Thursday, August 5, 2010

Twice, No, Three Times Dead?

by Andrea Campbell

When is a nightmare real? When you die two or more times.

Earlier this year, a Caucasian woman named Pamela Harper was found lying face down and unconscious in an alley behind her brother-in-law’s house at 1322 Hunters Cove Drive in Little Rock. Despite the March night chill, she was wearing a thin gown, light underwear and socks. Her right hand clutched a pair of gray sweat pants. It was 6:30 a.m.

MEMS Arrives
According to Detective M. Nelson’s police report, the patrol officers who arrived on scene said that a Metropolitan Emergency Medical Services (MEMS) was called, and vehicle Unit #503 arrived. Two paramedics named Pat Bajorak and Keith Summerman were the first responders, arriving within twenty minutes at approximately 6:40 a.m. The medics did their work and reported that the victim was deceased. The medics remained on the premises for about an hour altogether according to police officer Ronnie Carr. Carr then notified Sgt. Helton. A couple of other detectives, Sgt. O. Jenkins and Detective Haskins, came out to the scene as well.

Officers interviewed Jim Ducket, 71, the subject’s brother-in-law who lived at the address. Ducket said that Pamela Harper had called him a little after 1 o’clock in the morning. Ducket added that he thought she had sounded drunk, and that she said she had to get out of the house. Ducket claims he told Harper that she needed to not leave the house but that she should try to go to sleep. She said, “OK,” and ended the call. The next person police spoke to was the deceased’s husband, Tanny Harper, aged 60, who admitted that he and his wife had been drinking the night before and he thought his wife may have taken some pain pills. But Mr. Harper stated that he didn’t know if she’d left the house, and he reported last seeing her around midnight.

On Scene
Detective Nelson reports that he was urgently summoned from another crime scene to join the others at the Harper scene. Nelson reported that Lt. King said there was more going on with the dead body. Nelson arrived around 8:50 a.m.; Detective Haskins filled him in: the first MEMS unit had put a sheet over Ms. Harper before they left. Officers then went back to the body and when they pulled back the sheet, they noticed Ms. Harper had “goose bumps” on her shoulders and back! They observed that her stomach was moving up and down and that air was being exhaled from her mouth. He wrote in his report that they witnessed her taking about ten breaths over a two-minute period. Apparently, the first MEMS ambulance crew had pronounced her dead mistakenly, misdiagnosed rigor mortis. They immediately sought to cover her up and called the MEMS service again.

Second Ambulance Visit
This time MEMS Unit #408 was dispatched to 1322 Hunters Cove Drive at about 9:10 a.m. In the meantime, officers had spoken to the Pulaski County deputy coroner and described what they saw. The second ambulance crew arrived, immediately started CPR and Paramedic Brandi Johnson hooked Ms. Harper up to a heart monitor. Johnson determined that she couldn’t detect any heart rhythm, decided Harper was dead, and over the phone asked a doctor—Dr. Kennedy at Baptist Emergency—to "declare Harper officially dead.” Johnson was heard saying the victim showed signs of lividity and was cold. Harper's death was now logged in at 9:29 a.m., about three hours since she was first discovered. Before she left, Paramedic Johnson took the time to explain to the detective that what she believed he had observed was air leaving Ms. Harper’s lungs after death. The MEMS unit left the scene once again.

Officer Nelson notified his superior and called Deputy Coroner Patrick McElroy to tell him what had transpired and ask him to respond to the scene. Around 10 that morning, McElroy showed up with Pulaski County Coroner Garland Camper and another deputy coroner, Gerone Hobbs. Soon all of them observed Ms. Harper breathe again. She was covered in a blanket and MEMS Unit #133 arrived at 10:27 a.m.; and this time they were advised to take the victim to Baptist Hospital right away. They left around 10:53 a.m., according to the police report.

So let’s get this straight: about three and a half hours after she was first found in the 40-degree March temperature, she was pronounced dead several times and left to chill (literally).

Unfortunately, Ms. Harper died two days later at Little Rock’s Baptist Health Medical Center.

The Official Medical Ruling
Autopsy results determined the death was a suicide as the result of an intentional overdose of the narcotic painkiller Darvocet and alcohol. Hypothermia was a contributing factor in her demise.

The Aftermath
MEMS administrators accepted responsibility for the mistake, but Executive Director Jon Swanson, along with Medical Director Chuck Mason, said that once the two separate crews believed that 52-year-old Pamela Harper was dead, they followed the correct protocols and made decisions accordingly. They also felt that the coroner had portrayed the incident unfairly by criticizing the agency and its employees. Coroner Camper put in his report that paramedics should have followed a hypothermia protocol. Swanson disagreed, saying that paramedics should have done “Pulseless Electrical Activity” had they known Harper was alive. “I don’t know where he got his medical training,” said Mason, a physician and specialist in emergency medicine, said of Camper. “But it wasn’t medical school.”

Some other critical comments were bounced back and forth such as: the questionable age of the medic, a reluctance to share information, how likely the victim was to die, and, apparently, animosity was fully lobbied in both directions. The end result is that MEMS issued an apology for the mistakes and the Harper family did not reply to reporters' requests for comments.

“This is nothing to be proud of,” Swanson said. “We have done a thorough, honest and self-criticizing assessment of our performance. The responsibility is ours for the mistakes we made.”

Coroner Camper said he was confident in his report’s accuracy. “It is what it is,” the coroner said. “It’s as right as I could get it. I gave them the benefit of everything we address in the report.”

In Hindsight
MEMS is revising its training and protocols, in particular, Protocol 803 “Withholding/Withdrawal of Life Support.” The new policy adds four criteria for determining whether a person is “obviously dead”: No breathing through an open airway for 30 seconds, no pulse for 30 seconds, no heart sounds for 60 seconds and fixed and dilated pupils with “no neurological response to painful stimuli,” such as a pinch of the skin.

Other Cautions
There is also this: “Caution: Signs of death may be misleading.” Examples given in the manual are that a burn victim may appear dead and that poor hygiene can simulate decomposition.

And that pesky hypothermia? It “may simulate death, and resuscitation should be attempted if time of exposure to cold environment or water has been less than one hour or is unknown.”

According to news reports, Swanson said MEMS gets more than 6,000 calls a month and transports 4,000 people to hospitals. “Maybe only 1 or 2 or 3 percent of our calls are truly to render lifesaving service, to perform in life-threatening situations,” Swanson said. “We know we don’t get a second chance.”

Told that it would seem that ambulance crews got a second and then a third chance in Harper’s case, Swanson sighed deeply and thought about what to say next. "We acknowledge the duty that we have to do the best we can with each patient every time," he said after a pause. "This is an outcome that we regret. Which is why it is so important for us to learn what we can from it, to use it to better offer treatment and care to the people we will serve in the future.”

Source: MEMS criticizes coroner’s report on death Responders Erred in Overdose Case but Findings Unfair to Then, Officials Say by Jacob Quinn Sanders Arkansas Democrat Gazette, June 23, 2010.


Leah said...

I feel bad for the medics in a way because it was certainly the cold temps that hindered their ability to accurately assess her. But you'd think that when called out a second time, they'd have just taken her to the hospital for professionals to examine. An ambulance isn't equipped with all the technology, experience and education that a hospital is.

Kathryn Casey said...

Fascinating post, Andrea. Enjoyed it!

Andrea Campbell said...

Thanks for writing Leah. I had the same reaction at first but one of the detectives noted that Brandy looked at the woman and not the machine hook-up for results. You just can't want to hurry your job when others' lives are in the balance.