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 READ THE FULL REPORT HERE

December 18, 2008
Honorable John Hickenlooper (Mayor) City and County of Denver
 
Attached is the Auditor’s Office Audit Services Division’s performance audit report examining the City and County of Denver’s emergency medical response system.  The audit period was for January 1, 2003 through December 31, 2007.  The purpose of the audit was to examine and assess the City’s emergency medical response system and structure to identify possible inefficiencies or weaknesses.  This system is operated in conjunction with the Denver Health and Hospital Authority.  The audit focused primarily on response times and related processes as a key performance indicator.  Though we acknowledge there are other ways to measure performance, response times as performance indicators are a part of the agreement with Denver Health in its role in the emergency medical response system, and are the most meaningful and comprehensible to citizens.

Audit work identified systemic structural weaknesses and limited oversight practices that hinder the City’s ability to effectively monitor and assess the emergency medical response system in a comprehensive, strategic and deliberate manner to optimize the overall system.  These limitations result in limited levels of transparency and accountability within the system and emergency medical responses that are longer than the timeframes recommended by Emergency Medical Services (EMS) industry standards.

I am pleased to note that in the City’s response to our audit, the City is moving forward to address issues and recommendations identified by our audit.  The City’s commitment to improving the emergency medical response system is admirable and I applaud you for that
commitment.

It is distressing however, that emergency medical response times continue to increase year over year, and that Denver Health has not been in compliance with response time measurements as specified in the Operating Agreement during the period audited.  Furthermore, they have failed to recognize and adopt accepted standards in their performance goals even though they were
adopted by the City in the Building and Fire Code in 2004.  

When it comes to public safety and matters of life and death, the public demands and should expect that those entrusted with responding to a medical emergency do so in a timely manner, consistent with industry standards and best practices.  Audit analysis and evidence fully support 

recommendations presented in this report, and has identified significant opportunities for collaborative process improvements that can improve patient outcomes through improved emergency medical response.  While Denver Health is widely recognized for their quality services and staff, they may risk diminishing public confidence if audit recommendations are
dismissed.
 
If you have any questions, please call Kip Memmott, Director of Audit Services, at  720-913-5029.

Dennis Gallagher (City Auditor)

 READ THE FULL REPORT HERE

Denver Health: Outcomes More Important Than Response Times

 DENVER -- Emergency ambulance response from Denver Health Medical Center is failing to meet obligations to the citizens, according to Denver's auditor.

Auditor Dennis Gallagher formally presented the findings to the city's audit committee on Thursday. Click here to read a pdf file of the audit.

Officials with Denver Health said the hospital has the best trauma survival rate in the United States and it must focus primarily on clinical outcomes, not response times.

DENVER -- Emergency ambulance response from Denver Health Medical Center is failing to meet obligations to the citizens, according to Denver's auditor.

Auditor Dennis Gallagher formally presented the findings to the city's audit committee on Thursday. Click here to read a pdf file of the audit.

Officials with Denver Health said the hospital has the best trauma survival rate in the United States and it must focus primarily on clinical outcomes, not response times.

"The auditor says your response times don't meet standards and they need to improve. Will you improve the response times of your paramedic unit?" CALL7 Investigator Tony Kovaleski asked Denver Health CEO Patricia Gabow.

Gabow said, "I think what you heard from the audit report is that response time is not a very good reflection of performance of the system."

"That's not what I heard," said Kovaleski who continued, "I heard from the auditor that the response time is not meeting what the city needs and what the community needs. So will you improve that response time?"

"I think we need to work with the city to get good patient outcomes," said Gabow.

The audit follows a series of CALL7 Investigative reports that exposed a number of failures in the city's emergency ambulance response.

Earlier this year, one paramedic told 7NEWS that patients were waiting as long as 15 minutes for an ambulance and that "sometimes in Denver you would be a lot better off driving yourself to the hospital."

7NEWS also found the hospital does not station an ambulance at Denver International Airport even though it is the nation's fifth-busiest airport and has hundreds of emergency ambulance calls a year.

The nation's top four airports all have ambulances on site.

While DIA does have paramedics stationed in the airport, patients who need emergency room care have waited as long as 30 minutes for an ambulance to arrive.

The audit released Thursday lists "three general areas of deficiency" with the city's emergency medical response system, including confusion as to exactly when an emergency call begins.

The audit said the contract between the hospital and city has "significant weaknesses" and "two ambiguous 'clock start time' points for the emergency response measurement."

The audit goes on to say, "Denver Health is currently adhering to a third 'clock start time' point that is less restrictive."

Gallagher also points to a lack of city oversight for emergency medical response and inefficiencies with call processing at Denver's 911 center.

"I was dissappointed with the response of Denver Health which sort of implied, 'we're the Doctors, we know,'" said Gallagher.

"Do you feel like Denver Health has essentially snubbed your audit?" asked Kovaleski.

Gallagher answered, "Well that's a great way to put it ... I would say yes, I think they indeed snubbed our audit and think it was very unfortunate."

Denver paramedic Bob Petre told 7NEWS, "[The audit] suggested some hard parameters and I don't think Denver Health wants to be held to hard parameters. I think if you are going to serve the community that's what you have to do."

In a written response, Denver Health officials said the paramedic division lost $1.6 million in 2007, leaving the hospital to subsidize the service and "Denver Health and the City have begun to collaboratively review prospective changes that could help ... the Emergency Medical Services System perform even better, including enhanced data sharing, streamlining of the 911 dispatch system, improved identification of true like-threatening emergencies, and expanding citizen training in CPR and AED use."

SOURCE

When you're ill or injured, the last thing that should be on your mind is why the ambulance is taking so darn long to arrive.

But when you have the best trauma survival rate in the country, as Denver Health does, it's hard to criticize ambulance response times too harshly, either.

From 2004 to 2007, ambulance response times have increased in Denver at multiple steps of the 911 process - 46 more seconds for the police call center to process a request for help; 32 extra seconds for the call to emergency medical staff; 38 additional seconds of ambulance transit time.

Fri Nov 07, 2008 at 02:45:08 PM

The Colorado department that oversees EMT certification in the state is investigating a veteran paramedic for forging documents and working for six months without proper authorization at Denver Health Medical Center.

Westword has learned that Robert Loop, who began working as a paramedic at Denver Health thirteen years ago, failed to gain recertification of his EMT license in March. But after presenting hospital administration with false certification documents, Loop continued responding to calls as an EMS Operations Captain until mid-September. That was when Paramedic Chief Michael Nugent received a letter from the Colorado Department of Public Health and Environment stating that Loop was not certified.

DENVER -- A man accused of working as a paramedic for 17 months without proper training or certification is due in court next week. Todd Teel turned himself in to police last week on charges of forgery, criminal impersonation and practicing medicine without a license. A telephone number for Teel could not be found. KUSA-TV in Denver has reported that Teel worked for Greenwood Village-based American Medical Response from July 2006 until December 2007. Though he was a certified emergency medical technician, the National Registry of Emergency Medical Technicians said Teel was not a certified paramedic, KUSA reported.

Entry-level EMT certification requires far less medical knowledge than the paramedic certification, which is generally offered as a two-year degree program. Randy Kuykendall, chief of the state's Emergency Medical and Trauma Services Section, said only one other instance of falsified credentials has been discovered since Teel's case. Denver Health EMS Operations Supervisor Bob Loop allowed his certification to lapse, then provided the state a fake certificate, Kuykendall said. Loop lost his job Oct. 29. "He made a bad choice," Kuykendall said. He said Loop was not treating patients during the time he was uncertified. In a written statement, Denver Health said it never knowingly allows uncertified or unlicensed health care professionals care for patients.

SOURCE

DENVER - Veteran paramedic Bob Loop wasn't treating patients while he was uncertified to hold his job, instead he was responsible for planning for the Democratic National Convention.

Loop's falsified paramedic certificate was discovered when Denver Health checked its records against a state database. He lost his job a month later, on Oct. 29.

According to the Department of Public Health, use of that online verification technique has increased since a 9NEWS report in June on a paramedic imposter.

Denver Emergency Medical  Services (EMS) System Examining the Data, Clarifying Misperceptions - October 2008

Tracy L. Johnson, Ph.D. (Principal, Health Policy Solutions)

Read Full Document By Clicking the PDF Icon Below

Denver Emergency Medical Services (EMS) System White Paper Overview
Patricia A. Gabow, M.D., CEO, Denver Health

October, 2008

Denver Health retained an independent research firm, Health Policy Solutions, to conduct
a study of Denver’s Emergency Medical Services system.

Read Full DocumentBy Clicking the PDF Icon Below

 

CALL7 Review Prompts City, Hospital Action
Arthur Kane and Tom Burke and Tony Kovaleski , CALL7 Investigators

DENVER -- Officials are considering stationing an ambulance at or near Denver International Airport after a CALL7 Investigation found long delays in emergency responses to the busy air field.

By Joyzelle Davis, Rocky Mountain News
Published October 31, 2008 at 12:05 a.m.

Denver Health on Thursday released a study that argued the hospital's emergency medical system's performance should be judged on more than just ambulance response time - an issue that's become controversial in recent months.

The 60-page report, conducted by a research firm hired by the hospital, comes as the city auditor nears completion of a review of whether the hospital is meeting the terms of its city contract. That pact says a Denver Health ambulance must reach a patient within 8 minutes, 59 seconds for 85 percent of 911 calls.