"Man down"

June 20, 2006 1:24 PM

At approximately 9:20 PM (ET) on January 6th, David E. Rosenbaum, a longtime reporter for the Washington bureau of the New York Times, was found lying on a sidewalk in Washington, DC. He was disoriented. He was bleeding from the head. He was vomiting. And, as it turned out, he had been assaulted and robbed. [more inside]
posted by scrump (49 comments total)

Two days later, on January 8th, he died of his injuries.

Now, with the release of a damning report from the Washington, DC Office of the Inspector General, what happened to David Rosenbaum between the time he was mugged and "the early morning hours" of January 7th has exploded into a political nightmare for District of Columbia Fire Chief Adrian H. Thompson and a personal nightmare for at least one emergency medical technician and two of the police officers involved.

The controversy continues to flare, but among all the noise, the report at the heart of the matter stands as a horrifying example of how one troubled system failed David Rosenbaum at almost every level.
posted by scrump at 1:24 PM on June 20, 2006

This has been on DC local news for a while now.
basically the EMS thought he was drunk, went to the further hospital and got lost. Then the nurses also thought he was drunk and put him on low priority, leaving him to sober up.
posted by Suparnova at 1:30 PM on June 20, 2006

What a chilling story. Has there been reporting on what that EMT's "personal reason" was for choosing the more distant hospital?
posted by nakedcodemonkey at 1:33 PM on June 20, 2006

One wonders how often such things happen to people who aren't well-connected to the media and aren't as likely to have their stories publicized. Would we have even heard about this story if David Rosenbaum was a janitor?
posted by Johnny Assay at 1:35 PM on June 20, 2006

Obviously an Ann Coulter fan who discovered he worked for the NYT.
posted by wendell at 1:36 PM on June 20, 2006

No, we wouldn't have. And his story is obviously less tragic and less worthy of attention because of that.
posted by Zozo at 1:38 PM on June 20, 2006

Ugh. That was a bitchy and slow rejoinder to Johnny Assay.
posted by Zozo at 1:38 PM on June 20, 2006

OK - sorry - posted too quickly. I did not see the info inside. The linked editorial/essay/7th grade report in the FPP was what really evoked my ire.

I suppose it's not news that civic infrastructure in DC has about as much stability as Marion Barry's sobriety.
posted by docpops at 1:43 PM on June 20, 2006

hey-oh!
posted by sonofsamiam at 1:43 PM on June 20, 2006

It's sad to live a full life and then have two animals kill you for a few dollars.
posted by The Jesse Helms at 1:45 PM on June 20, 2006

nakedcodemonkey—the report has this to say about it:

While Ambulance 18 was en route to Gramercy Street, EMT 1 told EMT 2 that she wanted to go to Howard because she had a toothache and wanted to go to her house for medicine.

EMT 1 then wanted to get some money from a nearby ATM for dinner. EMT 1 complained to EMT 2, “This is b******* [sic]. We shouldn’t be all the way up here.”

posted by scrump at 2:00 PM on June 20, 2006

Ahh the poor firefighters. First, they die under tons of concrete and steel, get all the "hero" tag all over their names , but they request to learn how to do better gets discarded

The firefighter, a 24-year veteran, said he had repeatedly asked for such training, but he "just fell through the cracks." The report said he was not "in any way qualified to oversee" other firefighters on an injured-person call.

The other firefighters on Engine 20, who are trained as EMTs, failed to do "a complete assessment of [Rosenbaum], and not one of the patient's vital signs were recorded at the scene." Because one of the firefighter/EMTs "perceived an odor of alcohol coming from the patient," the crew assumed Rosenbaum was drunk and had passed out.

So if they get some they get lousy training and obviously poor practice . Hey but BILLIONS were spend for Homerland security..where is the money gone ?
posted by elpapacito at 2:02 PM on June 20, 2006

A few winters ago I stumbled upon an elderly man in a ravine in Toronto. He was dressed for summer and it was freezing out. I kept him warm (difficult) and conscious (more difficult) while waiting for paramedics. He told me a bit about his life--that he was homeless and his name was Bill.

I was rather frazzled as I waited. It was fucking cold and I was certain he was going to die. It didn't help that I was in a ravine and thought that they'd never find me as it was difficult to describe my location.

When they finally arrived, they approached slowly, with no stretcher or other equipment. The first words out of the closest paramedic were "Are you drunk? Have you been drinking?" I was disgusted. They had him walk (no shit) to the road with them. They neither thanked me or acknowledged me, but, rather, behaved as if I hadn't found him, giving me the impression they wished I hadn't. From my time spent with the man (about 20 mins), he neither smelled or sounded drunk.

The following September, I stumbled upon the man again--pretty close to the first location, in fact. This time, I was too late. Police and emergency workers were already there. He was dead, beaten to death with a blunt object, most likely a bat, I read later.

Last year I read the excellent book (shit movie), Bringing Out the Dead. This gave me a bit of perspective, I suppose, but good Christ it's a depressing world when things like what happened to Bill and Rosenbaum occur.
posted by dobbs at 2:09 PM on June 20, 2006

so in all the 24 years in the department he couldn't take a weeklong course in EMT?

...you can do a wilderness first aid course in a weekend and that covers first assessment of an individual.
posted by virga at 2:12 PM on June 20, 2006

Johnny Assay: One wonders how often such things happen to people who aren't well-connected to the media and aren't as likely to have their stories publicized.

The answer is "it depends". In EMS systems like DC's, that are massively dysfunctional, it happens often. In well-managed services like King County Medic One, these kinds of incidents are extremely rare.

Anecdotally, within the industry, KCMO is regarded as one of the best places, if not the best place, to work in the country. DC, well, isn't. The correlation is significant: quality of care is directly related to employee happiness in EMS systems.

Happy EMS employees work their rear ends off for their patients, and are personally invested in making sure this kind of incident never occurs on their watch. They also actively participate in staying current with medical practice and literature.

Unhappy EMS employees wind up being immortalized as EMT 1 in the OIG investigation report leading to their firing.
posted by scrump at 2:12 PM on June 20, 2006

dobbs: What you said is unfortunately accurate for far, far too much of our industry. EMS is, as a profession, just over 30 years old, and we have a lot of maturing ahead of us.

That said, if I and my cohorts in the current generation of paramedics have anything to do with it, books like Bringing Out The Dead and medics like the one you encountered will become historical artifacts as soon as possible. Bad stories are the ones that get told, but try not to let them become the totality of what you believe about EMS.
posted by scrump at 2:20 PM on June 20, 2006

They thought he was intoxicated, but didn't even bother to do the basic care required for indoxicated people. Sweet.
posted by delmoi at 2:23 PM on June 20, 2006

"so in all the 24 years in the department he couldn't take a weeklong course in EMT?

...you can do a wilderness first aid course in a weekend and that covers first assessment of an individual.
posted by virga at 2:12 PM PST on June 20 [+fave] [!]"

And it's nowhere close to an NREMT course. Sorry. Far too many of the "wilderness" courses are a joke, and it seems there's no real standard. (And before you say "you don't know what you're talking about", I've studied quite a few wilderness first aid programs. Also, the medical director for our Red Cross chapter is the editor of a reknowned wilderness first aid journal and I work with several of his students.)

Here's a question I don't see answered.. was this a private ambulance company, or were these fire department employees? I do read that the FD medics assessed the guy on scene, but I don't see what agency transported the guy.
Sometimes there's a quality difference between the FD medics & private agency medics. I see it quite often.

And scrump speaks the truth. I'm very happy with the EMS agency I work with, and we bust our ass to provide excellent patient care.
posted by drstein at 2:31 PM on June 20, 2006

There are a lot of great things about living in the DC area. Anything related to the DC government however, including really important things like emergency care or the educational system, is a clusterfuck through and through. Which is a shame--it's really a small, beautiful city. Just try not to get hit by a bus while you're here. Or have kids and be too poor to send them to private schools.
posted by bardic at 2:32 PM on June 20, 2006

Just to comment a little further on the woeful state of the DC FEMS system:

The area of upper Northwest DC where Rosenbaum was found is quite close to Maryland. While most people have a sense of how terrible DC FEMS is, folks who live in those areas (which also happen to be the wealthy, tony sections of town) are lucky enough to live near the Maryland line. So, when they have an emergency, they bypass the DC system altogether and call the Bethesda-Chevy Chase Rescue Squad, across the border in Maryland. BCC responds, even though it's not in their actual service area, and people get decent emergency medical treatment rather than a trip to the EMT's house for lipstick. Lots of folks who live up there are (rich enough to be) big donors to the BCC squad for exactly that reason. Who knows what would have happened to Rosenbaum if the person who found him called BCC instead of 911?

docpops: which linked editorial/essay/7th grade report did you take issue with? The WaPo synopsis of the inspector general's report or the NYTimes Rosenbaum page with links to articles about his life and career? Seriously, I'm curious.
posted by heydanno at 2:40 PM on June 20, 2006

I just recently started out as an EMT with a private company. It was a smaller company that was micromanaged by the owner, it was ridiculous. Right out of training they partnered me with someone from the same class and had me driving without any training on going red (lights and sirens). They fired me, literally because I said I was uncomfortable not having someone experienced to watch my back and that I wasn't being given an opportunity to learn how to do the job right. Training gives you a lot of preparation, but it's a long way away from having someone screaming in your face after a hit and run. That happened my 3rd day on the job, my partner was in my EMT class and he totally froze and did nothing on the call. I handled it well enough and got the guy taken care of. A week later the guy that froze had a job and I didn't. Just thought I'd share that little story.
posted by andywolf at 2:51 PM on June 20, 2006

Ah, it was a DCFD medic.. Press release from he DCFD.
posted by drstein at 3:03 PM on June 20, 2006

Hey but BILLIONS were spend for Homerland security..

Yeah, and according to most of the studies I've seen went to two places: capital expenditures (fancy new radios and SCBAs were very popular buys) and salaries. No one thought to include training in those budgets. The typical reponder profile now is lots of new hires with new, very complicated gear and little formal training.
posted by bonehead at 3:03 PM on June 20, 2006

Hillary Clinton became the most hated woman in America for trying to spend money on health care.

President Bush became wildly popular by spending ten times as much money on a war with a country that never did us any harm.

Between 1950 and 1975 (more or less), America spent billions to build one of the great health care systems in the world. Now the system is breaking down, being starved by the government and looted by doctors. This isn't going to improve until Americans get a true sense of priorities. Unfortunately, I don't think there will be much of the country left by that time.

(Not that there aren't quite a lot of decent, hard-working doctors but after going over two separate people's catastrophic medical bills, which included thousands of dollars for doctors whom the patients never met and who never generated any sort of report or any record of giving any sort of treatment, it's clear that there's an awful lot of theft going on there...)
posted by lupus_yonderboy at 3:15 PM on June 20, 2006 [1 favorite]

Homerland security..

How true, how true - d'oh!
posted by bashos_frog at 3:22 PM on June 20, 2006

To those that don't know DC, Sibley Hospital (located in quiet, wealthy, mostly white NW DC) is a hell of a long way from Howard and cater to, ahem, slightly different patient populations. This kind of crap has been killing DC residents by the thousands every year. When it happens to someone who's not poor and black, it's newsworthy. Honestly, it's this level of dysfunction that led to me to flee DC years ago.

I hadn't heard this story before now. As someone who worked in the medical system in DC, I think this is far from a crap FPP.
posted by Slarty Bartfast at 3:36 PM on June 20, 2006

Now the system is breaking down, being starved by the government and looted by doctors.

Haha. So true. I just built a lap pool with my profits from Medicare.
posted by docpops at 3:37 PM on June 20, 2006

Who knows what would have happened to Rosenbaum if the person who found him called BCC instead of 911?

Or if they had gotten him over to Sibley hospital rather than Howard. From my experience going to the Sibley ER in college, they have good docs and not much of a caseload.

When I lived in Dupont Circle in DC in about 1994, I once saw a man outside my window staggering around the street screaming. My roommate and I called 911 and we ran downstairs to help the guy. He was homeless, screaming incoherently, and seemed to be having trouble breathing. We did our best (which was practically nothing) to calm the guy until 911 arrived. The first responder was a DCPD officer in a car who basically just sat in his car for 5 minutes looking at us while putting on latex gloves and talking on his radio. A few minutes later, a fire truck showed up and the cop finally got out of his car. It must have been another 10 to 15 before an ambulance showed up. Nobody really did anything to help the guy during all that time, as far as I could see.

The guy died that night in the hospital. Someone had thrown lye all all over him. Unclear to me if something could have been done to wash him off / reverse the ph issue if someone had acted quicker.
posted by Mid at 3:44 PM on June 20, 2006

I'd like to defend the purchase of SCBAs. In California, if you
want to do any firefighting or rescue in any "hazardous
atmospheric condition" (car fire, structure fire), you have to
have a Self Contained Breathing Apparatus. Period. It's
OSHA mandated.

The radios are the same way. If you ever want to interoperate
with any federal agency (in our case, the California Department
of Forestry), or other fire agencies that have already upgraded
their radios to the recently updated federal standards), then
you have to be able to talk to them on radios.

I guess I'm talking to you, Bonehead.
We have to keep records on each firefighter on all the training
that they have received, because that too is OSHA mandated. Right now the County is requiring that all of our
firefighters attend WMD response training, or our
firefighters will not be authorized to operate in our
response area.
posted by the Real Dan at 4:02 PM on June 20, 2006

Anyone mind if I steer the conversation a little? So what do you do about clearly failing institutional structures (this applies to schools also)? Money doesn't always do it (DC schools case-in-point, but that maybe a separate issue).

Some of these organizations are clearly protected by the nature of political structures, lack of quick direct accountability, no reviews etc. So what's the answer? Competition? Private companies? Do you gut the management?

Does anyone have examples of failing organizations that have managed to turn it around?
posted by stratastar at 4:21 PM on June 20, 2006

this is a great post. it clearly points out institutional failure, which, unfortunately, is becoming more and more common these days. doesn't anyone care anymore?
posted by brandz at 4:43 PM on June 20, 2006

"Unclear to me if something could have been done to wash him off / reverse the ph issue if someone had acted quicker."

If it was a powder, washing it all off or trying to neutralize it could have made things a lot worse. Standard protocol (here) is to brush off the dry stuff the best you can.

and brandz - "doesn't anyone care anymore?" - the answer is definitely a yes - there are a lot of us that care. We're just not in much of a position to do anything about it except squawk at our elected officials. Sadly, they seem to be more interested in enacting asinine legislation regarding copyrights & pirated mp3s than anything useful.
posted by drstein at 5:30 PM on June 20, 2006

Real Dan, I'm not saying that spending mony on capital items or salaries was a bad idea, I'm saying that the planners didn't allocate enough to training. The studies I've seen were based on questionaires sent out to firefighters and other responders and asked them to score their knowledge of their equipment. The first responders themselves gave their training a failing grade. Not every state in your union is as proactive as California.
posted by bonehead at 5:37 PM on June 20, 2006

I just built a lap pool with my profits from Medicare.

Did you locate it next to the spa?
posted by PeterMcDermott at 6:08 PM on June 20, 2006

One wonders how often such things happen to people who aren't well-connected to the media and aren't as likely to have their stories publicized. Would we have even heard about this story if David Rosenbaum was a janitor?
posted by Johnny Assay at 1:35 PM PST on June 20

*clap* *clap*

Yup. Son of local businessman who used his Daddys connections to build a business with enough cashflow to give millions to local non-profits had his car broken into and the radio stolen. The mayor and head copper were stumbling over each other to tell him how terrible it was and how they would work to solve the issue.

I get *MY* car and home broken into and the best I get is a letter saying I filed a report.
posted by rough ashlar at 6:12 PM on June 20, 2006

Now the system is breaking down, being starved by the government and looted by doctors.

Why not blame it on the shift from not-for-profit to profit? There is a whole book on the subject.
posted by rough ashlar at 6:15 PM on June 20, 2006

Sure, a frequent Clinton administration critic is bludgeoned to death in the same city that Billary Klint00n lives in. And the liberal so-called "mainstream media" is silent! Will the Dragon Lady's reign of terror never end?

IF Hillary Clinton were innocent, she'd certainly go on "The Factor" to tell us all she knows about this so-called "robbery".

She hasn't. She's guilty, guilty, guilty!
posted by swell at 6:55 PM on June 20, 2006

Happy EMS employees work their rear ends off for their patients, and are personally invested in making sure this kind of incident never occurs on their watch. They also actively participate in staying current with medical practice and literature. Unhappy EMS employees wind up being immortalized as EMT 1 in the OIG investigation report leading to their firing.

I don't think it's just an issue of happy versus unhappy employees.

A people may simply be incompetent -- but folks seem to feel that its bad form to point such a thing out in this day and age. It's rude or unkind to insist that someone competently do their job!

You can be "unhappy yet competent" but someone may also be "unhappy and incompetent."

I suspect that the gal who got fired -- who screwed up the earlier IV before she took the long way to the hospital -- was incompetent and shouldn't have been an EMT.

Happiness with her job has nothing to do with it.

And she killed somebody because of her incompetence and utter lack of good sense.
posted by bim at 7:03 PM on June 20, 2006

That should say "A person may simply be incompetent...."
posted by bim at 7:05 PM on June 20, 2006

heydanno, I didn't know this before following the link in your comment, but it turns out you're wrong and the BCC service area of the Bethesda-Chevy Chase rescue squad actually does reach well down into the Upper Caucasia region of DC. A new number is going into my cell phone tonight.
posted by exogenous at 8:06 PM on June 20, 2006

I work in a group home in Washington DC. The EMTs and the fire department have been by a number of times and always done a pretty good job - as far as I can tell. We have aging residents and they have helped stabilize them and taken them off to good hospitals. And used humor and friendliness as a way to reassure our scared folks in the process.

I do ask them NOT to go to Howard U hospital - cause of the stories I have heard and past experience there. They usually get orders where to go - but sometimes they can change what hospital they take people to.

Not to say the EMTs and FD in DC are all great - but some of them are good.

But, the fire department inspectors - they routinely come by and cite us for all kinds of things. Some thoughtful and some that seemingly make no sense. The Fire chief Adrian Thompson was recently asked by a Washington Post columnist on a radio show - why a fire inspector told a local elementary school that they could not have bulletin boards - as they were a fire hazard.

My nieces and nephew go to that school. It is cinder block construction everywhere. The most they would lose I would think would be the bulletin board. Code does say nothing within 18 inches of the ceiling - but the inspector is given discretion to let some things go if most of it is fine.
posted by donkelly at 8:11 PM on June 20, 2006

A quick check of the business page of your paper should show you where the money for healthcare is going in this country. I had a copy of a paper once where in the Health section it said "Blue Cross forced to increase premiums to keep up with spiraling healthcare costs" and in the Business section, of the same paper mind you, there was a story trumpeting "Another record profit for Blue Cross". I wish some journalist would merge the two and report the truth: "Blue Cross forced to raise premiums to maintain record profits". That would play a bit differently, perhaps?

Medicine is a funny business. I don't know of any other business where the consumer (or their proxy) can set the price of the service AFTER the service is performed.

"Yeah, I know you charge $100 to set a broken arm, but we're gonna pay you $24 instead. And don't try to charge for the supplies as those are bundled in with the service."

Would that work with anything else?

"Yeah, I know you charge $18 for this steak, but I've decided I'm gonna give you $5.75. And that includes drink."

Doctors have found themselves in a rather unique situation of not being able to dictate what they charge for their work. And don't get me started on when a 22 year old punk in a phone farm right out of school contradicts an MD on why a patient doesn't need an MRI so it won't be covered by insurance.

I think healthcare in america is one tiny, tiny step away from total catastrophe. I'm basically staying in the industry just out of morbid curiosity.
posted by Ynoxas at 9:28 PM on June 20, 2006

Medicine is a funny business. I don't know of any other business where the consumer (or their proxy) can set the price of the service AFTER the service is performed.

Nope. It's set BEFOREHAND. Rates are negotiated beforehand when an insurance plan makes a particular provider part of the plan.

"Yeah, I know you charge $18 for this steak, but I've decided I'm gonna give you $5.75. And that includes drink." Doctors have found themselves in a rather unique situation of not being able to dictate what they charge for their work.

The analogy is wrong. It's more like "Yeah, I would really like to charge you $200 for this steak so I can buy another Mercedes, but the insurance plan makes me charge only $18."

Honestly, take a look at the original charges on most any medical bill. You don't have to be a rocket scientist to know that they're grossly inflated. So I won't be boo hooing over most doctor's complaints.
posted by bim at 3:12 AM on June 21, 2006

drstein: My understanding is DC FD is under the DC FEMS umbrella (e.g. see the logos at the top of the press release you linked to). Adrian Thompson is the FEMS chief as well. I'm not sure if your comment was trying to say they were two wholly separate entities...

exogenous: interesting... I didn't realize the service area covered that much of DC.
posted by heydanno at 6:01 AM on June 21, 2006

In regards to billing, it's all very standardized as to the cost of procedures. Hospitals have books with tables that lay out how much everything cost. Some very extensive studies were done to sort it all out.
This New Yorker article lays out how medical billing is done and how the conclusions were made, it's really interesting.

posted by andywolf at 11:38 AM on June 21, 2006

Nope. It's set BEFOREHAND. Rates are negotiated beforehand when an insurance plan makes a particular provider part of the plan.

Not always. Not every doctor is a member of every corporate plan. Many times you have claims processed "out of network". And even if they are under contract, that does nothing to prevent the claims adjusters from writing off certain procedures, denying coverage for certain procedures, or bundling procedures together for $0. Then don't even get me started on "usual and customary" charges. So yes, the price is changed after the fact every single day.

And note that with some payers like Medicare, you have no recourse of any kind, and the rules are changed frequently, with no notice, and no ability to appeal, and no contractibility to prevent it.

The only choice the doc has is to accept it or not, and unless your specialty is pediatrics or plastic surgery, you have no real choice but to accept Medicare.

The analogy is wrong. It's more like "Yeah, I would really like to charge you $200 for this steak so I can buy another Mercedes, but the insurance plan makes me charge only $18."

That was the case several years ago, but you're about 5 years behind on your thought process.

American medicine is changing, rapidly, and for the worse.

Example: my company accepts Blue Cross for our providers, and we use Blue Cross to insure our own employees.

In 4 years, our BC premium for employees increased 40%. Our reimbursement to our doctors dropped 8%-20% depending on factors such as location and specialty.

Where is that money going again? Not to the doctors.

Hospital bills are extraordinary because hospitals write off 40% or more of their charges. Some urban hospitals write off up to 2/3 of their charges. So that bill for $850 looks scary until you realize your insurance is only "allowing" (a technical term in healthcare billing) $300, but since you are on an 80/20 plan you are responsible for 20% of that, so they actually only pay $240.

From the article andywolf linked: That’s how a doctor makes money, she told me. It’s a war with insurance, every step of the way.

That part is without question true.

Doctor charges $850, you pay $60, insurance pays $240, the remaining $550 is written off by the provider as contractual adjustment.
posted by Ynoxas at 12:24 PM on June 21, 2006

We'll have to agree to disagree, Ynoxas. I'm not behind on my thought process at all. Where you stand depends on where you sit, dude.

Most people DO see doctors that are in their plan. And for the ones that don't, the patient is expected to make up the difference not covered by insurance. And since these rates have not been negotiated and are much higher than the plan rates, the result is that the people least able to afford health care get screwed the worst. It happens every day.

As for the contractual adjustment thing, if someone agrees to be a participating provider, characterizing that as being "written off" by the doctor as if it's an unpaid bill is disingenuious. Participating providers are getting patients steered to them as a result of being in the plan, thus they offer a discount (on their already inflated price) in return for selling their services "bulk."

Now I do realize that not every doctor is in it just for the money. But many of them are, IMHO. Some doctors are greedy bastards. So as I said before, I'm not getting too worked up about a lot of their moaning and groaning.

And we haven't even gotten to the drug companies and their unbridled greed yet. :)
posted by bim at 4:56 PM on June 21, 2006

bim: You're of course right, some doctors are only in it for the money. The problem is that the same system that helps prevent fraud from the few bad apples makes the entire doctor population suffer (to some degree). And the administrative waste at insurance companies is simply staggering.

However, I'm with you completely about the pharmaceutical companies.

Bartender! A Guinness for me and my mate!
posted by Ynoxas at 8:11 PM on June 21, 2006

bim: You're of course right, some doctors are only in it for the money. The problem is that the same system that helps prevent fraud from the few bad apples makes the entire doctor population suffer (to some degree). And the administrative waste at insurance companies is simply staggering.

However, I'm with you completely about the pharmaceutical companies.

Bartender! A Guinness for me and my mate!

I totally agree, Ynoxas. Bartender, we need a bite to eat too! :)
posted by bim at 5:01 AM on June 22, 2006