Legal Review & Commentary: Ambulance errors lead to $10.2 million settlement
News: While in route to a 911 call from the home of an infant experiencing febrile seizures, a dispatched ambulance became lost. Once it arrived on the scene and packed the infant for transport to the hospital, paramedics were instructed to administer a controlled substance. Then they discovered they did not have the key to their narcotics cabinet. The plaintiffs claimed that the series of delays resulted in permanent brain damage. The ambulance company settled for $10.2 million.
Background: An infant developed febrile seizures due to a high fever and her parents called 911. An ambulance was dispatched, but it got lost in route and was delayed by approximately 13 minutes. Upon arrival, the paramedics assessed the infant as being hypoxic with a 78% blood-oxygen level.
On the way to the hospital, paramedics were advised to give Valium to the infant to control her seizures. However, the paramedics were unable to comply with this instruction because the key to the narcotics cabinet had been forgotten. Another ambulance was dispatched to intercept the first ambulance so that the Valium could be accessed. This resulted in a delay in administering the Valium of approximately 10 minutes.
Once the infant arrived in the hospital, she was diagnosed with profound hypoxic ischemic brain injury. The plaintiff alleged that this delay in transporting her to the hospital and in administering the Valium resulted in oxygen deprivation for at least 40 minutes, which led to the permanent brain injury and spastic quadriplegia. These conditions require the use of a wheelchair and gastrostomy tube for feeding. The plaintiff is unable to walk or talk and is completely dependent upon others.
The defendant ambulance company countered that any delay in administering medication did not effect the outcome and that the plaintiff’s seizures could not have been controlled outside of the hospital setting. Further, the defendant rebutted the plaintiff’s life expectancy and projected cost of care; however, the ambulance service provider ultimately settled prior to trial for $10.2 million.
What this means to you: While this scenario involved a pre-hospital provider, many health facilities are in the business of providing ground and air ambulance services. As participants in the emergency medical services (EMS) arena, hospitals may find themselves faced with the errors addressed in this case. It is a difficult reality when the public EMS providers or the organizations they have contracted with are unable to find a patient when they are in need of immediate medical care. The public is counting on EMS not to get lost, but when they do and the directional error is compounded by additional errors in the delivery of health care, settlement is usually the chosen route.
"While this tragic case was settled prior to trial, one of the major issues could have been resolved [although expensive] to avoid this situation. Ambulances can now be equipped with a GPS system [the newer ambulances have this as a standard feature] to guide the driver to the exact location," notes Lynda Nemeth, RN, MS, JD, director of quality/risk management at Norwalk (CT) Hospital. "For many ambulance services, there are maps that have been divided into grids for each section of a city/town, and the second EMS staff person locates the address and directs the driver to the specific location. Furthermore, in many towns, either the fire department or the police department are designated as first responders and are trained as emergency medical technician [EMTs], when a 911 call comes into the dispatch office, they respond and are the first to arrive on the scene to administer initial resuscitation or care, prior to the arrival of EMS."
Unfortunately, the errors did not stop with a few wrong turns. Once the ambulance arrived, the missing key also created a delay.
"The issue related to access to the narcotic cabinet is more difficult to resolve. Dependent on state laws specific to securing of narcotics and controlled substances, alternative methods of locking these drugs, such as a combination lock or keypad lock might be utilized. This would allow the entry code to be available to all of the EMS crew that would drive that particular ambulance, and it could be changed periodically by the company director. Some states, however, would not allow this, as they feel that the security of the drugs would be diminished using this type of system. The entity that owns/controls the ambulance service, whether private- or hospital-owned, would have to develop policy and procedure which complied with their state laws," adds Nemeth.
"While the facts of this case do not show whether the EMTs did a pulse-oximetry reading or whether oxygen was administered on arrival at the scene, this should have been part of the initial treatment of the infant. And so, in addition to the errors in the delivery of care, there may have also been a regrettable deviation in the standard practice of health care," concludes Nemeth.
Reference
• Anonymous Infant v. ABC Ambulance Co., Suffolk County (MA) Superior Court. M. Breakstone, Boston, for the plaintiff.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content