ORDERS:
ORDER AND DECISION
This contested case matter arises from Petitioner's request for a hearing regarding the decision of
the South Carolina Department of Health and Environmental Control ("DHEC") to suspend
Petitioner's Emergency Medical Technician ("EMT") Certificate for six months for alleged
misconduct on August 28, 1994. A hearing was conducted on August 22, 1995, during which
the parties presented testimony and introduced exhibits, all of which have been carefully reviewed
and considered. Petitioner is found to have violated 24 S.C. Code Ann. Regs. 61-7, Section
X(B)(6) and (8) (Supp. 1994). DHEC is ordered to suspend Petitioner's EMT Certificate for
ninety (90) days.
STATEMENT OF THE CASE AND DISCUSSION
FINDINGS OF FACT
By a preponderance of the evidence, I find the following facts:
(1) Jo W. Owens ("Owens") is certified as an EMT Intermediate by DHEC's Division of
Emergency Medical Services. She has been certified as an EMT for approximately seventeen
years and a registered nurse for approximately fourteen years.
(2) Owens is an EMT Intermediate with Barnwell County.
(3) Denise Gibson is an EMT Basic with Barnwell County, certified since April, 1994.
(4) Jack Kirby is an EMT Basic with Barnwell County.
(5) Lloyd Ward is an EMT.
(6) On or about August 28, 1994, at approximately 6:30 p.m., two Barnwell County EMS units
responded to a structure fire in Williston, South Carolina, being fought by the Williston Fire
Department.
(7) Owens and Gibson were on the crew for one EMS unit and Jack Kirby was the EMT for the
other unit.
(8) Off-duty EMT Lloyd Ward subsequently arrived on the scene, but left the scene to get
lighting equipment to assist firefighters.
(9) Owens was the EMS sector commander for the scene.
(10) Both EMS units attended to firemen at the fire scene suffering from overheating.
(11) When the EMS units arrived, three firemen were suffering from overheating and in need of
attention.
(12) During the time Owens was on the scene, three additional firemen also needed attention.
(13) Overheated fireman Larry Fields was transported to Barnwell County Hospital by EMT Jack
Kirby's EMS unit, as ordered by Owens.
(14) Fireman Chris Pennington was attended by Owens and Gibson.
(15) Dr. Arnold Campo, M.D. transmitted by radio from Barnwell County Hospital instructions
to begin Pennington with an intravenous infusion ("IV") of lactated ringers with a bolus of 300 cc
and upon completion of the bolus, adjust the IV drip rate to 150 cc an hour.
Dr. Campo also instructed Owens to transport Pennington as soon as possible.
(16) Owens and Gibson were both present and attending patient Pennington in the EMS unit
when Dr. Campo's radio instructions were received.
(17) Per instructions, Owens began the IV of lactated ringers with a bolus of 300 cc.
(18) Owens instructed Gibson to accompany and transport Pennington to Barnwell County
Hospital.
(19) Owens did not give Gibson specific instructions regarding the maintenance and adjustment
of Pennington's IV.
(20) Owens remained at the fire scene as sector commander at the request of Williston Fire Chief
Calvin Melton.
(21) At the time of Pennington's transport, Owens was left as the sole EMT at the fire scene.
(22) At the time of Pennington's transport, the fire was still being fought and additional EMS
units had not arrived as requested.
(23) Additional EMT personnel arrived at the scene after Pennington was transported.
(24) During transport to Barnwell County Hospital, Pennington's IV bag emptied and was
disconnected by Gibson.
(25) Pennington's 1000 cc IV bag emptied in approximately thirty (30) minutes.
(26) The drip rate of Pennington's IV was never adjusted to the 150 cc drip rate ordered by Dr.
Campo.
(27) The infusion rate of Pennington's IV was greatly in excess of the rate ordered by Dr.
Campo.
(28) A possible result of over-rapid IV fluid infusion is circulatory overload or pulmonary
edema.
(29) Patient Pennington suffered no serious side effects from the IV treatment.
CONCLUSIONS OF LAW
Based upon the Findings of Fact, I conclude, as a matter of law:
(1) This Court has jurisdiction in this case pursuant to S.C. Code Ann. § 1-23-600(E) (1994
Supp.) and § 44-61-70 (Supp. 1994).
(2) The standard of proof in weighing the evidence and making a decision on the merits at a
contested case hearing is a preponderance of the evidence. National Health Corp. v. S.C.
Department of Health and Environmental Control, 298 S.C. 373, 380 S.E. 2d 841 (Ct. App.
1989).
(3) Licensure and regulation of emergency medical services are governed by S.C. Code Ann. §
44-61-10, et seq. (1976 & Supp. 1994) and 24 S.C. Code Ann. Regs. 61-7 (Supp. 1994).
(4) 24 S.C. Code Ann. Regs. 61-7, Section IX(A) (Supp. 1994) provides, in part:
During the transportation of patients, there shall be an emergency
medical technician intermediate EMT or advanced EMT in the patient
compartment at all times. The crew member with the highest level of
certification shall determine which crew member will attend the patient
during transport.
Because Denise Gibson was only an EMT Basic, the transportation of patient Pennington on
August 28, 1994, from the accident scene to Barnwell County Hospital was not in accordance
with the requirements of 24 S.C. Code Ann. Regs. 61-7, Section IX(A) (Supp. 1994).
(5) After initiating care of a patient at the scene of an accident, Owens transferred care of a
patient to an EMT Basic without adequately providing for the further administration of care, in
violation of 24 S.C. Code Ann. Regs. 61-7, Section X(B)(8) (Supp. 1994). Although Owens
properly commenced the IV and bolus with the drip rate ordered by Dr. Campo and assumed
EMT Basic Gibson overheard Dr. Campo's radio instructions, Owens did not repeat the doctor's
direct instructions to EMT Basic Gibson as to the drip rate for the bolus and IV. Owens did not
instruct EMT Basic Gibson to adjust the IV drip rate transferring Pennington to Gibson's care
during transport.
(6) Owens followed an appropriate order by a physician concerning emergency treatment and
transportation of a patient by initiating the bolus and IV as ordered by radio by Dr. Campo's
instructions and by ordering EMT Basic Gibson to transport the patient to Barnwell County
Hospital. Owens did not give complete or appropriate instructions to EMT Gibson prior to
patient transport to assure that Dr. Campo's entire instructions were followed; however, Owens'
neglect in that regard constitutes a violation of 24 S.C. Code Ann. Regs. 61-7, Section X(B)(6)
(Supp. 1994).
(7) EMT misconduct, as delineated in 24 S.C. Code Ann. Regs. 61-7, Section X
(Supp. 1994), constitutes grounds for revocation, suspension, or other restriction of an EMT
certificate. S.C. Code Ann. §§ 44-61-70 and 44-61-80 (Supp. 1994).
(8) Penalties for violation of DHEC statutes or regulations must be analyzed individually to
determine appropriateness under the circumstances. The assessment of the penalty is committed
to the sound discretion of the trial tribunal. Midland Utility, Inc. v. DHEC, ___ S.C. ___, 437
S.E.2d 120 (Ct. App. 1993).
(9) Although Owens committed violations of 24 S.C. Code Ann. Regs. 61-7, Section X(B),
mitigating circumstances exist which warrant a lesser penalty than the six-month suspension
proposed by DHEC.
(10) Pursuant to ALJD Rule 29(B), all issues raised in these proceedings not expressly addressed
in this Order are deemed denied.
ORDER
IT IS HEREBY ORDERED, that DHEC suspend the Emergency Medical Technician
Intermediate certificate of Jo W. Owens for ninety (90) days, with such suspension to commence
no sooner than thirty (30) days from the date of this Order.
___________________________________
STEPHEN P. BATES
ADMINISTRATIVE LAW JUDGE
September ____, 1995
Columbia, South Carolina |