Leadership

D.C. Medical Director Explains ‘Toxic’ Culture in Fire Department

WASHINGTON – On Wednesday Dr. Jullette Saussy, the former medical director for the D.C. Fire and EMS Department, went before a city council committee hearing to explain the claims she made in her resignation letter that described the culture of the department as ‘highly toxic’ toward patient care.

Council chairperson Kenyan McDuffie began the hearing on fire and EMS by saying he was deeply disturbed by Dr. Saussy’s claims and asked if EMS can be saved in its current structure or if it should be taken out of the fire department and made to operate on its own.

Joining Dr. Saussy in her testimony was Jeffrey M. Goodloe, MD, NREMT-P, FACEP, professor and director of the EMS Division of the Department of Emergency Medicine at The University of Oklahoma School of Community Medicine in Tulsa and Dr. Neal J. Richmond, medical director for MedStar EMS/Mobile Healthcare System in Fort Worth, Texas.

Dr. Richmond told the council that EMS is stuck in the ‘you call, we haul’ mentality and that part of the many problems in EMS that the district experiences is that an extraordinary amount of time is spent on reaching the patient, but very little is given to the value of measuring operations, or the methods of care.  Richmond added that consideration of EMS needs to shift from a public service to public health, “let the medicine drive the operation, not the operation drive the medicine,” Richmond said.

Changing the view of EMS and managing it responsibly was the main theme of the testimony and answers provided by Saussy, Goodloe and Richmond.  “We must remain patient focused, and we must remain accountable and transparent even with the bad situations. There are simple fixes that can occur.” said Saussy.

 

Watch the entire committee hearing below.

When questioned about the brevity of her time as the department’s medical director, Dr. Saussy surprised the committee by explaining in greater detail the obstacles she met when trying to reform the department.  “I was immediately met with resistance in simple assessments (of EMS providers) and knew this would not work.”  Saussy added that in the seven months she was medical director, the resistance led her to believe that the urgency to change was not going to happen.  In explaining further the resistance to assessments, Dr. Saussy told the committee that she was told in a formal letter that assessment findings would cause embarrassment and stress among EMS personnel and therefore would not happen.

“Knowing the medics’ skills, the baseline assessments,” was one of the simple fixes Dr. Saussy told the committee.  “Relying on two year recertification is not adequate,” Saussy added.  “I was very sensitive to some previous attempts at assessment that had left them, the providers, feeling vulnerable, criticized and quite frankly I think embarrassed on some level. That was not my intention.”

Chief among those simple fixes discussed was the authority of a medical director within the fire department.  When asked by council member Mary Chey to explain why the medical director’s position had no role in the department beyond medicine, Saussy told the committee that according to Fire Chief Gregory Dean, medicine stays on the EMS side and the medical director is not involved in policy changes or operations.

When asked about her input on accountability and discipline Saussy replied that she had the authority to make recommendations on remediation of personnel but a cultural “fire wall’ existed separating her from department management.  This limited scope of practice was highlighted again during the testimony when the organizational command chart of the fire department was mentioned, drawing attention to the low number of management positions within EMS as compared to those on the fire suppression side.

“It’s not about fire-based EMS and EMS-only (service); it’s about a culture, a want to invest, to do the job.  It needs investment from the top down, from the mayor and chief.” said Dr. Goodloe in his testimony.

Goodloe said that the department needs to identify what is wrong and what will be the small steps to gradually improving the situation as well as identifying where it wants to be, “Practicing medicine is more than just a public service. You have to care about the people you serve and the people doing the serving.”

Within the theme of training the subject of the third-service, soon to be provided to the District by American Medical Response, was raised by some of the council members.  McDuffie asked Dr. Saussy how the third service will work if the department cannot measure themselves.  “We need the basic assessment skills, clean out own house first and then bring in a third service if needed,” was her reply.

 

Members of Local 3721, representing the District’s EMS employees were adamant in their testimony against the introduction of a third ambulance service.  “This third party is a profit service and the Nation’s Capital should have a government service,” said Arthea Lyles, President of AFGE Local 3721.  “If we are going to implement a third service, then why not separate EMS from the fire department?” added Vice President Darlene Nelson.

Their testimony also supported the need to have assessments, a medical director with complete operational authority, and a culture change as mentioned by Dr. Saussy earlier.  “The culture has yet to change appropriately.  The chief was a good start and so was the medical director,” said David P. Milzman, MD, FACEP.  “There are three things that must happen to fix this situation; medical control must be regulated by the medical director; the medical director must have the final say on medical calls; and the medical director must have a connection with local emergency rooms to assess their people, protocols and patient care.” Milzman added.

Throughout the hearing it was evident that neither those testifying nor those sitting as committee members were there to discuss the pros and cons of fire-based EMS.  Instead, the focus from all involved was on providing quality, consistent and appropriately measured patient care in the District of Columbia.  Each round of testimony from all of the witnesses did highlight training, staffing and the operational range of the medical director.

“The issues brought to light here have been brought to light in previous years by Local 36,” said IAFF Local 36 President Ed Smith.  Smith added that the department would do well to expand its current Street Calls program, with assistance from the health department, and include an expanded community paramedicine program.

However the District of Columbia officials work to resolve the problems in EMS, the latest awakening of what is wrong appears to have enlightened many council members. While a few council members were brought up to date on the difference between an ‘ambulance’ and a ‘medic unit’, and that ambulances are kept inside firehouses, the elected officials showed a frustration of repeated problems and a strong desire to learn more about EMS in order to provide a quality service.

In the past, issues with ambulances, staffing and dispatching were often the repeated contributors in the many repeated EMS errors the fire department has struggled with.  Dr. Saussy’s letter and testimony, as well as the testimony from Dr. Goodloe, Dr. Richmond and the members of Local 3721, point to a greater cause, one where the full use of a medical director is cut short by a culture in the department that is so pervasive that the same problems will continue to reappear.

“Humans don’t like change,” Dr. Saussy told the committee, “Adding more medics is not the answer if we cannot assess their skills.”