Medical helicopters nowhere near school shootings, records show

SEATTLE — Top leaders at

UW Medicine used the Marysville Pilchuck High School shootings to disparage the competence of counterparts at Providence Regional Medical Center Everett, and for five months they withheld records that disprove a key premise of their criticism, an investigation by The Daily Herald has found.

Internal emails show that only hours passed before UW Medicine officials began second-guessing why four gravely wounded victims of the Oct. 24 school shootings were taken to Providence instead of being flown by Airlift Northwest helicopters to Harborview Medical Center in Seattle, the region’s top trauma center. Harborview and the helicopter ambulance service are part of UW Medicine, the sprawling health-care system governed by the University of Washington.

Harborview and Airlift Northwest repeatedly have claimed that helicopters were hovering over Marysville Pilchuck when paramedics waved them off. But flight logs containing detailed tracking data show that two helicopters dispatched to help that morning were both 27 miles away — one above north Seattle and the other over Burlington in Skagit County. [Map for mobile readers]

At those distances, it likely would have taken at least another 30 minutes for the helicopters to reach the high school, land, load and then transport the teenagers to Harborview. Instead, the victims were raced to Providence by ground ambulance — trips that took 12 minutes or less.

Airlift Northwest previously provided the media with timelines that contradict data in its own flight logs. UW Medicine used those timelines in urging the state Department of Health to review the Marysville triage decisions.

On Thursday, UW Medicine officials acknowledged that the newly released flight logs are correct and that no helicopters were hovering over the high school when the decision was made to transport victims by ground.

They offered no explanation for the earlier misleading information, nor did they explain why nothing had been done to set the record straight. UW Medicine did not, for example, share the facts of helicopter locations at a private meeting with Providence and emergency responders, held in part to discuss Harborview’s complaints.

Late Thursday, UW Medicine released a statement that said, in part: “We continue to have ongoing discussions with our Snohomish county colleagues on best practices to ensure that the Snohomish community always has access to the most appropriate care in accordance with state trauma guidelines.” [Complete statement at end of story.]

While The Daily Herald awaited release of the records, UW Medicine claimed that patient privacy prevented them from releasing the flight data requested five months ago, even though no patients were transported.

University of Washington public records officials recently decided to release the flight logs and emails in compliance with state public records law.

The records made available so far reveal that Harborview’s chief health system officer, Johnese Spisso, and the hospital’s chief of trauma, Dr. Eileen Bulger, both were prominent in behind-the-scenes criticism of first responders in Snohomish County:

• By 6:10 p.m. Friday, Oct. 24, less than eight hours after the 10:38 a.m. gunfire, Spisso wrote Bulger that she was “appalled” by the on-scene decisions made in Marysville that morning. “We should file a formal complaint with the state,” Spisso wrote.
• In her reply, Bulger agreed, asserting that the helicopters were at the shooting scene, ready to ferry patients to Harborview, “and they were turned away.” She said a meeting was needed with Providence and emergency responders in Snohomish County.
• Bulger that day emailed Dr. Elizabeth Stuebing, her counterpart at Providence. “Difficult day and my thoughts are with your staff,” she wrote. “I think it is important as a trauma system that we plan a meeting to debrief regarding the triage decisions for today’s shooting.” She suggested it happen quickly while memories were fresh.
• That weekend, Bulger sought state involvement in the review. That earned praise from Spisso, who later wrote Bulger that she was exercising her “leadership role” as the medical director of a hospital with a higher rating for treating trauma than Providence.
• Dr. Mary King, who oversees pediatric critical care at Harborview, wrote Bulger on Oct. 26 that what happened in Marysville was an “epic system failure.” She added: “It is crazy that we build such a phenomenal system, have such great (neurological) outcomes, and yet, a small center can totally and unilaterally disregard the importance” of using those resources.
• Even Providence’s televised updates about the care being provided the Marysville shooting victims came under fire.

“I watched their press conference,” Spisso wrote Bulger the evening of Oct. 26. “They don’t know what they are doing. They tried to use it for personal PR. Those (patients) could have been air transported to us in 15 minutes.”

The flight data

The flight logs are important to resolving where Airlift Northwest helicopters were the morning of the high school shootings, and whether Marysville firefighters made the right call in opting to take patients by ground ambulance to Providence. Because the data contain time-stamped coordinates, it was possible to map the flight paths of each helicopter, nearly minute by minute.

The Seattle Times was the first to report on Harborview’s distress over the Marysville Pilchuck response and to publish the timeline that suggested helicopters were turned away. Seattle television stations followed.

Five students were shot in the head at close range by a friend who asked them to meet him at a cafeteria table. One girl died at the scene. So did the shooter, who turned the gun on himself.

Two girls and two boys were found alive but critically injured. The girls died at Providence in the days after the shooting. The boys were transferred to Harborview. One died, and one boy, who was shot in the jaw, survived.

At the scene that morning, Marysville firefighters opted to transport patients by ground after being advised that Airlift Northwest helicopters were still quite far away. In any case, paramedics said they followed protocol by taking patients to Providence, as directed by emergency medical experts in Everett.

It wasn’t long before 911 recordings and other records of that morning surfaced showing that Airlift Northwest told dispatchers its helicopters were 19 minutes away when the first shooting victims left in ambulances for the 10-minute drive to Providence.

A minute before Airlift Northwest was advised to stand down, it told dispatchers that its closest helicopter was still 14 minutes out.

When asked later to reconcile the conflicting information, Harborview officials still insisted Airlift Northwest was waved off. In a Nov. 25 statement they said a different helicopter – one that hadn’t been assigned to the incident – was actually over the school during the critical moments.

Data in the flight logs are clear, however, that all Airlift Northwest helicopters were dozens of miles away, in King and Skagit counties.

Ridicule in emails

After news stories appeared questioning the response, people involved in emergency medicine in Snohomish County wrote UW Medicine officials, urging them to set the record straight and to consider the fallout.

Emails show those concerns were dismissed, ignored or ridiculed by UW Medicine officials.

Dr. Ron Brown, a longtime emergency physician who works with Snohomish County EMS, wrote Harborview’s Bulger and Dr. Paul G. Ramsey, CEO of UW Medicine and dean of the university’s medical school.

Brown said the public critique was inappropriate, noting that some firefighters at the Marysville Pilchuck shootings also had children inside the high school that morning. People working at Providence, meanwhile, now had “public criticism from a respected institution added to their personal grief.”

“You have some serious, very serious damage control yourselves to perform in Snohomish County, and I speculate far beyond, as every firefighter or chief in the region will see himself or herself possibly in similar circumstances, being second-guessed in the press by the regional trauma center,” he wrote in the letter that went to Ramsey.

Ramsey forwarded Brown’s message to Spisso without comment.

“Please handle this,” he wrote.

Bulger responded to Brown, saying she hadn’t contacted reporters and that a private review was planned. By then, a Nov. 13 meeting had been arranged by the state health department to debrief on decisions made after the Marysville shootings. By law, those discussions were closed to the public.

“I tried to encourage them (The Seattle Times) not to run a story now as the focus should be on supporting the patients and their families,” she wrote Brown. She sent a similar message to Dr. Eric Cooper, who directs emergency medicine at Snohomish County EMS.

But UW Medicine’s internal emails applauded the Times’ helicopter coverage and expressed pleasure over a feature about Harborview published a month earlier in the newspaper’s Sunday magazine.

When other stories surfaced in which Marysville firefighters defended their decisions, Bulger traded email with Chris Martin, who oversees Airlift Northwest. Martin had given multiple interviews expressing surprise that victims weren’t immediately flown to Seattle.

“This really tells the story. They will use Prov Everett for everything,” Martin wrote Bulger.

“It is clear to me that the problem lies with the medical direction at Providence and this is what we need to address at the meeting,” Bulger replied.

‘All about marketing’

Preston Simmons, chief executive officer at Providence, wrote Harborview’s Spisso when the controversy first surfaced. He urged that any differences between the hospitals be discussed privately.

“Let’s as leaders in the healthcare community make sure we are taking the high road to get the families and communities through this tragic situation,” Simmons wrote.

He later suggested that both hospitals issue a joint statement, questioning the accuracy of the Times report.

Spisso and others at Harborview vetoed that idea. In an email to UW Medicine CEO Ramsey, Spisso suggested that Providence had encouraged people to complain about the criticism. She said her staff had simply provided facts in response to questions.

“Providence also needs to understand that all trauma centers, regardless of designation level, are held accountable to the public and when inquiries are made we need to proactively review and respond” through the state’s system for reviewing the quality of medical decisions, she wrote.

Emails show UW Medicine leaders were generally pleased with news coverage critical of Snohomish County’s emergency response to the high school shootings.

Some went so far as to question Providence’s motives.

“I think this was all about marketing their hospital and that is just wrong on so many levels,” Laura Hennessey, research nurse supervisor, wrote Bulger in an email. “How dare they say in a press conference ‘we sent the least critical to Harborview and feel they can handle that.’ Still makes me furious!”

Others at the Seattle hospital wrote of their concerns about how Harborview could be viewed.

Clark Collins, chief marketing and communications officer for UW Medicine, suggested they needed to “shut down” some who were talking with the media.

He singled out Martin at Airlift Northwest, and a particular comment that was published in the Times: “In a situation like this, we would absolutely believe that we would be transporting patients. We were surprised when three of our four helicopters came back empty. We all just thought it was so odd. Why didn’t they use us?”

Collins wrote in an Oct. 29 email that “Chris’ comments gave the appearance of greed on our part, which I know was not her intent.” In a separate message, he attached a reader comment posted to an online story, chastising Airlift Northwest and Harborview for “seemingly crying sour apples” because they didn’t get the opportunity to showcase their abilities at Marysville Pilchuck.

Tina Mankowski, director of community relations and media relations for UW Medicine, sent a response agreeing with Collins. “This all could have been handled better,” she wrote.

Scott North: 425-339-3431; north@heraldnet.com. Twitter: @snorthnews.

• UW Medicine emails
• Airlift NW flights
• Airlift NW timeline 1
• Airlift NW timeline 2
• Response re: timelines

UW medicine statement

A spokeswoman for UW Medicine released the following statement late Thursday in response to inquiries by The Daily Herald:

“UW Medicine continues to express our heartfelt sympathies for these patients, their families and the community.

“ Two Airlift Northwest helicopters were deployed to the scene of the Marysville shooting and were cancelled by SnoPac 911 before they reached the scene. A third helicopter was returning to its Arlington base and was not involved with this incident, however the aircraft was two minutes away over Everett and could see the event. This aircraft communicated its willingness to land at the scene or the hospital to help with transport, if needed. Later in the day, two patients were transported to Harborview Medical Center for their care, one by air and one by ground transport.

“Airlift Northwest, Providence Everett, the Snohomish County EMS and other early responders held a debriefing with the state Department of Health to identify areas for improved communication and collaboration during crisis situations of this magnitude. We continue to have ongoing discussions with our Snohomish county colleagues on best practices to ensure that the Snohomish community always has access to the most appropriate care in accordance with state trauma guidelines.”