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On Oct. 24, 2007, John Valentine, general manager of River Medical Inc., the city’s private ambulance service, called his two newest paramedics, Nathan Carter and Peggy Gould, into his office. Recently relocated from Denver, over the previous three weeks the two had clashed with fire department paramedics over patient care and the documentation of emergency calls.
“The fire department wants you guys gone. Vaporized,” Valentine told them. “They don’t want to see you. They don’t want you in their system.”
What Valentine did not realize at the time was that the two paramedics were secretly taping the meeting. In an interview with city investigator Dennis Wilson, Carter and Gould, who are engaged to be married, said they recorded that and subsequent conversations because they feared “something was wrong” with Valentine’s handling of two cases on successive days in which they documented perceived errors in care by Lake Havasu City Fire Department paramedics. In both instances, the patients died. The tapes are contained in Wilson’s full investigative file.
The recordings, which span several meetings, reveal how fallout from Carter and Gould’s clashes with fire department paramedics escalated into an full-blown feud between River Medical and the fire department over control of emergency medical care in the city.
“I don’t think you understand what the ramifications of this are,” Valentine told them in the recording. “I don’t know how to fix this.”
For Valentine, the stakes were high. A day earlier, Battalion Chief Rick Felish, the direct supervisor of the fire department’s emergency medical services, had issued a department-wide memo by e-mail upending the department’s longstanding emergency care arrangement with River Medical.
“Effective immediately Lake Havasu Fire Department will assume an aggressive posture as the Primary Care Provider on all EMS calls,” Felish wrote.
Felish ordered his paramedics to assert control over all medical calls, even those where River Medical was already on scene. Paramedics were told remain in control of care even as patients were being transported to Havasu Regional Medical Center in River Medical ambulances. Felish further instructed his paramedics to withhold medical documents from River Medical employees.
While not naming Gould, Carter and Valentine outright, Felish made clear where he believed the root of the problem lay.
“The newest employees and supervisor seem to be the catalyst for the problems… be aware!” Felish wrote.
Valentine issued a brief statement about the paramedic investigation, but declined comment on the content of the recordings, “Because of the ongoing investigation by the city, River Medical will not comment on personnel issues relating to these matters, and will not offer any opinions or speculations regarding any actions or statements made by Rick Felish,” he wrote. He denied improperly handling any complaints about patient care.
The apparent trigger for Felish’s memo was an emergency call for Terri Taylor, a 72-year-old woman in cardiac arrest during which River Medical paramedic Gould raised concerns about the use of a particular medication by fire department paramedics Joe Tobin and Nick Hovdal.
According to the city investigator’s report, Tobin described Gould as stating “If you give that drug, you’re going to kill that patient.”
Taylor’s husband, Donald Taylor, 65, had no recollection of any such statement being made. “I watched the whole thing from start to finish,” he said in an interview. “I didn’t hear anything said by a woman.”
Gould admitted raising doubts about the drug, vasopressin, but denied saying that it could kill the patient. According to national guidelines, vasopressin is not contraindicated for unconscious cardiac arrest patients such as Taylor, who died the next day.
Gould also complained about Tobin’s timing of other heart medications and his use of shock paddles.
Despite the conflicting accounts, Felish blasted Gould in the memo.
“RMI personnel have openly, on-scene accused LHCFD medics of improper medication administration in front of family, creating an aire (sic) of malpractice for LHCFD,” Felish wrote.
Felish failed to state in the memo that the day before the Taylor incident, Lake Havasu City paramedic Mike Partain had drawn up and handed off for injection the incorrect medication for a 45-year-old woman suffering from a stroke. She later died in a Las Vegas hospital.
The medication error had been properly recorded and reported by River Medical paramedic Carter.
Soon after Felish issued his memo, Carter and Gould were out of the system, transferred first to River Medical stations in Parker, and then on to Quartzsite.
In an administrative report issued in late May, investigator Wilson cited the Valentine recordings and Felish’s memo as supportive of Carter and Gould’s contention that they were targeted for retaliation by fire department leadership after reporting alleged medical errors by fire department paramedics.
Felish did not respond to requests for comment.
Wilson’s report alleges that Felish violated the city’s code of ethics by failing to properly investigate complaints about substandard performance by paramedics under his supervision and improperly pressuring River Medical to transfer Carter and Gould out of Lake Havasu City.
Fire Chief Dennis Mueller is also accused of violating the code of ethics, by failing to follow city procedures for investigating allegations of substandard performance of his subordinates and complaints of harassment by fire department personnel against Gould and Carter.
The three paramedic-firefighters named in the report are Partain, Hovdal and Tobin.
In an interview Wednesday, Fire Chief Dennis Mueller discussed the report specifically for the first time. He acknowledged Partain’s medication error, but said that Debra Gulyanics, medical director at Havasu Regional Medical Center, who oversees all EMS care in the city, had dealt with his error.
Tobin, accused in the report of violating medical protocols and falsifying records related to his treatment of a 72-year-old woman in cardiac arrest, was cleared by Gulyanics of any wrongdoing, Mueller said.
“Everything I’ve found out so far says, in the Tobin incident, he did his job. He saved a life. He brought a person that was clinically dead to the hospital with pulse and respiration,” Mueller said.
Tobin was also not found to have altered medical documents in the incident, Mueller said. “The question about that whole incident was the documentation, was the documentation properly filed. From what the hospital’s told me, it was,” he said.
Sheena Benson, a spokeswoman for Havasu Regional Medical Center, declined to discuss the paramedic investigation in depth. “Havasu Regional Medical Center is aware of the issue with the paramedics and we are looking into the situation at the hospital level,” Benson wrote in a statement.
A letter from Gulyanics to Rick Felish and John Valentine, dated Oct. 25, 2007, states “the concerns regarding the medication administration and documentation discrepancies are of valid concern and have been discussed with the specific paramedics involved.”
The letter does not address paramedic Gould’s allegations that she was pressured to sign a patient care form she believed was inaccurate. “The documentation that was presented as the patient record was signed by all parties involved,” Gulyanics wrote. “This reveals that all parties agreed, at the time, that it was as accurate as possible.”
Mueller called Felish’s memo changing the fire department’s EMS protocols “inappropriate,” and said that the order had been immediately reversed when it came to his attention. Felish was also disciplined over the memo.
Mueller said he had concerns about Partain’s compliance with hospital sanctions after the medication error. According to hospital documents, Partain ignored repeated requests to perform an annual pharmaceutical review and only complied after being threatened with suspension of his medical privileges by Danielle Stello, the pre-hospital care coordinator for Havasu Regional Medical Center.
No disciplinary sanctions have yet been taken against any fire department personnel named in the paramedic investigation.
Carter and Gould are no longer employed by River Medical. Carter resigned, and Gould was terminated after a supervisor ruled that she had lied during the filing of a sexual harassment complaint. Gould, who disputes the ruling, is now weighing legal action against the company.
Editor’s note: Part one of this series referenced a Lake Havasu City police department incident report which triggered the initial investigation of alleged misconduct by fire department paramedics. The police contact was made by a friend of Walter Gould, River Medical paramedic Peggy Gould’s father, not by Walter Gould himself, as originally reported. The online version of the story has been updated to reflect this correction.
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