- The Washington Times - Wednesday, August 25, 2004

D.C. Fire Chief Adrian H. Thompson yesterday said he has no plans to purge the leadership of the Emergency Medical Services division after firing the department’s medical director last week.

The Washington Times reported yesterday that several of the EMS division’s 35 or so managers stand to lose their jobs in the next two weeks as officials fully investigate how confidential patient records ended up in the hands of city officials.

“Chief Thompson said he was not looking to fire anybody,” said Alan Etter, fire department spokesman.

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

Mayor Anthony A. Williams yesterday defended Chief Thompson’s decision to fire Dr. Daniels.

“He wants a team around him that’s going to carry out his agenda,” Mr. Williams said during his weekly press briefing. “I’ve got to let him have his team.”

The patient records, some of which were obtained by The Washington Times, include names, addresses and detailed descriptions of conditions for seven patients treated recently by firefighter/medics.

The disclosure of such information is a potential violation of the federal Health Insurance Portability and Accountability Act (HIPAA), a set of rules designed to safeguard patient information.

Violators can face civil fines from $100 to $250,000 and criminal penalties of up to 10 years in prison.

Mr. Etter said Chief Thompson today will meet with the fire department’s HIPAA officer and the city’s HIPAA officer to determine whether there were any violations.

The federal Office of Civil Rights, which is responsible for investigating HIPAA violations, referred a call for comment yesterday to a spokesman for the Department of Health and Human Services, who did not return a phone message.

The patient records detail recent instances of what evaluators say has been substandard care administered by firefighter/medics, who have become the linchpin for a restructuring of the fire and EMS staff. The restructuring, which began in 2002, relies heavily on firefighters trained as paramedics.

A regional EMS instructor with knowledge of the District’s emergency-medical protocols reviewed the records for The Times and said five of seven of them detail “minor” emergency care violations.

A sixth record about a nursing-home patient details a “moderate” error by a firefighter/medic, who administered a drug without contacting a supervisor for permission, the instructor said. The firefighter/medic should have been temporarily assigned to ride an ambulance with a field training officer who could monitor his performance, he said.

The seventh record details an “egregious” mistake, in which firefighter/medics fitted a patient complaining of difficulty breathing with an oxygen rebreather mask but did not take the patient’s vital signs or notice that the patient’s heart had stopped.

“If I were [the Department of Health] and I saw this report, I would strip everyone of their [emergency medical technician] cards,” the instructor said of the incident.

Jim McElhatton contributed to this report.

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