Autopsy report: Private ambulance company paramedic responsible for Pflugerville man's death
A paramedic from a private ambulance company caused the death of a patient in Pflugerville in January, according to an autopsy report.
According to the report, obtained by the American-Statesman, a 42-year-old man died due to the improper medical treatment he received from a medic with Allegiance Mobile Health, which operates in the city. The official case of death is listed as "improper emergency medical therapy, resulting in death." The man was treated after falling at home and hitting his head, it said.
In the report, pathologist Satish Chundru said the man received a cricothyroidotomy, an incision through the skin to open an airway, that he did not need.
"A series of missteps and improper protocols were performed by the primary medic in charge that eventually led to the unsuccessful attempt at a cricothyroidotomy while in the ambulance," the report reads. "There are strict step by step protocols in place for medics to follow to manage airways if the airway is compromised. In (this) case there does not appear to be a reason to even manage his airways as there was no such indication for such."
Neither a previous heart condition nor medication given at the scene could have resulted in the man's death, the pathologist's report says.
It says that after the man received two doses of the nerve-blocking agent midazolam intranasally, he could have only survived if an airway was established. When one was not established, it compromised his heart and led to his death, it says.
Allegiance did not return requests for comment. During a Pflugerville City Council workshop meeting this month, Amanda Baum, Allegiance's regional vice president, said she could not comment on the fatal incident in January.
After hearing concerns about the medical care provided to Pflugerville residents by Allegiance, the City Council on Sept. 12 approved an agreement with the city of Austin to supervise the private ambulance company.
“Quality of life is our top priority, and this includes the safety and well-being of our residents," Cassie Balderas, a city spokesperson, said in a statement Thursday. "To ensure that Allegiance continues to provide the highest level of care and safety for our residents, the city has entered into an interlocal agreement with the City of Austin for the oversight of emergency medical services through Allegiance."
More: Austin to provide oversight of EMS in Pflugerville amid concerns about quality of care
Officials from Travis County Emergency Services District No. 2, also known as the Pflugerville Fire Department, have previously expressed concerns to the Pflugerville City Council about the quality of care provided by Allegiance medics, saying the death of one patient in January was because of negligence.
ESD No. 2 Chief Nick Perkins told the Statesman that Allegiance representatives told his department that the employee involved in the man's death would be fired. Perkins said he knows that the Texas Department of State Health Services suspended the medic's medical license.
ESD No. 2 used to provide ambulance service in Pflugerville and has expressed an interest in doing so again.
Perkins said Fire Department paramedics often have had to intervene to provide the high-level care that Allegiance medics have not. ESD No. 2 paramedics sometimes respond to the same calls as Allegiance.
“It’s not uncommon that we do intervene, either preventing unnecessary actions or we help with procedures where an individual provider is not able to do that,” Perkins said during a council meeting Sept. 12. "It breaks my heart. I am concerned about the residents in this city and the care that is being delivered.”
During a workshop meeting this month, Council Member Ceasar Ruiz said he has heard from residents about ESD No. 2 paramedics taking over at incidents because Allegiance medics did not know how to respond, and that an ESD No. 2 medic received a shock while helping with a defibrillator because of negligence by an Allegiance worker. Ruiz said he is worried that Allegiance responders do not have the proper equipment and training.
Under the agreement approved by the Pflugerville City Council, an Austin emergency medical services commander will oversee Allegiance's operations in the city and report to its city manager. The agreement will begin Oct. 1 and end Sept. 20, 2024. Pflugerville officials have the option to extend the agreement four additional times for one-year terms, according to city documents.
The agreement with the city of Austin comes a year after Pflugerville approved a contract with Allegiance to provide the city with ambulance and emergency medical services.
Pflugerville has been grappling with its ambulance services for years. ESD No. 2 used to provide EMS services to the city until it said it could no longer afford to because of increased call volume. In November 2021, voters in the area outside the city limits approved creating ESD No. 17 to handle ambulance calls in the ESD No. 2 service area. City officials said the district's stipend of about $2.8 million for EMS calls was unsubstantiated and did not put the creation of ESD No. 17 on the ballot. Instead, the city hired Acadian Ambulance Services on Jan. 1, 2022, to provide service in Pflugerville.
The city ended its contract with Acadian after only two months, citing dissatisfaction with its quality of service, including inadequate response times. In May 2022, the City Council voted to begin contract negotiations with ESD No. 2 to again provide EMS services, but later that month it also opened negotiations with Allegiance after a few council members said the ESD price tag would be much more than they had been led to believe.
Allegiance began providing services to the city on July 1, 2022. Under the contract, Allegiance must provide a minimum of four mobile intensive care unit ambulances at no cost to the city.
More: Allegiance to provide EMS services in Pflugerville
This article originally appeared on Austin American-Statesman: Autopsy report: Paramedic responsible for Pflugerville man's death
