Suit Filed after Seattle Woman Found Dead Weeks after 9-1-1 Snafu

When Pamela Hogan phoned 911 from her Seattle apartment, she was suffering from knee pain so intense she couldn’t stand up. She had been trapped in her bed all day, unable to eat, drink or get to the bathroom. Worried and alone, Hogan thought an ambulance would come quickly and take her to the hospital.

She was mistaken.

Seattle no longer is capping ambulance wait times for certain 911 patients, tracking those waits or penalizing its ambulance contractor when they run long.

Rather than send Hogan help right away, the Fire Department routed her to a nurse in Texas who determined her crisis didn’t need immediate attention.

So the 71-year-old, a retired executive assistant who loved cooking casseroles, watching “Judge Judy” and listening to The Pointer Sisters, waited one hour for a nurse-ordered ambulance, according to call recordings and court documents.

Two hours. Three hours. Four hours, phoning 911 back several times and telling the Fire Department about a heart condition. Ten hours.

By the time an ambulance arrived at Hogan’s building, it was the middle of the night and she wasn’t answering her phone. The ambulance left without her.

Weeks later, her body was found decomposing on the floor of her bedroom.

It’s not clear Hogan’s wait is what killed her, but her estate has sued and her experience raises questions about Seattle’s relationship with its for-profit ambulance contractor, American Medical Response, which also provides the city’s 911 nurse line.

“More checks and balances and accountability need to happen, said Josephine Ensign, a professor emeritus at the University of Washington School of Nursing who called Hogan’s case concerning and upsetting. “Seattle can do better.”

Seattle and AMR have denied the lawsuit’s wrongful death allegations and say the nurse line is generally working as intended. They say it’s reducing strain on hospitals and ambulances by diverting low-level patients to more appropriate care.

But most Seattle callers triaged by the nurse line are still being sent to hospitals in AMR ambulances, rather than being diverted, program data reveals. And officials have exempted those nurse-ordered rides, like Hogan’s, from city standards that normally require the company’s ambulances to arrive on time.

It’s possible that Hogan’s experience was an aberration. But the city stopped tracking ambulance waits like hers in 2022, so officials have no way to know.

To examine these changes, The Seattle Times plumbed public records, analyzed Fire Department data and spoke to about two dozen experts and advocates across the nation, including 911 administrators, emergency medicine physicians and professionals, telephone triage specialists and health care watchdogs.

Many said Seattle’s system should be reviewed for transparency and safety. Some said that could be especially important as rising health care costs and federal cuts to social services threaten to increase reliance on 911.

“It does seem incredibly important to get to the bottom of how something like this could happen,” said Harold Pollack, a public health policy professor at the University of Chicago who co-directs the university’s Urban Health Lab.

When The Times shared results from its investigation with the Fire Department and AMR, including in a list of more than 125 bullet points, they declined to address any specific points, citing the litigation over Hogan’s death.

A Fire Department spokesperson said The Times' reporting misrepresented the Nurse Navigation program but didn’t identify any errors. A spokesperson for AMR said the reporting was inaccurate but also didn’t identify any errors.

The audio clips in this story have been edited for brevity and clarity.

4:18 pm, Call 1

Hogan’s wait started when she dialed 911 on the afternoon of April 8, 2022.

“I’ve got really bad knees because of rheumatoid arthritis and there is damage to them as well, and I’ve gotten to the point where I can’t get up,” she told the Fire Department dispatcher who answered, according to a recording of the call obtained through a public records request. “I’d like to go to the ER and have them look at my knees.”

Hogan had used 911 for emergencies before, assuming this time would be the same. Instead, her call was transferred to the nurse line operated by AMR’s parent company, Global Medical Response, from a call center outside Dallas.

“I’m going to bring the nurse on the line here and let them kind of help figure out the best course of action,” the Fire Department dispatcher said.

Hogan told the nurse she had been stuck in bed all day and had completely filled an adult diaper, according to a recording disclosed by AMR in the Hogan litigation. She described her pain intensity as 10 out of 10.

“I will get someone out to you,” the nurse said. “To get you to the hospital.”

Then the nurse ordered an ambulance, recommending care within four hours, according to another recording disclosed in the Hogan litigation. An AMR dispatcher in Seattle said it would take three to four.

Neither of them told Hogan, who was no longer on the phone.

Strained system

In the years before Hogan’s emergency, the Seattle Fire Department and AMR were dealing with a mounting number of 911 calls from patients with low-level needs, said Michael Sayre, the Fire Department’s medical director.

A sore throat. Anxiety. A stomachache. Patients who don’t really require emergency transport and care. The city received 44% more low-level medical calls in 2021 than in 2017, according to Fire Department records.

Few 911 patients receive lifesaving interventions and most emergency room visits are for nonemergency issues, national research has shown. People sometimes dial 911 not because they’re in imminent danger but because they’re not sure whether they’re sick or not, Sayre said.

These patients put pressure on the Fire Department’s dispatchers, who work long, grueling shifts. Such calls often involve homeless people or other patients without regular doctors, noted Ensign, whose decades of Seattle-based work has focused on health and social inequities.

“They don’t know what else to do, so they call 911,” Sayre said.

For acute 911 calls, the Fire Department sends its own highly trained crews. They can transport patients in red Medic One ambulances or hand the patients off to AMR emergency medical technicians in white ambulances.

For less-acute calls, the department may simply send AMR. One way or another, the company handles most of Seattle’s ambulance responses, approximately 50,000 annually.

4:26 pm, Call 2

Eight minutes since first call

Eight minutes after her first 911 call, Hogan phoned 911 back with a question.

“I forgot to tell (the nurse) and she didn’t ask: I can’t walk to the door and unlock it for you — are you going to be able to get in?” Hogan asked a Fire Department dispatcher, who suggested a building manager could help.

“Oh, we transferred you to the nurse line,” the Fire Department dispatcher added after checking Hogan’s file. “Were they going to send an ambulance?”

Hogan said yes, so the Fire Department dispatcher added an AMR dispatcher to the call. “We’ll get there as soon as we can,” the AMR dispatcher told Hogan.

New program

Like other cities that use ambulance contractors for 911 callers, Seattle allows AMR to bill patients. In return, the company must meet standards for patient care: For years, its ambulances were supposed to arrive within 11½ minutes for more-urgent calls and one hour for less-urgent calls, at least 90% of the time.

But in the wake of the COVID pandemic, AMR was struggling with ambulance staffing in Seattle, arriving late for many of its 911 patients and paying a price, Fire Department records show. The city assessed the company almost $1.4 million in contract penalties for ambulance delays in 2021.

Enter the Nurse Navigation program, which Seattle and AMR leaders said would relieve that strain and improve ambulance response times in the city by diverting low-level callers to cheaper, better solutions. When it launched with fanfare in February 2022, then-Mayor Bruce Harrell called it “a strong example” of how to make a system “more efficient and ensure better care at the same time.”

The idea wasn’t new: King County had been using a 911 nurse line on a smaller scale for years, and cities across the world were experimenting. When implemented well, these programs can deliver real benefits, many experts say.

Seattle preferred not to hire its own nurses, said Sayre, the medical director, citing the costs involved. So the Fire Department turned to AMR, which agreed to triage the city’s callers almost for free. AMR had launched Nurse Navigation in Washington, D.C., in 2018 and had been attracting positive attention.

4:55 pm, Call 3

37 minutes since first call

Hogan dialed 911 a third time.

“Usually in the past, when I’ve had to call, it has not taken nearly this long … The firemen can’t come anymore?” she asked, moaning as a Fire Department dispatcher again brought an AMR dispatcher onto the call.

“We’re still looking at about three to four hours,” the AMR dispatcher reported.

“Three or four hours?!” Hogan exclaimed. “I can’t do that. I am in so much pain.”

The Fire Department dispatcher suggested Hogan get a ride or hail a cab. Hogan said she wouldn’t be able to get into a car because of her knees. The dispatcher apologized, blaming the delay on AMR.

“There’s nothing else I can do to make it any faster,” the Fire Department dispatcher said. “They’re super busy today, I’m really sorry about the wait.”

Hogan couldn’t believe it. “That’s not reasonable,” she said.

Mixed results

When Nurse Navigation went live in 2022, Seattle began transferring many 911 patients to the nurse line rather than straight to AMR’s ambulance dispatchers. There were about 8,000 transfers last year, Fire Department records show.

More than 1 in 4 of the nurse line transfers are resolved without hospital visits, according to AMR. The program is reducing unnecessary emergency room trips and freeing up ambulances, representatives from AMR’s parent company said, describing it in general as a win for patients and the health care system.

However, almost 3 in 4 Seattle callers triaged by the program are sent to emergency rooms by the nurses, according to AMR: 59% in ambulances and 14% in ride-share vehicles in 2024. They’re still putting strain on the system.

“The challenge is finding alternative places that can actually see the patient” in the context of a disjointed U.S. health care industry, Sayre said. “We’ve had some success at that but not as much as I was initially hoping could happen.”

5:25 pm, Call 4

One hour, seven minutes since first call

Hogan had been waiting about an hour when she phoned 911 a fourth time.

“It looks like you called earlier?” a Fire Department dispatcher asked.

“I did, and I’m — I’m dying here,” Hogan answered, with a nervous laugh.

The dispatcher said his hands were tied.

“We told you that it’s going to be three to four hours. There’s nothing we can do,” he said. “Why are you calling right now?”

“Because I hurt really bad,” Hogan replied, later returning to her concerns about the situation by adding, “I didn’t hear anything about this new procedure.”

Then Hogan mentioned an underlying medical condition.

“I have congestive heart failure. Does that bump it up at all?” Hogan asked.

The dispatcher didn’t engage.

“We’re not going to play that game,” he told Hogan. “Continually calling us is not appropriate, OK? We have 911 calls to take and I’m going to need to go.”

Evolving concerns

The nurses can transfer callers back to Seattle’s Fire Department dispatchers if they determine an immediate response is warranted after all, city and AMR representatives said, describing that option as an important safeguard.

“The nurses are not bashful about kicking something back over to us when they think it’s on the margins,” department dispatcher Lt. Charles Hubschman said.

But those referrals back are rare, according to AMR. Meanwhile, assessing and determining risks for patients rapidly over the phone can be difficult, “because I cannot see or touch that patient,” said Carol Rutenberg, a nationally recognized nurse line expert who co-authored a book on the subject.

And once it’s determined that a caller can wait, there’s no way for the patient to directly update the nurse line. All a caller like Hogan can do is redial 911.

That’s disturbing, according to experts like Sue Pivetta, a longtime 911 dispatch educator who said, in her view, a nurse should have checked back on Hogan.

Experts say patients should be reassessed each time they call 911, and Hogan had suffered a heart attack in the past. But her nurse didn’t ask about her medical history and the dispatchers didn’t request many details as her wait dragged.

“She was helpless, in pain, elderly, alone and immobile,” said Pivetta. “Lying prone in bed with (congestive heart failure) is dangerous.”

8:28 pm, Call 5

Four hours, nine minutes since first call

Hogan had been waiting more than four hours when she placed her last call.

“I’m just wondering if there’s any ETA that you could update me on,” she said. “I’ve tried to be patient but I’m just still in a lot of pain.”

A Fire Department dispatcher said AMR’s ambulances were backed up, and an AMR dispatcher said Hogan would have to wait another 60 to 90 minutes.

“I just don’t have a unit available,” the AMR dispatcher told Hogan. “As soon as a crew gets pushed out of the ER, we’ll send them over.”

Requirements removed

Before Nurse Navigation, patients like Hogan could expect assistance in under an hour. That changed in 2022 with an amendment to AMR’s contract that gave nurse-ordered ambulances a reprieve from any response-time standards.

Seattle and AMR officials say this made sense, because the nurse line is allowing ambulances to prioritize critical patients over stable ones. The company is no longer incurring late penalties for its Seattle responses still subject to time standards, a representative said, citing the nurse line and better recruiting.

But the city removed a significant guardrail when it removed standards for an entire category of ambulance rides, experts contend. Last year, more than 4,600 rides ordered were completely exempt from time standards and contractual penalties.

“Your community’s leaders may think 10-hour waits are OK,” said Matt Zavadsky, a nationally recognized health care administrator who managed a 911 system and helped start a nurse line in Fort Worth. “If your community’s leaders are not OK with that, you need a contract that prevents that.”

Instead, Seattle has left itself in the dark. Response times for nurse-ordered ambulances are excluded from AMR’s monthly reports to the Fire Department, so the city doesn’t know how long patients like Hogan are waiting.

That’s a red flag, many experts told The Times, describing transparency as crucial when vital government services are contracted out. Some other U.S. cities with nurse lines have maintained oversight for all ambulance rides.

“If you’re not looking at your data, you can expect things to go wrong,” added Kevin Mackey, medical director for the Sacramento Fire Department and former board chair at the National Registry of Emergency Medical Technicians.

2:29 am, Call 6

10 hours, 11 minutes since first call

Ten hours after Hogan’s first 911 call, an AMR dispatcher left her a voicemail, her estate’s lawsuit alleges.

“Earlier today you had requested an ambulance. I have one en route to you now,” the AMR dispatcher said, according to a recording her son later found on her phone. “If you’re still needing one, please give us a call back.”

Three dozen other Seattle patients not routed to the nurse line had received ambulances from AMR by then, despite calling 911 after Hogan, records show.

Lonely death

Hogan never got her ambulance ride.

An AMR dispatch log disclosed in the lawsuit over Hogan’s death shows her ride was canceled and reassigned three minutes after the ambulance crew arrived at her apartment building’s address; the reason listed was “patient not found.”

Six weeks later, Hogan’s body was found decomposing near her bed.

Hogan lived on the seventh floor of an affordable housing complex for seniors. Visitors must be buzzed into the lobby by a resident or staffer, and the office is closed at night, a manager said. Hogan had told the Fire Department and AMR to have their crews break her door down, if necessary. That didn’t happen.

The King County medical examiner’s office found receipts and food items dating to the days before Hogan called 911, “with no evidence of activity” afterward. The office reported the cause of death as probable heart disease and the time of death as April 9, the same day AMR left the voicemail on Hogan’s phone.

Phone records obtained in the lawsuit show calls from Hogan’s phone on April 10 to bank customer service numbers and a medical clinic, suggesting she was still alive then. The records show no calls after April 10. It’s hard to know exactly when and how she died.

In court papers filed last month, AMR asked a judge to dismiss the lawsuit’s claims against the company, arguing Hogan’s estate can’t demonstrate AMR’s conduct was the proximate cause of her death. An attorney for AMR cited the April 10 calls and the length of time before Hogan’s body was found.

Hogan’s son, Alex, says he was in touch with his mother in the days before she called 911 but didn’t hear from her on April 8 or in the weeks after.

Her estate’s lawsuit alleges her ambulance wait was too long, accusing Seattle and AMR of gross negligence.

“Ms. Hogan dialed 911 because she was having an emergency that required emergency services to transport her to the emergency department,” the active King County lawsuit alleges. “Defendants breached the duty of care.”

No one would want their mother to experience what Hogan went through, said Pollack, from Chicago. Yet Hogan’s 10-hour ambulance wait was acceptable under the city’s amended contract with AMR. And it could happen again.

The city signed a new five-year contract with AMR in September that continues to exempt nurse-line ambulance waits from contractual time standards.

New Seattle Mayor Katie Wilson’s office declined to comment for this story, citing the Hogan lawsuit. In December, a spokesperson for then-Mayor Bruce Harrell said Harrell couldn’t comment on the case, except to express sympathy to Hogan’s family. Nurse Navigation has consistently received positive survey reviews, the spokesperson said.

Still, Seattle’s setup alarms experts like Patricia Kelmar, health care campaign director at the Public Interest Research Group, a national consumer advocate.

Giving patients various ways to access care makes sense, but when someone needs an ambulance, they should get one in a timely manner, she said.

“If 911 isn’t going to take you seriously,” Kelmar asked, “what else is there?”

This coverage is partially underwritten by Microsoft Philanthropies. The Seattle Times maintains editorial control over this and all its coverage.

Reporter: Daniel Beekman

Project editor: Molly Harbarger

Project coordinator: Laura Gordon

Illustrations: Jennifer Luxton

Design and development: Ava Mandoli and Frank Mina

© 2026 The Seattle Times. Visit www.seattletimes.com. Distributed by Tribune Content Agency, LLC.