Small town troubled by ambulance crew carelessness

Photo: Arvet Mägi

Though not a taxi, decisions by ambulance crew to take or not to take individuals to hospital may be fatal. And have led to lots of local complaints towards emergency medicine in Tapa Parish. 

«We were planning this nice get-together for the relatives but it wasn’t to happen,» said daughter of a woman at Tapa to have turned 85 on February 26th but taken by complications due to burst gall bladder on January 14th in Rakvere Hospital. In May, the elderly couple would have celebrated 60 years of marriage.  

«We can’t get it. Three ambulances did come,» said the daughter, asking for anonymity and unable to understand how the crews failed to read the seriousness of the condition – especially the crew who came at the second call.  

For days before reaching the hospital, the elderly woman had complained strong stomach ache and called for the ambulance repeatedly. On the first time, early hours of January 11th, she was administered a painkiller injection and was advised to call back if pain persisted. She was not hospitalised as she got somewhat better after the injection.

The same day, she also attended her family doctor Katrin Kuusik at Tapa Family Doctors Centre. The doctor claims she had all tests done and the outcome was satisfactory.

Hospitalised in severe condition

«The next night ambulance was summonsed again, and she was in such pains so she simply asked to please take me with you. Then to be told by someone – a woman I’m told –, that we ain’t no taxi,» said the daughter, thus referring to the Karell Ambulance Tapa crew who paid a visit in the morning of January 12th.  The admonition seemed out of place as the elderly couple rarely called the ambulance – only as last resort.

And so the elderly woman was left home for second day running in severe stomach pain. On the third day, January 13th, the ambulance again called finally took her to Rakvere Hospital. The daughter said they only did so as demanded by a relative being present. «But the next day she died,» she said.

In the morning of the day of her death, attending physician called the daughter from Rakvere Hospital. «I didn’t really understand, she was perhaps already preparing me... She said she did not know if she was going to come out of it,» said the daughter who failed to understand what her mother was supposed to come out of. «She wasn’t even ... we were not prepared for anything like this at all,» she said.

On the very day she was taken to the hospital by ambulance, her mother had actually called her husband to say they were not doing anything with her there so she was considering to come home by taxi.

Alarm Centre data shows all three crews were from Karell Kiirabi local ambulance service. The crew that came the third day was the same who came on fist occasion. «In all three instances, the ambulance vehicles were sent from Tapa,» said Alarm Centre PR-head Jaana Padrik.

Rakvere Hospital chief doctor Sirje Kiisküla said the senior patient arrived in a very severe condition, diagnosed with septic shock and multiple organ failure. «The patient was examined pursuant to sepsis treatment guidelines and empirical antibacterial, rehydrating, vasoactive and pain treatment was immediately,» described Ms Kiisküla.

She said it was far from going home. «A patient in septic shock is definitely not for home treatment and she was not given such input by medical staff,» explained the chief doctor.

While Ms Kiisküla said  it is hard to tell if her life could have been spared if hospitalised a day of two earlier, but she did admit the options would definitely have been better. «Timely diagnosis of a sickness and swift treatment yield better results,» she noted.

Multiple problematic occasions

The relatives of the woman who died say they are not the only ones in these past couple of years running into problems with the local ambulance service. «There is this one definite crew who lashes out at once,» said the daughter who in conversations with locals has heard of other cases of like negligence with patients.

The same is confirmed by family doctors servicing Tapa parish, as well as parish council chairman Urmas Roosimägi. «Regrettably, with that very ambulance we do have problems,» said family doctor of the above deceased woman Katrin Kuusik who till end of last year also served as social committee chairman at parish council.

She said the committee collected a string of complaints last year which were forwarded to parish council chairman for the council to be able to call Karell Kiirabi on the carpet for often leaving people home in severe condition. «There have been pretty bad things happening here: people left home with high blood pressure, strokes and attacks missed,» described Ms Kuusik.

She said she has repeatedly had to explain to relatives that family doctors cannot intervene in these cases as the ambulance crews are under Karell Kiirabi encompassing the entire West-Viru County. «It is only during our reception, during these eight hours that we can call an ambulance for people in case of severe sickness,» said the doctor.

Another family doctor in the area Riina Niibo operating in Tapa and Lehtse confirms complaints among her patients. «There are several crews there. There are some wonderful people, employees of former Tapa emergency care, with whom we are highly satisfied; but there are some concerning whom patients say they have been barked at and treated bad,» said Ms Niibo.

While her patients include a case ending in death due to alleged negligence by ambulance, she would not comment as having been asked for confidentiality by relatives.

«I have a string of complaints regarding them,» confirmed Tapa Parish council chairman Urmas Roosimägi, referring to a couple of dozen applications collected from family doctors. He added the actual amount may be near 30–40 at least. «You can’t get into emergency care – you may cut your arm and stand there at the door and bleed to death –, if you have no telephone,» he said to describe the daily situation at Tapa emergency care station where ambulances are standing empty in the yard and the door is mostly locked.  

Saddened that no-one asks the local government opinion about ambulances picked to service a region, he promised to tackle the issue at parish council within two months and on the basis of that to address Health Board.

Surgery survivable

Regarding the woman of 84 who died, her family doctor says she would surely have survived surgery as her prior health condition was good enough. «Gall bladders are operated on at this age if these are full of stones and get acute,» noted Katrin Kuusik.

The main sign of gall bladder bursting is a stomach ache so strong one can’t lay hand on the belly. «It’s like electric, hot» she said, adding that then it is a matter of hours and surgery is the only option.

Since end of 2013, West-Viru County is serviced by Karell Kiirabi which won the competition organised by Health Board and assumed services of Tapa, Väike-Maarja and Kunda emergency medical care stations in the place of Rakvere Hospital emergency care. While the crews used to be composed by local people only, the change brought partial swap of staff.  

Health Board, responsible for ambulance service in Estonia, said they only have one complaint since 2014 regarding Tapa ambulance when an individual earlier employed by Tapa ambulance complained regarding the new arrangement of the service.