Travis County Commissioners Court
March 23, 2010,
Item 25
Now, we have a couple of executive session items dealing with starflight, and we have residents who have come down to address us on them.
and so let's call them up now.
actually, we have four or five items.
what items are they here on?
>>
>> [inaudible - no mic].
>> okay.
25 is to consider and take appropriate action concerning the settlement offer regarding payment for starflight services rendered to christian gibbs.
and if you would have a seat, sir, you can give us your name and we would be happy to get your comments.
>> my name is walter gibbs, I'm christian gibbs' father.
christian is currently 17 years old.
>> we need you to speak right into that mic, mr.
gibbs.
>> I think what is at issue here, and why I'm so passionate about this case, is that to a layman's eyes, starflight is used in trauma cases.
when you think of starflight you think of somebody that's been in an automobile accident that has a head trauma or something like that, and needs to be transported to a level 1 trauma care unit somewhere, memorial, southwest, I don't know what's here in Austin, st.
david's or whatever.
a little bit of history.
my son had a pulmonary niewm mow thorax.
this was about eight months ago.
it's taken me eight months to get to this point to be in front of you all.
he complained about chest pains to me a week before he ever went to the hospital.
i said, chris, was there anything unusual?
did you get hit or something?
and he said well, a friend tackled me in the hall at the high school or something.
and I said, we'll keep an eye on it.
and the next day, kind of rethinking it, we took him down to the little local clinic.
and they had a series of x-rays taken at the clinic.
and the doctor that's our physician at our little clinic really didn't know what she was looking at.
she gave him an inhaler for possible asthma.
and she went out of town for the weekend.
the next week she came back and she said -- she called me and said I really think I would like to have him have another set of x-rays or a cat scan.
and I said let's let him have a set of x-rays because obviously that's cheaper, but they'll be read by a radiologist.
and I'm not a medical doctor, but I do know that at times chest x-rays can be very hard to discern just exactly what's going on.
so he had another set of chest x-rays taken and the doctor called and said I want you to get christian up to the hospital just as soon as you can.
he's got a 70% collapsed right lung.
and we were about to sit down to dinner.
he was totally taken off guard.
and I said things like do I need to pack a bag?
and she said yeah, you need to pack a bag.
the kid is going to the hospital for a few days, he's got a collapsed lung.
so we were at the local hospital in rhymer.
if you live in a rural community you know that generally there is a clinic in all of the towns and then there is a community hospital that serves a two or three-county wide area or something like that.
and he was attended to by the local emergency room doctor.
i think his name was dr.
van burkeelow.
and he called to the attending physician and they -- she recommended that he go to dell children's here in Austin.
a ground transport ambulance was called.
at first they didn't have a ground transport ambulance in colorado county.
they called fayette county and they found the ground ambulance to come down and transport christian to dell children's.
the attending physician or one of the er people said, it takes about half an hour for the ambulance to get from la grange to weimar.
you guys just hang tight.
so we did.
we waited for the ground ambulance to get there.
i'm not -- I don't want to question you all's intelligence, but christian was deemed asymptomatic, and that means he was showing absolutely no signs of a collapsed lung, okay?
the kid was up, he was walking around, he was going to school.
it was the 20th of may.
the only thing that he could think about was he was going to miss his final exams because he was going to be in the hospital.
and this is a very, very bright kid.
he's applying to the aerospace engineering department at the university of Texas and the aerospace engineering school for his upcoming college careers.
we were at the hospital.
we were under the assumption that he was going to be transported by ground ambulance.
apparently the calls between the clinic or the hospital in weimar and dell children's, there were things stated that because of the copies of the audio transcripts that christian was asymptomatic.
we were sitting at the hospital and all of a sudden a starflight helicopter lands.
the crew gets out and basically whisks christian away to dell children's here in Austin.
kind of prior to getting the actual bill.
the bill was one of the things that, you know --
>> do you know who contacted starflight?
>> dell children's.
now I know who contacted starflight.
dell children's.
>> and said go to weimar and get christian?
>> yes.
so even before I got the first bill there was something that kind of wasn't right about this whole thing, in my eyes.
number one, the emergency room staff at our little colorado-fayette county hospital was totally taken off guard when the helicopter landed.
it was obvious they had no idea that the helicopter was coming.
i mean, up until the time we were putting him on the helicopter -- instant as a mattf fact, they had to call the ground ambulance away five minutes before it got to the hospital.
kind of like, if I got in my car and drove to Austin to dell children's, I watched my son taking off literally into the sunset in this helicopter.
and I got to dell children's and he was in dell children's emergency room facility, still sitting up, talking to the emergency personnel at dell children's, still no chest tube in him, which apparently was the -- the underriding fact of getting him to dell children's.
and dr.
meyer was -- who was his attending surgeon at the time, was busy.
i hate to say it, but from what I understand he was lansing a boil on a kid's arm or something.
so I never saw any emergency.
like I said at the beginning, when you think of life flight you think of a trauma case.
i've learned since then that life flight is used for transporting medical patients from facility to facility.
i guess like a case like ours, if somebody went in to cardiac arrest and -- we're just a little community hospital.
we don't have the facilities to treat somebody that their other things are failing, they would have to go to memorial herman or other place where they have all the bells and whistles and give the best medical care possible.
and I don't want you all to think that I didn't want the best possible care for my son.
i love my son dearly.
but in this case I still feel that the fact that life flight, starflight, there was no -- nobody at my little hospital knew that star night was landing.
they were totally taken off guard.
it's taken me 10 months to come before you all, because of all the people I've talked to at starflight, at Travis County e.m.s., at dell children's, at colorado-fayette county hospital.
the transcripts I have from colorado-fayette county hospital show that there was never, ever a helicopter called from their facility.
i won't name names.
one of the ladies I talked to at starflight said the sending hospital cannot be the hospital to order a helicopter or the receiving hospital.
the sending hospital to has to be the one to order a helicopter.
my contention is dr.
van burkelow might not be denton cooley or michael debakey, but he's certainly qualified to be running an emergency room at colorado-fayette county hospital.
and if he deemed christian as asymptomatic, why was a life flight helicopter called?
in fact, I asked that doctor could I take christian to dell myself?
and he said -- and I understand a liability issue.
once he's been admitted to colorado-fayette, if anything should happen on the transportation to dell children's, then colorado-fayette could be held liable.
i understand that.
but I still don't understand why a helicopter was called to pick up an asymptomatic patient.
>> well, now, we'll get a response from staff.
but my guess is when dell children's said christian is sick down in weimar, some doctor said 70% of the right lung is collapsed, we consider that to be a life-threatening emergency and I guess helicoptered down there and picked him up and brought him back to dell.
>> right.
but who makes the call?
is it the physician that's actually looking at christian saying that he's asymptomatic and they were the ones that called a ground ambulance to take christian --
>> let's get the answer.
i know it was not the starflight pilot, though.
my guess is we were sitting there with a helicopter there and we got the --
>> if I could continue a little bit.
>> let's get a response.
all this boils down to a bill that we sent you eight months ago that you have not paid and don't think you should and you think it should be waived.
>> did you receive my letter, judge Biscoe.
>> I'm Sam Biscoe.
>> I said have you received my letter?
>> I sent your letter to appropriate county staff and that's how we got here today.
i read your letter several times before doing that, though.
this is casey with starflight.
>> morning, judge, Commissioner.
to my left is the starflight medical director.
typically on the specialtd team transports like this case with mr.
gibbs' son, we received a call from the receiving hospital.
in other words, dell, brackenridge, st.
david's, any of those teams that we fly, they receive the request from the rural hospital, a physician evaluates that flight, that medical condition, and determines how the patient is going to be transported.
so in this case we simply received a request to transport the dell pediatric team to weimar and bring back christian.
we were not involved in the clinical assessment of the patient in any manner prior to being dispatched.
we reviewed the request and it met all of the current policies that we have as far as how those flights are approved and selected.
>> I certainly appreciate and understand mr.
gibbs' concern about this.
when you're dealing with something like a pneumo thor roks, it's not uncommon to be asymptomatic.
chest pain and some occasional shortness of breath.
the issue here is the potential for very rapid decompensation.
and real quickly without getting into the medical details of this, what can happen when air is leaking out the outside of the lung, the lung is basically like a large balloon.
the problem is that air can't go to any other space except outside of the lung.
as it does so it continues to compress the lung.
as the lung continues to be compressed, it then starts to compress the blood vessels returning blood to the heart.
what happens, that situation is called a tension neumo thorax.
you can do for a certain amount of time and nobody can predict how long that time will be before you suddenly get decompensation.
in other words, get pressure on the blood vessels and then you basically go into cardiac arrest because the heart no longer has any blood supplying it with the oxygen that it requires.
so it requires urgent recognition of that situation of attention neumo thorax and then also rapid placement of a chest dart or a chest tube.
many times in these situations we can just treat the patient with oxygen and it will resolve spontaneously.
however, there is a very high risk that this patient is going to deter rate and if they do it will happen very, very rapidly.
so I think when you consider the time that it required to transport the patient by ground, which would have been somewhere near two hours based on google maps and other web-based software that you can use to estimate the time of transport, as well as having appropriate personnel to recognize if the patient is deteriorating, I think it was very appropriate to use an agency like starflight.
again, we are not involved in making that decision process.
that was determined by the pediatric icu attending bho looks at these situations and then determines the appropriate mode of transportation.
>> we were kind of like you, mr.
gibbs.
we got a call to send starflight down to weimar to pick up christian.
christian is 18 years old now?
>> 17.
>> 17.
and I guess we do some sort of quick evaluation of the request, and move, and it looks like the situation may not have been as critical as we believed in hindsight, but I don't know how --
>> well, I mean, there's an emergency room doctor at my hospital looking at christian.
they're sitting up talking about going fishing in aransas in the back bays for red fish.
that doctor, if he thought that christian needed immediate care, if christian was going to, quote, crash or whatever, that attending emergency room doctor is perfectly qualified to put in a chest tube.
it's a relatively -- from what I saw you make a small incision in the side of the chest and insert a plastic tube to reinflate the lung against the chest wall.
i understand his -- this gentleman's saying that --
>> who called dell hospital?
>> excuse me?
>> who called dell?
>> they wanted christian to have -- our doctor, our physician wanted christian to go to a better facility than our little facility.
she wanted him to go to dell children's.
>> so she called.
>> no.
the emergency room doctor called.
because all he wanted to do was find out if there was room at dell for christian, could they take his case.
from what I understand from the audio transcripts from weimar hospital to dell children's, there was -- there were mentions of him being asymptomatic, you know.
that means that the emergency room doctor told the people at dell -- and I understand.
i've gotten this for 10 months.
starflight is just a transporting -- all they do is transport.
i've gotten that.
mr.
gibbs, all we do is transport.
we don't make the call.
>> it should be a life-threatening situation, right?
>> correct.
>> otherwise ground transportation units are used even here in Travis County.
>> ground transportation was called.
again, ground transportation was five minutes away from my hospital.
the attending physician deemed that ground transportation was perfectly suitable.
if he had needed to, he could have put a chest tube in at my little hospital.
in between there is st.
mark's in la grange.
there are to or three hospitals in bastrop.
so if christian started to crash, and you know, where he was in a ground ambulance, he could have gotten to any number of hospitals to have a chest tube put in him.
>> what's the outstanding balance?
>> about $7,800.
>> and your request is that we waive that in full?
>> yes, sir, but it kind of goes beyond that.
and I think I state that had in my letter.
i'm not -- I don't know about the medical community.
i really don't know, but to our -- to a layman's -- to us, starflight is used in medical emergencies, trauma.
i mean, what if --
>> life-threatening.
>> yes, sir.
what would happen if this helicopter had been transporting my son to who is asymptomatic.
and again, I wanted him to have the best care possible, but what happened if there had been a 33-vehicle accident on i-35 in Round Rock and your helicopter, who should have been transporting a trauma case, is sent down to weimar to pick up an asymptomatic patient?
and again, this is my son I'm talking --
>> our information was that christian had a life-threatening situation, right?
so that car wreck would have had to wait until we delivered written christian in the safe hands of dell hospital personnel.
then we would try to help the other situation.
i mean, I guess -- we're not in a position to make that medical call.
we assumed that --
>> who is in the position to?
is it the emergency room doctor that is looking at christian?
>> the people who called us at dell.
>> but they're making a call for a starflight helicopter based on a call to request just a room or can they take him?
>> yes, ma'am.
>> is a 70% collapsed lung considered a trauma circumstance?
>> not necessarily.
it depends on the circumstances of the knew ma thorax.
if it occurred after a traumatic event and there was a questionable thing was he injured at school or not.
the bottom line is that a 70% pneumo thorax is very large, regardless if it happened spontaneously or through a traumatic event.
>> so with regards to the asymptomatic and the presentation -- christian's asymptomatic presentation, are the stimulus what is considered in the protocol for dispatch or is it -- or is it clinical -- what's the word for it?
the clinical determination that 70% of the lung is collapsed?
>> let me put it this way.
and to kind of hopefully answer mr.
gibbs' concern at the same time.
i've been on -- I'm board certified and trained in emergency medicine and being doing so for the past 15 years.
if I was working in a rural community in this situation, for me to even consider transporting a 70% collapsed lung by ground would be close to malpractice.
and I'm not trying to criticize his position at all, and again I've got no say in the matter.
we were just purely a transport agency.
but I consider that a potential life-threatening emergency.
in other words, he has a very high potential to decompensate.
>> in the case of decompensation would ambulance transport be able to handle a test tube circumstance in route?
>> it really depends on the transferring agency.
some of them will be -- will have the chest darts, which are the temporary measure to kind of initially relieve that pressure.
the problem is, though, that if they do decompensate, unfortunately the turnout could be fatal before it could be appropriately intervened.
and they decompensate very, very rapidly.
>> mr.
gibbs, the first request is to waive the outstanding balance.
the second request is --
>> well, I'm not sure, your honor, except that it just seems to me --
>> maybe you only have one.
>> in the letter there were numerous people I talked to all over starflight, all over Travis County e.m.s.
one lady told me specifically it cannot be the receiving hospital that authorizes the helicopter.
it has to be the sending hospital.
now, I've since learned because of dell's protocol that that's not necessarily the case.
okay?
i had some commanders at e.m.s.
tell me go to colorado-fayette.
they'll have all the backup documentation.
i wasn't going to even do it, but I took a drive up to colorado-fayette and sure enough, on their transfer flow sheet there's nothing about a hypothetical.
there's nothing in their documentation except for a memorandum of transfer that I kind of question in the first place that shows a helicopter even came.
and --
>> you saw the helicopter pick up christian, you said.
>> oh, yeah.
>> and christian was delivered to dell hospital.
>> but again, we get pack to -- and to contest what he said again, was that christian is sitting -- I'm sorry I'm so passionate, you know.
he was sitting in the emergency room at my hospital.
he was being looked at by emergency room physicians.
the physician deemed it appropriate for ground transportation.
he got to dell.
i didn't get there for an hour and a half.
he was still sitting in the emergency room.
if it was such a trauma case or if it was such -- why didn't they put a chest tube in at colorado-fayette?
if he was in that bad a shape, we were perfectly capable of doing it.
and he sat there at dell children's for another hour and a half before the surgeon even came in to talk to him and say chris, this is what we're going to do.
you have a 70% collapsed lung.
we're going to make a small incision and we're going to reinflate your lung.
besides that why --
>> do you think the medical personnel at dell hospital concluded that in fact starflight should not have been sent to pick up christian?
>> not in my eyes.
i'd also like to know -- I mean, you kind of had to be there, but when the helicopter landed at my little facility -- and it doesn't make any sense.
the people were running around like chickens with their heads cut off.
they did not know that helicopter was coming.
why didn't -- why wasn't -- you know, why weren't they told that a helicopter was coming to pick up christian?
>> what's our protocol on when to use starflight?
>> in these cases we respond at the request of the receiving facility.
>> so it's the receiving, not the second.
so we would have relied on dell's request.
>> yes.
that's consistent with our specialty team protocols.
i would answer a couple of questions for mr.
gibbs that when he referenced he talked to starflight personnel that said that it was the sending hospital's request, that was really Austin-Travis County e.m.s.
billing staff who were providing that information.
in fact, he did get some incorrect information.
so there was information that was not accurate related to the specialty teams.
in most inner facility transfers that don't involve a specialty team, we respond at the request of the sending hospital.
so if it was a transfer from seton highland lakes in burnet to Austin without the specialty team, we would go at their request.
>> but it's the second request that we review our protocol?
>> I would think that might not be a bad idea.
>> we'll do it.
let's review it.
if there's a way to review it, I think we ought to look at doing t.
>> that would be the one thing this that we did identify and have already talked to the specialty teams.
in their discussion with weimar they made some comments like we'll get the pd team going, some generalized comments that if you knew what you were hearing would make sense that they were going to send the team.
but it was also not clear.
we've already communicated that to our specialty team members and partners to make very clear what they're requesting to have happen for that patient so that there is no doubt in these cases.
i do believe mr.
gibbs is correct that the hospital was not -- did not grasp those concepts and those statements to mean that the hospital with the specialty team was coming.
i do think it caught them by surprise.
and we have asked that the specialty teams make sure that there shouldn't be any surprise about how they feel that patient should be managed and transported.
>> I'd like to say one more thing.
it's nothing derogatory against starflight.
but I think to send a helicopter crew and a specialty team up is not a light thing.
i think it was the state of arizona a year or so ago they had two medivac helicopters do down within a period of a year or something like that.
so it was almost a harder decision for me because I knew about this, to let christian get on that helicopter, as it was for him to have a chest tube inserted, say.
but at the time you do what you think is right.
i mean, if the helicopter lands -- don't get me wrong.
if they thought that a helicopter was needed, then go, but I just-- I think that to -- I'm not going to say put an air crew in jeopardy.
that's not the thing.
but because I'm sure starflight is a marvelous operation and they take care of their equipment and everything like that.
but there's always a chance that when you hear about these medivac helicopters going down with a patient and a crew, a pilot and a crew of three, it's pretty scary to me.
i agree with casey.
what I understand after talking to tim lavity about the audio transcripts was that it was something along the lines of saying we're getting our specialty team together.
it wasn't that we're getting our specialty team together and sending them down in a helicopter.
it was we're getting our specialty team together.
it took me two months to figure out from these people what a specialty team was.
i didn't know whether it was star night or what.
i learned later that starflight's call by the hospital.
starflight is just the transporting end of this.
they go to dell, pick up the specialty team.
if it was a child -- if it was a woman that was going into labor or they had a premature baby would be a neo natal nurse.
it would be the people that would be specialized in just that thing.
i don't know who came on christian's flight, whether it was a pediatric pulmonary specialist or what.
there were a lot of things in this case that just kind of made me --
>> okay.
we were glad you were able to visit with us today.
we'll discuss this with legal later and it may be this afternoon before we go into executive session.
but we will let you know what we think.
>> I appreciate your time.
>> thank you.
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Last Modified:
Tuesday, March 23, 2010 2:53 PM
