Fired Iowa Captain Fighting to Get Job Back

Aug. 8, 2013
Authorities questioned his treatment of a patient, who was later released from the hospital.

Aug. 08--CEDAR RAPIDS -- Fire captain and paramedic Tom Mackey, a 28-year veteran of the Cedar Rapids Fire Department, is fighting to get his job back after being fired on July 2.

At the center of Mackey's termination is a June 15 emergency medical call that sent him and his fire crew to the MercyCare North medical clinic in northeast Cedar Rapids. In a patient room there, they found a hysterical, hyperventilating, crying woman about to throw up who told them she suffered from recurring severe migraine headaches. She termed the headaches "thunderclap" migraines, according to testimony at a 12-hour Cedar Rapids Civil Service Commission appeal hearing that continued deep into Wednesday evening.

In the 21-minute encounter that cost the 28-year firefighting veteran his job, Mackey, a certified paramedic specialist, explained last night that he administered a "slow push" of Valium to the woman to calm her down and subsequently administered a dose of morphine for her pain. He also directed one of the two other firefighters on his crew, also a paramedic, to administer a drug to control nausea.

Mackey, 55, said the woman was agitated, anxious "to a high degree" and in severe pain. He said his crew's intervention helped calm the woman so she was able to walk with assistance to a cot for transport to the hospital when the Area Ambulance Service arrived on the scene.

The woman subsequently was treated and released from the hospital with a good outcome, the Fire Department's contract medical director, emergency physician Dr. Brad Wisnousky, testified.

Even so, the Fire Department's own routine review of the medical call report, which is part of the department's "continuous quality improvement" program or CQI, raised a red flag about the use of Valium and morphine on the call. A subsequent in-house review by a battalion chief and the department's emergency services coordinator soon questioned the thoroughness of Mackey's written report about the medical call and about his failure to use monitoring equipment to test the woman's vital signs after the drugs were administered.

Ultimately, Cedar Rapids firefighter paramedics like Mackey work under the direction of the department's contract medical director, and Wisnousky concluded that he would no longer allow Mackey to work under him.

Wisnousky testified that the woman treated by Mackey and his crew could possibility have been suffering from a brain hemorrhage, and the drugs administered by Mackey could have compromised her in that condition.

He said the department operates by specified medical protocols, and Mackey failed to identify which protocol he was following and failed to monitor the woman to see what effect the drugs were having on her.

Fire Chief Mark English said decided to fire Mackey after an investigation by his top commanders which he said showed that Mackey's actions showed poor judgment and could have been fatal to the woman.

"This could have cost somebody her life," he said.

Mackey's attorney, Bill Roemerman of Cedar Rapids, emphasized that the Iowa Department of Public Health in January came out with its latest emergency services protocols, protocols that all departments in the state must follow unless they seek exceptions. Wisnousky's protocols for the Cedar Rapids department, which Mackey is accused of not following, date from April 2012. Wisnousky is releasing new ones later this month, he said.

Mackey, who works part time as the director of Tipton's ambulance service in Cedar County, said he has read and incorporated the new state standard there. One of the protocols spells out the treatment for "behavioral emergency," which he said is what he used on the medical call in question in Cedar Rapids.

The Fire Department officials said Mackey should have been only following the older Cedar Rapids protocol book.

One key point of debate centered on the necessity of taking a patient's vital signs at an emergency scene upon administering drugs.

Mackey noted that a nurse or other medical professional had just taken vitals and handed them to him when he and his crew arrived at MercyCare North, and he said he had just finished administering drugs to her when Area Ambulance arrived to take her to the hospital.

As for the possibility of a brain hemorrhage, he said he ruled that out because the woman did not show signs of trouble on just one side of her body. Instead, he used the treatment protocols for pain and a behavioral emergency.

Fire Chief English noted that Mackey also had other disciplinary issues over the years, though Roemerman characterized them as minor. Three times he was required bring in doctor's explanations when taking sick leave because of how he used sick leave.

Copyright 2013 - The Gazette, Cedar Rapids, Iowa

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