On the surface this story looks incredibly bad. Here is one headline from the Journal of Emergency Medical Services, and industry trade magazine.

Two New Bedford Paramedics to be Disciplined for not Continuing CPR

A little careful reading of this article and the one from The Boston Globe will reveal that despite the misleading headlines, the issue appears to be documentation more than it is of inappropriate or inadequate care.

So, let us look at some of each of the articles and dissect what is written.

First though, come the verses of full disclosure. I know three of the people involved in this situation. I’ve worked with two of them at various times and observed the third at work on both an ambulance and in a hospital emergency department. I’m going to try to keep both my opinions of the people involved and my usual snarkiness out of this post.

First from the JEMS article.

A state investigative report found the paramedics, Rosemary Nunes and Ivan Brody, violated state protocols during a December 2008 emergency call by failing to perform cardiopulmonary resuscitation on a baby in cardiac arrest and then inaccurately recording the details of the call.

In EMS it’s almost a cliche that if something isn’t documented, then for all practical purposes you didn’t do it. Lawyers I know who have litigated this type of case say that often they have to settle because the paramedic either failed to write a report (required by state law) or did such a poor job that they might as well not have written one. On the other hand, a well written report has saved many a paramedics bacon when a complaint was lodged.

The issue here is that the state has no choice but to conclude that the decision was incorrect because the rationale for not performing CPR was not documented. Hence the use of the term “inaccurate”. Incomplete or inadequate could probably have been used as well. What was not found was fraudulent, misleading, or untruthful. Any of those would have been far more serious and required more severe penalties.

Also from JEMS,

In December, the city immediately reported the CPR incident to its contact at the state Department of Public Health, Lang said.

At that time, the consensus between the city’s Emergency Medical Services department, its medical director at St. Luke’s Hospital and its contact at DPH was that the incident could be appropriately addressed through remediation training, according to Lang.

Here, it appears that the city was at fault for not promptly reporting the incident in writing. This again leaves room for the person from DPH to deny that he or she was ever contacted. Once again, poor documentation causes problems.

Note also that the initial recommendation was for remediation. Unfortunately, remediation for what isn’t reported in the article. It could be remediation for making the incorrect decision or remediation for not documenting completely. I’ll hazard a guess that it’s the latter since the former likely require more serious action.

Continuing from the JEMS article, quoting the Mayor Scott Lang,

“For some reason, the December incident was not regarded as an incident that would lead to action by me, the solicitor or DPH for that matter, including by DPH,” he said. “That’s the disconnect I want to find out about.”

I would say that the reason was because no one considered this a serious breach of duty or protocol. Again, this points me towards documentation being the issue, not improper care.

One last quote from JEMS,

Pimental’s letter, which he sent first on March 24 and then again on April 7, discussed the December incident and the state investigation.

Pimental first filed a written report of the incident with EMS Director James Trout the day it occurred.

So, [Tom] Pimental filed a report with his boss when the incident happened, which is correct. Whether or not his boss should have notified the Mayor’s office is a different issue. I do have to wonder why he sent two other letters directly to the Mayor after he was laid off? Was this something that so troubled him that he felt compelled to continue to follow up even after he was no longer employed? Or was it just trouble stirring because he was angry at being laid off? No real way to know, but it’s something that has to be considered.

From The Boston Globe article,

But the DPH said neither paramedic made the required medical analysis on the child to make sure the infant had died before they decided to withhold CPR.

The paramedics first needed to check the child for signs of rigor mortis, body temperature, lung sounds, and reaction to light, the DPH said.

“There is no evidence that this patient met the criteria for (paramedics) to withhold or cease CPR efforts,” the DPH concluded. “There was no Comfort Care/DNR verification form, no trauma inconsistent with survival. and no body condition clearly indicating death.”

The bold emphasis is mine. Evidence in this case would be the report, which as I said appears to have been incomplete. Without reading it there is no way for me to know what they did or didn’t document, however obviously someone who did read it felt that the documentation was inadequate at best.

Is the state meting out discipline for improper care or for improper documentation of what may well have been a proper decision? It would seem to be the latter, but a 30 day suspension of certification seems more than a bit harsh.

Finally, I don’t have a lot of kind words for the Mayor. He seems determined to hand out some sort of discipline, even though he appears not to know what why he doing that. Seems like typical CYA governing to me.