Detroit EMTs fired after tool indicates CPR fell short; union fights back
Detroit — Two EMTs are out of their jobs after a controversial life-saving device indicated the pair didn't adequately deliver CPR during an emergency run in January that ended with a death.
Michael Morgan and partner Julian Holts were terminated by Detroit's fire administration last month after using a Zoll monitor-defibrillator, a device designed to detect and evaluate cardiac rhythm problems and heart attacks — and it reports out CPR feedback, which the union contends was used against the men in their dismissals.
The fire union, in a March 4 complaint, noted that the Jan. 4 run was the first in which the two-man crew deployed the Zoll monitor-defibrillator. Roughly 200 EMTs were trained on the device with two-hour training late last year, according to the fire union representing them.
"It's pretty disheartening to go from paramedic to dishwasher." The Detroit News
An investigative report by the fire department reviewed by The Detroit News concluded the pair failed to complete a thorough assessment of the patient and administer proper CPR. The Zoll device evaluates whether the EMTs provided high-efficiency CPR based on rate and depth of compression.
"This is a nightmare, a nightmare for both of us," said Morgan, 31, who has worked in the medical field for the last decade and was recognized in December as part of a life-saving team that came to the aid of a 14-year-old girl who'd been shot in the head.
"I treat people like they were my family. No one gets overlooked. If they have a problem, that's what they call us for."
Detroit's fire union is pushing back against the firings, battling with the city to get the EMTs back to work and waging a separate battle to have a state suspension of their licenses lifted.
Detroit's Fire Fighter Association has filed an unfair labor charge in its efforts to have the two EMTs reinstated after they were let go by fire administration for "neglect of duty."
"You have an EMT in the back of an ambulance, unsecured, with a victim, driving lights and sirens on the way to the hospital, doing CPR the best they can and then they have this machine that's like 'well, you aren't doing it good enough,'" Detroit Fire Fighter Association Vice President Bill Harp said. "This whole ability of this machine to tell you exactly the depth of your compression based on how much inertia you are putting into it, I'm not sure I buy all that."
At issue, according to Harp, is whether the device can truly evaluate the care being administered. He said the sensors evaluating the compressions have to be perfectly lined up between the patient and the EMT's hands to understand the quality of the force. And each patient needs a different level of force for effective compression.
In a Tuesday interview with The News, the medics declined to discuss specifics of the run because of the pending legal matters but said they remain in limbo amid efforts to overturn the city and state decisions.
Holts, 21, said he and Morgan both joined the department about a year ago.
"At no point in my career, and I assume the same for Morgan, did we just stand by idly and watch someone die," he said. "It's pretty disheartening to go from paramedic to dishwasher. It's one of the worst feelings in the world."
In a statement to The News, Sydney Puricelli, a deputy fire commissioner, said the department is unable to comment because the case "is still under investigation and subject to legal proceedings."
The fire department's investigation, subsequent license suspensions and firings came after the patient's mother expressed her intent to file a formal complaint against the EMTs, saying they "robbed my son of his life."
The ordeal unfolded after Morgan and Holts responded to a life-threatening priority call to the Palmer Park Apartments on Whitmore to tend to a 30-year-old man who had fallen down.
The EMTs helped encourage the man, identified in departmental paperwork as Patrick A. Clemons, to get up from a narrow hallway, with support from a walker, and into an ambulance, according to a copy of the run report. Clemons had been "alert and oriented" upon arrival, it notes.
Once inside the rig, Clemons told the crew he'd had a history of pulmonary embolism and that he was experiencing a burning sensation in his chest. They then attached pads from the Zoll monitor to track his heart rate.
Two minutes after the machine had been turned on, it advised that Clemons needed a shock, Harp said. Then, the CPR began. Holts drove, while Morgan administered the CPR.
"When (administration officials) say they didn't do CPR, the thing says they did CPR," said Harp, referencing a real-time feedback report generated by the device.
Morgan continued with the CPR, Harp said, until Clemons arrived at the emergency room. It took eight minutes to get to the hospital, according to the run sheet. Soon after, Clemons was pronounced dead.
Harp added the incident was the first time the crew had ever used one of the machines, which are newer to the department and purchased with grant funding.
'A standard of care'
Elijah White, president of Zoll Medical, declined to weigh in on the case in Detroit but did say that Zoll was the first to manufacture equipment with CPR technology, which is used to help people perform better CPR.
All major manufacturers, he said, now have some version of the technology that was first introduced in 2002. Today it's "a standard of care," he added.
"It's that important to improving outcomes and survival to cardiac arrest," he said. "To have technology that both coaches and assists and measures medics and makes sure they are doing it well. It is the thing that determines whether patients live or not."
White said the technology aims to improve the quality of CPR chest compressions by providing real-time feedback and it enables review of individual cases, after the fact, to make improvements.
"It is very widely used," he said. "It is the exception to not have it rather than to exception to have it."
Detroit's fire administration, citing the ongoing review, declined to answer questions about the value of the monitors, how widely used they are within the department or how long Detroit has had them.
Harp said there are about a dozen Zoll devices deployed in the city.
Rommie L. Duckworth, a fire captain and EMS coordinator for the Ridgefield Fire Department in Connecticut, said early and effective CPR as well as early defibrillation, are most likely to give a patient the chance to survive sudden cardiac arrest.
But Duckworth, who also is founder and director of the New England Center for Rescue and Emergency Medicine, said the role real-time feedback devices play in saving lives is not yet clear and most agencies aren't using them.
"While I can't cite specific numbers, I can assuredly say that most EMS agencies in the U.S. do not use such devices," Duckworth said in an email to The News. "Some large agencies do, but in terms of both geographic and population coverage, most people in the United States will not encounter a CPR feedback device as part of their resuscitation."
On Jan. 23, Clemons' mother sent a letter to an administrative fire captain, raising concerns beyond the level of CPR performed.
In a copy of the letter, obtained by The News, Angela Hodges contends the EMTs failed to evaluate her son's vital signs, provide him with oxygen or assist him in getting up from the floor and on a stretcher.
Her son, she wrote, who was 6-foot-3 and 280 pounds, had fallen and was fearful that he was having a heart attack.
He slumped to the side as he was being transported from the apartment to the rig and then was unresponsive, Hodges wrote. But the EMTs, she said, "did nothing. Just turned on the siren and left."
Shortly after Hodges arrived at Sinai-Grace Hospital, she was informed her son had died.
"I am beyond angry at the lack of care, concern, compassion and consideration for his medical state," she wrote. "I hope this tragedy does not occur to another family based on lack of human decency."
Reached by The News, Hodges deferred comment to her attorney, who did not respond to multiple requests seeking comment.
Two days after Hodges' letter was received by fire administration, the EMTs were asked to submit an explanation of the run in writing. Prior to that time, Harp said, no questions had been asked about the monitor or the run.
Detroit Fire Department Capt. Robert Olkowski, in an administrative report, contends that based on witness accounts, lack of action and proper documentation as well as data showing "CPR NOT being performed the conclusion drawn is that this compliant is substantiated."
Olkowski also wrote that while Morgan was the primary care provider on the run, Holts, a state-certified paramedic, "had a responsibility to ensure that the patient received proper and adequate care."
The department held a charge hearing last month, citing the Zoll monitor, the union said. The EMTs were fired on Feb. 21 after a period of time on suspension without pay.
The Detroit East Medical Control Authority, a local authority that sets protocols, then suspended their licenses as did the state, according to the Michigan Department of Health and Human Services.
The local authority last week lifted its suspension, placing the EMTs on a six-month probationary period and requiring random audits and additional training.
As of Wednesday, the state suspension remained in place, according to Lynn Sutfin, an MDHHS spokeswoman. The emergency suspension went into place Feb. 22, according to state records.
Robert Dunne, medical director for the Detroit East Medical Control Authority, said complaints from patients typically result in a temporary suspension of EMT privileges pending local investigation and peer review meetings, where medics can offer their perspective.
The state's action, in this case, was "unusual," he said in an email. Typically, the state does not take action during the medical control authority's investigation period.
"Based on the complaint that we received and our investigation, it was determined that emergent action was necessary to protect the health, safety and welfare of the patients who may receive care from the licensees," Sutfin said of the state's decision.
The union's unfair labor complaint with the Michigan Employment Relations Commission over the Zoll monitor being used for discipline is pending.
The fire union, in its charge, notes employees were told that the monitors would "help save firefighter lives and improve patient care."
"The DFD did not indicate — on its application, to employees, or to DFFA — that the Zoll Monitors would be used to discipline employees," the charge notes. "Still, DFD has now used Zoll Monitor data for disciplinary purposes — rather than for patient care or employee training."
Morgan and Holts said they have struggled to find work as they await word on what's next.
"At the end of the day, I can't really imagine myself doing anything else," Holts said.