Official Refuses to OK Paramedic Plan Before Probe

Los Angeles County’s top regulator of emergency medical crews said Wednesday that she will not approve a controversial redeployment of city paramedics until her watchdog agency completes a thorough review of persistent errors in how they are dispatched.

Virginia Price Hastings, director of the county Emergency Medical Service Agency, said she was troubled that problems in the dispatch system--tied to three recent cases of patient deaths--were not corrected despite critical internal Fire Department studies dating to 1997.

“It appears to us a fix did not take place. That concerns us,” Hastings said. “We will not agree to an implementation date until we are comfortable that the city will get paramedics to the people.”

The review will examine not only the performance of individuals, but also the operation of the entire dispatch system, which handles more than 300,000 emergency calls a year.

Hastings said she ordered the inquiry after disclosures in The Times that firefighters regularly fail to ask scripted questions designed to ensure that the correct level of medical aid is sent.

In one recent 60-day span, the department estimated that the wrong medical personnel may have been dispatched to 160 patients, including the three who died.

Fire Chief William R. Bamattre said Wednesday that the review will not affect his proposed paramedic redeployment because such examinations are usually swiftly completed. He said he hopes to begin the program by early December. “We’re ready to go now,” he said.

Hastings said, however, that it is impossible to predict how long the inquiry will take until the process gets going.

Under the “one-plus-one” program, two-person paramedic teams assigned to ambulances would be split up so the highly trained medical rescuers can be assigned to all of the San Fernando Valley’s 35 stations. In theory, the change would get at least one paramedic to patients sooner to begin sophisticated medical treatment. The chief has said he would like to see the program expanded citywide.

Bamattre, who said he has attempted to fix the dispatching problems, has made the pilot program in the Valley a top priority for his administration. He has promoted the plan as an answer to dispatch problems and, ultimately, a prescription for improving paramedic service throughout the city.

One of the most crucial junctures in the plan’s development was winning the approval earlier this year of Hastings’ agency. County policy normally requires that advanced lifesaving units be staffed by two paramedics. Until Wednesday, only the start date for the plan remained to be worked out with the county.

The county’s unexpected move was applauded by the head of the union representing the city’s more than 3,000 firefighters, who said it shows weaknesses in the entire proposal. “The one-plus-one program is ill-conceived and ill-thought out,” said Capt. Ken Buzzell. “There’s a whole host of questions that haven’t been asked.”

Critics, who have been waging a running battle with Bamattre, say the plan will dilute the quality of medical care. They contend that two-person paramedic teams are essential because one backs up the other when quick life-and-death decisions have to be made.

The latest complication for the redeployment program comes as the mayor-appointed Fire Commission meets today in special session to review the status of one-plus-one and other issues, including dispatching breakdowns.

Hastings, who is among those scheduled to appear at the hearing, said her agency supports the concept of Bamattre’s trial plan because it is promises to get at least one paramedic on the scene faster.

But the success of the experiment, she said, is “built on the ability to dispatch” proper rescuers as quickly as possible.

A series of Fire Department studies has shown that, on average, dispatchers have failed to ask key questions nearly half the time, sending less trained emergency medical technicians on some calls. A July report to Bamattre by the department’s quality assurance commander warned that firefighters are “dispatching inappropriately, thereby increasing the risk of liability to the department and reducing the quality of patient care.”

The report said that fixing the dispatch problems is important for gauging the effectiveness of the redeployment program.

The county’s probe will be directed by the emergency medical agency’s chief physician, who can enlist the help of nurses and, if necessary, state investigators.

Among the areas to be examined are the three fatal cases, including how help was dispatched and what paramedics did at the scenes. Officials also are likely to look at the scripted dispatch questions and listen to dispatch tapes, Hastings said.

“We’re going to be interested,” she said, “in looking at all of that.”