Nurse fights to change EMS policies after son’s care
PENSACOLA, Fla. (AP) — Sean Harris, 28, was five days away from his wedding when he died in a hospital bed on May 16, 2017.
He was struck by an SUV the night before while out with his friends celebrating his bachelor party. The group was crossing Pine Forest Road from a Circle K gas station when, as his friends would describe to his mother later, a car came out of nowhere.
The response by Escambia County Emergency Medical Services to the crash was captured on video. The lack of care portrayed in the video propelled Dawn Bybee, a nurse and the mother of Harris, to work for nearly two years to get EMS to change how it handles patient care.
Her uphill battle is indicative of the lack of urgency surrounding the ongoing issues alleged in the county’s EMS division. New Escambia County Medical Director Dr. Rayme Edler raised questions about how training was done in the county after taking over in May 2018, and the EMS Chief resigned in June 2018.
The investigation into EMS training has been turned over the state and the county has launched its own evaluation of the county’s Public Safety Department.
While Edler’s complaints weren’t official until she took over as medical director, her concerns with EMS care began at least as early as that 2017 video showing the lack of care received by Harris and friend Gary “Chris” Surgner, who also died from his injuries.
One of the first people Bybee shared the video with was Edler, months before she became the county’s medical director.
In the minutes after the crash, Escambia County EMS responded and the driver of the SUV, who at that point was standing on the side of the road, took out his phone and began to film the scene.
Bybee said she was at home putting together flowers and crafts for her son’s wedding when she received the call that he had been struck by a vehicle.
Harris passed away the next day in a hospital surrounded by friends and family. His mother said she remembers many of the women there, including herself, still had their nails painted lavender, one of the colors for the wedding.
In the months after her son’s death, Bybee gathered every record she could, including the video, which was part of the police record.
She watched the video with her husband, Toby Bybee, who is also a nurse. They were both horrified at how the emergency medical technicians and paramedics handled the situation.
The video shows two members of the EMS crew who responded walk around Harris and Surgner, lift them up to check their pulse without care to protect their necks, then allow them to flop back on the ground, potentially cutting off their airways. They next dug around in their pockets before beginning treatment.
“What you see on the video is below sub-par care,” Dawn Bybee said. “I’ve said that it’s no care.”
When she showed Edler — then a doctor at Baptist Hospital — the video, Bybee said Edler was outraged by what she saw. Edler began her career as an EMT and paramedic in New Orleans before getting her medical degree and moving to Pensacola as an emergency room doctor.
Edler declined to comment for this story, saying since she is a county employee, she must receive authorization from the county administrator before speaking with the media. The News Journal has requested an interview through the county.
“A paramedic digs through my son’s pockets at one minute and 29 seconds into the video, but yet he’s never secured an airway,” Dawn Bybee said, describing the video. “He’s never secured his head, his neck, his spine, rolled him over. They are just walking around on scene.”
Her husband pointed out that how EMS staff checked for a pulse, allowing both men to flop back on the ground, could have caused neck and head injuries.
“If they would’ve had the ability to live, and their injuries weren’t substantial, they (the EMT and paramedic) would’ve caused more injury to that patient,” he said.
Harris was placed on a stretcher with one medic grabbing his underarms, another man lifting him by his belt loops and a third person, one of Harris’ friends, lifting his feet.
Surgner was given a backboard, provided by firefighters who by that point had arrived on scene, to be placed onto the stretcher.
Dawn Bybee said her first thought when she saw EMS checking for the pulse and allowing the men to flop back to the ground was that those actions could have cut off their airways.
“That’s all I thought about when I saw that. If he had a broken neck, like Toby said, any chance of survival ... ” she said, unable to finish the last words of her sentence.
County spokeswoman Joy Tsubooka said both of the EMS crew members who responded to the call are no longer employed with the county’s Public Safety Department. Tsubooka said one member of the crew was fired from the county, and the other resigned “to go to a fire school.”
Opening Pandora’s box
Dawn Bybee said she thought her son’s case was an isolated incident. But after another experience her husband had with Escambia County EMS in which he allegedly witnessed lack of care for a patient, she decided to bring her son’s case to the attention of EMS administration.
She dropped off the video of her son’s incident in September 2017 for then-Deputy EMS Chief Leon Salter. She talked to Salter on the phone a few times asking for a meeting, but he never called back.
Salter is now interim EMS manager.
After getting no response from EMS staff, she went to her commissioner, who at the time was Grover Robinson, now mayor of Pensacola.
Robinson agreed to meet with her and set up the meeting for Jan. 30, 2018. His office sent out an email about the meeting telling her County Administrator Jack Brown, Assistant Administrator Matt Coughlin and Public Safety Director Mike Weaver would be at the meeting. EMS is part of the Public Safety Department.
“When I saw Mike Weaver’s name, I got mad,” Dawn Bybee said. “I was like well, I’ve already tried to talk to them. This is so ridiculous. I was so mad, so I put it on social media.”
She posted her story on the Escambia Citizens Watch Facebook group, and invited other concerned citizens to come with her to the meeting.
She was joined by 13 other people who sat silently in support as she described her son’s injuries and presented to the county their own protocols on responding to trauma. One of the people who joined her was Edler.
Then she played the video, and she said there was silence in the room.
Another meeting was held Feb. 14, 2018, and officials promised change, as well as a patient advocacy program to hand out cards with contact information to patients.
“I will say Mike Weaver was the only one, that sat back and said, ’What you see in the video is awful, and I’m sorry,” Dawn Bybee said. “He’s the only one ever that has apologized.”
Edler was named medical director on April 17, 2018.
Once news started coming out in recent weeks that Edler had raised concerns about the department, a state investigation had been filed and officials were resigning, Bybee said she thought to herself “Pandora’s Box had been opened.”
She went back and looked at her email with Brown and the Public Safety leaders after the January 2018 meeting.
“The last sentence (of the email) says, ‘Sean’s case very well may be the foundation for change,’” she said. “And when I read that, I decided to go public because, why has it taken this long?”
When asked for comment Friday about Bybee’s story, county spokeswoman Kaycee Lagarde said the county had created customer service cards “as an effort to improve patient outreach and quality assurance.” She said the cards are given out by EMS staff to patients and have contact information for EMS staff, including the EMS shift commander and deputy chief, public safety director, assistant county administrator, county administrator and EMS billing.
“Escambia County EMS also participates in the District 1 EMS Council of Northwest Florida, which actively works to improve and promote patient care and patient outcomes,” Lagarde said.
The county also has a public safety quality assurance and quality improvement policy that it follows, however, the policy was updated this year.
“When areas for improvement are discovered through the QA (quality assurance) process, they will be addressed with additional training and procedural improvements as necessary according to the QA policy,” Lagarde said.
Lagarde provided the News Journal with a copy of the policy. It was adopted by the county on March 12, 2019, signed off by Edler, more than a year after the initial meetings.
The previous policy, also provided to the News Journal by the county, dates from 2011 and says it’s meant to meant to comply with federal and state law.
The old policy didn’t specify what issues need to be reviewed or who can raise an issue to QA besides field training officers and employees. It recommended employees fill out the form for “At-a-boys,” but made no mention of medical issues or errors. Rather, much of the old policy was more focused on the proper way to fill out the county’s software form.
The new policy calls specifically for EMTs and paramedics to receive remedial training if an issue is raised. It also allows any family member, other county staff member, hospital staff or member of the public with direct knowledge of an incident to file complaints and begin the quality assurance process.
Other parents have reached out to Bybee to share their stories and experiences with EMS. Jackie and Tony Nichols tried to raise questions with the county over their son’s death nearly five years ago.
Aubrey Nichols was 28 in 2014 when he died after suffering from cardiac arrest from a heart defect. He was a musician in the popular local Pensacola band Timberhawk.
His father said Nichols was a self-taught musician who was well liked by everyone and had a great group of friends.
“His big thing for his birthday is they’d boil hot dogs,” he said. “It was like the big thing on his birthday. It was just so goofy.”
In 2014, Aubrey Nichols said he felt like he was having a heart attack, and EMS responded. His mother, who is also a nurse, remembers seeing her son in the hospital and noticing that first responders had performed a field intubation.
Months later when the family received the hospital bill, she noticed it read that an intubation had also been done at the hospital. The family later found out that the EMS intubation had been botched and another intubation was done at the hospital. During the ambulance ride, instead of air flowing into Nichols’ lungs, it was being forced into his stomach.
“My son didn’t have to die,” Jackie Nichols said.
Because of a Florida law that prevents parents from suing for wrongful death on behalf of their children older than 25, and since both Bybee’s and Nichols’ sons were unmarried, they were left with no way to hold the county accountable through a court.
In 2010, the American Heart Association released new protocols that called for treatment of circulation issues before dealing with breathing. The Nichols argue if EMS was following that protocol, a field intubation should have never been attempted.
“The fact that they prevented him from getting oxygen by not following the guidelines, they took away any chance he had of surviving,” Tony Nichols said.
Not able to go to court, Jackie Nichols tried approaching EMS administration to tell her story and find out what could be done to stop it from happening in the future. She said they weren’t interested in talking to her, telling her “mistakes happen.”
“They really did not seem interested in a solution,” she said. “They asked me, what do you want us to do, do you want this paramedic to lose his job? No, I don’t want anyone to lose their job. I want them to be able to function properly in their job.”
She said she takes away one positive from her son’s death.
“My son was an organ donor and gave the gift of life to 82 people,” she said, adding that even a part of his defective heart was used to save someone’s life.
Both the Bybees and the Nichols said they are working to ensure this doesn’t happen to other parents. And, they said, they believe that 99% of paramedics and EMTs correctly perform their jobs, which they say is one of the toughest jobs in medicine.
“I think the culture is willing to change now,” Dawn Bybee said. “Has it been exposed? Has it been? That’s the question.”
Information from: Pensacola (Fla.) News Journal, http://www.pensacolanewsjournal.com