Travis County Commissioners Court
March 23, 2010,
Item 26
>> number 26 is to consider and take appropriate action concerning the settlement offer regarding payment for starflight services rendered to victor anderson.
we appreciate y'all's patience also.
>> thank you.
>> and if you would give us your full name, we would be happy to get your comments.
>> my name is doug anderson.
this is my daughter kara, this is my daughter rachel and this is my mom helen anderson.
she's the wife of victor anderson.
we received a bill in the mail from the city of Austin for what was referenced as starflight pronouncement/resident in the amount of $2,700.
and what I've been able to figure out is that -- my dad died on January 24 the.
and I was out there with my mom at his house.
we live out in the southwestern corner of Travis County, and we've got 10 acres out there.
i've got half, mom and dad have got half.
and we've each got a house on the same basic 10 acres.
the mortgage -- it was Sunday morning, the 24th, and I was up and getting my family ready to go to church.
i got a call from my brother who said, you need to go check on mom.
there seems to be something going on.
so I went over, checked on mom, went and found that dad was sitting in a rolling chair similar to the one that you're sitting in, and he was nonresponsive, unresponsive.
i'm not a medical doctor, I'm not a nurse, but I have been giving care to my parents for a number of years, probably the last 10 or 12 years.
my dad throughout his whole life has been -- had lung trouble, and over the last 10 years it's been off and on.
he's been in the hospital several times.
and as a result of his having lung trouble he's also had some heart trouble over last couple of years.
so that morning I went over there and found my dad sitting in the chair.
his eyes were can closed, his mouth was slightly open.
i tried to get him to respond.
he would not respond either verbally or move in any way.
i listened to his chest, I couldn't detect any kind of heartbeat.
i listened for any kind of breathing, I checked for a pulse, couldn't find anything going on.
so I basically determined that he had died that morning.
he had been up earlier that morning, mom and dad had -- mom had helped dad to the bathroom and then they had gone to the kitchen and that's where dad was sitting.
so he went peacefully to sleep as far as best I can understand.
which was a blessing to me.
that's what I have always wanted.
not for him to be in the hospital, not to be anywhere else.
but for some reason starflight came out.
i guess how that led up to that happening was that when I determined that my dad had died, or what I thought he had died, I called 911.
and I talked to the operator that answered and said, okay, my dad is nonresponsive, he's got no heartbeat, he's got no pulse.
and they said, okay, let us hook you up with another person at the same time as the 911 operator was on the phone, a medical personnel, to help me determine is this what's really going on.
so they had me do a lot of the same things that I had already done, listen to his heart, listen to his chest, you know, try and listen for breathing, check his pulse, do all the same things that I had done, which I did and I tried to assess the situation with them.
in the meantime they decided to send out people to do something, I don't know what.
>> now, they refers to?
>> they refers to a lot of different people that showed up.
there were two sheriffs deputies that showed up, there were a number of fire department personnel, emt's that showed up.
>> who asked them to?
>> 911.
>> 911.
>> what I got on the phone and explained to them was, you know, my dad is not breathing, he doesn't have a heartbeat, you know.
i don't know if I actually used the word he died, but that was the implication that I tried to give to them.
i said can I get a justice of the peace or somebody else out here to, you know, make a pronouncement of death or whatever needs to happen?
i didn't know what actually needed to happen, but I knew that I needed to report this.
and then after I had reported it, then we would take care of the funeral arrangements and all the other details that had to go along with it.
so they sent out two sheriff's deputies, a large fire truck with a number of fire personnel on, they sent out ground ambulance and they also, I guess, sent out as far flight.
-- starflight.
i never requested, you know, for starflight for come out.
i didn't request for ambulance to come out.
i simply requested that, you know, I get somebody out here, a sheriff's deputy, a constable, somebody.
now, what I think I've learned in the meantime is that, you know, either a medical examiner or a physician or sometimes a nurse are the ones who are able to make that pronouncement.
there may be others, I don't know.
but we got this bill for starflight coming out and making a pronouncement of death, and it's for $2,700.
i don't feel it's an appropriate bill.
we had ground -- we had plenty of other people on site already.
and what's been discuss sheriff's department that mr.
lavity I've spoken to half a dozen times over the last week, and at first we talked about getting rid of the bill entirely.
we also talked about just reducing it down from a 2,700-dollar charge to an 885-dollar charge, which I believe is the charge for a ground ambulance coming out or something and making the trip.
certainly $885 would be a lot better than $2,700, but I guess I'm not sure that even anything is appropriate, but --
>> may I ask -- I'm sorry for the loss, but grateful that it was peaceful.
>> thank you.
>> having gone through the very similar circumstance with my father.
>> did you all have the dnr on hand?
>> we had -- my mom and dad had set up a living trust, and the dnr is the do not resuscitate.
and they did have it in their paperwork, which was a huge package.
i couldn't lay my hands on that packet.
i know that south Austin hospital where he had been on several occasions over the last number of years had a dnr on file, and when the firemen, emt's first came into the house, I told them south Austin hospital has a copy of the dnr on file.
at some point emergency personnel did get in contact with south Austin hospital and found that there was a dnr on file and at the same time the physician there at the hospital did make the pronouncement of death.
>> that's wonderful that y'all have those kinds of documents together.
that sort of -- the living will and the dnr.
that's so important.
>> yes.
it is important and I -- if anybody needs to take responsibility for that, I did.
i screwed '.
i should have had them sitting out somewhere and I didn't.
>> well, most people don't.
>> mom's birthday was the day before.
we had just celebrate the night before over at our house.
mom and dad had just been over there.
that death the next morning caught me totally unexpected.
i was not prepared for it, I don't know that many people are, but my dad was 79.
i knew that any time he could die.
he's had a wonderful life, but the circumstances that he's had to endure have been tough and I think he just got tired.
and maybe he made it through one last celebration and that was all he could do.
>> starflight?
>> this was a little bit of an unusual case for us in Travis County in that starflight was sent in what we call our auto launch.
that's where the ground ambulance has an estimated response time of greater than 20 minutes on a priority 1 or priority 2 call.
so the reason that starflight was assigned initially was simply how long it was going to take the ambulance to get there.
in reviewing of the 911 communications processes, medically, unless there are signs incompatible with life, we respond to people that have just died as if they're still resuscitatable.
so that's the way that they would process that call.
so they would send out the emergency personnel that would include local fire departments, the ambulance, and again starflight was only added because of the ground response time.
in fact, the helicopter beat the ground ambulance by 10 minutes to this call.
when the starflight arrived, cpr was in progress by the first responders.
again, if they walk in and the dnr is not readily available, by protocol they are supposed to start -- get the paperwork so that can be confirmed that the dnr is for that patient, and then we can make decisions about rhesustative efforts.
if we weight to look for paper we are in essence, you know, making a death decision for that patient because we all -- seconds count.
>> I'm sorry, go ahead.
when the first responder got in there, I told them dad had died.
and there were people there that said, yes, he has.
and they knew that dad had died.
and I understand to a certain point that there are rules that, you know, some people feel they need to follow, but there's -- there's got to be some common sense here too.
and if it only took a few seconds, less than a minute for someone once they tried to call south Austin hospital to determine that the dnr was on file, so when somebody walks in they know a person has died, for them to come in and start doing all the procedures and processes that they did, which bothers me a lot.
it's tough for me to talk about because I had to sit there and see people pounding on dad's chest after he had died, doing things to him that never should have happened.
>> I have -- I have heard there survivors of sudden cardiac arrest that their spouses were asked to leave the room because of the -- because of the pounding that the person takes.
this is a difficult -- a difficult call in the moment because I do -- I have heard on museum numerous occasions -- actually, there's an actual event of survivors of sudden cardiac event where there are descriptions by their spouses and loved ones of them having been pronounced dead and then beaten on, frankly, and brought back.
but I'm also respectful that under a dnr order, which I too have for myself, that I would not want my remains put through that.
this is a difficult -- this is a difficult call.
i hear both sides.
>> and I tried to make everyone aware, every step along the way, that there were dnr orders on file.
i had dad's dnr paperwork there somewhere.
i couldn't lay my hands on it.
i was trying to care for my mother, talk to the doctor, talk to the emergency personnel, deal with lots of other situations, and I didn't feel that I should go looking for some piece of paper that somebody else had already.
>> let's let you finish.
>> and under normal circumstances again, starflight would probably not have been sent to this call had the response time not been what it was.
and the 885-dollar bill that was discussed would be the bill that they would be getting for an ambulance bill if there was significant rhesustative efforts made, which in this case there was.
i think that lasted about 10 minutes.
if the ambulance had walked in or the starflight crew had walked in and the patient had had an active tnr, o.
-- dnr, then it probably wouldn't have been started and there wouldn't have been fees initiated, just a response only.
so we certainly would support our discussion of at least the ground ambulance fee.
and that would not be -- he would also not gee get a fee from the ambulance.
it would be one or the other.
you get a ground ambulance fee or you get the starflight fee.
normally the ambulance arrives first and in these cases we'd be charging the fee and not the helicopter.
>> 885?
>> 885.
>> well, I'm sitting here thinking all that pounding, I mean, we're getting in a whole lot more trouble not trying to bring somebody back than arriving and doing it.
and I guess we never know exactly the condition of the person until we go through certain steps, right?
>> yes, sir.
that's the way the dispatch protocols and the medical priority dispatch cards that we use and that communication uses to assess these are nationally based.
and again, we don't know when -- in many cases, not in this case specifically, but in lots of cases we don't know when that person actually lost their heartbeat.
there could be cases where it's very difficult to did detect.
it could be a weak pulse.
and so in those cases we generally -- crews are generally trained to start rhesustative efforts and then assess afterwards.
again if we delay those things you won't have cardiac arrest survivor events, you won't have that because it's so time sensitive.
the effort has been to start and evaluate after it's started.
>> any questions for mr.
anderson?
anything further, mr.
anderson?
>> I can't think of anything right now.
i just would ask that, you know, this is probably a legislative matter, but at some point in time we need to start respecting people's wishes a little bit more and start respecting life and end of life matters.
it's so very important.
there are people that do not wish to go through those extraordinary measures that some personnel decide needs to happen.
i understand to a certain extent what they're saying.
>> it's a real delicate call.
it seems to me that potential legal liability is a whole lot greater the less you do.
we have to factor that in.
>> and in response to that, there is actually state legislative on out of hospital dnr that defines our actions.
and so it's very clear on when a dnr is present.
there are multiple ways -- I absolutely agree with mr.
anderson that these are things that people need to take and evaluate how they want their end of life to go, and there are mechanisms to do that, whether it be a bracelet, whether it be a necklace, whether it be the paperwork.
and those things are in place to prevent this from happening where the emergency person they will that are responding are not put in that position of either I either do this or I don't.
and either way they could be under scrutiny.
if they resuscitate the person and it's not requested, it's under scrutiny.
if they don't resuscitate and it shouldn't been, their that under scrutiny that way.
they're in a difficult position.
>> but if you have that evidence you show it and the steps aren't taken?
>> yes, sir.
>> if the evidence is not available, the law says you go through these steps?
>> yes, sir.
if indicated based on the clinical presentation.
>> the evidence was available at south Austin hospital.
>> I know that would have taken a phone call, but they made that phone call at some point and determined that the paperwork was there anyway.
so why couldn't they have done that in the beginning?
>> in resuscitation efforts ended once they did receive information from south Austin.
>> the resuscitation ended once they were -- once dad was pronounced dead.
the physician -- my understanding is the physician at south Austin hospital that they talked to told them that there was a dnr order and he also pronounced dad dead.
by phone.
>> the information that I have is a little bit different than that in that the emergency room physician naid a decision based on the clinical presentation of the patient and what had been done and the fact that he was at the time not able to confirm there was a dnr, which is not unusual.
they don't just have those readily available, but he made a determination based on the fact that the crew did tell him there's a dnr, they did tell him what had been done and at that point he made a determination to stop resuscitating efforts.
>> thank you for coming down.
we appreciate your efforts today.
i hope it gets decided a whole lot sooner.
>> thank you.
with that I move that we recess until 1:30.
all in favor?
that passes by unanimous vote.
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Last Modified:
Tuesday, March 23, 2010 2:53 PM
