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Ala. EMS Official Declines Call; Crew Responds Anyway

Eric Fleischauer

Feb. 09--On Sept. 20 at 10:39 p.m., Carol Montgomery returned from the grocery to find her 42-year-old son lying motionless on her floor.

Two Morgan County 911 dispatchers worked Montgomery's ensuing emergency call -- one talking to the panicked mother and the other to David Childers, who operates First Response Ambulance. The contrast in the transcripts of those two calls explains one reason the EMS Committee wants the Decatur City Council to give them more enforcement authority when regulating the two ambulance services that share a city-authorized monopoly on emergency runs and transports.

After dispatching the call to the nearest ambulance -- First Response Unit 302 -- the first dispatcher worked with Montgomery.

"He don't even act like he's breathing," Montgomery told the dispatcher, according to a 911 transcript obtained through a public records request. "Oh God, he's white as a sheet."

The dispatcher confirmed her son's chest was not rising and falling.

"Do you want to do CPR?" the dispatcher asked.

"I don't even know if I can," said the mother, who has had several strokes and suffers from heart problems.

The dispatcher walked her through the procedure for giving chest compressions. "And do it 200 times hard and fast."

And Montgomery did. She counted out each compression to the dispatcher.

"Three, four, five, six ... ."

At the count of 50: "I can't do no more," although she did. "I'm a disabled person, too. Can you send an ambulance?"

That simple question was not as simple as Montgomery thought, the dispatcher was discovering.

At 10:45, six minutes after Montgomery called 911, Childers called the dispatcher.

What followed was a debate over whether Montgomery's South Bethel Road address was within First Response's coverage area, which includes Decatur's police jurisdiction.

"Hey, listen, you guys just dropped a call on 302," Childers said. "I can't have them going out of the city."

"It's not out of the city," the dispatcher replied. "It's in the (police) jurisdiction."

A second dispatcher took over the call with Childers while the first one monitored Montgomery's efforts to save her son. Childers and the second dispatcher discussed whether Lee's Mobile Home Park, where Montgomery was counting out chest compressions, was technically within the city's police jurisdiction and thus within First Response's coverage area.

"According to my map, that address is still Decatur," the dispatcher said. "It's in (police) jurisdiction and it's still in our fire response area."

"It's south of Spring Valley Road," Childers said. "That's out of PJ."

"OK. So you're -- you're refusing --"

"I'm declining the call," Childers said at 10:47 p.m., eight minutes after Montgomery called 911.

Childers wrong

As it turned out, Decatur Fire and Rescue later confirmed, the South Bethel Road address was within Decatur's police jurisdiction and thus in the First Response coverage area.

At 10:49, a Priceville firefighter who did respond to the call advised a dispatcher to call the coroner. Montgomery's son was dead.

An odd wrinkle in the drama is that despite Childers' refusal to respond to the call, the ambulance kept going. According to Decatur Fire and Rescue Battalion Chief Ted McKelvey, the EMS coordinator, the crew would have know that Childers declined the call from their on-board communications system.

At 10:46, while Childers was debating police jurisdictions with the dispatcher, his crew was on the U.S. 67 bridge in Wheeler Wildlife Refuge, according to data compiled by McKelvey from Morgan County 911 GPS records. At 10:47, when Childers declined the call, they had reached Upper River Road. And they kept going, although in radio silence.

"On the tapes, there is no radio traffic of a First Response unit arriving or clearing from the Bethel Road call," Morgan County 911 Director Ryan Welty said.

Asked whether his investigation indicated the radio silence was the result of a deliberate attempt by the crew not to receive instructions cancelling the run, McKelvey said he did not know.

"We were able to confirm the crew did show up," McKelvey said. "Normal procedure would have been for radio or (mobile data terminal) traffic indicating they pulled up on-scene. Why that didn't happen, I don't know."

Asked whether his crew turned off its radio, Childers said that would have violated company policy.

"Who said that?" Childers asked. "An employee said that? Who was it? That's very inaccurate. If I can't get the name of the employee, both crew members will be terminated. Then I can make sure I got the right one. But that is inaccurate."

The crew members did not respond to The Daily's efforts to contact them.

McKelvey filed a report of the incident with the state Department of Public Health, but the state took no action.

"Basically the state said, since the crew did go on, there was no actual act that would have been a refusal of call," McKelvey said. "He (Childers) was lucky the crew went on."

Childers said the incident -- which resulted in an administrative action by McKelvey and a new set of regulations adopted by the EMS Committee -- was overblown.

"The crew continued on because obviously we want to put the patients first," Childers said. "As far as resolving it, First Response continued on to the call and was not needed once we got there. It's a dead issue as far as providing service."

More trouble

The tragic night was not quite over for Montgomery. Overwrought with emotion and struggling from the exertion of giving her son chest compressions, she began having chest pains. At 10:59, a Priceville firefighter called dispatch to request an ambulance. Even though the radio-silenced First Response ambulance was either at the scene or had just left it, Morgan County 911 records indicate it was not called because Childers already had said First Response would not respond to Montgomery's address.

So instead of retrieving the First Response ambulance, the Morgan County 911 dispatcher called for Decatur Emergency Medical Service Inc.'s closest ambulance, Unit 421, which was near the corner of Danville Road Southwest and Kathy Lane. It arrived at Montgomery's home 13 minutes later, and the crew was able to treat her on the scene.

Montgomery, looking last week at the room where her son died of congestive heart failure, wept. She has been doing that a lot lately.

"I can't get over it," she said. "I still have bad days. I just sit all day and cry."

For three weeks after her son's death, she stayed with relatives rather than return to her home. The memories -- sparked by the many pictures of her son, Ben Chandler, and the belongings he had brought with him while visiting her -- are too intense.

"He was my oldest son," she said. "He was my rock. It's been hard, hard, hard."

She remembers her attempts to revive her son while trying to hear the dispatcher. Her younger son, Chris Chandler, had time to pick up a friend who used to be a medic and drive the 5 miles to her trailer. He beat the ambulance, which he said he never saw. With her chest throbbing and pains shooting into her left arm, Montgomery allowed her son and his friend to continue chest compressions and mouth-to-mouth resuscitation.

'It's just not right'

Montgomery doubts a faster ambulance response would have saved her son, but she tears up again as she contemplates the debate over police jurisdictions.

"They're fighting about whether they should come out and my son's here dying? It's just not right," Montgomery said.

"There's about 15 kids here," Montgomery said, gesturing out her window into the trailer park. "What if something happens to one of those kids? Are they going to lie there and die while the ambulances argue about whether they should come?"

After hearing of Childers' refusal to take the call, McKelvey investigated the matter. He ultimately drafted a rule, adopted by the EMS Committee in November, requiring any disputes about the propriety of an emergency call to be resolved after the ambulance has completed its response.

First Response was not penalized for declining the call. The EMS Committee has no enforcement authority. All it can do is recommend a suspension or revocation of an ambulance service's license to the City Council. Such a sanction is not feasible, especially against First Response. DEMSI has struggled to maintain even the city-required minimum number of ambulances and is laboring under tax liens. For about three hours Friday, all DEMSI ambulances were offline when some of its employees walked off the job after ongoing payroll issues.

At least two-thirds of the 911 calls are dispatched to First Response, Welty said, because its more numerous ambulances usually are closer to the incident.

Dr. Larry Sullivan, chairman of the EMS Committee, said Childers' debate with the dispatcher and his expressed refusal to take the call were inexcusable.

Moving forward

"The ambulance has got to go," Sullivan said. "It is not appropriate for them to try to decide if it's appropriate for them to go or not go. They need to respond to the call, take good care of the patient and get them to the appropriate place to take care of them."

Neither the issue of whether the call is within the police jurisdiction, not the likelihood that the patient is uninsured, should affect the response, Sullivan said.

"You're going to have some where you make a decent profit and some where you're going to lose," Sullivan said. "They all know that. That's like me working in the emergency room. I treat people and I don't know the patient's names or whether they have insurance in extreme situations. I'm not going to walk out on somebody that's coding and make sure they have Medicare. That's the way it should be for the ambulance services."

Unless the City Council amends the ambulance ordinance to give the EMS Committee enforcement authority, Sullivan said, there is little his committee can do.

EMS Committee member Dale Trammell said he wants to see an ordinance that gives the committee the authority to impose penalties short of revoking an ambulance service's license.

"It could take the form of fines or something else that will get their attention," Trammell said. "We're dealing with an aggressive bunch of business people that are trying to do the best that they can, and sometimes that gets out of hand."

Montgomery hopes something changes.

"This should never have happened," she said. "I don't want it to happen again to someone else."

Eric Fleischauer can be reached at 256-340-2435 or eric@decaturdaily.com. Follow him on Twitter https://www.twitter.com/DD_Fleischauer">@DD_Fleischauer.

Copyright 2014 - The Decatur Daily, Ala.

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