The discovery of Rosenbaum's extremely critical condition an hour after his arrival at the hospital apparently concerned Wadhwa. However, he might also have been disturbed to learn that the ambulance crew had assessed and given Rosenbaum a Glasgow Coma Score of 6, a red flag that cried out for a Code 1 transport, not the lower priority Code 3 he was assigned.
My request to speak with Wadhwa, the Engine 20 firefighters and Ambulance 18 EMTs was denied by the fire department. FEMS spokesman Alan Etter wrote in a March 16 e-mail: "Because the D.C. inspector general is still investigating this matter, we cannot allow access -- through the department -- to these individuals at this time." He said that while the individuals are free to express themselves on their own terms, "all statements relative to this specific case will be deferred until the completion of this investigation."
But one participant in the Rosenbaum case did choose to express herself on her own terms. EMT Selena Walker was the crew member in charge of Ambulance 18 on Jan. 6. She stepped forward on Thursday because she said she believed higher-ups in the department were trying to single her out for blame.
In a phone conversation, Walker said that when she and Deems returned to their firehouse after dropping off the John Doe patient at the hospital, they were told that Wadhwa had ordered them taken out of service. After writing her statement for the medical director as ordered, Walker said, she was sent home on administrative leave. She considered that treatment to be unfair. Her role in the whole affair on Jan. 6, she said, was minimal.
Walker's account: Engine 20 firefighters were already there when she and her partner, Deems, arrived at Gramercy Street NW. She said she observed a "semi-conscious" man on the ground. The firefighters told her the man was drunk. Deems and the firefighters placed the patient on a stretcher.
Walker said she asked Deems, "Are you okay with the patient?" He said yes, so, she said, she got behind the wheel of the ambulance and waited. About five minutes later, Deems told her the patient was a Code 3, and she then proceeded to Howard University Hospital, where they took him to the triage desk. Walker said she went outside to smoke a cigarette. When she returned, hospital staff told her and Deems to put the patient on a stretcher in the hall.
Walker maintained that at no time did she assess the John Doe. She also declared that she never saw the Form 151 patient care report that Deems filled out. Walker said if she had known that Deems had given the patient a GCS of 6, she would have immediately upgraded him to a Code 1 and sought trauma care.
Now, pray tell: Does Chief Thompson still stand by his sunny appraisal?
Two other points:
· Walker said senior fire department officials claim she was wrong to defer Rosenbaum's care to Deems, a "basic" EMT, since she is an advanced EMT. Walker, however, told me that her advanced EMT card expired 2 1/2 to 3 years ago, and she is only now undergoing advanced EMT training. Told about Walker's assertion, spokesman Etter said Walker was an advanced EMT on Jan. 6 and her status has not changed. She is now undergoing "remedial" EMT training as a result of the Rosenbaum incident, Etter said. Her partner, Deems, completed similar training days ago.
· Phil Mendelson, chairman of the D.C. Council committee that oversees FEMS, wrote in a memo to Chief Thompson that he thought Walker transported Rosenbaum to Howard rather than to the much closer Sibley Hospital because "Howard was on the route back to A-18's firehouse" in Southeast Washington. In our phone conversation, Walker acknowledged that on the way back to her firehouse from Howard University Hospital, she drove the ambulance to her mother's house, where she made a brief stop. Walker said: "My mother lives only four blocks from firehouse Engine 18."
View all comments that have been posted about this article.