AssHat or Tony K interview Part Duex

Some pertinent facts provided to 7 News’ Tony Kovaleski in response to a Colorado Open Records Act request, prior to his interview with Dr. Markovchick:

Ø DIA is one of only two airports in the nation that have paramedics in the terminal and on the concourses 24/7. Denver Health paramedics were at the gate (B 36) waiting for the patient as he disembarked from the plane, with all same the equipment carried on an ambulance. Therefore, the response for medical care in this case was zero.

Ø On July 8, 2008, shortly before this call was received by dispatchers, Denver Health Paramedics had responded to, and cared for, two other patients at DIA. Two transport ambulances had just departed the airport transporting patients to local area hospitals within an hour of this call.

Ø Denver Health Paramedic Dispatchers called four private ambulance companies requesting assistance with the transport of this patient. None of the four had an ambulance available to go to DIA.

It seems that Tony K., for some reason chose not to mention these. Wonder why?

Dr. Vince Markovchick, Director of Emergency Medicine and the Emergency Department at Denver Health, interview with Tony Kovaleski, 7News

August 13, 2008, 1:30 p.m.

TK- Looks good, go ahead and say and spell your first and last name.

VM- Vince Markovchick, M-A-R-K-O-V-C-H-I-C-K.

TK- Doctor, you were working on July 8 of this year.

VM- Correct.

TK- Can you tell me what happened?

VM- Sure, I was working as the attending in the Emergency Department. Paramedics called me from DIA, and stated they had got a call to one of the gates, I believe on the main concourse. They met the plane when the plane got to the gate, and that the patient when the patient got off the plane and the patient was short of breath. They had been caring for the patient for I don’t know – 15 minutes or so, about 20 minutes, when they called me. And I can’t go into the patient’s specific history they gave me because of HIPAA patient confidentiality issues.

TK- Let’s talk about response times.

VM- Oh, okay,

TK- What happened? What happened?

VM- Well, they called me for medical advice; I gave them some medical advice then they called me back about 5 minutes later and said we want to know if we should request a helicopter and what I said to them at that time I said if the helicopter if the time that the helicopter can get the patient to the ED is less than the time it would take if we have our responding ambulance get the patient to the ED then go ahead and call the helicopter. I then called our dispatch center to see where the ambulance was. The dispatch center informed me that the ambulance at that time was at Tower Road and Peña so when I did the calculation the ambulance would have gotten the patient to the emergency department about the same time as the helicopter could have gotten the patient and the medics made a a judgment to allow the ambulance to proceed on in and the ambulance then took the patient to the hospital.

TK- What was the Denver Health Paramedic ambulance response time to this call?

VM- The ambulance was called, the request for the ambulance came in at 17:29, the dispatcher then called because two of our ambulances…[interrupted]

TK- I don’t mean to interrupt you sir, but I have to repeat the question.

VM- Well, I’m getting to…[interrupted]

TK- What was the response time?

VM- I need to give you the times, and then I’ll give you the response time…[interrupted]

TK- I know the times, I know the times, I’d like to know the response time.

You know the times? Then why ask the question?

VM- Would you please, would you let me answer the question?

TK- I’m trying to ask you the question, what was the response time?

VM- Well, the response time for ambulance transport, not for patient care, because the response time for patient care was zero; the medics met the patient and were caring for him…[interrupted]

TK- Let me be more clear, what was the response time of the ambulance for this emergency call?

VM- The response time of the ambulance was 33 minutes.

TK- 33 minutes?

VM- Correct, from downtown because there were no other ambulances anywhere available to go out to DIA at that time of day, no privates and two of our own were already transporting patients from DIA at that time.

TK- So this guy was really unlucky?

VM- No, because his outcome wouldn’t have been any different had we of had an ambulance sitting at DIA.

TK- And you knew that when the call came in? You knew he was going to die?

VM- Of course I don’t know that when the call comes in. I know it now.

TK- So, that’s irrelevant.

VM- No, it’s not.

TK- To say that the outcome wouldn’t have been any different is truly irrelevant. You took 33 minutes to get to a man that’s dying.

VM- No, we didn’t. The paramedics got to him…[interrupted]

TK- You said, it took 33 minutes for an ambulance to get to a man who’s dying.

VM- The paramedics got to the man immediately when he got off the plane. There was no wait for the man to be cared for by the medics.

TK- You know what he died from and so do I, and you know that the paramedics could not have helped him.

Yes. He knows that and so does anyone with a minute understanding of what a PE is.

VM- Why are you…[interrupted]

TK- The only solution for him was to get to an emergency room and your ambulance took 33 minutes to get to him.

The only solution for him would have been bot to have a PE. The only viable solution would have been to do so in the presence of a thoracic surgeon with his chest already open and hands on pulmonary arteries. This reminds me of the case of the police officer that the “three P’s” tried to take advantage of last time the Fire based ems argument came up. For those not around division at the time a DPD officer riding his bicycle without a helmet was hit by a car and suffered a traumatic brain injury. As was quoted by the neuro surgeon at the time, “ this accident could have occurred in DG’s parking lot and the outcome would have been the same.” The point is that in both cases ED care would not have benefited either patient. Response time to either is a non-starter. In the case today it is bullshit because the care, which is usually brought to bear in a transport rig, was by his side with a zero response time. Which according to my limited education is still less than 8:59.

VM- No, had he walked into the emergency room here today, and collapsed and goes into cardiac arrest the outcome would be exactly the same.

TK- And you know…[interrupted]

VM- Massive pulmonary embolisms. Well, I know that if, what our paramedics do in the field initially is exactly what we do in the ED. And we know that if there’s a cardiac arrest in the field and the paramedics are unsuccessful with their first round of drugs and therapy we know that those patients die.

TK- Doctor, why do you think so many paramedics reached out to us after this call?

To try and make the Division look poorly, duh.

VM- I have no idea, you’d have to ask them.

TK- We have, and they say that the management at Denver Health attributed to this death and they’re tired of it.

How so?

VM- I absolutely disagree with that, that is not even…[interrupted]

TK- They say the way you’re operating the program, the way top management is operating the program…this is testimony to the fact that there are not enough ambulances on the street to help people when their lives are on the line.

VM- We have paramedics at DIA 24/7. We are one of two airports in the country that do that. This was handled perfectly from that perspective. This is not an issue of ambulance response time as paramedics were there, inside the terminal and responded.

TK- Did the dispatcher make an error here?

VM- The dispatcher made an error, in that for 16 minutes the ambulance was going Code 9 and should have been going Code 10 red lights and sirens, but we lost about 5 minutes. The ambulance would have gotten there about 5 minutes sooner had they been going Code 10.

TK- Did the hospital take a look at what happened after this issue?

VM- Yes.

TK- And what’s the conclusion?

VM- That’s an internal investigation, it’s an employee issue and I can’t discuss that, but there was an error made.

TK- A hospital error?

VM- A dispatcher error.

TK- Employee of the hospital, right?

VM- Yes.

TK- How can people know that this won’t happen again?

VM- What won’t happen again?

TK- This error.

VM- Well, all we can do is continue to educate people, continue to emphasize what the protocols are, and get them to follow the protocols.

TK- You’ve said this was an error by the dispatcher at the hospital.

VM- In not stepping up the ambulance from Code 9 to Code 10 when the dispatcher was requested to do so, yes.

TK- Does Denver Health owe the widow and her two children an apology?

VM- No, because the care . . .

TK- No?

VM – Was completely appropriate the entire time. Had the ambulance gotten there five minutes earlier, the patient would have arrested just as he was being put in to the ambulance rather than just a couple of minutes before. The outcome would have been the same.

TK- Did Denver Health know that outcome was going to happen as it went through this process?

VM- Well, we never know what the outcome is going to be. We do, we provide appropriate high-quality, pre-hospital and emergency care which was done in this case, and we hope for the best, and most of the time we are very successful in outcomes.

TK- Is a 33 minute response time by the ambulance appropriate and high-quality?

VM- Under the conditions that occurred that afternoon, that was the best that we could do. There are times in every city when the system is overloaded with calls, when you can’t get an ambulance to respond from a very close place. But the point here is we had the paramedics already there. There wasn’t a delay in getting paramedic care to the patient.

TK- So for Mr. (XXXXXX – DH deleted name used) and his widow and children, it was an unfortunate day.

VM- Well, it was unfortunate that he had a massive pulmonary embolism which is uniformly fatal, that’s what’s unfortunate. His care was, I think, very high quality and very appropriate the entire time.

TK- Are you at all embarrassed by a 33 minute ambulance response time?

VM- To DIA and under these circumstances, no. I would have liked for it to be about 28 minutes that would have been the best we could have done.

TK- We asked Denver Health for staffing levels that day. How many ambulances were on the street and where were they located. Do you know what the answer was?

VM- No.

TK- The answer was, “we don’t know how many ambulances were on that day and we don’t know where they were located.”

VM- Well, there’s now way to tell you, looking back two or three weeks at a fixed point in time during the day exactly where the ambulances were. We know that most of them were in service and the two ambulances closest to DIA were already transporting patients from DIA to hospitals.

TK- Was Denver Health short staffed that day?

VM- I don’t believe so. I believe we had, I would assume we had, normal staffing but I don’t know for certain.

TK- You told me in the interview, you’ve done an internal investigation. Would it not make sense to know how many ambulances were working and where they were on that day when this call came in?

VM- Sure.

TK- But you don’t know that right now?

VM- I don’t know the results of that and again, it’s an employee issue about why there was a delay in stepping up the ambulance from a Code 9 to a Code 10.

TK- Back to the paramedics, tremendous frustration, they say this call…[inaudible]

VM- No, as I said before, every city is going to have the occasional long response time, this was not a long response time.

TK- 33 minutes is not a long response time?

VM- By response time I mean to getting a paramedic to care for a patient. In this case, we have the perfect system in place to have paramedics immediately to care for patients at DIA.

TK- But you know better than I, that when you have a pulmonary embolism every minute matters and a paramedic on scene can’t treat that. That individual had to be in an emergency room and the sooner he got there the more likely it is he would have lived.

VM- I don’t agree with the premise of your question. In any emergency you would, the lay public, and I understand why believes every minute matters. We have done two retrospective studies from Denver Health where we analyzed outcomes in thousands of patients both medical and trauma and the question we ask in both these studies is what difference in outcome do ambulance responses make. And with the exception of a medical cardiac arrest where minutes do count in terms of delivering electricity to the heart, a slight difference or prolonged response times made no difference in patient outcome.

Come on now Dr. Markovchick, don’t confuse the Tony K or TB BOB, or Mr. Mann or the other intellectual midgets with SCIENCE! Emotion is such a better basis for argument.

TK- How do you treat a pulmonary embolism?

VM- You would have to treat the pulmonary embolism, once you’re certain with the diagnosis with heparin to prevent further propagation of the clot.

TK- Would you open up the chest cavity?

VM- Well, you have to have a cardiothoracic surgeon and cardio bypass team available and the only chance of this kind of person surviving is if he had his cardiac arrest in an operating room with a cardiac surgeon. The problem with the ER is that we don’t know for certain what the diagnosis is when the patient gets here. We have to work the cardiac arrest. If we get the patient back than we can proceed on. If we don’t get the patient back then the patient dies.

TK- Why would so many of your paramedics reach out and say this is wrong, this shouldn’t happen and call 7 News?

VM- Well, I don’t think they have the facts in the case or they wouldn’t have come to this conclusion if that’s what they’re talking about.

TK- Did you talk to the paramedic that responded on this call?

VM- I talked to the paramedic caring for the patient at the airport and I talked to the medics enroute to the hospital from the airport in the ambulance. I talked to both medics.

TK- Do you understand what it’s like looking in the eyes of an individual and having a conversation with them and then watch them die because the ambulance didn’t make it?

Nope, I am certain in his nearly 30 years of being a Dr. in a high acuity medical facaility, in the field in Vietnam, he has never had to see that look. As opposed to you who can only imagine it.

VM- That’s not why this patient died. This patient did not die because the ambulance didn’t get there. Your premise is totally incorrect. It’s not true. The patient did not die because the ambulance took 33 minutes to get to the airport. The patient had the same kind of care we would have initially given in the Emergency Department had this happened there and the patient had a fatal condition and there was no way he could have survived. That’s why he died. It had nothing to do with how long it took the ambulance to get to DIA.

TK- More than a half dozen of your paramedics that we’ve talked to, they don’t believe that that was the case they believe that this guy would have survived if that ambulance would have got there in a timely fashion and did not have to drive from downtown Denver.

VM- Well, I would be happy to talk to all of those half dozen paramedics, explain to them the medical issues here, and why their premise or their conclusion is wrong, because it is. Our paramedics do a great job under very difficult conditions day in and day out, and they take great care of patients and this is impugning the care of this patient by our paramedics at the airport and enroute to the hospital because this was done perfectly. No problems, because I was in direct contact with them about the care of the patient.

TK- What’s the average staffing level of paramedics units being used a day?

VM- Anywhere between 10 and, paramedic units? Anywhere between 9 and 11 or 12 paramedic ambulances, another 3 to 4 basic life support ambulances staffing the city at any given time, depending on time of day and call volume.

TK- The Democratic National Convention is coming up. Our sources say there’s going to be 28 ambulances on the street in Denver. Is that correct?

VM- I can’t give you the exact number but clearly we are staffing up. We’ve cancelled all vacations, we’ll have a lot of overtime, we’re getting help from outside city paramedics they’re helping out with staffing, so yeah, we are staffing up for that week.

TK- So, why would the week of the Democratic Convention bring so many ambulances and the time when this man needed an ambulance there wasn’t one? There’s seems to be a disparity?

VM- I don’t think it’s disparity.

TK- Do the Democrats deserve better treatment than this man deserved?

Seriously? You really went there Tony? From my limited understanding of the situation, DHP is the designated lead medical agency for this event. As such they are obligated to provide certain venues with medical care. This is in addition to the normal obligations they are under. In order to meet these obligations the admin of the DHPD cancelled days off, as well as vacations. They also went to 12 hour shifts. Now I suppose they could continue this staffing model after the DNC, but at what cost? It has been attributed in other forums that the crash of last week may have been due to the medics working so much. This of course would also lead to a huge increase in overtime, which then the auditor could critisize, as his office has done in the past. Basically your question Tony is asinine, just as you are.

VM- But what are the Police doing for the week of the Democratic National Convention? What about the Fire Department…everybody is staffing up because it’s a request of the federal government. That’s why we’re doing it. It’s not that we need that level of staffing to cover the city, we don’t.

TK- If you put more ambulances on the street would it have saved this man’s life that day?

VM- No, absolutely not. No way, more ambulances on the street, as I said, if we had an ambulance parked at DIA or at 48^th and Tower Road, which is where we are normally stationed, the outcome would have been exactly the same.

TK- How will people know that, I guess, I know we’re running out of time…what…what did Denver Health learn from this unfortunate situation?

VM- We learned that we have a great response system at DIA, we have wonderful paramedics who worked, who took care of this patient exactly like I would have cared for him if he were in my ED.

TK- So you’re proud of what happened?

VM- I’m proud of the way our paramedics functioned and the fact that there was about a 20 minute difference in getting the patient to the ED than there would have been if the ambulance at Tower Road and 48^th responded. Didn’t make a difference in this case and in fact with paramedics in attendance the whole time with the patient, usually makes no difference.

TK- You’re kind of saying that someone is making something out of nothing.

VM- Well, I believe that you’re making a bigger deal out of this than it is, quite honestly, I really do, because this patient had great care. The paramedics met him when he got off the plane, he died of a pulmonary embolism. The story you should be doing is the risk in air travelers of getting pulmonary emboli and how this might be prevented. That would be a better story for the public to hear than something like this.

TK- [inaudible]

VM- I did the times, the patient would have…[interrupted]

TK- [inaudible] Share with me your analysis of the times.

VM- There was a 33 minute response time from the ambulance downtown.

TK- And that was to the gate.

VM- To the gate, correct. If the ambulance were coming from 48^th and Tower where it is normally stationed, and I checked on it this morning red lights and sirens is 12 minutes to the gate, all right, so the difference there is 33 minus 12 – 21 minutes. The time it takes to get the patient from the concourse through the terminal to the ambulance usually takes anywhere from 12-15, 18-20 minutes. It took them 18 minutes because they were working a cardiac arrest.

TK- He was still alive?

VM- Well no, his heart, I can’t get into the medical aspects of what his heart rhythm was and the medications they gave him. His heart had stopped. His heart stopped about 4 minutes before the ambulance arrived. So, if we had the normal response time it took them 18 minutes to get from the gate to the University Hospital ED. So doing all those times, he would have had a cardiac arrest in the ambulance on the way to the ED if we had shorter response times of the transport ambulance to DIA.

TK- One last time, does Denver Health owe an apology to the widow and her two children?

VM- Well, I’m sorry for the unfortunate outcome and that this happened to her husband but there’s not apology here for the care that we rendered. I think it was very appropriate and to apologize would be to say that we provided substandard care in the pre-hospital arena. Our paramedics…[interrupted]

TK- Taking 33 minutes to get there isn’t substandard? In your contract it says you’re going to be there in 9 minutes or less.

The reason this is chosen is that it, under most circumstances the response is tied to the arrival of the care. At DIA as well as other aspects of calls (MCI, Coors Field) where care is already there the response time is not a factor in the contract. Another one of those things that Tony and his idiot squad might look into before jumping on the dumb train!

VM- No, it says 9 minutes or less 85 percent of the time. It does not say 100 percent of the time, and that’s response time with paramedics to care for the patient. This is different this is a response time to transport between the airport not for paramedics to get to the patient. They were at the patient’s side when he got off that airplane.

TK- Anything I haven’t asked that you would like to…[interrupted]

Sure, Why are you seemingly ignorant and arrogant in your demeanor? It is my understanding and belief, as well as experience that those two things when combined are very dangerous.

VM- No.

TK- Thank you.

Forgot to add the video linkage.

φ Veritas