Ohio Court Upholds Suspension of BC Over Scope of Practice Error

The Ohio Court of Appeals for the Sixth Appellate District has upheld the suspension of a battalion chief over his handling of a scope-of-practice error at an EMS scene. Battalion Chief Mark W. Stahl of the Allen-Clay Joint Fire District was suspended for 60-days without pay and placed on probation for one year in the aftermath of a medical run in 2018.

The penalty was imposed by Board of Trustees of the Allen-Clay Joint Fire District, and appealed initially to the Ottawa County Court of Common Pleas who upheld the board’s ruling. Chief Stahl then appealed to Court of Appeals. As explained by the Court of Appeals:

• On August 9, 2018, the Allen-Clay Joint Fire District was dispatched to a home in Williston, Ohio, where an elderly man was reportedly unresponsive and not breathing.
• Appellant, Battalion Chief Mark W. Stahl, responded to the call along with one paramedic and six emergency medical technicians.
• They arrived to find the patient slouched in his recliner. His pulse was weak and he did not respond to sternal rubbing.
• The responders soon observed agonal breathing, then the patient stopped breathing entirely. He was in cardiac arrest.
• The patient was moved to the floor and the team began resuscitative efforts.
• Paramedic C.O. situated herself at the head of the patient so that she could intubate him.
• Stahl situated himself at the patient’s left arm to start an IV.
• Other technicians performed chest compressions and bag-valve mask ventilation.
• C.O. was experiencing difficulty intubating the patient and Stahl was having problems placing the IV.
• Because the IV had not been placed, it was quickly recognized that an intraosseous infusion would be needed to administer medications to the patient.
• IO is an invasive procedure that involves drilling through the patient’s tibia bone in order to inject fluids and medication into the patient’s bone marrow.
• Of the eight emergency responders who were present, only two of them carried the necessary certification required to perform the procedure—C.O. and Stahl, who was an EMT-intermediate.
• Notwithstanding this fact, the procedure was performed, successfully, by EMT-basic, J.F.
• Medications were administered through the IO, and the patient was placed on a board and transported to the hospital via ambulance.
• The patient did not survive, but there is no suggestion that his death was attributable to the care rendered by the first responders.
• As is required after emergency medical services are rendered, C.O. prepared a patient care report.
• The report identifies the treatment provided and the provider who administered the treatment.
• C.O. listed herself as the provider who performed the IO.

Following an investigation, each of the other providers accepted responsibility for their roles in allowing JF (an EMT) to perform the IO procedure. Chief Stahl requested a hearing before the Board of Trustees arguing he did not order JF to perform the IO, nor was he even aware he performed it. The board found him not guilty of ordering JF to perform the IO, but “guilty of misconduct in office by reason of nonfeasance [by] failing to administratively address the issue of EMT-BASIC performing an I/O medical procedure in violation of his EMT-BASIC Certification Authority and District Protocol.”

As further explained by the Court of Appeals:

• Stahl argues that the board’s finding that he was guilty of misconduct in office is based entirely on its conclusion that Stahl should have known that an IO procedure was performed by somebody who lacked the certification to do it.
• He maintains that there is no evidence that Stahl owed a duty—either under departmental protocols or under Ohio law—to ascertain who performed what duties at the scene.
• He insists that even if he owed such a duty, had he reviewed the run report prepared by C.O., it would have indicated that C.O. herself performed the procedure.
• Thus, he contends, there would have been nothing to report because he had no reason to believe the report was false.
• Stahl also argues that the court abused its discretion in affirming the board’s decision because by the time he became aware that J.F. performed the IO, the matter was already in the hands of his superior.
• The testimony before the board demonstrates that as a battalion chief, Stahl was responsible for supervising the scene, regardless of whether it was a fire or an EMS scene.
• As the highest ranking officer on the scene, Stahl’s superior expected him to report improper activity.
• Additionally, Ohio Adm.Code 4765-9-01(G) requires a certified EMT to report knowledge of a violation of R.C. Chapter 4765 or Ohio Adm.Code.
• Stahl frames the legal question here as whether he owed a duty under departmental protocols or under Ohio law to ascertain who performed what procedures “when he had not personally witnessed everything that was being done for the patient” and “was not responsible to prepare the run report.”
• But the board found—and the trial court agreed—that the evidence demonstrated that Stahl was aware that J.F. performed the IO, even if he did not direct him to do so.
• According to various testimony and evidence before the board, the team had worked in very close quarters, the only other person certified to perform the procedure was within Stahl’s line of sight trying to intubate the patient, and after the run was completed, J.F. thanked Stahl for allowing him to perform the procedure.
• The board’s decision did not turn on whether Stahl “personally witnessed” J.F. perform the procedure—it turned on whether he knew or should have known.
• Although disputed, there is evidence to support the board’s finding that Stahl knew or should have known that J.F. performed the IO, either by process of elimination or because J.F. specifically mentioned it to him.
• Accordingly, we cannot say that the trial court abused its discretion in applying the law when it concluded that the board’s decision finding Stahl guilty of misconduct was not unconstitutional, illegal, arbitrary, capricious, or unreasonable, and was supported by the preponderance of reliable, probative, and substantial evidence in the record.

Here is a copy of the decision: