The City of Columbus has agreed to settle a wrongful death suit brought by the estate of a woman who died in 2011, for $1.2 million. The case has garnered some sensational headlines, including allegations the medics appeared more concerned with their own lunch plans than the condition of the patient, and comes on the heels of a Court of Appeals ruling earlier this year sending the case back to the trial court for a jury trial.
The incident triggering the suit occurred when Sonia Bray, 76, was undergoing an MRI and began feeling ill. Fire department paramedics James Hingst and James Amick responded. The parties differ greatly on the care provided, with Bray’s family claiming the medics did nothing for 25 minutes and the medics claiming they may not have been perfect, but they were not grossly negligent, reckless, or willful and wanton.
The trial court granted the city and the firefighters summary judgment based on immunity protection, concluding the medics did enough so as not to lose immunity by being “reckless, willful or wanton”. Earlier this year the Court of Appeals for the 10th Appellate District reversed sending the case back for trial. Rather than risk trial, the city agreed to pay Bray’s estate $1.2 million.
For those interested in the details of the case beyond the $1.2 million settlement – let’s use the Ohio Court of Appeal’s description of the facts:
- Amick and Hingst are emergency medical technicians employed by the city. On January 31, 2011, Bray was undergoing a mechanical resonance imaging procedure for her hip at an MRI facility when she signaled to the MRI operator, Shauna Wilson, that she needed to be removed from the MRI machine. Bray had vomited and possibly aspirated the vomit.
- Another employee of the facility called 911, and Hingst and Amick, among others, responded to the scene. Appellant contends that Hingst and Amick did little to nothing to help Bray for approximately the next ten minutes.
- Paramedics eventually moved Bray to a cot, but she could not be immediately placed into the ambulance due to distress she experienced whenever her legs were raised. After some discussion about the best way to transport Bray, the paramedics loaded Bray into the ambulance. Soon after being placed in the ambulance, Bray slumped over and became unresponsive. Appellant claims Hingst’s and Amick’s actions in response to Bray’s condition in the ambulance were inadequate. Bray died on February 2, 2011 as a result of cardiopulmonary arrest.
- [Bray’s estate] claims that Hingst and Amick failed to evaluate Bray and treated her in a manner that a reasonable jury could have concluded to have been reckless, willful, or wanton.
- [The city and the firefighters] counter that they provided sufficient treatment to demonstrate they did not act in a willful, wanton, or reckless manner. In their respective pleadings addressing summary judgment in the trial court, the parties relied on a combination of affidavits and depositions to argue their respective points. After thoroughly reviewing these numerous affidavits and depositions, as well as other proper evidence submitted on the issue of summary judgment, we find there remains a genuine issue of material fact as to whether Amick’s and Hingst’s actions constituted “any care,” and, as such, whether immunity was warranted.
- To support their respective positions, [both sides] submitted the depositions and affidavits of the EMTs and firefighters present at the scene, the MRI facility employees, and their respective expert medical doctors. Amick testified in his deposition that the call was dispatched as a cardiac arrest, but when he and Hingst arrived at the MRI facility, a police officer was at the entrance and told them that the patient was awake and it was not a cardiac arrest.
- Amick said that he interpreted the officer’s statements as warning them they could relax because it was not a cardiac arrest, and Amick speculated that the police officer informed them because he expected them to arrive tense or excited but what had happened was less serious than a cardiac arrest.
- When they entered the MRI facility, Bray was coughing, but it did not appear to Amick severe or dangerous, and Amick did not consider it an emergency. Bray was conscious, seated upright in a wheelchair, of normal color, and communicating, although with difficulty because of her coughing. Amick saw no reason why they would have needed to establish a proper airway, and Hingst testified that he did not think intubation was necessary because she was managing her airway on her own. McClain testified he would not sedate and intubate a patient if the patient was breathing on her own, even if she had rales and edema.
- At some early point upon his arrival at the MRI facility, Amick heard one of the employees state that Bray had been lying down, she had vomited, and she might have aspirated, so he considered that maybe she had become claustrophobic in the MRI machine, had a panic attack, and vomited, and was coughing to dislodge aspirated vomit.
- Amick’s initial thought was not that she was suffering from an exacerbation of congestive heart failure, because Bray’s son, who was present, said she had no history of heart problems. Hingst testified that Bray was talking, but not much because she was coughing, so he asked staff and family about her situation so she could have time to calm down and relax. During this time, Hingst said he and the other paramedics discussed why there was fluid in her lungs. Hingst considered using a continuous positive airway pressure machine, but it was reported that she had vomited, which is a contraindication for CPAP.
- Also, although Amick did not witness it personally, he said the run report indicated that Bray was given a nose cannula and oxygen. Hingst stated that they put a blood pressure cuff on her shortly after they arrived on the scene, they used a stethoscope to read her blood pressure, gave her oxygen using an oxygen bottle and nonrebreather mask, and assessed her lungs with the stethoscope. Hingst said that, after Bray was given oxygen, she looked like she was doing okay, and she told him she was feeling better. They took her vital signs within the first ten minutes of arriving on the scene.
- Hingst said that when Bray was told she was going to the hospital after about ten minutes, she stood up, walked to the cot on her own, and sat on the cot. She exhibited no breathing problems or discomfort when she moved onto the cot. After her legs were extended upward on the cot to place her in the ambulance, however, she indicated to him that she wanted her feet to be let down, and once they put her feet back down, she was able to speak again and her breathing eased. Hingst said that she had the oxygen and non-rebreather mask on during this whole period. Amick and Hingst then discussed solutions to this problem. In her deposition, Moore concurred that this issue and the subsequent discussions regarding their options delayed Bray’s transport, but she did not believe the call was moving any slower than normal, and the amount of time they spent on the scene was reasonable. Ream and McClain also testified that they observed the actions at the scene, and did not believe the run was any different or slower than their typical run. Hingst and Amick placed Bray in the ambulance about ten minutes after she first got on the cot.
- [Bray’s] medical expert, Dr. Keith Wesley, testified at his deposition that [Amick and Hingst] failed to properly assess and detect CHF, and they failed to treat Bray’s respiratory distress, which led to cardiorespiratory arrest and her eventual death. He said none of the records showed that the paramedics actually spoke directly to Bray to discover her chief complaint. Appellees failed to obtain Bray’s pulse oximetry and capnography, and failed to connect her to a cardiac monitor, which is standard protocol when a patient is having difficulty breathing and has a fast heartbeat.
- By continuous use of oximetry and capnography, appellees would have been able to judge urgency and measure breathing improvement or deterioration without merely guessing.
- Wesley stated that a cardiac monitor was important because one of the earliest signs of someone going from respiratory distress to failure is an increasing heart rate. Without the use of capnography, cardiac monitoring, or pulse oximetry, one would not know if Bray’s breathing difficulties were from CHF or something related to her recent history. If measurements are deteriorating, appellees could have used a bag valve mask or intubation. With regard to her respiratory distress, Dr. Wesley testified that appellees should have applied CPAP and then administered furosemide to remove fluid from Bray’s lungs and albuterol to reduce broncospasm and improve ventilation.
- Appellees’ contention that they did not apply CPAP because it was contraindicated by vomiting was unfounded, Dr. Wesley stated, because no one confirmed such with Bray or examined the expelled material, the color of which was more consistent with pulmonary edema fluid than vomit. Dr. Wesley said that the duration appellees were on the scene was not so much of a factor as the fact that they accomplished very little during their time on the scene. Dr. Wesley also testified that appellees should have pointed toward CHF as a diagnosis when Bray could not breathe when they raised her legs on the cot, because the raising of legs puts pressure on the heart and causes difficulty breathing. Dr. Wesley opined that appellees’ actions were reckless because of their failure to adhere to a number of protocols.
- Shauna Wilson, an MRI technician at the MRI facility at issue, averred that when the paramedics initially arrived, they simply stood around and asked her what had happened without providing any care to Bray. She averred that, despite the fact that one of the paramedics initially criticized workers at the facility for not having taken Bray’s vital signs, appellees took no vital signs until over 15 minutes after they arrived, and that was only after Wilson demanded that they do so. Only one paramedic talked to Bray, and that was only very little, while the other paramedics and firefighters stood several feet away.
- Bray was unable to talk to the paramedic because she could not breathe, sounded as if she had fluid in her lungs, and was coughing constantly. Wilson averred that appellees put Bray on oxygen via nasal cannula and took her blood pressure, but that was 15 minutes after arriving. She said that no one used a stethoscope to listen to Bray’s lungs, hooked her up to an EKG monitor, checked her pulse oximetry, checked her pulse, tried to start an IV, or tried to intubate Bray. She averred that appellees did not demonstrate a serious attitude toward Bray, did nothing to evaluate Bray without Wilson asking them to do so, and exhibited a total lack of regard for Bray’s health and breathing problems.
- Kathy Jordan, a patient coordinator at the MRI facility, averred that she never saw anyone take Bray’s blood pressure, use a stethoscope, hook up an EKG monitor, do a pulse oximetry, take her pulse, or start an IV. She never saw Bray speak, and Bray was constantly coughing and having trouble breathing. Jordan averred that she had witnessed paramedics care for patients at the facility four or five times, and the paramedics in those cases immediately took over care of the patient, unlike the present case. Jordan averred that appellees showed no regard for Bray’s health or her breathing problems.
- After viewing the foregoing evidence in favor of appellant, we find there remain genuine issues of material fact.
Here is a copy of the Court of Appeals decision: Herron v Columbus