- The Washington Times - Thursday, May 21, 2009

EXCLUSIVE:

D.C. fire officials promoted an internal candidate to lead their troubled emergency medical services division knowing that their choice to institute agency reforms was himself facing a multimillion-dollar lawsuit for wrongful death and medical malpractice.

Rafael Sa’adah was named assistant chief for EMS on March 29, more than three months after he was cleared in an internal departmental investigation of having mishandled the case but four days before the city’s inspector general informed Chief Sa’adah that he had been unable to substantiate the complaint during a second investigation.

The city officials also were notified late last year that a D.C. emergency medical technician planned to sue the city, charging that Chief Sa’adah had mishandled the response to her son’s fatal shooting in August.

The lawsuit, filed last week in D.C. Superior Court, seeks $10 million from the District and Chief Sa’adah in his personal and professional capacities for medical malpractice and wrongful death, among other things.

Tonda Wright, who has worked for the D.C. fire department since 2001, filed the lawsuit on behalf of her son, Johnquan Wright. Mr. Wright, 18, and another man were shot in the unit block of K Street in Northwest on Aug. 14. Mr. Wright died from his wounds.

The lawsuit charges that Chief Sa’adah thought Mr. Wright had been shot in the head and ordered emergency workers to stop treating him, thinking he was dead. The complaint says an autopsy revealed Mr. Wright had not been shot in the head and that the gunshot wounds were to his torso and leg.

Chief Sa’adah did not respond to an e-mail from The Washington Times and declined to comment on the incident through Deputy Chief Kenneth Crosswhite, a department spokesman.

Reached by phone, Ms. Wright referred questions about the lawsuit to her attorney, Stephen S. Millstein, who declined to comment. A scheduling conference in the case has been set for Aug. 28.

City Attorney General Peter J. Nickles provided documents to The Times that indicate the department’s medical director, Dr. James J. Augustine, reviewed the case last year.

“It was determined that the care of the victims was appropriate, according to the protocols of the department,” Mr. Nickles said.

Mr. Nickles also forwarded to The Times a copy of a letter from D.C. Inspector General Charles J. Willoughby, who looked into the incident and wrote to Chief Sa’adah that investigators “have not found evidence to substantiate” charges that he prohibited emergency workers from attending to Mr. Wright. The letter was dated April 2.

The department’s Web site says Chief Sa’adah was appointed as full-time assistant chief for EMS on March 29, four days earlier.

The lawsuit argues that “the gunshot wounds suffered” by Mr. Wright “were life-threatening, but there was a chance of survival had the decedent received appropriate and immediate emergency medical care and attention and immediately [been] transported to a health care facility for life-saving care.” It says the response by Chief Sa’adah violated department protocols and procedures, and it cites recent fire department special orders that tell medics that any victims who have “penetrating wounds” in the torso should be treated and transported with an advanced life-support response. According to the complaint, another order says medics should not stop CPR in the field for patients suffering from acute traumatic injury.

“Providers are to notify the receiving facility that they are en route and are not to cease transporting under any circumstances,” the order says, according to the complaint.

The complaint argues that emergency responders and Chief Sa’adah “at no time based on the circumstances presented in this case had the right to make ‘life and death’ medical decisions in the field.” Dr. Augustine, the department’s medical director, said in a letter to Ms. Wright dated Nov. 24 that the incident was “reviewed by a panel of experienced paramedics” who examined documents, patient care reports, autopsy reports and department protocols and “independently interviewed some of the providers.

“It was noted that both victims in this incident received care from multiple providers from D.C. Fire and EMS, so several persons contributed to decision making for each of the victims,” Dr. Augustine wrote in the letter, which does not mention Chief Sa’adah.

But the court papers quote statements from two D.C. emergency workers who responded to the incident and said Chief Sa’adah ordered them away from Mr. Wright in order to attend to the other shooting victim, an older man who also died from his wounds.

The complaint cites a statement from EMT Chris Young, who said he was directed by a police officer to where Mr. Wright had fallen. The complaint quotes Mr. Young as saying he began an assessment of Mr. Wright’s condition and had found blood at the back of Mr. Wright’s head when he was approached by Chief Sa’adah. He told this to Chief Sa’adah, who then directed him to assist other medics providing care to the second victim.

“I abided by his request,” Mr. Young said in the statement.

Sgt. Lucy Jones, a paramedic, said in a statement that she told Chief Sa’adah that she had a cardiac monitor and “would like to, at the very least, attach it to the young man to observe his cardiac status, if nothing else, as no appropriate resuscitative actions were being taken at that time.” According to court papers, Sgt. Jones said Chief Sa’adah appeared “indignant” at the request and ordered her away from Mr. Wright in an “intimidating way.” The complaint quotes Sgt. Jones as saying Chief Sa’adah told her someone else was coming with a monitor but that she never saw anyone else attend to Mr. Wright.

The Times obtained copies of special reports on department letterhead that were written by Mr. Young and Sgt. Jones in October and addressed to Chief Dennis L. Rubin. The comments from both medics are similar in nature to the comments cited in the lawsuit.

City officials were notified in a letter from Mr. Millstein in December that a lawsuit was forthcoming. The letter was dated Dec. 23 - one month after the city posted an announcement advertising its vacant position for assistant chief of emergency medical services.

Chief Sa’adah, who had served in the position in an acting capacity for more than a year, was selected by Chief Rubin, who had pledged that he would mount a national search for the most qualified candidate.

The handling of the search and the decision to promote Chief Sa’adah upset some observers, who said Chief Sa’adah was not qualified for the position.

D.C. Council member Phil Mendelson, chairman of the Committee on Public Safety and the Judiciary, which has oversight of the fire department, addressed the appointment in his committee’s budget report last month.

“Stakeholders have expressed dissatisfaction, both with the transparency of this process and the resulting selection,” Mr. Mendelson wrote. “To conduct a ‘national’ search for an assistant chief of EMS that results in the selection of the same in-house candidate who has been holding the position in an interim capacity raises questions, but is not impossible. However, several key stakeholders in this process do not believe that this was an open and transparent selection process.” Among those who questioned the search was Anne Renshaw, president of the D.C. Federation of Citizens Association, which has closely monitored the city’s efforts to reform EMS.

“We did not feel the present assistant chief was ready for the position, and we thought the head of EMS must be a nationally recognized, experienced individual who could bring all his training and all his experience and all his contacts to bear on improving and elevating the emergency medical services for the District,” she said.

Chief Rubin told Mr. Mendelson in an April 2 letter announcing the choice that a five-member panel had selected 10 finalists. Four of the finalists were “invited but failed to appear before the search committee,” Chief Rubin told Mr. Mendelson.

He said the national search consisted of advertisements in February in the trade publications JEMS Magazine and Fire Rescue Magazine and the posting of an announcement on Web sites associated with the two magazines for 60 days.

Chief Rubin said in the letter to Mr. Mendelson that Chief Sa’adah “possesses an outstanding reputation and collection of field and administrative experience.”

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