By Rich Connell and Robert J. Lopez
Los Angeles Times
Copyright 2007 Los Angeles Times
All Rights Reserved

LOS ANGELES — Los Angeles fire officials have launched an effort to improve patient care among medics and boost compliance with state laws requiring that serious problems be reported to regulators.

In a memo last week to the department's 104 firehouses, Battalion Chief Daniel R. McCarthy alerted employees that the department has an obligation to report certain problems to regional and state authorities for investigation and possible discipline.

He cited a Times investigation earlier this month that found breakdowns in oversight of paramedics and lesser-trained emergency medical technicians in Los Angeles and statewide.

Fire departments and ambulance companies are largely responsible for identifying their own patient care failures and turning them over to regulators. But the newspaper found instances in which alleged problems were never passed on to independent regulators, even when patients died or were harmed.

McCarthy, commander of emergency medical services, wrote that the "negative focus" of the newspaper's disclosures has "created an atmosphere of suspicion" among the public.

"As we perform our duties, members should strive to elevate their level of professionalism and compassion for our patients and their families," he wrote.

McCarthy's memo included a letter from Dr. Marc Eckstein, the department's medical director. Eckstein said regulators must be notified when paramedics or EMTs are given days off or fired for alleged medical negligence, performance of medical procedures without proper authority, mistreatment of patients or criminal convictions.

The newspaper found that the Los Angeles Fire Department had not reported any of the 30 paramedics suspended since the state law tightening such reporting requirements went into effect two years ago. At least a third of those cases involved issues related to patient care.

Part of the problem was that Eckstein, who reports cases to regulators, was not informed of internal discipline against department medics.

That has changed, Eckstein said in an interview Tuesday. He said he now receives regular reports on all internal investigations and disciplinary actions. He reviews those related to emergency medical care to determine whether regulators should be notified.

The Times found 13 cases in which Eckstein had been unaware of alleged wrongful deaths, including three that led to settlements of tens of thousands of dollars.

The paper cited a Hollywood grandmother's death from pneumonia after paramedics diagnosed her as having the flu and concluded that she did not need to be taken to a hospital. The state Emergency Medical Services Authority has since begun an inquiry into the case.

Eckstein said the department is moving to ensure that he reviews all legal claims and lawsuits regarding alleged lapses in medical care.

"As is often the case, media attention at the time may be uncomfortable but often results in positive changes," he said. "Our internal investigation processes have been tightened up."