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Newspaper Archive of
Shelton Mason County Journal
Shelton, Washington
February 1, 2007     Shelton Mason County Journal
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February 1, 2007
 
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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.)