- The Washington Times - Tuesday, October 21, 2003

An emergency-room doctor at George Washington University Hospital in Northwest erroneously tried to reroute an ambulance carrying a critically ill patient from Southeast earlier this month, according to an internal review by the D.C. fire department.

“Based on the facts, GW Hospital was not on closure at the time Ambulance 18 initiated contact with them,” Dr. Fernando Daniels III, medical director for the D.C. Fire and Emergency Medical Services Department (EMS), wrote in a memo to Fire Chief Adrian H. Thompson.

“There is no documentation in the EMS log that GW had requested closure or diversion six hours prior to the alleged incident,” Dr. Daniels said.

D.C. paramedics had filed complaints stating that GWU Hospital’s emergency-room chief, Dr. Robert Shesser, had discouraged an emergency crew from delivering a 97-year-old woman suffering from congestive heart failure to the hospital on Oct. 11, as The Washington Times first reported on Thursday.

The woman remains hospitalized.

According to taped radio communications, Dr. Shesser told the paramedic on the ambulance that he had closed the emergency room.

EMS logs indicate the hospital was placed on closure at 11:41 p.m. — after Ambulance 18 arrived with the patient, Dr. Daniels stated in his two-page memorandum dated Friday. He also wrote that in addition to trying to divert the ambulance, Dr. Shesser “did not provide the crew of Ambulance 18 any medical-control instructions that would have assisted the patient en route.”

“For instance, with the patient en route to the facility that was unresponsive, whose respirations were 12 and needed assisted ventilations, there was no mention of additional care that should be administered en route for this ‘sick’ patient.”

Dr. Daniels stated that the results of the review were preliminary and that a final review should be completed this week.

Last week, GWU Hospital cleared Dr. Shesser of any wrongdoing. The report issued on Friday did not claim that GWU Hospital asked EMS officials to be placed on closure, but it said Dr. Shesser “knew, better than EMS command-and-control or the paramedics, whether he could care for additional patients without jeopardizing the safety of the patients already in his care.”

EMS officials say they have the final authority to make such decisions.

D.C. Council member Kevin P. Chavous said last week that he had learned that an EMS supervisor was dispatched to the hospital to determine whether its emergency-room patient volume necessitated closure. The supervisor found there were eight empty beds in the emergency room and seven ambulances standing by with patients.

D.C. Mayor Anthony A. Williams on Thursday asked Dr. Daniels and city Health Director James A. Buford to investigate the incident.

Dr. Daniels recommended that Chief Thompson send a protocol-training staff to local hospitals to remind emergency-room doctors of the standard operating procedures for requesting closure or diversion and assisting paramedics with medical advice while en route to a hospital.

Paramedics have filed official complaints against Dr. Shesser, saying he has denied hospital access to patients from Southeast several times, and Mr. Chavous, Ward 7 Democrat, has accused the doctor of racial bias.

The D.C. chapter of the American College of Emergency Physicians issued a statement Monday saying the incident was the result of “severely overcrowded emergency departments and a strained emergency care system.”

The college defended Dr. Shesser, describing him as an “outstanding emergency physician who is deeply committed to providing high-quality emergency care for all patients in the District of Columbia.”

“Emergency-care providers cannot work in a climate of fear and intimidation, and singling out one emergency physician to malign will not solve the underlying crisis of an overburdened citywide emergency care system,” said Dr. Eric Glasser, president of the college’s D.C. chapter.

Dr. Glasser said there needs to be better coordination between hospitals and emergency workers so immediate feedback can be given about overcapacity, which will enable selection of alternate hospital destinations.

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