Insufficent EMT staffing at state sex offender facility breaks rules, audit finds

Emergency medical technician staffing at the sex offender center on McNeil Island often has not been at proper levels for at least two years, a new state auditor’s report shows.

Auditors found the state Department of Social and Heath Services is not requesting money in the next budget cycle to fund four firefighter positions required to meet state rules.

The state auditor’s office launched its investigation after a whistleblower complaint alleged former Special Commitment Center CEO Mark Strong failed to make sure emergency medical staffing — two EMTs on duty at the facility at all times — followed state rules.

“We found emergency medical staffing was not consistent with state rules,” the auditor’s report states. “However, we could not attribute this failure solely” to Strong, it added.

The SCC’s current CEO, Bill Van Hook, said there are no documented cases of medical emergencies made worse by short staffing.

“It is a state requirement and we have not complied,” said Van Hook, who took over the SCC after Strong left in April. “We want to comply. We have not harmed anyone, and there has been no adverse impact from that.”

At least one SCC resident has sued the state in U.S. District Court in Tacoma over the EMT staffing levels. Richard Scott, who represents himself, filed the lawsuit, which a federal judge allowed to continue in 2016.

The SCC houses 235 sex offenders who are civilly committed after completing their prison terms and who have been defined as “sexually violent predators” more likely than not to reoffend.

At any time, from 40 to 80 state employees are on the island, which is west of University Place in Puget Sound and accessible only by boat and helicopter.

The SCC’s fire department is licensed by the state Department of Health as a trauma-verified ambulance service.

“According to state rules governing its license, the fire department is required to have at least two certified individuals at all times to provide care and transport in medical emergencies,” the audit report reads.

Instead, the investigation found, there are “many instances” when only one firefighter or EMT is on duty at the fire department.

Data included in the report show that only one EMT responded in 33 of 88 incidents the fire department dealt with between Jan. 1 2015, and May 12, 2016. The number of EMTs who responded is unknown in another 23 events, according to the audit.

Because of the short staffing, the report states, “Witnesses said EMTs have been forced during medical emergencies to request assistance from (SCC) staff who are not trained in first aid or the operation of emergency vehicles.”

Strong submitted an ambulance license renewal to the state health department in November 2014 and signed a document certifying the fire department had sufficient staffing to qualify for licensing.

However, the application itself disclosed there was insufficient staffing to always meet the requirement.

In cases when only one EMT was on duty, the application stated, the EMT drove the ambulance and left the patient in the back with staff members without medical training.

The health department approved the license renewal despite the shortcomings, spokesman David Johnson wrote in an email.

“It’s important to remember that McNeil Island is in a unique geographic location,” Johnson wrote.

Because long transportation times would be exacerbated if first responders had to come from the mainland, the health department approved the license renewal, Johnson wrote.

“In this case, the care that can be provided by the limited number of EMS personnel available on the island was a greater benefit than no care,” Johnson wrote.

After the application was renewed, Johnson noted, the SCC fire department joined a mutual aid agreement with Anderson Island emergency medical services.

Strong was made aware of the short staffing in March 2014, the audit report found, but he opted not to hire more full-time firefighters and instead had security staff members cross-trained as EMTs.

That approach was only partly successful, the audit found: Many people failed the EMT training, didn’t get national certification or declined requests for assistance during medical emergencies.

The auditor’s report also said that when a cross-trained security staff member takes a patient to the mainland for medical care, the staff member must remain with the patient. The EMT then returns to McNeil Island, leaving the SCC below the two-EMT minimum level.

Strong told investigators that “Nothing, by law, requires firefighters on the island,” the report states.

When a firefighter emailed Strong in January 2016 to say 21 extra shifts were needed for proper staffing, according to the report, Strong replied nine minutes later that there was no money to support the plan.

“The reality is there is hardly ever a fire,” Strong told investigators, adding it’s impractical to pay people with no job to do.

DSHS management knew there were not always enough EMTs on the island to follow state rules, audit investigators found.

Strong told investigators that each year he requested additional funding for proper firefighter staffing, but investigators found no requests made for that.

Van Hook submitted an internal request for more fire department staff, but no such request was included in the DSHS budget proposal to Gov. Jay Inslee, the report found,

A DSHS employee told the auditor’s office in November that the department submitted an additional request to the governor for four full-time firefighters.

But DSHS spokesman Chris Wright said in a recent email to The News Tribune that the department did not submit the additional budget request for four full-time firefighters to Inslee.

“We recognize the state has multiple budgetary challenges and we were being sensitive to these many other priorities,” Wright wrote.

Van Hook said in an interview after the auditor’s report was released that budgetary concerns pushed him to continue to use cross-training of security staff members as EMTs, instead of hiring the four staff needed to reach “ideal” levels.

“I’m staff and I’m not the youngest guy in the world, and I feel I would get good care,” said the once-retired state lawyer, who is in his late-60s.

This story was originally published January 17, 2017 at 3:21 PM with the headline "Insufficent EMT staffing at state sex offender facility breaks rules, audit finds."