- The Washington Times - Tuesday, August 24, 2004

D.C. fire department officials plan to purge the leadership of the Emergency Medical Services division over the leak of confidential patient records that already has forced the ouster of the agency’s medical director.

Several of the EMS division’s 35 or so managers — who serve as at-will employees — stand to lose their jobs in the next two weeks as officials more fully investigate how patient records ended up in the hands of city officials, fire department sources said.

Dr. Fernando Daniels III, the EMS medical director, was fired Friday. Dr. Daniels was not accused of leaking the records but was held responsible as the EMS quality assurance director, fire administrators said.

“If [investigators] present the fire department with findings that people knowingly engaged in violations of the law, that could lead to penalties up to and including termination,” said fire department spokesman Alan Etter.

Wrongful disclosure of patient records violates the federal Health Insurance Portability and Accountability Act (HIPAA). Violations can carry a maximum penalty of a $100,000 fine and/or five years in prison.

Fire Chief Adrian H. Thompson will meet with the department’s HIPAA officer and the city’s HIPAA officer tomorrow, Mr. Etter said.

“The purpose is to figure out what happened and how it happened,” Mr. Etter said. “Chief Thompson has been presented with photocopies of documents in what may be a violation of HIPAA. We need to determine if a violation has occurred.”

The patient records detail recent instances of what evaluators said has been substandard care administered by firefighter/medics, who have become the linchpin for a restructuring of the fire and EMS staff. Chief Thompson initiated the restructuring in 2002, and the latest phase began in May.

One of the records includes a complaint lodged by officials at Greater Southeast Community Hospital that a firefighter/medic complicated a patient’s condition through negligent care. Another indicates that a different patient died under the care of a firefighter/medic, though it could not be determined whether the paramedic was at fault.

The Washington Times has obtained copies of some of the records.

The fire department announced Monday it had hired Dr. Clifford H. Turen, medical director of the Maryland Fire and Rescue Institute, as Dr. Daniels’ replacement. Dr. Turen’s hiring was unusually quick for a bureaucracy in which high-ranking jobs often go vacant for several weeks or months while candidates are recruited, interviewed and examined.

Kenneth Lyons, president of the American Federation of Government Employees Local 3721, which represents the city’s medics, said he was aware of plans to dismantle EMS administration.

“I think if [Chief Thompson is] able to replace these individuals, it’s game, set and match,” Mr. Lyons said.

Chief Thompson in May ordered a reorganization aimed at merging the firefighting and EMS divisions into one uniformed agency. City medics, who are civilians, no longer have a separate chain of command and now report to fire officials.

The move has increased tensions between the two divisions, which work on different schedules, have separate pay and benefits schedules, and are represented by different unions.

Medics say that fire officials do not have the necessary understanding of emergency medical care to supervise them. But firefighters say EMS supervisors are unfairly targeting firefighter-medics because they are bent on proving that dual-role cross-training will not work.

Chief Thompson’s long-term goal remains to have a cross-trained firefighter/paramedic riding on each of the city’s 33 fire engines and to have every ambulance staffed with one paramedic and one advanced-protocol-trained emergency medical technician.

Some other jurisdictions use the bifurcated system that the D.C. fire department is abandoning, while others employ the dual-role cross-trained system the department is adopting.

New York City, Los Angeles and Arlington County employ the bifurcated system; Houston, Miami, Fairfax County and Montgomery County use firefighter/medics.

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