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BELFAIR HERALD
Serving Belfair -- Allyn -- Grapeview Tahuya m Mason Lake South Shore m Victor
Thursday, February 1, 2007
Section of The Shelton-Mason County Journal
At Fire District 2:
Mediation report hits
on a series of conflicts
THE ALLYN Community Association is set to host its
iittal dinner, dance and auction this Saturday at the
Ctor Hall.
T00his Saturday:
.00kllyn group to
Llold its auction
bThe Allyn Community Associa-
Ln. is planning their ninth au-
al dinner, dance and auction
. ginning at 5 p m on Saturday,
!ebrUary 3, at the Victor Hall,
Cated at 51 East Victor Road
tate Route 302) directly behind
ae fire station.
hTiclets are $15 per prson and
• i evenin¢ will begin with a so-
la h o
our at 5 p.m., with dinner
!a silent auction from 5:30 to
'! ) p.m.
i live auction will start at 7
b'a. aad dancing to live music will
from 8"30 to 11 p.m. Lennard
,s restaurant of Allyn is catering
he even
t and big-band music will
• Provided by the Swing Fever
d, led by Stan Yantis.
The ticket price includes soft
beverages and the tickets will
also be entered into drawings for
door prizes. This event is a ma-
jor fund-raiser for the association
and this year's proceeds will sup-
port publication of The North Bay
Review and the feasibility study
for the proposed Allyn Aquatic
Center. Tickets are available
from Kitsap Bank, Lennard K's
and Windermere Real Estate, all
of Allyn.
The community association is
still looking for donations for the
auction.
For more information about
the event or the association call
Ina Culberson at 275-6769 or Jan
Thoemke at 275-0434.
Group planning
for graduation
i e parents of North Mason
;h School graduating seniors
busy planning the annual
L d Night Party.
he annual party is a super-
m, alcohol-free and drug-free
at that begins immediately
r the graduation ceremony.
lla s who attend must board
Chartered bus which takes
hi to surprise locations for a
,at of fun. The graduates are
rned the following morning
t e, high school. The cost per
student is $80, but organizers
emphasize that all students may
attend, regardless of their ability
to pay.
Payments may be made in in-
stallments if needed and spon-
sorships will be available. Pay-
ments can be mailed to North
Mason High School Grad Night
at P.O. Box 2642, Belfair, 98528.
Those that would like more in-
formation should contact Sher-
rie Nielsen at 275-4122 or Kathy
Walsh at 275-0495.
When Fire District 2 put out
their newsletter last fall, it ran a
front-page announcement that a
"long-standing question over pa-
tient care and the use of air am-
bulance helicopters" had been re-
solved between the county medical
director and the district chief, Mi-
chael Greene.
The upbeat announcement was
indeed good news, but it didn't
even begin to hint at the months
of well-documented conflict that
eventually led to the intervention
of a state-provided mediator.
The Herald has recently ob-
tained a copy of the mediation re-
port and resulting agreement and
it sketches out a very serious situ-
ation wherein the county's medical
program director, Dr. Joseph Hoff-
man, adopted hospital transport
procedures that differed mark-
edly from those of all other rural
counties in Washington, and also
from the policies of the counties
surrounding Mason County. Hoff-
man is an emergency-room physi-
cian at Mason General Hospital in
Shelton.
THE POLICIES at issue, ac-
cording to the mediation agree-
ment, created differing levels of
care fbr patients with similar con-
ditions, and in some cases serious-
ly delayed treatment for patients
with life-threatening conditions.
Central to the conflicts was the
authorization of emergency medi-
cal service (EMS) providers, such
as paramedics, to determine at
what locations ambulance-trans-
port patients could receive the
most appropriate care.
State-wide protocols regarding
where ambulance patients are to
be transported have been estab-
lished by the Washington State
Department of Health (DOH),
which oversees all emergency
medical service and trauma care in
the state. In turn, DOH appoints
county medical directors to assist
in providing patient-care protocols
and procedures; the end result is
supposed to be patient care that
is both consistent and also fine-
tuned to the unique characteris-
tics of each particular county.
DOH also establishes hospital
ratings which indicate the level
of emergency services available at
each facility. Seattle's Harborview
Medical Center is the state's only
Level One hospital, providing a
full range of emergency services;
Mason General Hospital, in con-
trast, is a Level Four hospital, in-
Pirates kick off Reading Olympics
yd Hill narents and teachers recent- will keep track of their daily reading
ressed as pirates and provlded an minutes to earn bronze, silver or gold
tllusiastic play to start this year's medals. Seen here in full pirate rega-
tading.Olympics program. As part of lia are Sally Cassidy, Cathy Dunn and
qe Specml reading program, students Carrie Boschee.
dicating that it offers a minimum
level of services.
OF THE THREE hospitals in
Kitsap County, Naval Hospital
Bremerton is a Level Three cen-
ter, and both campuses of Harri-
son Hospital (Bremerton and Sil-
verdale) are Level Two facilities.
The level of care at the Kitsap
hospitals was an important factor
in the conflict, because Fire Dis-
trict 2's boundaries border Kitsap
County and a decided majority
of the district's residents receive
their health care there, rather
than in Mason County. In fact, 85
percent of Fire District 2's ambu-
lance transports go to Kitsap hos-
pitals, and only 10 percent go to
Mason General Hospital.
DOH also classifies ambulance
transports as for either trauma
or medical patient. Trauma pa-
tients suffer injuries from external
events such as car accidents or as-
saults while medical patients suf-
fer from internal events, such as
heart attacks and strokes•
In any critical transport the
time it takes EMS providers to
get their patients to an appropri-
ate treatment facility is the single
greatest determining factor in the
patients' survival. In recognition
of this, EMS providers are exten-
sively trained to recognize a va-
riety of patient conditions which
require specialized care.
DOH PROTOCOLS allow the
EMS providers themselves to de-
termine the appropriate hospital
destination for trauma patients,
including the need for airlift. Kit-
sap County also allows their EMS
providers to make the same deter-
mination for medical transports.
When Hoffman became the
Mason County Medical Program
Director in 2003, however, he re-
quired Mason County EMS pro-
viders to first contact a Mason
General Hospital emergency-room
physician and have the physician
make the determination.
The mediation report cited
five specific events in which that
policy, as well as other decisions
of Hoffman's, resulted in greatly
delayed patient care. Specifically,
the report said the following:
• On-going problems between
two separate dispatch agencies
resulted in a 24-minute delay in
care for two critical patients, in
which the closest paramedic unit
was not dispatched and another
unit which was 25 miles away was
summoned instead. Fire District 2
requested intervention in resolv-
ing the issue, and Hoffman never
responded to the request.
• In June of 2004, Fire District
2 paramedics were transporting
a mental-health patient to Ma-
son General. When they informed
the hospital that they were five
Magera
winner
in bee
Kelly Magera of Grapeview
School has won the school's Na-
tional Geographic Bee.
All of the school's students par-
ticipated in the preliminary rounds
just before winter vacation. Mag-
era, an eighth-grade student, was
one of eight finalists.
Magera will now take a written
test to be submitted at the state
level. The top 100 scorers in that
competition will be in the state fi-
nals in March and the winner of
that round will advance to the fi-
nals in Washington, D.C.
Other school finalists include
Sabrina Selby, grade four; Aman-
da Clifford, grade five; Matthew
Selby, grade six; Alex Griffin,
grade seven and Karlie Clifford,
grade eight.
Magera is the son of Shari Mag-
era and Dave Magera, Grapeview.
minutes away, the on-duty emer-
gency-room physician, Hoffman
himself, ordered the ambulance to
turn around and transport the pa-
tient to Harrison, then 50 minutes
away. Once at Harrison, it was de-
termined that the patient was in-
eligible for care there due to county
mental health requirements and
the patient had to be transported
back to Mason General• The para-
medic unit was out of service for
an extended period of time, care
was significantly delayed, and the
mediation report notes that the
situation also entailed "problems
with local law enforcement."
• Fire District 2's Greene met
with Hoffman in January 2005 to
attempt to resolve the destination
issues and cited two examples of
differing destinations for patients
with intracranial hemorrhages
(strokes). The treating paramedic
in the first instance was denied
airlift to Harborview and instead
ordered to provide ground trans-
port to a receiving hospital in
Kitsap County. That facility did
approve the paramedic's request
for airlift, but the patient died at
Harborview several hours later•
ELSEWHERE IN the report it
is noted that ground transport to a
Kitsap hospital takes an average
of 25 minutes from Fire District 2,
while airlift requires an average
of only six minutes. The combined
time spent in first ground trans-
port and then subsequent airlift
apparently resulted in treatment
delay.
In the second incident, the me-
diation report did not detail specif-
ics except to say that the treating
paramedic's request for airlift was
denied. After Hoffman's January
2005 meeting with Greene, Heft-
man filed a complaint regarding
the accuracy of that paramedic's
radio report, stating that airlift
was denied because the para-
medic's report was inaccurate,
although no discussion of accu-
racy or the patient's condition was
made with the paramedic at the
time. DOH investigated the com-
plaint and ruled that it was with-
out merit. Significantly, the treat-
ing paramedic in that case was
Greene himself.
• In August 2006, Fire District
2 responded to a stabbing inci-
dent. Chief Greene himself called
for a trauma helicopter moments
after arriving on the scene; after
learning that the helicopter would
be delayed, Greene contacted
Hoffman and requested permis-
sion for a ground transport to the
nearest Level Two trauma center.
Hoffman gave the order to trans-
port to a Level Three Kitsap hos-
pital which was 10 minutes closer;
upon arrival the patient was im-
mediately airlifted and later died
during emergency surgery.
"ACCORDING TO a detailed
post-accident critique," noted the
mediation report, "the patient
could have received emergency
surgery twenty-five minutes ear-
lier" had the transport been to the
Level Two facility.
The mediation report also notes
that Greene and Fire District 2's
commissioners made a number of
efforts to resolve these and other
issues, including through direct
discussion with Hoffman, and lat-
er through 11 separate requests
to DOH for intervention, as well
as similar requests made to the
board of Mason General Hospital
and also to the local EMS council.
Other issues of concern cited in
the mediation report include:
• A report in which a respond-
ing EMS provider was intoxicated
and interfered with patient care
for a car accident victim. Greene
requested intervention in the mat-
ter, but Hoffman did not respond
to those concerns.
• A detailed investigation by
the district was sent to Hoffman
regarding the actions of two EMS
providers who failed to perform
CPR and attempted to use unau-
thorized equipment. Hoffman only
requested the providers retake a
CPR course.
(Please turn to page 4.)
BELFAIR HERALD
Serving Belfair -- Allyn -- Grapeview Tahuya m Mason Lake South Shore m Victor
Thursday, February 1, 2007
Section of The Shelton-Mason County Journal
At Fire District 2:
Mediation report hits
on a series of conflicts
THE ALLYN Community Association is set to host its
iittal dinner, dance and auction this Saturday at the
Ctor Hall.
T00his Saturday:
.00kllyn group to
Llold its auction
bThe Allyn Community Associa-
Ln. is planning their ninth au-
al dinner, dance and auction
. ginning at 5 p m on Saturday,
!ebrUary 3, at the Victor Hall,
Cated at 51 East Victor Road
tate Route 302) directly behind
ae fire station.
hTiclets are $15 per prson and
• i evenin¢ will begin with a so-
la h o
our at 5 p.m., with dinner
!a silent auction from 5:30 to
'! ) p.m.
i live auction will start at 7
b'a. aad dancing to live music will
from 8"30 to 11 p.m. Lennard
,s restaurant of Allyn is catering
he even
t and big-band music will
• Provided by the Swing Fever
d, led by Stan Yantis.
The ticket price includes soft
beverages and the tickets will
also be entered into drawings for
door prizes. This event is a ma-
jor fund-raiser for the association
and this year's proceeds will sup-
port publication of The North Bay
Review and the feasibility study
for the proposed Allyn Aquatic
Center. Tickets are available
from Kitsap Bank, Lennard K's
and Windermere Real Estate, all
of Allyn.
The community association is
still looking for donations for the
auction.
For more information about
the event or the association call
Ina Culberson at 275-6769 or Jan
Thoemke at 275-0434.
Group planning
for graduation
i e parents of North Mason
;h School graduating seniors
busy planning the annual
L d Night Party.
he annual party is a super-
m, alcohol-free and drug-free
at that begins immediately
r the graduation ceremony.
lla s who attend must board
Chartered bus which takes
hi to surprise locations for a
,at of fun. The graduates are
rned the following morning
t e, high school. The cost per
student is $80, but organizers
emphasize that all students may
attend, regardless of their ability
to pay.
Payments may be made in in-
stallments if needed and spon-
sorships will be available. Pay-
ments can be mailed to North
Mason High School Grad Night
at P.O. Box 2642, Belfair, 98528.
Those that would like more in-
formation should contact Sher-
rie Nielsen at 275-4122 or Kathy
Walsh at 275-0495.
When Fire District 2 put out
their newsletter last fall, it ran a
front-page announcement that a
"long-standing question over pa-
tient care and the use of air am-
bulance helicopters" had been re-
solved between the county medical
director and the district chief, Mi-
chael Greene.
The upbeat announcement was
indeed good news, but it didn't
even begin to hint at the months
of well-documented conflict that
eventually led to the intervention
of a state-provided mediator.
The Herald has recently ob-
tained a copy of the mediation re-
port and resulting agreement and
it sketches out a very serious situ-
ation wherein the county's medical
program director, Dr. Joseph Hoff-
man, adopted hospital transport
procedures that differed mark-
edly from those of all other rural
counties in Washington, and also
from the policies of the counties
surrounding Mason County. Hoff-
man is an emergency-room physi-
cian at Mason General Hospital in
Shelton.
THE POLICIES at issue, ac-
cording to the mediation agree-
ment, created differing levels of
care fbr patients with similar con-
ditions, and in some cases serious-
ly delayed treatment for patients
with life-threatening conditions.
Central to the conflicts was the
authorization of emergency medi-
cal service (EMS) providers, such
as paramedics, to determine at
what locations ambulance-trans-
port patients could receive the
most appropriate care.
State-wide protocols regarding
where ambulance patients are to
be transported have been estab-
lished by the Washington State
Department of Health (DOH),
which oversees all emergency
medical service and trauma care in
the state. In turn, DOH appoints
county medical directors to assist
in providing patient-care protocols
and procedures; the end result is
supposed to be patient care that
is both consistent and also fine-
tuned to the unique characteris-
tics of each particular county.
DOH also establishes hospital
ratings which indicate the level
of emergency services available at
each facility. Seattle's Harborview
Medical Center is the state's only
Level One hospital, providing a
full range of emergency services;
Mason General Hospital, in con-
trast, is a Level Four hospital, in-
Pirates kick off Reading Olympics
yd Hill narents and teachers recent- will keep track of their daily reading
ressed as pirates and provlded an minutes to earn bronze, silver or gold
tllusiastic play to start this year's medals. Seen here in full pirate rega-
tading.Olympics program. As part of lia are Sally Cassidy, Cathy Dunn and
qe Specml reading program, students Carrie Boschee.
dicating that it offers a minimum
level of services.
OF THE THREE hospitals in
Kitsap County, Naval Hospital
Bremerton is a Level Three cen-
ter, and both campuses of Harri-
son Hospital (Bremerton and Sil-
verdale) are Level Two facilities.
The level of care at the Kitsap
hospitals was an important factor
in the conflict, because Fire Dis-
trict 2's boundaries border Kitsap
County and a decided majority
of the district's residents receive
their health care there, rather
than in Mason County. In fact, 85
percent of Fire District 2's ambu-
lance transports go to Kitsap hos-
pitals, and only 10 percent go to
Mason General Hospital.
DOH also classifies ambulance
transports as for either trauma
or medical patient. Trauma pa-
tients suffer injuries from external
events such as car accidents or as-
saults while medical patients suf-
fer from internal events, such as
heart attacks and strokes•
In any critical transport the
time it takes EMS providers to
get their patients to an appropri-
ate treatment facility is the single
greatest determining factor in the
patients' survival. In recognition
of this, EMS providers are exten-
sively trained to recognize a va-
riety of patient conditions which
require specialized care.
DOH PROTOCOLS allow the
EMS providers themselves to de-
termine the appropriate hospital
destination for trauma patients,
including the need for airlift. Kit-
sap County also allows their EMS
providers to make the same deter-
mination for medical transports.
When Hoffman became the
Mason County Medical Program
Director in 2003, however, he re-
quired Mason County EMS pro-
viders to first contact a Mason
General Hospital emergency-room
physician and have the physician
make the determination.
The mediation report cited
five specific events in which that
policy, as well as other decisions
of Hoffman's, resulted in greatly
delayed patient care. Specifically,
the report said the following:
• On-going problems between
two separate dispatch agencies
resulted in a 24-minute delay in
care for two critical patients, in
which the closest paramedic unit
was not dispatched and another
unit which was 25 miles away was
summoned instead. Fire District 2
requested intervention in resolv-
ing the issue, and Hoffman never
responded to the request.
• In June of 2004, Fire District
2 paramedics were transporting
a mental-health patient to Ma-
son General. When they informed
the hospital that they were five
Magera
winner
in bee
Kelly Magera of Grapeview
School has won the school's Na-
tional Geographic Bee.
All of the school's students par-
ticipated in the preliminary rounds
just before winter vacation. Mag-
era, an eighth-grade student, was
one of eight finalists.
Magera will now take a written
test to be submitted at the state
level. The top 100 scorers in that
competition will be in the state fi-
nals in March and the winner of
that round will advance to the fi-
nals in Washington, D.C.
Other school finalists include
Sabrina Selby, grade four; Aman-
da Clifford, grade five; Matthew
Selby, grade six; Alex Griffin,
grade seven and Karlie Clifford,
grade eight.
Magera is the son of Shari Mag-
era and Dave Magera, Grapeview.
minutes away, the on-duty emer-
gency-room physician, Hoffman
himself, ordered the ambulance to
turn around and transport the pa-
tient to Harrison, then 50 minutes
away. Once at Harrison, it was de-
termined that the patient was in-
eligible for care there due to county
mental health requirements and
the patient had to be transported
back to Mason General• The para-
medic unit was out of service for
an extended period of time, care
was significantly delayed, and the
mediation report notes that the
situation also entailed "problems
with local law enforcement."
• Fire District 2's Greene met
with Hoffman in January 2005 to
attempt to resolve the destination
issues and cited two examples of
differing destinations for patients
with intracranial hemorrhages
(strokes). The treating paramedic
in the first instance was denied
airlift to Harborview and instead
ordered to provide ground trans-
port to a receiving hospital in
Kitsap County. That facility did
approve the paramedic's request
for airlift, but the patient died at
Harborview several hours later•
ELSEWHERE IN the report it
is noted that ground transport to a
Kitsap hospital takes an average
of 25 minutes from Fire District 2,
while airlift requires an average
of only six minutes. The combined
time spent in first ground trans-
port and then subsequent airlift
apparently resulted in treatment
delay.
In the second incident, the me-
diation report did not detail specif-
ics except to say that the treating
paramedic's request for airlift was
denied. After Hoffman's January
2005 meeting with Greene, Heft-
man filed a complaint regarding
the accuracy of that paramedic's
radio report, stating that airlift
was denied because the para-
medic's report was inaccurate,
although no discussion of accu-
racy or the patient's condition was
made with the paramedic at the
time. DOH investigated the com-
plaint and ruled that it was with-
out merit. Significantly, the treat-
ing paramedic in that case was
Greene himself.
• In August 2006, Fire District
2 responded to a stabbing inci-
dent. Chief Greene himself called
for a trauma helicopter moments
after arriving on the scene; after
learning that the helicopter would
be delayed, Greene contacted
Hoffman and requested permis-
sion for a ground transport to the
nearest Level Two trauma center.
Hoffman gave the order to trans-
port to a Level Three Kitsap hos-
pital which was 10 minutes closer;
upon arrival the patient was im-
mediately airlifted and later died
during emergency surgery.
"ACCORDING TO a detailed
post-accident critique," noted the
mediation report, "the patient
could have received emergency
surgery twenty-five minutes ear-
lier" had the transport been to the
Level Two facility.
The mediation report also notes
that Greene and Fire District 2's
commissioners made a number of
efforts to resolve these and other
issues, including through direct
discussion with Hoffman, and lat-
er through 11 separate requests
to DOH for intervention, as well
as similar requests made to the
board of Mason General Hospital
and also to the local EMS council.
Other issues of concern cited in
the mediation report include:
• A report in which a respond-
ing EMS provider was intoxicated
and interfered with patient care
for a car accident victim. Greene
requested intervention in the mat-
ter, but Hoffman did not respond
to those concerns.
• A detailed investigation by
the district was sent to Hoffman
regarding the actions of two EMS
providers who failed to perform
CPR and attempted to use unau-
thorized equipment. Hoffman only
requested the providers retake a
CPR course.
(Please turn to page 4.)