Disney death and the media

[Guest guest]

The media are really hammering how the AED was not on the scene of the

Disney roller coaster death even as they state that " Paramedics arrived within 3

minutes " . no one will ever know if an AED was on site before the medics but the

fact that they got there in 3 minutes is being presented as a non issue.

I've never been on a scene in 3 minutes!

Another teachable moment lost!

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@...

(Cell Phone)

(Home Phone)

(IFW/TFW/FSS Office)

(IFW/TFW/FSS Fax)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

[Guest guest]

In a message dated 6/30/2006 2:05:04 P.M. Central Daylight Time,

jimmnn@... writes:

Preliminary autopsy results found no injuries, but indicated congenital

heart abnormalities in a 12-year-old boy who died after a Disney ride in

Florida, according to a statement from the medical examiner's office.

CNN just reported that and again made the point about the AED not being

there and the medics being on scene in about 3 minutes. Oh and to top that they

added " we may never know if the AED would have made a difference " which is

true but assuming the facts are presented correctly (I know I know) the

likelihood it would have seems slim even with fast CPR on the part of the Dad.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@...

(Cell Phone)

(Home Phone)

(IFW/TFW/FSS Office)

(IFW/TFW/FSS Fax)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

[Guest guest]

Preliminary autopsy results found no injuries, but indicated congenital

heart abnormalities in a 12-year-old boy who died after a Disney ride in

Florida, according to a statement from the medical examiner's office.

_____

From: Paramedicine [mailto:Paramedicine ] On

Behalf Of lnmolino@...

Sent: Friday, June 30, 2006 10:10 AM

To: aedif-discuss@...; Paramedicine ;

texasems-l

Subject: Disney death and the media

The media are really hammering how the AED was not on the scene of the

Disney roller coaster death even as they state that " Paramedics arrived

within 3

minutes " . no one will ever know if an AED was on site before the medics but

the

fact that they got there in 3 minutes is being presented as a non issue.

I've never been on a scene in 3 minutes!

Another teachable moment lost!

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

[Guest guest]

an incident like that happened here in north richland hills at their lil water

park and an aed WAS used but made no difference, the lil girl had an abnormality

that killed her no matter what was done. they made a fuss about the AED being

something like 100feet away inside the first aid station instead on top of the

water slide where she collapsed. the water park USED to keep an AED up there but

the extreme exposure to the sun & heat made it a less than desireable place to

store it. better have one that works 100feet away than a malfunctioning one 5

feet away.

Re: RE: Disney death and the media

In a message dated 6/30/2006 2:05:04 P.M. Central Daylight Time,

jimmnn@... writes:

Preliminary autopsy results found no injuries, but indicated congenital

heart abnormalities in a 12-year-old boy who died after a Disney ride in

Florida, according to a statement from the medical examiner's office.

CNN just reported that and again made the point about the AED not being

there and the medics being on scene in about 3 minutes. Oh and to top that

they

added " we may never know if the AED would have made a difference " which is

true but assuming the facts are presented correctly (I know I know) the

likelihood it would have seems slim even with fast CPR on the part of the Dad.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@...

(Cell Phone)

(Home Phone)

(IFW/TFW/FSS Office)

(IFW/TFW/FSS Fax)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with

unless I

specifically state that I am doing so. Further this E-mail is intended only

for its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by

the

original author.

[Guest guest]

In a message dated 6/30/2006 8:31:59 P.M. Central Daylight Time,

kenneth.navarro@... writes:

How about a third option...bring the working AED with you!

Now there's a concept huh

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@...

(Cell Phone)

(Home Phone)

(IFW/TFW/FSS Office)

(IFW/TFW/FSS Fax)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

[Guest guest]

>>> an incident like that happened here in north richland hills at

their lil water park and an aed WAS used but made no difference, the

lil girl had an abnormality that killed her no matter what was done.

<<<

According to media reports at the time, the AED was NOT used. The

first shocks were delivered by the fire department after they arrived

on scene. The little girl died of an arrhythmia brought on by

hypertrophic cardiomyopathy, a genetic disorder that predisposes the

patient to arrhythmia during periods of physical activity (climbing

the stairs to the slide).

>>> they made a fuss about the AED being something like 100feet away

inside the first aid station instead on top of the water slide where

she collapsed. the water park USED to keep an AED up there but the

extreme exposure to the sun & heat made it a less than desireable

place to store it. <<<

The " fuss " was because the park paramedic was summoned to the water

slide but did NOT bring the AED to the scene. When the cardiac

arrest was discovered, the medic sent someone back to the get the

AED. Before it could be brought to the slide, the fire department

arrived and took over care.

The park medic's defense (again, according to media reports) was that

the original call for help reported a 12 year old girl who passed out

(or lost consciousness) and that sudden cardiac death in a 12-year

old was so uncommon that the AED was not determined to be necessary.

In my opinion, the medic played the odds that day and the little girl

lost. A lawsuit was filed in the matter just last week against the

city (they owned the park) and the park medic. If it happened to my

child, I might also raise a " fuss " .

>>> better have one that works 100feet away than a malfunctioning one

5 feet away. <<<

How about a third option...bring the working AED with you!

Navarro

UT Southwestern Medical Center at Dallas

[Guest guest]

Its a water park, there is no standard of care. I love that you can take

the good graces of a an institution (buying an AED, having a medic) and sue

them if it isn\t perfect.....get a life.

Kirk D. Mahon, MD, ABEM

6106 Keller Springs Rd

Dallas, TX 75248

[Guest guest]

Kirk,

While I'm with you that it's sad that folks want to sue when there is no

clear wrongdoing, I must comment on standard of care. We're probably talking

semantics and nuances, but there is a standard of care for EVERYTHING. The

jury

decides what it is. Physicians and other experts do not. They state their

opinions about it, but it is the jury that makes the ultimate decision.

Hypothetically, you would testify that there was no breach of duty, since in

your judgment and experience, there is no clearly defined standard for theme

parks; the plaintiff's expert would testify that AHA guidelines are clear

about what works and what does not work in cardiac resuscitations, and that

mistakes were made amounting to a breach of standard. They would argue that

the

standard of care for cardiac emergencies is the same no matter what the

setting. They would then apply the facts of this case to those standards, or

vice

versa.

The defense would probably file a motion for summary judgment and might win,

but if the plaintiffs can show through enough evidence to get to the jury that

there is a legitimate question of fact about the actions of the park

employees, then the jury will decide what the standard is. That's the way it

is in

all lawsuits.

We can all bemoan the litigious society that we live in. But it doesn't

change things. Because of the media's representations of expected conduct and

outcomes, together with the plethora of " Court " shows, the public no longer

sees filing a lawsuit as being an extraordinary thing.

When I was growing up, malpractice suits were unheard of. Even when I

graduated from law school, the suits were few and far between and when they were

filed there usually was a BIG smoking gun. Not so today. People have a sense

of entitlement that reflects our " something for nothing " society and we are

stuck with it.

Now we all have to practice defensive medicine whether we like it or not.

It's sad. I don't like it but it's prudent to do so.

My advice to EMTs is to buy insurance. It's still ridiculously cheap for

medics.

Gene Gandy

>

> Its a water park, there is no standard of care. I love that you can take

> the good graces of a an institution (buying an AED, having a medic) and sue

> them if it isn\t perfect..... them if it

>

> Kirk D. Mahon, MD, ABEM

>

> 6106 Keller Springs Rd

> Dallas, TX 75248

>

>

>

[Guest guest]

Kirk,

You raise some good questions. Why should an EMT or an RN carry personal

insurance.

One theory, the one you suggest, is that if you carry insurance, you're a

target. There's some degree of truth to that I suppose, but none of the

plaintiff's lawyers I talk to adhere to it. You're a target if you're a

tortfeasor.

Period. No tort, no case. Tort, case.

Let me name a few situations where you might want to have your own insurance.

1. You have a conflict with your employer or your partner over the case.

When you are in conflict with the insured party, what happens is that the

insurance carrier IS SUPPOSED TO provide you with separate counsel, but you

don't

have any control over what attorney is assigned to your case. If you have

your own insurance, there are two separate entities at work, and your insurance

attorney is more likely to be committed to your defense than otherwise.

2. You are subject to disciplinary proceedings by your regulatory

authority. Your employer's malpractice policy will not defend you against an

attempt

to decertify or delicense you. Your personal insurance will.

3. You are called as a deposition witness in a case where you are not a

defendant, but you are afraid that during the deposition, facts will be revealed

that might make you a target for litigation. Your employer's malpractice

policy will not provide you with counsel for depositions when the employer is

not

being sued.

4. You may be sued even though the plaintiff's lawyer knows that you're

judgment proof. You are sued as a means of reaching the employer and it's

assets. The employer's malpractice carrier will defend it and all its

employees,

but if conflicts arise, the insurer's loyalty is to the insured, and you are

only an employee of the insured. I have seen more than one case where the

company threw a medic to the crocodiles. In one case, the service settled the

case but sold the medic down the river, and he ended up losing his paramedic

certificate because he could not afford to hire defense counsel to represent him

before the Texas Department of Health. If he had had a personal malpractice

policy he would have had representation and might well have kept from losing

his certification.

If I were a plaintiff's lawyer, I wouldn't care whether or not any of the

targets of suit were insured or not. I would sue all of them and watch the

fallout. The object of litigation is to get a judgment. After that, you have

to collect the judgment. You never know where you'll find assets. No

competent plaintiff's lawyer that I know will give up a judgment against any

defendant just because he might be judgment proof at the moment. Judgments

last 10

years and can be renewed for subsequent 10 year terms. Once a judgment is in

place, it becomes a lien on any and all property the judgment debtor owns or

may own. It attaches to retirement plans, real property, personal property

in the form of cars, jewelry, accounts receivable, bank accounts, and on and

on.

Insurance gives you a way to reach settlement. If you don't have insurance,

then you have no cards at the settlement table. Lawyers don't fall for the

proposal that doctors are penniless. They know that they make good money,

live in nice houses, drive good cars, put money into 401(k) s, and so forth.

There are lawyers that do nothing but enforce judgments. They are experts at

finding assets. I haven't seen a doctor yet who has no assets. I've seen a

bunch of paramedics who truly have no assets, but if they have a judgment

against them, they'll never get any. An insurance policy gives them the

ability

to settle the case and end up without a judgment on file.

So I cannot agree that not having insurance or having less limits is a good

thing. This has been a fable, a fairy tale, that has gone through the medical

profession cyclically. It's one of those things that is a belief based on

faith rather than evidence. Very much like spineboarding every patient in an

MVA and believing that helicopters save lives.

A malpractice policy for a paramedic who also instructs costs $160 a year.

That's about 50% of the hourly charge for a good malpractice defense lawyer.

Remember this: Lawyers don't want to sue innocent people. If you haven't

committed malpractice, then you shouldn't be afraid. Corollary to that

maxim: If you're an asshole, expect to be sued even if you're the best

caregiver

in the universe. Nobody likes an asshole. Act the fool with your patients,

and you'll sooner or later find yourself in the courtroom.

Act nice to your patients, do your best to care for them, and you're almost

lawsuit proof. People sue those that they hate and despise. They don't

usually sue their friends. There are some good studies that show that people

don't sue caregivers they like, no matter what they've done. They will try to

sue those that they think are jerks even if they are the best practitioners.

The best lawyers do not take cases that they can't win. They know what the

standards of care are, and they do not waste the courts' time and their money

with lawsuits that are not well-founded.

There are some lawyers who are not clear on the concept, and they may file

suits that are unfounded. Those suits have to be defended nevertheless. If

you fail to defend a suit, the plaintiff will take a default judgment against

you. So you must defend.

I would want my defense to be working for ME, not for my employer or

stretched between my employer and me and my partner, and trying to resolve the

inevitable conflicts into one solidified position. That doesn't work. The

employer's interests always prevail. Do you trust your employer to preserve

your

rights and interests?

Gene G.

>

> Gene,

>

> Sounds like we probably agree for the most part. I would say two things in

> response.

>

> One, there is something we can do about a litigious society, we can continue

> to let our views known on forums such as this one. The winds are changing

> already I believe.

>

> And as for insurance, I would argue that you only make yourself a target. I

> think it is foolish for RNs, EMTs, or anynody who doesn't have to to get

> med-mal insurance. If you don't have it, they won't get you. That is

> debatable of course, but many MDs are moving to lower limits and find that

> the sharks swarm less. Would you rather target me, who now has a 200K

> policy, or my colleague with a $1M policy. Rarely will a jury go after

> personal assets for an MD who is trying to do the right thing. Now if you

> can be villified, who knows.....

>

> my 2 cents.....

>

> Kirk D. Mahon, MD, ABEM

>

> 6106 Keller Springs Rd

> Dallas, TX 75248

>

>

>

[Guest guest]

Gene,

Sounds like we probably agree for the most part. I would say two things in

response.

One, there is something we can do about a litigious society, we can continue

to let our views known on forums such as this one. The winds are changing

already I believe.

And as for insurance, I would argue that you only make yourself a target. I

think it is foolish for RNs, EMTs, or anynody who doesn't have to to get

med-mal insurance. If you don't have it, they won't get you. That is

debatable of course, but many MDs are moving to lower limits and find that

the sharks swarm less. Would you rather target me, who now has a 200K

policy, or my colleague with a $1M policy. Rarely will a jury go after

personal assets for an MD who is trying to do the right thing. Now if you

can be villified, who knows.....

my 2 cents.....

Kirk D. Mahon, MD, ABEM

6106 Keller Springs Rd

Dallas, TX 75248

[Guest guest]

The corporation you are referring to has made some fundamental mistakes in

risk management. Their risk managers are idiots. It's fundamental that each

case exists on its own facts. So what is done at another venue has no

application upon what is done at another venue.

If there is a question about the availibaility of the AED at any site, it

will be determined upon the facts of the situation.

They will be questioned about their decisions to place AEDs in their

facilities, and they will have to discuss their decisions with the lawyers.

They

will have to justify their decisions to place AEDs or not to place them.

In your scenario, they chose to have no AEDs bacause they couldn't have them

everywhere. That position would give a good plaintiff's attorney a slam dunk

to show that they didn't use the resources that they had to save the lives of

those who might have arrested in certain situations.

They should have employed AEDs in all the places that they could, and then

they could have justified their failure to provide them to one venue by lack of

resources. But just saying that they won't put AEDs anywhere because they

can't put them everywhere doesn't make sense.

Your lawyers are not very smart. Get other lawyers.

GG.

>

> Let me give you one example of how the idea of " standard of care " in the

> corporate world hurts society.

>

> I was a volunteer medical director for an AED program at a large chain of

> fitness centers which I will not name. They emphasize wellness and

> community and decided that it would be a good idea to purchase AEDs for all

> of their locations in my region. That was over 20 locations but they did

> not at the time have enough funds for that many. I proposed that they

> purchase the number they did have budgeted, perhaps using a lottery system

> or based on client volume and then purchase the remainder the net fiscal

> year when there were more funds. However, the risk management folks pointed

> out that if they had someone collapse and die at one of the few facilities

> that didn't have one that first few months they would be sued because the

> SHOULD have one simply because they had them at other locations. They

> would be below their " standard of care. " What standard requires a health

> facility to have an AED?

>

> So, no AEDs at any until you can buy them for all of them. That is an

> example of how the litigious mindset is destroying our community and making

> us less safe.

>

> Kirk D. Mahon, MD, ABEM

>

> 6106 Keller Springs Rd

> Dallas, TX 75248

>

>

>

[Guest guest]

Gene,

Wow, that was long! You obviously put a lot of thought into that.

I think that having insurance that covers your litigation costs is sensible

I suppose for an EMT. What percentage of EMTs get named in a suit in their

career? I have no idea, let me know if you have the stats. MIght be a good

question for the list, informal survey.

I of course have coverage for all of it, but MDs get named often as you

know. It is no surprise that your attorney friends recommend insurance,

that is the chum they all feed off of. Perhaps lower limits do not help,

but I still suspect they do. Anecdotal evidence from the hill country bears

it out in one small community I know of where they all lowered their limits.

Kirk D. Mahon, MD, ABEM

6106 Keller Springs Rd

Dallas, TX 75248

[Guest guest]

Let me give you one example of how the idea of " standard of care " in the

corporate world hurts society.

I was a volunteer medical director for an AED program at a large chain of

fitness centers which I will not name. They emphasize wellness and

community and decided that it would be a good idea to purchase AEDs for all

of their locations in my region. That was over 20 locations but they did

not at the time have enough funds for that many. I proposed that they

purchase the number they did have budgeted, perhaps using a lottery system

or based on client volume and then purchase the remainder the net fiscal

year when there were more funds. However, the risk management folks pointed

out that if they had someone collapse and die at one of the few facilities

that didn't have one that first few months they would be sued because the

SHOULD have one simply because they had them at other locations. They

would be below their " standard of care. " What standard requires a health

facility to have an AED?

So, no AEDs at any until you can buy them for all of them. That is an

example of how the litigious mindset is destroying our community and making

us less safe.

Kirk D. Mahon, MD, ABEM

6106 Keller Springs Rd

Dallas, TX 75248