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Lawsuit accuses Collier EMS of refusal to Medflight 394-pound patient

naplesnews.com
By Liz Freeman
Saturday, March 3, 2007

One calamity after another led to the death of Diana Lopez, a 37-year-old business owner in Naples who cared for her disabled parents and helped raise a niece and nephew, her family contends in a recent lawsuit.

She was the victim of a tire blowout one January afternoon last year on Interstate 75 and was thrown from her Ford Expedition after the vehicle flipped near mile marker 63, just inside the Collier County line. She wasn't wearing her seat belt.

The next disaster came when the Collier County Emergency Medical Services Medflight helicopter declined to fly her to the trauma unit at Lee Memorial Hospital in Fort Myers because she exceeded the 300-pound weight limit per patient, according to the wrongful death lawsuit filed by her family against Collier County government in Collier Circuit Court in February.

Instead, she was put in a ground ambulance for transport to Downtown Naples Hospital, which doesn't have a trauma unit.

The third disaster struck three miles later when her ambulance broke down. A second ambulance had to be sent out to get her.

By the time she got to the hospital, nearly two hours after EMS initially got to the accident scene, Lopez was in heart failure and unresponsive. Emergency room doctors tried to revive her but it was too late.

"I think she was in severe trauma by the time she reached the hospital," said Naples attorney Sharon Hanlon, who represents the Lopez family in the lawsuit. "She was outside that golden hour."

The "golden hour" is the standard held by emergency responders for getting accident victims and anybody else in a critical medical condition to a hospital for treatment, under the doctrine that chances of survival improve greatly if that is achieved within one hour.

The wrongful death lawsuit claims, among other things, that EMS was negligent in failing to assess the seriousness of Lopez's injuries by deciding to transport her by ambulance instead of Medflight because of her weight. She met criteria as a trauma patient, having been thrown from her vehicle, and should have been transported by the fastest way possible to the nearest trauma unit, the lawsuit says.

Moreover, EMS was negligent by not maintaining ambulances in good operating order and failed to remove from service an ambulance with mechanical problems, according to the lawsuit.

"The ambulance had significant maintenance issues in the past, electrical problems, transmission problems, engine problems," Hanlon said. "That is our review of the previous maintenance records."

Assistant County Attorney William Mountford, who is handling the county's defense, has not filed his answer to the lawsuit yet and said he is still investigating the case.

"My understanding is the county has some valid defenses," he said.

Lopez, who owned a trucking company to haul construction material, weighed 394 pounds at the time of her death. She had lost 94 pounds after gastric bypass surgery a few months earlier at a Miami hospital.

She was returning to Naples after an appointment with her nutritionist in Miami when the accident occurred. Her niece, Jane Trevino, was with her that day and so was Trevino's 1-month-old son, who was in a car seat in the rear passenger seat. Trevino, now 21, and her son were not seriously injured.

Because Collier government has sovereign immunity protection, the maximum damages that the family can receive by law is $200,000, unless a jury awards a higher amount and the state Legislature approves a larger award.

That scenario would only happen if Hanlon were to pursue a "claims bill" with the state Legislature, which would have to be filed by a legislative member. Hanlon said she doesn't intend to do that.

The EMS rule of not transporting patients who weigh more than an estimated 300 pounds is arbitrary and not required by any regulatory agency, Hanlon said.

"I was shocked when I learned of the 300-pound limit. It doesn't make sense," she said. "I can't find any state or national standard for that (rule)."

The EMS rule likewise says the maximum weight limit for each medic on board and the pilot is 200 pounds, yet Hanlon said the Medflight helicopter can handle a total of 1,300 pounds, which includes all equipment on board.

The rule has been in place for many years and is tied to how much fuel the Medflight is carrying at the time it is called to a scene, said Terry Henderson, chief pilot for EMS.

"With the amount of fuel and the patient's weight, we would have exceeded the weight limit for that aircraft," Henderson said.

Henderson said he doesn't know how much fuel the Medflight was carrying when it responded to Lopez's accident. The flight manifest with that information is no longer on file. By law, those documents must only be kept for 30 days, he said.

"I don't know whether they had information of a large patient before they got at the scene," he said.

Medflight pilots have had to make the same call before not to transport someone, usually when there are two injured patients and both are heavy, he said.

"Frequently it happens," he said. "We can't take both patients."

Trevino, Lopez's niece, vividly remembers the accident and what happened in the minutes afterward. She and her baby were fine except for cuts on her fingers. Her aunt was conscious and told Trevino she couldn't move, that her whole body was hurting.

"They (paramedics) told me they were taking me to the hospital," Trevino said.

She thought she and her son were going by ambulance and that her aunt would go by the Medflight. Instead, she and her son were put in the Medflight and taken to the hospital and her aunt was put in the ambulance.

"I thought (Diana) must not be that bad by taking her in the ambulance," Trevino said.

After getting to the hospital, she wondered where her aunt was, not knowing her aunt's ambulance had broken down. When her aunt finally arrived at the hospital, Trevino was being sent for X-rays. She remembers a nurse later handing her son to her and saying she was sorry.

EMS workers were wrong in their decision, she said.

"I thought they knew what they were doing," she said.

© 2007 Naples Daily News and NDN Productions. Published in Naples, Florida, USA by the E.W. Scripps Co.

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