New developments in the case of EMT charged with assaulting patient

DEKALB COUNTY, Ga. — The city of Dunwoody has declared a state of EMS emergency. Councilmembers are asking the state for help accusing DeKalb County of not holding American Medical Response accountable for delayed emergency response times.

The county has a contract with the ambulance provider that will expire in December. An incident on May 12 involving an AMR emergency medical technician brought the issue to the forefront.

“In the hands of a first responder who is charged with patient care punching the patient, it was just stunning. It was shocking. It was unbelievable,” said Terry Nall a Dunwoody City Councilman.

The incident occurred when Dunwoody police picked up a 17-year old boy on a mental health hold to take him to the hospital for a mental health evaluation.

After the teen walked out of the back of the ambulance, Dunwoody police handcuffed him and restrained his ankles while he was put on a stretcher in the back of the ambulance.

AMR EMT Deannah Williams, 37, was attempting to put a spit mask on the teen when she claims the teen spat on her. On police body cameras, Williams can be seen repeatedly punching the boy in the face. Dunwoody Officer Kevin Lopez can be heard yelling and physically pulled Williams out of the ambulance.

The other officers consoled the teen and took photographs documenting the physical injuries to the teen. They can be heard on video saying:

“Is he hurting? He’s bruising in the face, oh yeah, good grief. Did you take pictures? He’s got a goose egg.”

Another officer told the teen: “She hit you pretty good.”

Williams was interrogated by Lopez and repeatedly claimed the teen spat on her. She was placed under arrest for misdemeanor assault and battery. AMR terminated Williams employment.

She bonded out of the DeKalb County Jail on a $1,000 bond. For Nall, this was the final straw for AMR.

"The Dunwoody City Council voted unanimously 7-0 to declare a 'state of EMS emergency' in Dunwoody. We are seeking state remedies and relief. We've been tracking and reporting AMR's failing DeKalb County EMS response times and patient care service since 2016, but to no corrective action by DeKalb County, who holds the EMS certificate and the contract with AMR.The area north of I-285 is the forgotten area of DeKalb County EMS/AMR."

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Nall cited two recent instances in which AMR’s response times were far below the nationally accepted industry standard designated by the National Fire Protection Agency.

"We had a pedestrian struck and there was a 58-minute response time by AMR,” Nall said.

Another emergency response to a restaurant took AMR 36 minutes.

"I think people’s lives are at stake. I think severity of injuries, severity of emergencies will be worse because of the delayed response,” Nall said.

Halloran obtained an email thread from DeKalb County Commissioner Nancy Jester dated May 21, 2018 in advance of the Dunwoody City Council meeting:

“I do believe that it is widely acknowledged that the county's 3rd party provider of EMS services, AMR, has not provided the level of service that they are contractually obligated to do. Their lack of service delivery is certainly not acceptable to me. I have expressed this directly to the leadership in DeKalb. I am also copying Fire Chief Fullum, Deputy COO Lumpkin, and COO Williams on this email.

“I do want to make sure that all involved know that Dunwoody has one of the best response times in the county for fire personnel being on scene. All fire department personnel receive the same EMT training, and many have advanced paramedic training.So, once a county firefighter is on scene, they start administering care at that point. Also, the suggestion that Dunwoody and areas north of I-285 are forgotten, or something more purposeful is at play; is not congruent with the facts. We are having a countywide problem with AMR. The response times in southeast DeKalb are the worst.”

A statement Channel 2 Investigative Reporter Wendy Halloran received from Quinn Hudson, Chief Communications Officer for DeKalb County, reveals the county has imposed more than $1.5 million in fines to AMR for not complying with the contracted response times. But those fines have not yet been collected.

The contract calls for an 8:59-minute response on 90 percent of the calls. AMR did not respond to requests for comment.

Here’s Hudson’s full statement:

“The DeKalb County Fire Rescue Department recognizes the challenges with the performance of EMS transport services, particularly with our current contractor, AMR. Importantly, the DCFRD operates an integrated service delivery system whereby Fire Rescue units respond initially to most medical calls to access and initiate care while the transport unit is in route.

"All firefighters are certified EMT’s, and many are certified paramedics.  The highly trained firefighters are able to provide the same level of care and have the same equipment and resources as an ambulance.  

"This system ensures care is started at the earliest interaction with a patient.  Currently the average response time for the Fire Rescue is 7 minutes/37 seconds.” 

 
The following is a timeline/fact sheet related to the current status of the relationship between AMR and the County
 
DeKalb County contracted with American Medical Response (“AMR”) on June 24, 2013.
The contract ends December 31, 2018.
 
Per the terms of the contract, penalties can be assessed if the “Contractor cannot respond to calls (Inability to follow system status plan)”. The applicable penalty for each occurrence is $1,000.
 
AMR consistently incurs instances of No Ambulances Available for Transport (NAT) at the time of dispatch due to inability to adequately staff units as per their deployment plan.
 
AMR has taken several actions to correct deficiencies to include: installing a posting system program for better deployment of units, adding staffing to the E911 Center to dispatch units.   
 
Prior to assessing any penalties, a memo was sent to Zachary L. Williams, COO on December 8, 2016, addressing the AMR contract for medical transport.
 
At the time, AMR had added personnel in all areas of operation, modified salaries, changed scheduled, added ambulances to the fleet, upgraded technology, increased supervision, and changed and added management in an effort to meet the performance measures outlines in the contract
 
DCFRD agreed to:

• Maintain the current oversight processes and evaluations that are in place (Ongoing)
• Evaluate the current rate structure for areas of adjustment (Ongoing)
• Evaluate the current performance measures for response time for areas of adjustment (Ongoing)
• Work with DeKalb 911 Center and AMR to improve the efficiency in unit response recommendations in the 911 Center (Scheduled 1st QTR 2017)
• Begin the process of developing the Scope of Work for the next RFP (1stQTR 2017)
• Evaluate AMR's monthly performance and assess penalties for categories listed in the current contract, to include response time delays (Beginning Jan 2017)

In early 2017, DeKalb Fire Leadership met with AMR Leadership and requested a mitigation plan to improve service delivery. AMR named poor staffing and recruitment, increasing employee wages, and increasing task times as the reason for this and took action to increase recruitment. At that time, DeKalb fire leadership notified AMR that failure to improve performance will result in enforcement of penalties as outlined in the contract.
 
AMR has taken steps to improve performance including: Alternative unit deployment, increased recruitment and hospital based initiatives to reduce wall times.
 
As of September 2017, DeKalb County began enforcing contractual penalties for noncompliance.
 
As of date, AMR has been assessed the following penalties:

No penalty fees have been collected.

AMR responded on March 9, 2018 contending that the there is a difference of opinion over the application of penalties based on the terms of the Agreement.

DeKalb County is in the process of drafting an RFP for EMS transport services for a future date to be determined. 

The County Attorney has recommended that the County pursue all legal remedies to ensure compliance with the contractual provisions of the agreement. Prior to taking formal legal action, the County will take reasonable steps to address outstanding issues without the necessity of litigation.

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