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  1. #1
    Forum Member medicmaster's Avatar
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    Default Firefighter/Paramedic's Case Goes to Court

    Check out this article about a career Firefighter/Paramedic from Burlington, Iowa whose life has been hell for the last year and half because of this case....

    FIREFIGHTER'S CASE GOES TO COURT
    By JEFF ABELL

    jabell@thehawkeye.com

    The opening salvos were fired Tuesday in the city of Burlington's appeal of a Civil Service Commission ruling in favor of a Burlington firefighter who received a one–day suspension last year.

    In his opening arguments in Des Moines County District Court, Scott Power, who is serving as the city's attorney in the matter, alleged Detmer Kobza of West Burlington failed to follow department protocols when dealing with an elderly female subject during a Dec. 29, 2004, ambulance run.

    Attorney Darwin Bunger of Burlington, representing Kobza, argued the patient, who had apparently fallen and was bleeding from a laceration to the bridge of her nose, did not require immobilization.

    Power charged Tuesday that Kobza failed to provide proper documentation of emergency procedures. Power said Kobza was verbally warned about not adequately completing ambulance run reports prior to the Dec. 29 ambulance run. Kobza was suspended Jan. 3, 2005, by Bur–lington fire officials.

    At the heart of Power's argument is whether Kobza should have immobilized the patient using a cervical collar and a back board prior to transporting her to Great River Medical Center in West Burlington.

    "Evidence showed it (immobilization) should have happened in this case," Power said.

    Bunger said Kobza, as a paramedic specialist, used knowledge and expertise garnered in more than a decade in the field when deciding to forgo a cervical collar on the ambulance run in question.

    Bunger dismissed a Dec. 29 telephone call placed by a Great River Medical Center nurse to fire officials alleging the patient treated by Kobza had a cervical fracture.

    "No C–collar was needed and the facts in this case prove that out. This is a case of an overzealous nurse and a rush to judgment by the fire department," Bunger said. "The alleged fact of a C–2 fracture was dispelled at (University of Iowa Hospitals and Clinics) Iowa City."

    Fire Chief Tom Clements testified Kobza was suspended because he disregarded department protocols when he failed to use a cervical collar during the emergency call.

    "It's a no–brainer, we always err on the side of patient care. What does it take, a few minutes to package a patient?" said Clements.

    District Judge David Fahey briefly interrupted the defense's cross–examination to submit a question to Clements.

    "If a person falls forward and hits their head against a door frame but doesn't fall to the ground, what is the protocol then? Should I have been in a cervical collar?" asked Fahey.

    "To me, a fall means when you travel downwards you gather speed, and that's a tremendous mechanism of injury," Clements replied.

    Esther G. Schwerin of Burlington, who was at the scene when paramedics arrived, served as the key witness for the defense.

    Schwerin, a retired registered nurse, testified her sister–in–law was bleeding from a cut on the bridge of her nose, but her spine and neck weren't injured.

    "When I arrived, she was sitting there wiping her nose back and forth. She was moving her neck all around ... she had no pain when they put her on the gurney and she didn't complain of pain in her neck," Schwerin said.

    Fire Marshal Mark Crooks testified Kobza failed on more than one occasion to file paperwork correctly under department procedures. He said 41 percent of the reports filed by Kobza needed to be corrected.

    In April 2005, the three–member Burlington Civil Service Commission said in its ruling, "Kobza complied with criteria for initial assessment ... the commission finds no evidence of improper care."

    Testimony will continue at 9 a.m. today in the third–floor district courtroom in the Des Moines County Courthouse
    ______________________________ ______________________________ _____

    For a little background, he had been suspended without pay for a day...the case went to the Civil Service Commission who ruled in his favor and ordered he be given his lost wages. The city and fire department has taken this to court to appeal the civil service commission's ruling...this translates to spending somewhere between $10,000 and $15,000 in legal fees to get back about $360 worth of pay.

    My favorite line in this article is the fire chief (who by the way is no longer a paramedic) when he states that "it is better to err on the side of patient care" in regards to immobilization.

    BTW, this department DOES have a selective spinal immobilization protocol.
    Last edited by medicmaster; 03-17-2006 at 12:16 AM. Reason: The link will expire soon...so I posted the text
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  2. #2
    Forum Member DixieFire53's Avatar
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    Exclamation

    If a PT. Falls and hits her head, neck, or face and they fill it’s bad enough to call 911 and get an ambulance then she get’s a collar. It’s a no brainer. Let the Doc who makes 3 times more then you make that decision.

    I agree with the chief.
    Last edited by DixieFire53; 03-16-2006 at 01:17 PM.
    DixieFire53, Deputy Fire Chief FF/EMT-P, Local 272

  3. #3
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    Quote Originally Posted by DixieFire53
    If a PT. Falls and hits her head, neck, or face and they fill it’s bad enough to call 911 and get an ambulance then she get’s a collar. It’s a no brainer. Let the Doc who makes 3 times more then you make that decision.

    I agree with the chief.

    Hardly what you should be making a decision based upon. If you truely base your treatment on the medical knowledge of a civilian, then I would suggest for your financial security that you continue to board and collar every pt in such a situation.

    I, on the other hand, will continue to treat patients based on not just the story but what I find upon exam. A small cut to the bridge of your nose would not immediately require a board and collar.

    I have a feeling that this guy may just have been a trouble maker and the brass thought they finally found a way to "bang him". Too bad for the brass that the civil service commision didnt agree. My opinion would be that this guy is fighting so hard to keep this off his record because he knows they will continue to "bang him" until a pattern is established and then try to take his job. I would highly doubt that this is truely over a couple hundred bucks.
    Just another one of the 99%ers looking up.

  4. #4
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    I think PFD has nailed it. This ain't about the $360, it's about which step in the progressive discipline progression he's on.

    From what I read, the protocols allowed gave the medic the flexibility to board or not, and the follow up on the patient showed it was the correct decision.

    Chief wasn't binging him for failing to follow protocols, he binged him for not using the same judgement he would have.

    Especially where there's a civil service board, you don't just jump and dock someone's pay. Me thinks there is probably something that says, "Verbal counseling, written counseling, suspension, termination" and the fight is over the suspension part that puts you on the edge of step #4, not the $360.

  5. #5
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    Default

    Quote Originally Posted by DixieFire53
    If a PT. Falls and hits her head, neck, or face and they fill it’s bad enough to call 911 and get an ambulance then she get’s a collar. It’s a no brainer. Let the Doc who makes 3 times more then you make that decision.

    I agree with the chief.
    1. The pt's only injury was a laceration to the nose, acoording to later exam by "the doc".
    2. She had no complaints indicating the use of spinal immobilization.
    3. The anatomy of elderly females (ie kyphosis) and lack of soft tissue over bony prominences often causes pressure sores and/or nerve damage when secured to a backboard.
    4. Assuming an average height of 5'2" for an elderly female, this hardly constitutes a reasonable mechanism of inujury to warrant full spinal imobilization, particularly when there are no complaints of pain in those regions.
    5. Spinal immobilization is a medical procedure, with inherent risks. Needlessly using this procedure has been found in court to be grounds for liability on the part of the EMS personnel. Search for old threads about C-spine, in particular a case in Detroit, involving to 2 EMT's that lost litigation for a very similar case.
    6. A thorough exam by well trained EMT's will provide the proper information to determine need to apply spinal precautions.

    "CYA" does not hold up in court.

  6. #6
    Forum Member Weruj1's Avatar
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    Arrow

    damned if you do ..........damned if you dont. Good luck...........
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  7. #7
    MembersZone Subscriber EFD840's Avatar
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    Default

    From the story:

    Fire Marshal Mark Crooks testified Kobza failed on more than one occasion to file paperwork correctly under department procedures. He said 41 percent of the reports filed by Kobza needed to be corrected.
    Now, why would paperwork issues be under discussion if the problem was a failure to board the patient? PFD and Dal have it right. His appeal isn't about the money and his suspension isn't about this call.

    BTW, based on the info presented in the story (which might not be accurate) I doubt I would have boarded her.

  8. #8
    Forum Member medicmaster's Avatar
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    Default And There's More....

    PARAMEDIC TAKES STAND IN HIS DEFENSE
    By JEFF ABELL

    jabell@thehawkeye.com

    After a day of listening to others testify during the city of Burlington's appeal of an April 2005 civil service commission's ruling in his favor, veteran Burlington firefighter and paramedic Detmer Kobza took the stand Wed–nesday to defend his record.

    Kobza of West Burlington was suspended Jan. 3, 2005, by Burlington fire officials who allege he failed to provide appropriate care to an elderly female subject during a Dec. 29, 2004, ambulance run.

    Kobza appeared Wednesday in Des Moines District Court where he vehemently denied allegations made by fire officials that he was derelict in his duties during the emergency call in question.

    Kobza stood by his decision not to immobilize the patient who had apparently fallen and was bleeding from a laceration to the bridge of her nose.

    Kobza said the patient's wound was bandaged, and her spine and back were checked for soreness or discomfort.

    The patient never complained of neck or back pain and thus no cervical collar or back board were needed, Kobza added.

    "She was moving her head back and forth before we arrived. There was nothing that would have led us to think there was trauma," said Kobza.

    City attorney Scott Power argued the patient should have been immobilized prior to arriving at Great River Medical Center in West Burlington.

    Power also accused Kobza of failing to provide proper documentation of the ambulance run. Power asked Kobza why he ddin't note in his report the subject's spine had been checked for fractures at the scene.

    "Why are pertinent negatives not in the report like whether he checked the spine," Power asked.

    Power then pressed Kobza whether there had been a positive outcome from his suspension.

    "My narratives are a lot better. That would come from fear and intimidation," Kobza shot back.

    "Because you're afraid," Bunger added.

    His voice cracking at one point, Kobza testified his mental and physical health had deteriorated as a result of the suspension and subsequent hearings. He added the stress had forced him to seek counseling.

    "I have become so damn paranoid from their constant reviewing of my charts. I guess you don't know how low you can go. I was there down low ... and I was a wreck there at the bottom," said Kobza.

    Testimony from a relative of the patient who asserted she had no neck or back trauma was recapped by attorney Darwin Bunger of Burlington to corroborate Kobza's assertion that proper patient care was provided.

    Esther G. Schwerin of Burlington, who was at the scene when paramedics arrived, testified Tuesday her sister–in–law was bleeding from a cut on the bridge of her nose, but her spine and neck weren't injured.

    During the two–day civil trial, prosecution witnesses claimed Kobza failed to follow proper departmental protocols by not using a cervical collar or back board on a potential fall victim.

    Defense witnesses on Wednesday portrayed Kobza as a seasoned paramedic who utilized over a decade of expertise in the field to make a correct diagnosis.

    "He's a suberb paramedic," said Jason Wagoner, a paramedic specialist at Southeastern Community College in West Burlington.

    In April 2005, the three–member Burlington Civil Service Commission said in its ruling, "Kobza complied with criteria for initial assessment. The commission finds no evidence of improper care."

    Written closing arguments in the case will be filed later this week with a ruling from District Judge R. David Fahey expected early next week.
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  9. #9
    Forum Member MIKEYLIKESIT's Avatar
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    We are allowed to clear c-spines in the field. This case smells awful fishy to me. It also is a prime example of a municipal government taking the taxpayers for a ride just to try and prove a point.
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  10. #10
    Forum Member DeputyChiefGonzo's Avatar
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    Posted by medicmaster

    a little background, he had been suspended without pay for a day...the case went to the Civil Service Commission who ruled in his favor and ordered he be given his lost wages. The city and fire department has taken this to court to appeal the civil service commission's ruling...this translates to spending somewhere between $10,000 and $15,000 in legal fees to get back about $360 worth of pay.
    Another prime example of governmrntal waste, this time on the local level!

    From the story:

    Fire Marshal Mark Crooks testified Kobza failed on more than one occasion to file paperwork correctly under department procedures. He said 41 percent of the reports filed by Kobza needed to be corrected.
    If this were the case, why didn't the administration stop this need for correction to reports in the beginning when they noticed reports needed correction instead of waiting to drag it into court?

    A memo from the Chief in charge of the EMS division to all personnel would cost a few electrons and a few pieces of paper instead of the $10 to 15K the City is spending to avoid paying $360!


    Posted by DixieFire53
    If a PT. Falls and hits her head, neck, or face and they fill it’s bad enough to call 911 and get an ambulance then she get’s a collar. It’s a no brainer. Let the Doc who makes 3 times more then you make that decision.

    I agree with the chief
    Most ER docs are paid what are the equivalent of slave wages for the amount of responsibility... and not all docs really know what goes on in the streets. They are used to having all kinds of medical equipment and x-rays. CAT scans, MRI's and surgical suites at their beck and call, if they are lucky enough to be working in a hospital that has them or has them nearby.

    I would trust a street smart paramedic with years of experience.
    ‎"The education of a firefighter and the continued education of a firefighter is what makes "real" firefighters. Continuous skill development is the core of progressive firefighting. We learn by doing and doing it again and again, both on the training ground and the fireground."
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  11. #11
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    does it really matter what you think the pt needs??


    "Fire Chief Tom Clements testified Kobza was suspended because he disregarded department protocols when he failed to use a cervical collar during the emergency call. "


    protocols are there for a reason.
    if they fell bad enough they deem neccesary to call 911, they get immobilized per protocols.

    if they dont want full spinal immobilization, they sign a treatment refusal form, and your on your way.

  12. #12
    MembersZone Subscriber EFD840's Avatar
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    Quote Originally Posted by 275fbvfd
    does it really matter what you think the pt needs??


    "Fire Chief Tom Clements testified Kobza was suspended because he disregarded department protocols when he failed to use a cervical collar during the emergency call. "


    protocols are there for a reason.
    if they fell bad enough they deem neccesary to call 911, they get immobilized per protocols.

    if they dont want full spinal immobilization, they sign a treatment refusal form, and your on your way.
    Did you see this comment in medicmaster's first post:

    BTW, this department DOES have a selective spinal immobilization protocol

    He may have been following protocol. The second story seems to make it clear that they're really after him because of his paperwork.

    What I don't get is why not suspend or otherwise punish him for the inadequate documentation?

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    does it really matter what you think the pt needs??

    Um, yes.

    Mittlesmertz's original post said they have a selective spinal imobilization policy, and he had a great 2nd post on the protocol's reasons.

    if they fell bad enough they deem neccesary to call 911, they get immobilized per protocols.

    if they dont want full spinal immobilization, they sign a treatment refusal form, and your on your way.


    Three Magic Words: Online Medical Control. Standing Medical Control i.e. Protocols can not possibly cover every situation you will encounter.

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    Sounds like a witch hunt. We have the same thing going on here right now and the city is going to loose. This kind of action stems from poor managment on several levels. First is the non-use of progressive discipline starting at the company officer level and second is the overall problems with the fire service failing to adapt to the changing managment requirments of a different type of work force.

    If this guy was having a problem filling out his run tickets properly then it should have been addressed through councelling. A proper councelling session by his company officer is non-punitive and is a way to establish positive, achievable goals for the employee to meet in order to come up to standards. This falls right into the problems the fire service has as a whole with adapting its management style.

    Historically firefighters were hired “from the neck down”. Don’t think, don’t question, follow orders. A councelling session was a strong butt chewing by the Lieutenant or Captain. The problem is when you hire medics you get a group of people who are trained to question everything. This even holds true for the basic fire fighter. As we have had more and more responsibility piled on the fire service, we are hiring better educated personnel. Many of these people are college educated and are taught to think critically. The old ways of management just won’t work with these people. The end result is you get what you have here. The city looses on two counts. They loose money trying to burn the guy, and the have a disgruntled employee who will never work to his full potential.

  15. #15
    Forum Member MIKEYLIKESIT's Avatar
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    As a 19-year paramedic who has treated as many injured old ladies as anyone on these forums, I think the last statement is one of the most ridiculous things I have ever seen. "Originally Posted by 275fbvfd
    does it really matter what you think the pt needs??... Absoultely... its what YOU the PROFESSIONAL thinks. Not a book. I am not strapping an old lady with a nose laceration to a board unless she NEEDS it. I dont see any mention of the EMS SYSTEM going after this guy. It's the FIRE DEPARTMENT BRASS. I dont want a medic treating me that needs to follow a book to give competent PROFESSIONAL medical care.
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    i apoligize for that post, i totally missed the selective spinal imob. part at the bottom.

    i wasnt trying to question a medics experience, as i have none whatsoever ( other than first responder calls )

    just pointing out that protocols are there for a reason ( if they are not selective like i didnt read )

    sorry folks, wasnt trying to hit a hornets nest with a broom like i did

  17. #17
    Forum Member MIKEYLIKESIT's Avatar
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    Default Right on Brother..

    See how easy it is. Post something goofy..Get pounced on. Realize the gaffe, fix it and move right along. If everyone (including me) would follow the lead of 275, this forum would not get so bogged down in negativity. And I am not being sarcastic either.
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    Forum Member MIKEYLIKESIT's Avatar
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    Default 275

    One more thing. If I knew you weren't a medic when I read that post, you REALLY would have got it!
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    haha, im sure i wouldve gotten it good, if i hadnt cought my error ( prolly wouldve cought it with everyone pouncing though )

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