Over the years of my career in the field it was common to work as closely as possible with other agencies. This wasn’t always easy where I worked, particularly with the Sorta Big City fire department. It was easier with the Sorta Big City police department for any number of reasons. Sorta Big City EMS and Sorta Big City PD worked more closely on the streets and when I started the fire department had no interest in EMS at all. In fact, a few years before I started in the late 1970s the fire department had refused an offer from the Mayor to take over the emergency ambulance service that a recent state law had required every city to either operate or contract with someone to operate.
While EMS and PD in my city had a very good working relationship, it also became apparent than when push came to shove the police would shove us under the ambulance.
Which beings me to today’s story.
A Pierce County Superior Court judge has dismissed a lawsuit that accused local authorities of negligence after a Puyallup woman was arrested for DUI but actually had suffered a stroke. Jane Carhuff and a family representative sued the city of Puyallup and Central Pierce Fire & Rescue more than three years after her November 2019 arrest for which charges were dismissed, alleging that Puyallup police ignored protocol for DUI testing and firefighters rendered a medical opinion without the necessary expertise.
Those were the allegations, but it doesn’t seem that the case got to a trial on the merits of the claim.
As a result, the 54-year-old postal worker spent more than three hours in custody reportedly acting strangely. A day or so after Carhuff returned home and her condition — alleged to have been the product of drug intoxication — didn’t improve, her family took her to a local hospital where she was diagnosed with having suffered a massive stroke, according to the suit. The delay in receiving medical care significantly worsened Carhuff’s chances of recovery, and she continued to suffer strokes until her death in September 2023, according to the suit and her obituary.
More details of the case,
Officers identified Carhuff as the suspect and learned her whereabouts from family upon visiting her home, leading police to respond to her doctor’s office, the suit said.
The late Mrs. Carhuff was at her doctors office when the police arrived to arrest her.
The following alone should have been enough to prove the families case,
Fire personnel conducted their own medical assessment, instead of consulting with Carhuff’s doctor or taking her to a local hospital roughly 300 yards away, according to the suit. Only Carhuff’s blood sugar was tested after she reportedly referenced being diabetic, the suit said, adding that CPFR concluded that she wasn’t in medical distress but under the influence of an unknown intoxicant.
She’s in her doctor’s office, either waiting or being examined for a chief complaint of apparent altered mental status. The police and fire show up and the fire paramedics conduct and exam. No one thought to ask her doctor what he thought? No one thought it odd that a woman thought it a bit weird that that she went to a doctors office while possibly intoxicated?
The police would have said that they depended on the paramedics medical expertise, but the paramedics clearly did not do an adequate exam. Nor did the ask the doctor or his staff anything about the patient.
Here is another thing, perhaps the most important. Part of the process of obtaining a patient refusal is determining if the patient has the present mental capacity to make in informed and rational decision. That does not mean it’s one that the providers agree with, but it’s one based on an examination to the extent the patient will allow. That the results of the examination are explained to the patient. That the risks and benefits of the proposed course of treatment are explained. That the risks of refusing the propsed course of treatment, up to and including death are explained to the patient and that the patient understands said risks.
In this case a reasonable paramedic (me) would do the following.
Examine the patient as thoroughly as possible. That would include a Stroke Exam.
Ask the doctor his opinion of the patient’s condition.
Ask the patient if she wanted to go to the hospital.
Tell the police that it is very likely that she is having a medical emergency.
Without having access to the Patient Care Report, there is no way of knowing what the paramedics did other than a blood glucose level. That apparently was normal, but is only part of the examination.
The failure to do and document any of the above means that the report was inadequate, not to mention the care.
In a response filed in court, the city of Puyallup did not dispute that Carhuff had been unsteady on her feet and unable to follow simple instructions; that three EMTs who examined her had reported finding no medical problem; or that she was later diagnosed with a stroke.
Here is something else to consider. There is no rule that says that a patient can only have one condition at a time. She could have been having a medication reaction AND a Stroke simultaneously.
We’ll never know because by the time she was seen at a hospital and diagnosed the effects of the medication had likely worn off.
Even though the city and the individuals seemed to have escaped liability for what happened, it was still sloppy medicine. I’m sure there were high fives all around when the judge issued her ruling, but Mrs. Carhuff is still dead and still suffered from the time of her stroke until she died.
We’ll probably never hear more about this as it goes through the appeals process. Which is too bad as it’s a good illustration of bad EMS.