Tony K and Dr. Colwell
Tony Kovaleski (TK): Dr. Colwell if you would spell your first and last name and
the title you prefer.
Chris Colwell, M.D. (CC): Christopher Colwell, last name is spelled C-O-L-W-E-L-L,
medical director of the Denver Paramedic Division and Denver Fire Department.
TK: We probably can’t get all that in, how would you shorten it?
CC: Medical director of Denver EMS system.
TK: Okay, that works. Do you prefer Chris or Christopher?
CC: Chris
TK: Okay. Dr. Colwell let’s start out with, what’s the goal of the Paramedic
Division?
Go through all that and you still just do what you want. Arrogant.
CC: The goal of the Denver Paramedic Division would be to provide quality health care.
TK: Save lives?
CC: Save lives.
TK: Is saving lives your number one priority?
CC: I would say that would be a very fair number one priority.
TK: How long have you been head of the Paramedic Division?
CC: I have medical director for 8 years now.
TK: How would describe morale with paramedics right now?
What a bullshit question! Morale is a very subjective thing. As I have noted you go to the principles office and you think moral sucks. As point of reference when has anyone ever said morale is at an all time high? How is it that folks who have been there, patched for less than 3 years can say with a straight face “I have never seen morale lower.” Question- how much of this morale “suckage” is a direct result of having Toe Bouncing BOB, via the media drag the name of the place you work for through the mud?
CC: Morale is a hard thing to describe, a lot of it depends on what individuals you are
talking to. I would say morale over the past – I have been associated with the division for
15 years now both as a resident in training when it was Denver General, and then as an
attending physician and now as medical director – and I have seen morale go up and
down fairly consistently throughout those 15 years. I would say depending on which
group you ask now, morale is very reasonable or lower than we would like.
TK: Why? Why would you say, it some would say it’s lower than you would like,
why would you?
CC: Well, as you know there are a lot of things that affect morale, and if say for example
disciplinary action were to be taken that, on a particular paramedic who might be popular
or who might have people who they work particularly closely with, that would impact the
morale of that group. In some ways almost irregardless of whether the disciplinary action
was deemed to be appropriately dealt or not. And so you might during the time period
where there was a disciplinary action or a concern raised or something like that find
morale in that group has dipped noticeably. Whereas a group that might not be
particularly close to that paramedic it might not affect morale. Or in some cases almost
have the opposite affect.
TK: Why do believe we’re here talking today?
Because you are looking for a “gotcha” moment and in front of a camera is the best way to do so. You have an agenda, provided by members of the 858 with complicity from 3634 and you work for the lowest rated new station in the region. Yes it is the fastest growing but when you have 10 viewers and it goes to 20 that is in fact a 100% jump. Still unimpressive. How about this- Gee tony if you don’t know why I am here and you don’t then I have lives to help save. good bye!
CC: I believe you are taking a look at the EMS system and would like to understand
better how we are trying to save lives.
TK: What issues do you think have brought us here today?
CC: Well, I don’t know specifically what issues might have brought us specifically here
today. I know that issues that we deal with fairly regularly in terms of trying to achieve
our goal is things like response times and things like medical care, outcomes that those
types of things. And so I would imagine those would be the topics of our discussion.
TK: What does the term frequent flyer mean to you?
It means I get mad discounts on my airfare, what does it mean to you?
CC: Frequent flyer generally means, and we refer to that both in the field and in the
emergency department in the hospital, as somebody who comes to our attention
frequently.
TK: Can you expand on comes to your attention frequently? I mean what’s the
difference between a frequent flyer and just a person who has a health issue?
CC: Well, some cases there are overlap depending on who’s using that term, so if a
frequent flyer, if some people that term it might indicate just somebody who calls 911 a
lot. And that might be somebody who very legitimately calls 911, other times there may
be a concern that they are using 911 for reasons that aren’t what the 911 system was
geared for and set up for. So, frequent flyer in and of itself doesn’t really define that very
well because a lot of is depends on who’s saying it. But usually it means for example in
the pre-hospital setting somebody who dials 911 frequently.
TK: Using a paramedic maybe as a taxi ride to the hospital?
CC: Sometimes it’s referred to in that setting, yes.
TK: So, for our purposes, let’s identify a frequent flyer as individuals who are using
the 911 system inappropriately.
Inappropriately as defined by whom? Just because “Richard Eagle-wounder” calls 50 times complaining of CP, do we not send him a bus on number 51, just based upon the 50 previous calls? Certainly if there were a poor outcome after doing that, there might well be a story, about how DHPD neglect the indigent.
CC: Inappropriately.
TK: Correct.
CC: All right.
TK: Okay. Does Denver Health track frequent flyers?
CC: Well we do track the number of times 911 has been activated, certainly, and identify
situations, individuals, locations, it’s not always an individual, that has activated 911
frequently to see if perhaps there are opportunities to intervene in ways that wouldn’t
necessitate a 911 call.
TK: Not sure you answered my question. So, these individuals that are using 911
inappropriately, the frequent flyers, do you as a paramedic division, as a hospital,
keep track of who is misusing the system?
Track them to what end and again by whose definition?
CC: Well I guess
TK: That’s a yes or no.
CC: We track them in term of, but not as a frequent flyer, in other words we don’t put
them under a frequent flyer, we use them, again, that can have many different
connotations to it, we would say… [interrupted]
TK: Let me back you up here. You described it as inappropriate use and we
defined it so people who are inappropriately using the paramedic division, your
services, your money, the tax payers dollars, the 911 system. Do you track people
who are inappropriately using the paramedic division, the 911 system?
CC: Well overall I would have to say yes, but I would like to clarify that by saying if you
asked me for a list, give me a list right now of the 10 most frequent users of 911, I would
have to go back and pull that. So I don’t have that right in my hands ready to give that
type of information. But yes, I do have access.
TK: Is that difficult to get?
CC: Not particularly. It’s not something that I’ve asked, you know I ask for regular
reporting – things like cardiac arrest, those types of things are regularly reported to me.
That’s not something that is regularly reported to me, but when we look at those systems
we do have access to information. So the answer to your question is no, it’s not
particularly difficult to find out how many times a particular address activated 911.
TK: We sat down with many current and former paramedics. They claim that the
mismanagement of frequent flyers is having an impact on your ability to get to a 911
scene when that scene is a life or death situation. How do you respond to the concern
of paramedics that, to be more accurate, how do you respond to the accusation of
paramedics who say you’re not properly managing the system?
I say they are disgruntled ex employees who have an axe to grind. I say as an investigative reporter I would do background on those who bring forward such things to find this stuff out prior to doing a story or series of stories that have little to do with these pesky things we in the academic world like to call facts. Of course it doesn’t hurt that the rumor is your 858 source is engaged in a “familiar” way with a channel 7 employee. Now THAT is a conflict of interest.
CC: Well, I would agree with the statement that frequent users of the 911 system put a
tax on that system. And, I would absolutely agree that is something that we would try to
pay attention to, and impact where we can. An example is, we have one particular, and
obviously I can’t go into specific names, but a particular individual who has activated
911 more than 40 times this year already. And often times it’s for things like a lift assist,
or, in other words, where we are literally assisting to lift, and although obviously our
system, fire and paramedics, are there to serve the public, that would not be a reason the
911 system should be activated. So, we asked for adult protective services to visit that
particular facility. Now, unfortunately that particular individual calls and says I know I
can’t ask for a lift, so I am saying I have chest pains. Now it is very difficult to sort that
out, until you’ve actually gotten there and done it. So, I would say to that concern, that it
is very difficult to sort out in many cases frequent 911 users truly for medical care and
quote unquote abuse or inappropriate use of the 911 system. And obviously we have to
err on the side of the care, and being overly careful to be sure we’re not missing
something medical.
TK: But you have the ability in your system to know that when somebody’s calling
from and address and a specific name that this Jane Doe or John Doe, is somebody
who has, as you’ve said, called more than 40 times this year. You have the ability to
manage and identify frequent flyers.
Manage by sending someone, you ass nugget. As cited above by CC and myself sometimes it has to be done. There is this thing called liability that impacts to a huge extent, in a negative manner all of healthcare.
CC: Yes, particularly if I were to say tell me how many times this particular address or
concern has called 911.
TK: Yes, and so your call takers, your dispatchers have the ability to know this is
somebody who said this. And I know other departments and other organizations
are managing this more proactively in other cities. I don’t know if you answered my
original question, which is current and former paramedics are saying you, and
Denver Health are not properly managing this system, and it’s putting other lives at
risk.
Wait, I would really like to hear of how this is being done in other cities Tony. Would you please send me the citations? Oh there are none.
CC: I would say we are trying to manage that aspect of the system, and I do agree that it
is a very difficult aspect to manage, and I do agree on its impact on the system.
TK: Would you agree you could do a better job?
CC: Well, no I wouldn’t agree that there is something clear that we should be doing
better. Now, I would be very open to any suggestions on a particular individual issue that
we maybe have not tried. So, for example, many of them require adult protective
services, social services, a variety, home health care, that they may or may not have
available to them. Many of those types of things. And we very proactively try to get
when we identify that there are individuals doing this, try to get those services involved.
Often times we get responses that say we can help a little bit but we can’t help a lot. And
there have been a couple of individuals that I’m very familiar with that have managed to
get through multiple attempts, so am I or we, I should say we as a system, perfect in
dealing with this? Absolutely not. It’s something that we have to be working on all the
time. But it is not because it’s low on the priority list, or something that we don’t believe
is important.
TK: Would you agree with claims by paramedics that these frequent flyers are
impacting your ability to get – let me rephrase that. Would you agree with other
paramedics that frequent flyers are delaying your ability to respond to true 911
emergencies?
CC: I believe that risk is very real. Yes.
TK: So, what they’re saying is accurate?
CC: I would say that on a given day, no. We may go a number of given days where that
doesn’t have any impact. But, that as a system, sure. That somebody activates 911 very
regularly, particularly for issues that 911 should not be activated for, does have an impact
and is an important aspect for us to address.
TK: So, then, now that we’ve got to that agreement, what are you doing to fix this
problem?
CC: We are identifying individuals, and actually we identify this even more frequently
through the Fire Department. Because our two-tiered system is one that the Fire
Department is the first response and they are often activated multiple times by a
particular individual. And, many of them may come to our attention by their recognizing
that we’ve responded to that four times in the last several weeks, can we look and see
how many times that response has been in the last month, year, or so on. Identifying the
individual and then seek to have input on how we can change that. So, in other words,
we are, if I could talk about individuals I could give four individuals right now where we
have specifically asked for adult protective services, our own social services in the
emergency department, and in some cases even other resources such as home health
nursing, and talk to their, some of them have, two of these individuals have home health
nurses, and talk to them about what types of things they need in terms of support so that
we wouldn’t reach the point where they have to call 911.
TK: Sources tell me frequent flyers in a recent one year study cost Denver Health
more than 2.5 million dollars. Individuals that aren’t paying that are bogging down
the system, and are in the frequent flyer category of four or more calls within a
year, and when they get here the reason for their call is not legitimate. Do you feel
that’s an accurate number?
CC: Just to talk about a specific number wouldn’t be fair because I couldn’t give you a
specific number. Do I feel like that is unreasonable or outrageous, no. I think that it’s
possible that would be the case.
TK: Let’s go to response times. How does Denver Health calculate response times?
CC: Well you know there is a variety of ways that response times are calculated across
the board. When we talk about response times that we report to the City… [interrupted]
TK: 8 minutes 59 seconds
CC: Correct. We calculate that from the moment we have the information to dispatch
the call to the moment we arrive at the scene.
TK: Why would some paramedics say, paramedics who have experience in
dispatch, say that the time that’s calculated is the time that a unit is available to
respond, not the time you receive the information?
CC: I’m not sure why they would say that, because that would not be accurate. When
they, our response time is gauged on when we have the information to dispatch the call to
when we arrive at the scene, and if anybody at dispatch were to vary from that, that
would vary from how we are responding, calculating our response times.
TK: So the sources are telling us that there is this period of time from when you
have the information to when you have a paramedic unit available to respond that’s
not included in the response time. We’ve been told response time starts when you
have a paramedic able to respond to that call, and many times there’s a difference in
the time you have the information to the time the unit’s available. Sometimes 5
minutes, sometimes 10 minutes. Are they lying to us?
CC: Well, I believe that is not accurate information because when I go to ask for a
response time, the response times I’m getting are from the time we have the information
to dispatch the call to when the time we arrive. So, I’m not sure where they’re coming up
with that particular information, or that particular concern. But, that is not what I ask for,
nor receive for response time data.
TK: So you can tell me without a doubt that Denver Health’s response time is when
you have the information to when you arrive on scene, and there’s no delay based
on when you have a unit available.
CC: I can tell you what I mean by response time, and what I am giving you as a response
time, yes, without a doubt what I am referring to.
TK: You’re reporting to the City of Denver. It started out at about, well it worked
up to 90% of the time you said you would get there in 8 minutes 59 seconds or less.
That’s upper limit is now down to 85%.
CC: At one point it was 83, went up to 90, and now at 85, yes.
TK: Explain that for me. Why the peak and valley, if you will.
CC: The response time contractual issues and reporting to the city is not something that I
have been integrally involved with. My understanding of the way that number is
calculated incorporates all aspects of the system, including inefficiencies in with the
software for which it is calculated. So, that number is arrived including and
incorporating all that information. Now I am not involved with the contract with the city
so I’m not privy to all the information that goes into calculating the various aspects of the
contract. But my understanding of the way that goes includes all aspects of how we
would report that including inefficiencies in the software issues.
TK: Right, those were in 2003, and there were problems with new systems put in
place at the Paramedic Division and the 911 response center and that’s why that
number came down in 2003. But since 2003 that number has stayed at 85% and
never returned to 90% where it was in 2000 and 2001. Does that not speak to a
system that is coming down in expectations instead of going up?
Just let me ask this-what has the DFD done in this same time frame? How is its time calculated? Of the times 4:59 and 8:59 which one has scientific based validity to support it?
CC: I know that the contract is renegotiated every year. And, not being part of those
particular negotiations I don’t think it would be fair for me to talk about why certain
numbers are in the contract with the City and not.
TK: 8 minutes and 59 seconds is the response time.
CC: Yes.
TK: Where does that number come from? Is it arbitrary?
It was in fact pulled out of thin air. It was based upon economic realities of getting cars to contractually obligated 911 zones while still allowing vai system management the number of cars needed to run transfers, which are the money makers
CC: It’s not entirely arbitrary, but where it came from is studies that looked at some
cardiac arrest data quite some time ago. And, there are not any scientifically, I should
say, better studies that show a different time. There are those that argue that that time is
arbitrary, and other that say it’s the best time we have from a national standpoint. And,
as you know, 8 minutes 59 seconds it what they look at nationally for a response time.
TK: That’s kind of fudged. Most places go 8 minutes, and that’s 8 minutes or less,
you’ve increased it to 8 minutes 59 seconds.
Most places? Most places it is a result of negotiations with the city and the agency providing the EMS, kind of like Denver. Which if you had done your homework would know.
CC: Well, as you know…[interrupted]
TK: With all due respect.
CC: I understand. And there’s, if you ask any…[interrupted]
TK: You’ve fudged just a little bit here haven’t you?
CC: Well I didn’t have anything to do with 8 minutes or 8 minutes 59 seconds. That was
determined by people, again, who look at this data across…[interrupted]
TK: But you’re ultimately responsible, right?
CC: Right. But I don’t ever come to an ambulance and say, “Why wasn’t this 8 minutes
and 59 seconds?” I will go an ambulance and say, “Why wasn’t’ it quicker?” If it was 4
minutes, why wasn’t it quicker? If it was 9 minutes, or 8 minutes and 59 seconds, why
wasn’t it quicker? My stand point, and to some degree it’s a better position to be in, the
numbers are always something to be improved upon.
TK: Right. But the standard at which your organization has decided to make the
measurement is 8 minutes 59 seconds. The number that you have fudged. Cause it
was 8 minutes and then it was moved to 8 59.
It is the number that was agreed upon in negotiations with the city and is no different than what the DFD uses when calculating 4 minutes to be 4:59.
CC: Well, as you know, many organizations use 8 minutes and 59 seconds.
And…[interrupted]
TK: And many use 8 minutes.
Which means there is no “standard” ergo your argument is bullshit. IF someone says it is a “standard” meter that is redundant. Although the standard of how to measure it has changed over the past 200+ years it is now accepted to always be the same. More importantly it was not based upon the length of ones foot. Since you have implicitly accepted that there are differences in the “standard” there then is no standard. This is what smarter people call logic, deductive reasoning. Try it.
CC: Some certainly use 8 minutes. In fact, if you go to almost any organization across
this country and look at how they calculate response times and measure those and report
those to the city, there are differences in almost every one of them. There is no standard,
or consistent way of measuring this. And it all depends on a variety of variables. What
they have under their sphere of control or influence or those type of things may dictate
what time that is used.
TK: But it is true that Denver Health made the choice to move it from 8 minutes to
8 59. Right?
If so it was done with the approval of the city in negotiations with them and in conjunction with DFD using the same criteria to move from 4:00 to 4:59.
CC: I actually don’t know of a move that was done. I haven’t been involved in the
numbers to specifically say it was moved from 8 minutes to 8 minutes 59 seconds. Or
whether it was always 8 minutes 59 seconds.
TK: Would you agree when somebody suffering from a heart attack or cardiac
arrest, every second matters?
CC: I would, which is why our system is geared the way it is, to respond as quickly as
we possibly can, and that’s generally within 4 minutes, with the time sensitive critical
medical components to somebody say, in your example, cardiac arrest. So, those critical
issues are electricity, CPR. We have lots of good data that show those are where we
make a difference in cardiac arrest survival. Oxygen administration, hemorrhage control,
those types of things are what our system is geared towards giving you even quicker, in
the first tier of that two-tiered response. And then the second tier is focused, has those
capabilities as well, but is focused also on the more technically difficult and experience-
related issues of medical care.
TK: So we agree, when talking about a cardiac arrest, every second, every minute
counts.
CC: Yes.
TK: We asked for cardiac arrest patients who did not survive when your response
time exceeded 8 minutes 59 seconds. Are you aware of that request?
CC: No. I was not aware of that request.
TK: Do you know, as medical director, how many 911 calls for cardiac arrest have
a response time exceeding 8 minutes 59 seconds, where the patient died?
Do you know of how many of these same calls had a response by the DFD of the only medically scientifically supported care that was beyond the 4:59? Do you also know how many of the 10-10 calls DFD has invited themselves to over the past 10 years end up contributing to this delay? How many of the “accident investigations unknown injuries” result in true patients that are getting the intellectually honest care for which DFD calls for an ambulance? In the cases that don’t, how does that contribute the delayed response to patients in cardiac arrest?
CC: I don’t know of specific situations like that because…[interrupted]
TK: You don’t know?
CC: Well, because you are referring to a response time just of one segment of our
system. In, for example, there was one case, again, without going into individual details,
fairly recently there was a concern over a response time of 9 minutes and another of 14
minutes. In fact, the response time with the critical time sensitive medical care was 45
seconds, and 3 minutes and 10 seconds. When you take a response time of a system it’s
not fair to take one segment and say this is what represents the system. The system is
geared towards getting you the care quickly. It’s not fair…[interrupted]
TK: But it’s a measurement tool that you’ve put in place. You can’t tell me that a
paramedic has been too late for your own goal and somebody has died, doesn’t that
speak to itself?
Tony, one does not cause the other. I believe the reason for the call is that the party was already dead. To blame the system or response times for an event that has clearly already occurred is ludicrous and lacks logic.
CC: Well, I’m not saying that. I’m saying that the way the system is geared is to get that
critical information, critical medical treatment, quickly. So, I don’t know of a case that
we were 8 minutes 59 seconds before we responded. If it is out there, I would be very
interested in that, and look at that. And, any case that is brought to my attention, and
some are brought to my attention by medical care providers, by paramedics, by fire
fighters, by…[interrupted]
TK: I know you time is limited, so I’m going to interrupt because I really want to
get to the meat of this issue. When a Denver paramedic exceeds your own goal of 8
minutes and 59 seconds on a call to a cardiac arrest is that information you would
want to know about?
I will argue no, it is not. The way the system is built and the expectations there of are not 100% of call 8:59. Currently it is set for 85% within 8:59. Which by default means that 15% will fall outside this goal. They could be one second or 10 minutes, it is all the same. Just as it is the same for meeting compliance 30 seconds is equivalent to 8:59 in a system that uses response time aggregates to monitor/evaluate it. Just from talking to friends on the inside, what role does routing to calls have in this? Whose responsible for that?
CC: Yes.
TK: Is it information you should know about?
CC: To clarify, my goal is not 8 minutes 59 seconds, my goal is as quick as we possibly
can.
TK: Right. I understand that, but I’m just talking about the standard goal you have in
place that says we passed or we failed. And the standard you put in place is 8
minutes 59 seconds. Right?
CC: The City…[interrupted]
TK: That’s the standard.goal
CC: The contract with the City talks about 8 minutes and 59 seconds…[interrupted]
TK: If you want to put in a 4 minute standard I can go to that number too.
CC: I, well I think in some cases we do have a 4 minute standard, for the critical time
sensitive issues, for electricity, for oxygen, for CPR.
TK: And we’re avoiding the issue. I really need drill down to the issue. The issue is
your standard goal is 8 minutes and 59 seconds, paramedic on the scene. Right?
In the context of 85% of the time.
CC: The contract with the City, reporting contract, is 8 minutes and 59 seconds, yes.
But, that’s not a standard that I stop at and say as long as they’re in that standard then
fine.
TK: I give you that. I hear that you’re that you’d like them to exceed to do better
than what the standard is.
CC: Every time.
TK: Correct. Okay. But all I can measure by is the standard goal that’s in place.
Okay? And you told the City you will respond with a paramedic in 8 minutes and
59 seconds.
CC: Okay.
TK: Okay. So, understanding all that. If you don’t meet the City standard of 8
minutes and 59 seconds, and a individual dies from cardiac arrest, should you know
about that?
CC: Yes.
TK: Should you know about every one?
CC: Yes.
TK: Do you know about every one?
CC: Yes.
TK: Then why would we do an open records request and your response is that you
need hundreds of hours to find this information?
CC: If I understand the open records request, and again, it was not made to me so I may
not understand every aspect of it, but if I understand the open records request, it asks for
information that is not normally kept as part of every, or a regular report that is done.
TK: But you just said that you should know about all of these if somebody dies
from a cardiac arrest. They said it’s not normally kept. Do you see how one and
one isn’t equaling two?
CC: I understand how that would come across that way, but I don’t believe that’s
accurate. I…[interrupted]
TK: Well what’s not accurate?
CC: I am tracking any cardiac arrest concern. And, remember, when somebody dies
there may be several reasons for that and in fact when a cardiac arrest has the ultimate
outcome, unfortunate outcome of death, and we look at it and the initial concern was
maybe the response was 10 minutes or 11 minutes, or 8 minutes or 7 minutes, and we
could have done better, we’ll look at that and try to determine, A) was that accurate, was
it in fact that response, and B) what else do we have to learn from this to provide a better,
better care. Sometimes we can get a wonderful response time and they still die.
Sometimes we don’t have a good response time and they don’t. And that’s all part of a
system that we manage, and have to look at every aspect of those. So, I know about any
cardiac arrest where our response time was concerning from any level, and have the
opportunity to look at it see what can we learn from that case.
TK: Give me a moment here because I want to show you the exact response. I’ll let
you catch your breath.
Dee Martinez, PR (DM): There’s another meeting in this room, so we’re going to have to
be going, and Dr. Colwell I know you’re on in the ED.
CC: I know. They called and let me, I have to be going.
TK: Alright, I know the time. Okay. So just so you know what we asked for. We
wanted to know how many times the Denver Health Paramedic Division failed to get
to a cardiac arrest in 8 minutes and 59 seconds or less. The response from the
hospital was we don’t keep that information. Is that true?
CC: We…
TK: Yes or no.
CC: I would say no to the question you just asked. It is not true that we don’t have
access to information…[interrupted]
TK: So why didn’t you provide the information?
CC: Well, if I understood what you said before. You said if a case resulted in a death, in
a cardiac arrest, and it took longer than 8 minutes and 59 seconds, am I apprised of that?
Now, part of that information is that it results in a death. And, as you know, our system
transports to 11 911 hospitals across Denver. And, we are not given access to the results
in congregated, or by individuals, from other hospitals. So, we don’t always
know…[interrupted]
TK: Our request was specific to Denver Health. And the response was we don’t
know, it’s going to cost you hundreds of hours, let me rephrase this, the response
was we don’t know and it’s going to take us hundreds of hours to find that
information.
CC: I don’t know the details of that response. And, again…[interrupted]
TK: The question is that you don’t know when somebody dies because you failed to
get there on your goal of 8 minutes and 59 seconds.
CC: I don’t think that is accurate.
TK: That’s what we were told.
CC: I don’t believe that statement is accurate.
TK: So the hospital lied to us in this response?
CC: Not being part of that conversation, I don’t know what the hospital told you. I don’t
believe it is accurate to say that we don’t know when arrive at a scene of a cardiac arrest
in 8 minutes and 59 seconds, or 8 minutes, or 7 minutes, or 6 minutes.
TK: We were told it would take hundreds of hours, we were told it would take
hundreds of hours to put together a report so we could hold you accountable for not
meeting your own goal. Is that somebody trying to prevent records from becoming
public?
CC: I don’t, again, know what details you asked for and were told in response to that.
With what you are telling me know, that is information that we track and that we are
available. And, in fact, we are publishing data that we did go through an IRB research,
response at each one of the facilities we transfer, to find outcomes of our cardiac arrest
patients. And found wonderful results. In fact, results that compare very favorably to
any city across the country.
TK: But when we asked for accountability and transparency of people who died
because you didn’t get there on time, the answer we received was we don’t regularly
keep that information, we’ll have to create a report. Is that true?
CC: Again, with what you’re asking, do we regularly keep information on our response
times to cardiac arrest, the answer to that is yes, we do. And, we also have to realize who
we are. That we as the public government hospital are subject to open records acts, and
that is not the case for instance almost all hospitals across Colorado. So, we are
responsible for being as transparent as virtually any hospital. And at the same time under
the law, have to protect the patient’s privacy. So to release information outside of
medical care providers, we do have to go back and assure that that information
is…[interrupted]
TK: I’m talking about HIPAA here. I’m talking about the raw numbers of
individuals when they call with a cardiac arrest your ambulance took more than 8
minutes and 59 seconds. Your public relations department here told us you don’t
track that information, we have to do a special report to create that number.
CC: Well…[interrupted]
TK: You’re telling me that’s not the truth.
CC: I am saying we track information on cardiac arrests, so, for example, if we ask
what’s the median response…[interrupted]
TK: Help me understand at this point.
CC: Because you may not have asked the exact question that we track. But we can track
a lot of aspects of it, and when you ask me the question do you know what your response
time is to cardiac arrest, the answer is yes I do.
TK: So you’re playing a semantics game when we’re talking about transparency?
CC: I don’t…[interrupted]
TK: Accountability for your own actions? And now because I didn’t use the exact
word, Denver Health doesn’t want to produce that information?
CC: Well, if I understand correctly, and again, not being part of the conversations I
might not be, but if I understand correctly they did come back to you and say these are
the reports we can get you for free, these was what we, or at least for inexpensive, this is
what we do track.
TK: When it came to tracking deaths when your response time exceeded 8 minutes
and 59 seconds, your response was hundreds of hours of work, we don’t regularly
track it, it’s going to cost you thousands of dollars to hold us accountable.
CC: Well, and again, that may be, in answer to your first question, does transparency
relate to semantics, the answer to that is no. In answer to your question how many deaths
with a response time of greater than 8 minutes and 59 seconds. Okay, no I don’t track
that, because the response time itself, 8 minutes and 59 seconds to a cardiac arrest,
whether it resulted in death or not, would be something that we would look at. We look
at all cardiac arrests to one degree or another throughout the QA process, and look at any
aspect of it that we might be improving on, whether it be the response time, and if it’s not
that, something else.
The following will be the quid pro quo portion of the interview. Here is where Tony K pays back Sawyer/Sproul for whatever information they gave him. Still in my opinion they was robbed on those disguises. Shit go to a costume store and buy a Nixon mask, although that might not work for Greg and his snoz and mannerisms.
TK: I’m going to move on, because I’m not sure how much time we have left. I
want to ask you a question about, define conflict of interest for me.
CC: Conflict of interest, I’m not a lawyer so I think that would be better…[interrupted]
For me it would entail being a Denver Health employee who didn’t take the time to research the DH policies or the CSA policies in depth enough to understand that the personal business I was about to embark on could get me shit canned. IT would the the same rules that after being told not to renew said contract did so anyhow and now is whining about having a policy actually enforced.
TK: Your definition.
CC: My definition would be if I’m asking or asked for an opinion on anything I would
have a pre-existing financial interest in, that my giving that opinion would be a conflict of
interest, because I have two different interests in that area.
TK: So if you’re collecting money from one place and collecting money from
another place and you’re making a decision about place B, that would probably be a
conflict.
CC: I’m not sure under those the circumstances, but certainly if I had two potentially
conflicting interests then that would be a potential conflict of interest.
TK: You’re employed by Denver Health.
CC: I am employed by Denver Health.
TK: Are you employed with or do receive money from any other paramedic
division in the metro area?
CC: Well we do provide medic oversight for a number of other divisions across the
metro area, and they do, it depends on whether the education they are looking for and
direct medical oversight those types of things. So the answer to that is yes.
TK: So you are individually compensated.
CC: No, I am not. I have a salary, I’m not compensated based on any of the medical
direction. I’m on salary.
TK: So you take no income from any other paramedic division in the metro area.
CC: Personally, no, I do not.
TK: Not Northglenn.
CC: No.
TK: What is your relationship with Northglenn?
CC: I am their medical director.
TK: Okay, are you paid to be their medical director?
CC: No.
TK: So you volunteer?
CC: Well, I have a salary, and in that salary is the responsibility of EMS. So no, I don’t
volunteer, I’m paid for my work, but…[interrupted]
TK: By Denver Heath, or by Northglenn?
CC: By Denver Health.
TK: Does Northglenn reimburse Denver Health for, why would Denver Health, the
tax payers pay for you to work for Northglenn? I’m baffled.
Not as much as I am Tony.
CC: Well, different situations come up, for example, they may just need educational
help, and they would reimburse us for the educational help that we gave them. They may
need advice or medication direction those type of things. So, depending on what they
need, they would reimburse Denver Health for, again, if it’s something where it was
oversight that didn’t require any particular attention or time, they would not necessarily
pay that. All I do know is that they don’t pay me an individual check.
TK: Does your salary at all increase because of what you do for Northglenn?
CC: Not for Northglenn specifically, no.
TK: For any paramedic division in the metro area?
CC: Well my responsibility over EMS here is an associate director position, so for
example I’m an emergency physician working in the emergency department, my salary is
at a different level because of my additional EMS responsibilities, what they call a C
band here at Denver Health, as opposed to where I would be if I didn’t have those
additional responsibilities a B band.
TK: So you make more money because of your association with Northglenn?
CC: No, not because of Northglenn. If Northglenn tomorrow went away my salary
wouldn’t be impacted at all.
TK: Okay.
CC: Or if we took on three more my salary would not be impacted at all.
TK: Is Northglenn your first priority after Denver Health as far as EMS response?
CC: No.
TK: There’s no directive that if Denver Health cannot respond the first place you
should is Northglenn?
CC: No. I’ve been very careful not to do that.
TK: Why would paramedics tell me that?
Gee I don’t know Tony, because they have an agenda and rather than own up to their mistakes they do the kindergarten thing of “well he picks his noes and eats his boogers too” routine. Fuck are you really that dense? Maybe if you had investigated the sources you would have found out why they are no longer employees. Oh they didn’t tell you that, did they? How sad.
CC: I don’t know why paramedics would tell you that. That’s not accurate. I have never
given, nor sanctioned, nor am aware of a directive that would preference any agency in
an overflow call.
TK: And you have no direct income from calls going to Northglenn?
CC: No.
TK: Anything I didn’t touch on you’d like to?
Well I had heard rumors that while your penis is small it looks bigger under poor lighting. as for conflicts would it be one to have a channel 7 employee involoved in a biblical way with a member of the 85 , which is in turn supplying your organization informations in this series?
CC: Yes, I would like to talk about, very briefly, I think that we have a very strong EMS
system here, and I believe it is because critical input by both the Denver Fire Department
and the Denver Paramedic Division. And, I believe our survival rates that you look at
when you compare both locally and nationwide in trauma and cardiac arrest would say
the same. That this a strong, well respected system across the country.
TK: Let me be clear so there won’t be any more surprises. We’ve had several, I’m
talking about more than a half dozen paramedics come to us in the last two months
talking about problems inside the system. A system they are no longer proud of.
Why? What’s, in your perspective, what’s the motive for this onslaught of
paramedics saying your system is no longer what it used to be.
CC: Well, I wouldn’t call it an onslaught because when I think you have a 130
paramedics you’re going to have 4 or 5 that maybe believe that things should be done
differently. But I wouldn’t discount that and say that that doesn’t matter. I would say
that anytime you have a member of a system and particularly a current member of the
system that is still active, that you would want their input. You would say what are the
things you think need to be improved and how can we best improve them. How can we
do that proactively. Sometimes we’ve done that. Sometimes there’s been some very
reasonable, wonderful suggestions. Other times there have been some expectations that I
think are unreasonable. And, I wouldn’t pretend to say that we are able to meet
everybody’s expectations, nor that we are perfect. And, we need to continually look at
ways that we need to be improving. And some of that is coming from our employees,
absolutely.
TK: Two other questions and then I’ll let you go. When a patient dies due to an
extended response time, are you as the medical director the one responsible for that
death?
CC: I would say that I am responsible for the medical system here, and any concerns that
come up, whether it be response times or medical care, or protocols or any of those, are
my responsibility.
TK: Do you think Denver Health has manipulated how their performance is
measured and reported to hide the failure to provide appropriate EMS services?
CC: No.
TK: When you send a captain out to stop the clock when a paramedic can’t make
it, clock is getting close to 8 minutes and 59 seconds, and you dispatch a captain to
stop that, is that not manipulating?
CC: Well I see that as trying to take advantage of an opportunity to intervene. That
captain might be closer and they have equipment in their car to be able to address those
critical early issues, then you would send that captain. And, I think you would be wrong
not to.
TK: But that captain is not able to provide what a fully loaded paramedic unit is
able to do. Two paramedics and a truck. That’s accurate isn’t it?
CC: It isn’t two paramedics, but they have all the equipment and they have experience
that tends to be beyond what the paramedics that are arriving are, so they’re able to give
all that early care, and again, the critical issue in cardiac arrest is that access to electricity
and defibrillation. I’m not saying response times aren’t important, but they one part of
the issue. There are many issues when we look at survival.
TK: Of cardiac arrest.
CC: And when we look at Denver survival it compares wonderfully across the country.
TK: Is there any data that you’ve not provided us that you can provide us? You
say you regularly keep that exceed 8 minutes and 59 seconds. Is there some report I
didn’t properly or semantically ask for that you could give me?
CC: I would love to provide you with the research data we are presenting at the national
meeting coming up in two weeks. And show you the cardiac arrest survival in Denver.
TK: Right. And I’m sure that’s interesting and I would be happy to look at it, but
it’s not the level I was talking about. People who don’t survive. Shouldn’t you
know that as much as you should know who is surviving?
Not that I will include anything that might show a two tiered system actually has a positive impact. That would fly in the face of my agenda. No, and the reason is that a delayed response is not causative of the death. However, early electricity, CPR followed by skilled ALS providers is causative for survival. But again this follows logic and not your agenda so you can’t see that.
CC: Well, I could give you right now a list of cardiac arrest patients for which we have
looked at for any concern. I don’t use just how they turned out as being a concern. Any
concern, whether they died or not. So I don’t track it just by that.
TK: But on your goal of 8 minutes and 59 seconds, if you didn’t get there in time,
shouldn’t you have that number there on the front of your desk? Isn’t that a point
where you go we need to get better here? Whether that’s one, ten or a hundred
people. As the director don’t you want to know when you’ve failed to meet your
own goal and somebody died?
CC: Yes. And I believe I do know that.
DM: You’re late for the ED Dr. Colwell. You’re late getting on shift.
TK: Do you need to go?
CC: I need to go. I promised I would be back. They gave me some leeway at 1 o’clock.
TK: Alright. Anything else you want to say?
CC: Again, I hope that as you look at the system, that you look at why they system is
geared towards the way it is, and that response times, while an important aspect, are one
of many aspects that result in whether patients die or not. That’s seems to be what you’re
getting to. And that is the critical aspect for all of us. Do they die because of something
we could have done better. That’s not just response times.
TK: But it’s part of it.
CC: It’s part of it, and remember when you say response times, response times are
calculated based on availability of electricity, qualified CPR, and oxygen done by mass
ventilation. And those are what we provide through our BLS first response. That’s why
the system is geared the way it is. It’s because the fire department gets there in 4 minutes
82% of the time, had those capabilities. So an ambulance response time of 8 minutes and
59 seconds whereas you’re immediately looking at might be where they access to
electricity and defibrillation in 45 seconds. And that was the difference between life and
death.
TK: But, what I’ve been told, and I hear what you’re saying, okay, that there are a
lot of factors that determine life and death, it’s not just one. But, when we asked for
the numbers of individuals who died because you didn’t get there in 8 minutes and
59 seconds and we’re told we don’t keep that information we’re left to wonder why
not.
CC: I do keep information on…[interrupted]
TK: So then you lied.
CC: I’m not lying to you. I’m telling you we have, we keep very close tabs on our
cardiac arrest data.
TK: People in this room responded to me and said we don’t have this information.
That it’s going to cost hundreds of dollars of your employee’s time to get it.
CC: When you’re asking for a specific issue which may not be an issue that is a medical
direction standpoint. I don’t know why any particular information may cost you more
than others. I do know we have to be fiscally responsible and if it takes time to sort
through that we have to charge that. But, I don’t know why that information would cost
more than others.
TK: It’s not the cost, it’s just that you need more, and I’m shocked that not only
did you say you don’t keep it , but you justified why you don’t keep it.
CC: I don’t say that we’re not keeping our cardiac arrest information, we are.
TK: When somebody dies of a cardiac arrest, it takes you more than 8 minutes and
59 seconds to get there, you know that number?
CC: That number specifically, because, again, many aspects go into how…[interrupted]
TK: But it’s black and white. I have a cardiac arrest, I call your system, I die, and
your ambulance got there in more than 8 minutes and 59 seconds. It’s not an either
or, it’s not grey…[interrupted]
CC: But we don’t always have access to that information. In other words when we go to
a hospital that don’t have the information…[interrupted]
TK: Just here at Denver Health.
CC: Well, but even then you’re connecting what goes on in the Emergency Department
to what goes on in pre-hospital. If I want data on how long it took us to get there, I can
get that in 30 seconds, and create a report on it. If I want data the combines pre-hospital
and hospital, I need to go manually and put that in. We don’t have a computer system
that ties those together.
TK: 30 seconds at 45 dollars an hour, I’ll pay for that report.
CC: And, if you’re just taking about response times, we do have that.
TK: Okay, you have my card, I would like to get that information, right now.
DM: Chris, you’re talking about aggregate numbers.
CC: Right.
DM: Tony, you’re talking specific data, you asked for individual cases.
TK: I asked for everything, Bobbi. Or Dee, I’m not sure.
DM: Chris talking aggregate numbers, we offered you aggregate numbers.
CC: I’m sorry I have to go.
For future reference. Apple Preview somehow bypasses the password protection on pdf files. Did not know that until today.
φ Veritas
