Delayed Emergency Response

Minutes can make the difference between life and death — but does Denver Health know how to tell time?

Michael Hancock got the call at 6:30 a.m.: His sister had been shot. Hancock lived less than five minutes away, and when he screeched to a halt on a quiet neighborhood street in Montbello, he saw his sister, 41-year-old Karen West, in the driver's seat of her SUV.

"I walked right up to my sister and heard her grunting for life," Hancock remembers. In the seat next to West was the body of her common-law husband, who had apparently shot West, the mother of two teenagers, in the head before turning the gun on himself. Police officers arrived just after he did; they told him that he had to step outside the perimeter until medical help came. Denver firefighters from the nearby station showed up less than a minute later, but they were trained only in Basic Life Support skills, such as CPR, and weren't equipped to staunch West's significant bleeding or transport her to the hospital.

"They said, 'There's nothing we can do,'" Hancock recalls. "'We need the ambulance service.'" By then, at least six or seven minutes had passed since the original 911 call. He and other family members stood by anxiously, waiting for the paramedics as the minutes ticked away. "It felt like an extra twenty minutes. It could have been ten minutes or fifteen minutes," he says. "But it felt like an eternity waiting for someone to get there to help my sister."

Bob Petre wants Denver Health to play by the rules.
Mark manger
Bob Petre wants Denver Health to play by the rules.
Michael Hancock has asked for a review of response times.
Michael Hancock has asked for a review of response times.

When the ambulance finally arrived, West was pronounced dead.

Six years after his sister died, Hancock is now the president of Denver City Council. He still doesn't know what would have happened if paramedics had arrived at the scene sooner — maybe his sister would have lived, maybe not. But he does know that the wait was excruciating. How could the police and firefighters arrive so quickly and the ambulance take so long? How many other people in Denver are waiting, and waiting, for paramedics to show up?

After consulting with numerous paramedics and Emergency Medical Services experts, Hancock has come to believe that the city's EMS system is inefficiently set up and routinely leaving citizens in the lurch, especially in outlying areas like Montbello, Bear Valley and Fort Logan.

"We have pockets of our city that are not covered at any given time, where [paramedics] take an extraordinary effort to get to patients, where we have to provide an outside ambulance service to get to someone, which is completely unacceptable," he says.

City Auditor Dennis Gallagher shares Hancock's concerns. In light of the Democratic National Convention coming up in August, in February his office decided to conduct an emergency-response performance audit of both the Denver Fire Department and the city's paramedic division, which is operated by the Denver Health and Hospital Authority. Unlike the fire department, Denver Health is a public/private entity that receives city funds but is not technically a city agency. And for three months, hospital administrators resisted Gallagher's request for response-time data, arguing that Denver Health was under no obligation to release financial records.

"The contract that the city and county has with Denver Health with regard to emergency services, among other things, says that the city can look at benchmarks that Denver Health has," says Denis Berckefeldt, spokesman for the auditor's office. "Among those are ambulance response times. We're just looking at the contract that says you must respond in a certain time. Are you responding in that time?"

When Hancock caught wind of the dispute, he contacted Denver Health CEO Patricia Gabow, urging her to cooperate with the auditor and requesting that she retain an independent EMS systems consultant to conduct an analysis of the Denver Paramedic Division's operating procedures. After a May 21 meeting, Denver Health agreed to cooperate with the audit. On Tuesday, Hancock received a letter from Gabow confirming that Denver Health was participating in the audit — but she didn't mention his request for an independent analysis.

Such an analysis might point out a disturbing development: Denver Health has changed the way it calculates its ambulance response times, violating specific requirements in its annual agreement with Denver — and potentially putting many citizens at risk every year.

In the '70s and '80s, Denver was renowned for having one of the finest trauma systems in the country. The Knife and Gun Club, a 1989 book by photojournalist Eugene Richards, offered a brutally frank depiction of life in the emergency room of what was then known as Denver General Hospital. Part of what made the hospital so progressive was its paramedic division, called "The God Squad" by other Colorado medics. Denver paramedics were among the first to take emergency care out of the emergency room and into the streets. Rather than just run an ambulance transport service, the paramedics provided vital care en route to the hospital, sometimes in extreme circumstances. Since Denver General took in the lion's share of the city's indigent and late-night emergency calls, it also caught the lion's share of violent-crime injuries, including gunshots, stab wounds and drug overdoses.

But by the early '90s, the hospital was running a $31 million deficit each year. At the time, the facility was overseen by the city's health department, and its manager was appointed by Denver's mayor. In order to allow Denver General to better compete with other regional hospitals, in 1997 it was spun off from the city as a quasi-public entity similar to the Denver Housing Authority. While the Denver Health and Hospital Authority's board of directors is still appointed by the mayor, the hospital now has control of its own budget and personnel. This makes most paramedics employees of Denver Health rather than of the city, a point of contention even as Denver Health was being set up. Back in 1995, Denver paramedics voted to be represented by the International Association of Fire Fighters, and began lobbying to have their division moved to the Denver Fire Department. Then-mayor Wellington Webb said he was against the switch, but appointed a task force to examine the issue — which determined that the paramedic division should stay put ("Firemen, Save My Department!" January 10, 1996.) Proponents of the status quo offered arguments similar to, if less colorful than, an analogy used by an attending physician in The Knife and Gun Club, who'd rephrased Richard Nixon's famous "If you got 'em by the balls, their hearts and minds will follow." As this version went, "If you get 'em into your ambulances, the patients and their wallets will follow."

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