Cover Story Feb. 9-15, 2001
CALL FOR HELP
A young woman collapsed on the street just 200 yards from a District fire station. It wasn’t close enough.
by Jonathan Agronsky
It was clear even before she fell that the tall, slender young woman was in trouble. She had been jogging on the east sidewalk of 16th Street just below U, heading south toward the White House, when, say eyewitnesses, she suddenly slowed down and began walking unsteadily. After reaching Caroline Street, she stumbled, then dropped like a stone, not even attempting to break her fall with her hands.
I realized this morning as I was taking the bus down to work that I really do love my life down here this summer. I have been lucky, really lucky, in so many ways. The apartment here is great and I like both living on my own and living out of the whole dorm atmosphere....I also love going to the gym. It's really been just too hot to run outside here, especially since I don't feel comfortable with the shape I'm in and if I went for a run outdoors I'd honestly be worried about fainting or something. The gym is literally 2 minutes from my apartment and it makes me feel like I am part of my own neighborhood in the city. I run on the treadmill every day and I am quickly remembering everything that makes exercising the wonderfully life-giving phenomenon that it is. I might take a step class one of these days, but I worry because most of the other people in this gym strike me as seriously hard core.
from a July 9, 1999 letter from Julia Rusinek to her friend Dina Frid
A moment later, just before 6 p.m., I looked out my fourth-floor apartment window and saw her lying motionless in the crosswalk. Her right cheek was pressed to the sun-baked pavement, her thick brown ponytail pointed at 16th Street. Her smoothly muscled legs were skewed awkwardly beneath her, her arms splayed limply by her side, hands palms up. A woman was kneeling over her and talking on a cell phone, no doubt calling 911. A bicycle was lying on its side in the street nearby. I thought for a moment that the woman using the phone had knocked the other woman off her bicycle, perhaps with her car. I raced downstairs.
After quickly checking on the supine woman's condition (pale, perfectly still, out cold), I jumped into my car, parked in front of my building. I knew from two previous experiences that calling 911 in the District of Columbia does not necessarily bring a rapid response, and I thought I could save precious seconds by driving instead of running to Engine Company 9, just around the corner on U Street.
"Another company got the call," explained a firefighter in response to my breathless report, delivered in person less than a minute later.
"But she's right down the street," I insisted, mystified that the emergency dispatcher would not give the call to the nearest fire company and amazed that nobody at this station seemed particularly concerned about the stricken woman's plight. "She's not moving. She looks bad."
"We'd go, but we've got to follow procedure," the same man replied.
"I know it sounds crazy," admitted another firefighter, about his duty officer's apparent refusal to dispatch the engine company's ambulance, which was sitting nearby in the engine bay. Then he added, perhaps trying to explain why he himself didn't just run over to the scene and administer first aid: "I'm sorry. I'd like to help, but I'm off-duty."
I found it incredible that my neighborhood firefighters seemed perfectly willing to defer their most crucial responsibility: saving a person's life. Struggling to contain my rising anger, I continued to implore crew members to forget procedure and help the fallen woman. Still, a few more critical minutes passed with no apparent response, until a man with a white Van Dyke beard ran into the station. "Her lips are blue," he announced, looking shaken. It didn't take a doctor to figure out what this must mean: The unconscious woman was starved for oxygen.
Finally, the officer in charge (Lt. John Desautels, I later learned) ordered one of his trucks to respond. Moments later, Truck 9, a 58-foot-long hook-and-ladder with steering wheels at both ends and a red metal nozzle mounted at the rear like a tail gun, sounded its siren and roared out of the station, carrying Desautels and three other firefighters. In Washington, D.C., as in a number of other U.S. cities with more medical calls than the ambulance fleet can handle by itself, firefighters on trucks are often the "first responders" to medical emergencies.
Meanwhile, Ambulance 1, a "basic life-support" unit assigned to Engine Company 9, still sat in the firehouse bay. Did it have a dead battery? Was it out of gas? Was any of its emergency equipment missing or broken? I was baffled by the apparent command decision to leave the medical vehicle behind and respond instead with equipment that would have been more suitable for battling a four-alarm fire.
Back at the scene, a small crowd had gathered; some merely gaping at the attractive young woman wearing blue nylon shorts, a white sports bra, and running shoes, who lay sprawled on the pavement. Others, it appeared, had stopped to help. One man pulled a pair of white latex gloves from his pocket, put them on, and checked the woman's carotid pulse. He apparently found one, then advised the 911 caller to tell the dispatcher that the woman's skin felt cold to the touch. Another passer-by, who identified herself as an off-duty emergency medical technician (EMT), also took the unconscious woman's pulse and checked her breathing. But then she, like the man who had preceded her, disappeared from the scene.
The hapless jogger would have to wait for the hook and ladder; which, according to Desautels, arrived at 16th and Caroline Streets at 6:05 p.m. Once on the scene, the Truck 9 commander instructed firefighter/EMT Robert Cooper to assess the patient's condition. Alarmed by what he was told, Desautels called the fire department's communications center on his two-way radio: "This woman's barely breathing," he told the dispatcher. "We need to get [Ambulance 1] over here!"
Unbeknownst to me, Desautels had ordered Engine Company 9's ambulance to follow the fire truck to the scene. Standing next to the unconscious woman, he watched along with his crew and a crowd of equally perplexed onlookers as the rescue vehicle appeared belatedly at the corner of U Street. Instead of turning right onto 16th Street, however, it turned left and headed north. "This is Truck 9," Desautels barked into the radio. "Where did Ambulance 1 go to?"
Realizing that the unconscious woman needed skilled medical attention right away, Desautels asked the dispatcher to send a medic unit to back up Ambulance 1. In the District, medic units are "advanced life-support" ambulances crewed by paramedics. Paramedics have more training than EMTs; they can administer drugs, "intubate" patients (insert a breathing tube down the throat), and perform other invasive medical procedures. Paramedics in D.C.; eight of whom now ride fire trucks in special "paramedic engine companies"; also carry a variety of drugs and more sophisticated rescue equipment, such as heart monitors.
According to fire department records, Medic 24 was dispatched from Engine Company 1, located at 23rd & M Streets NW, at 6:07 p.m., carrying a crew of three: driver Mark Baker and paramedics Janet Boswell and Timothy Baker. As it turned out, however, Ambulance 1, whose driver had realized his error and turned around, was the first to "mark on the scene," in fire department lingo. It pulled up, Desautels would later report, at 6:11 p.m. By this time, Desautels said, the unconscious woman had stopped breathing and Cooper had begun to administer cardiopulmonary resuscitation. Cooper might have been able to keep her heart and brain alive for a few minutes by using this technique, pumping some oxygenated blood to these vital organs, but a more aggressive intervention would be needed to restore a normal heart rhythm and thus save her life.
As soon as they arrived, the two EMTs from Ambulance 1, driver Raymond Duarte Jr. and crew member Mayra Palacios, took charge of the rescue effort. Duarte argued with Cooper over which stretcher they should use to lift the woman into the back of the ambulance: the "long board" from the truck or the wheeled stretcher from the ambulance. Duarte won; they used the wheeled stretcher; but the 15-year veteran EMT was so miffed by Cooper's attempt to tell him what to do that he later complained in writing to his supervisor.
After reassessing the patient; Palacios and Duarte found her "unresponsive, pulseless, apneic [not breathing]"; the EMTs took an electrocardiogram reading of the unconscious woman's heart rhythms by placing the EKG strip of their portable automated external defibrillator onto her chest. The device instructed them to administer a shock to the patient; ideally, to restore her heart to its normal rhythm; and automatically set the voltage level. They shocked her once, but she did not respond. Then they administered a second shock. Again, no response. At this point, Palacios said, the woman's pupils were nonreactive and dilated. (Despite palpable evidence to the contrary, Palacios also described the patient's skin color and temperature as "normal," in a report she later filed with the dispatcher. But the woman's lips were as blue as a berry Popsicle, her skin a ghastly white, and, as had already been described by the man who took her pulse, cold to the touch.)
Informed that Medic 24 was en route, Palacios asked Desautels for an estimated time of arrival. Desautels checked. Told that Medic 24 was still three minutes away, Palacios decided not to wait. She asked Desautels to notify fire department communications that they were "en route to Howard Hospital with CPR in progress." The university hospital was a mile away; barring any complications, they should have been able to reach it in two minutes or less. However, at 6:29 p.m., Ambulance 1 was still sitting at the corner of 16th and Caroline Streets, when Medic 24 finally marked on the scene; 22 minutes after being dispatched from an engine company a mile and a half away. Rather than rush their patient to the hospital as planned, Duarte and Palacios instead surrendered her care to Medic 24's crew.
For the next 10 agonizing minutes, the woman who had made the 911 call, other neighborhood residents, and witnesses, including me, stood by, growing increasingly anxious and bewildered, as the third team of rescuers to arrive at the scene in a half-hour span worked on the young woman in the back of Ambulance 1.
"Why aren't they leaving?" the good Samaritan with the cell phone; whose name, I later learned, was Simonetta Nardin; demanded after a few more minutes had passed.
"I'm afraid she's gone," I replied, basing my conclusion on the disturbing events I had witnessed. "They're using the [cardiac] paddles to try to bring her back."
"Oh, my God," muttered Nardin.
At about 6:40 p.m.; three-quarters of an hour after the young woman had collapsed and at least 22 minutes, by my reckoning, after she had stopped breathing; Ambulance 1 finally left for the hospital with a new driver, a Truck 9 crew member, replacing Duarte at the wheel. The rescue vehicle turned right onto U Street and disappeared from sight, its siren whooping eerily in the midsummer evening.
I felt helpless and angry. If it turned out; as now seemed probable; that the young woman who'd just been carted away died, somebody ought to speak up for her, I thought.
At 8:25 p.m. on the same evening, I entered the busy emergency room at Howard University Hospital. I took a quick look around. There were patients in several treatment bays and lots of activity, but I didn't see the jogger. Very soon, a harried-looking young man in hospital scrubs appeared before me. "Is there anything I can do for you?" inquired the man, who wore a stethoscope around his neck.
I asked the man, whom I took to be a physician, if a young white woman had been brought in recently; unconscious, possibly suffering from cardiac arrest.
"Are you related to her?" he demanded.
"No," I replied. "I saw her collapse on the street, and I know they brought her here. I just wanted to find out if she made it."
"I really don't know, sir," he replied, unconvincingly. Then he added, "Even if I did, I couldn't tell you; it's against the law."
I thanked him and left. As I drove home in the gathering darkness, I thought again about how the jogger had been forced by circumstance to depend for her very survival on the fire department rescuers. Unless a miracle had transpired in that emergency room, the mystery woman's next stop would be the D.C. morgue.
The following evening, I stopped by Engine Company 9, at 1617 U St. NW, to see what I could learn from the firefighters. By chance, the first person I encountered I recognized as the EMT who had taken the wrong turn in the ambulance a little over 24 hours earlier. Duarte was clean-shaven, with dark hair and a swarthy complexion. He appeared to be in his early 40s. He literally jumped out of his chair when I asked him if he knew what had happened to the unconscious jogger he'd taken to the hospital.
"I don't know," he said, looking uncomfortable. When I pressed further, Duarte explained that the hospital doesn't normally tell ambulance drivers what happens to their patients. He and his fellow crew members just deliver them, he said, then return to the station to prepare for the next run. After informing me that, if I had any further questions, I'd have to talk to his lieutenant, Duarte walked quickly away, then ducked into a room adjoining the engine bay, closing the door behind him. A few moments later, a polite, pleasant man, whom I took to be the officer in charge, emerged from the same room, which housed the engine company's "watch desk." After hearing the purpose of my visit, he informed me that I was at the wrong firehouse.
"You'll need to check with Engine 1," he said. "They carried her to the hospital."
I wasn't sure he was correct, but I didn't want to argue with him. I just wanted to find out what had happened to the jogger. The duty officer gave me Engine 1's address and phone number and wished me good luck.
It was after 10 p.m. when I rang the front doorbell of the two-story red-brick building housing Engine Company 1, at 2225 M St. NW. As I waited for someone to answer, I noticed a diamond-shaped black-and-yellow sign next to the door. It showed a stylized house and a human figure protectively embracing a smaller human figure (presumably a child), under which it said: "Safe Place."
After ringing the bell several times over a five-minute period and getting no answer, I walked around to the side of the firehouse and, through tightly angled window blinds, saw the unmistakable, flickering shadows of a color television set. The firefighters were in there, all right. Frustrated, I gave up for the night.
The following afternoon, when I returned to Engine Company 1, the engine bay door happened to be raised, so I strolled right in. I walked to the open door of the TV room, where several firefighters sat watching the tube. A young firefighter got up and came toward me. Upon hearing my story, he accommodatingly led me to a large green ledger, the same type found in police stations. The firefighter helped me find an entry from July 15, 1999. "Julie Weisner, 21" was neatly inscribed in cursive on one of the lines. The ledger didn't tell me what had happened to her, but at least I thought I finally knew her name. (I would later learn, to my consternation, that this was not the young woman's name; a mistake that would prolong my investigation for several more months.)
As I turned to leave, a short, blond, mustachioed man stopped me. After identifying himself as the officer in charge, he asked me my business at the firehouse. Apparently satisfied by my response, he explained that his company had become involved in the rescue effort only after a dispatcher decided to assign an advanced life-support ambulance, Medic 24, to the run. He said that dispatchers make such decisions on the basis of the patient's condition, as described by the 911 caller. At the time, I did not know that Medic 24 had gotten the call; which actually had resulted not from a dispatcher's decision but from a specific request by Desautels; a full 22 minutes before arriving. His explanation sounded reasonable, so I accepted it. Still, a lot of other questions remained. Most important: Had "Julie Weisner" been saved, or had she perished?
Luck played a role in my finally discovering the truth four days later. As I was again driving past Engine Company 1, I saw Medic 24 backing into the firehouse bay. I stopped my car and approached a female crew member who had just stepped out onto the concrete driveway.
I identified myself as a concerned citizen and asked after the jogger. "There was no breathing, no heart activity when we got there," the EMT told me. The woman, in her early to mid-40s, with short-cropped, orange-tinted hair, identified herself as one of the paramedics who had "run the call," as she put it. I later learned that her name was Janet Boswell. She seemed sympathetic, concerned, genuinely saddened that such a young, apparently healthy woman had died. "We worked on her [in the ambulance]. We shocked her; she was trying'." In fact, said the rescue worker, "We got her [briefly] in v-fib." V-fib is medical shorthand for ventricular fibrillation. Though preferable to no heartbeat at all, the wildly erratic heart rhythm is insufficient to pump blood effectively.
At Howard's emergency room, Boswell said, "they worked on her for a long time. She was tryin', but they just couldn't bring her back."
Five months after I began reporting on the jogger's death for the Washington City Paper, after being stonewalled repeatedly by the fire and police departments and the medical examiner's office; all of which persisted in invoking patient confidentiality; I finally learned the dead woman's name from a civilian witness. She was Julia Rusinek, not Julie Weisner. She was 21 years old.
Julia Rusinek, '00, who during her short life touched many with her deep concern and sensitivity for others, died in the early evening of Thursday, July 15 in Washington, D.C., where she was interning for the summer. Rusinek was returning home from the gym when she wandered into the street and collapsed. She was 21 years old and would have entered her senior year at Yale's Jonathan Edwards College this fall.
Her funeral, held on Sunday, July 18 in her hometown of Great Neck, N.Y., drew friends from across the country and from as far away as England.
Rusinek was a sociology major at Yale and a vivacious athlete whose love of running could only be topped by the satisfaction and joy she derived from devoting herself to others, particularly to children.
from the Sept. 1, 1999 issue of the Yale Daily News
Unlike D.C. Fire Department rescuers, who took so long to respond to the 911 call, detectives from the Metropolitan Police Department responded with alacrity to Rusinek's troubles. At about 8 p.m. on July 15, 1999; barely 30 minutes after Rusinek had been pronounced dead by an emergency room doctor, a 3rd District detective phoned witness Philippe Chabot, who had given his name and number to a patrol officer on the scene. The detective asked Chabot if he would come down to the station, at 1624 V St. NW, to provide a statement. Sitting down at a police computer less than half an hour later, the 31-year-old agricultural economist typed out a 300-word statement, a copy of which he retained for his own records. He subsequently provided it to me.
In his statement, Chabot said that he was riding his bicycle north on 16th Street, on his way home from his job as a researcher at the International Food Policy Research Institute at 20th and K Streets NW, when, "out of my peripheral vision," he saw Rusinek topple forward onto the pavement. While serving in the Peace Corps in Sierra Leone, Chabot had seen his share of death after civil war broke out in the West African country in 1994 (he was evacuated, along with his fellow volunteers); he told police that on that hot July evening in D.C., he "became very alarmed" when the young woman's "head hit the ground and made a loud sound."
Thinking he might be able to help, Chabot "rode up to her [but] there was [already] another woman there with a cell phone who called 911." At that point, said Chabot, Rusinek "was lying on her stomach in a rather contorted position. Her eyes were slightly open, her mouth was open. She was breathing though it appeared to be labored and she was letting out these slight, labored moans." He added: "Throughout the time I was there she never spoke a word or seemed to become conscious in any way."
About five minutes after Rusinek collapsed, noted Chabot, "a passerby who happened to be an EMT arrived...and monitored the woman's pulse and breathing. After that the police arrived and the firemen and...after that an ambulance [that] was taking too long."
Although detectives never interviewed them, at least four other witnesses, including me, were disturbed enough by what they saw to take action. Nardin, who had summoned help for Rusinek, wrote a letter to Battalion Chief Stephen M. Reid, who at the time was the D.C. Fire Department's senior public information officer. She offered to "collaborate with any investigation of this terrible" incident, most notably "the long wait for a rescue team."
According to Nardin, neither Reid nor any other fire department official ever responded to her Sept. 8, 1999, letter.
InTowner reporter Greg DuRoss, who had come upon the scene as the paramedics were loading Rusinek into the ambulance, subsequently wrote two stories about the incident for the local monthly newspaper. In the August 1999 issue, he wrote, "Information obtained from multiple sources raises questions about the response time of the Emergency Medical Service (EMS) unit in this and other instances, especially during shift changes."
DuRoss' stories brought forth another witness, who later wrote a letter to the InTowner describing what she had seen. Neighborhood resident Hilary Gates said she, along with her partner, Henry Posner; the man with the white Van Dyke beard; had seen Rusinek collapse about 5:55 p.m. After waiting for several minutes, "keeping our ears peeled for sirens from the U Street [fire] station," Gates wrote, "Henry left the scene to go alert the firefighters, thinking that perhaps they had somehow not received the call.
"Needless to say," she continued, "this whole incident furthered my lack of confidence in the District of Columbia's [EMS] operations."
Perhaps most difficult of all for her and Posner, Gates wrote, "We were helpless bystanders...appalled at the abysmal response time of the U Street station." She told the newspaper, "Henry and I continue to discuss this incident, shocked at the death of a seemingly healthy young woman." She closes her letter: "I am not sure what would have happened had a crew arrived at the scene earlier."
Just over a week after burying their daughter, Dr. Henry Rusinek, an associate professor of radiology at New York University Medical School, and his wife, Roza Rusinek, who teaches mathematics at Queensborough Community College, came to Washington. They wanted to learn how; and, more important, why; their seemingly healthy youngest child had met an early death. Besides breaking their hearts, the whole thing didn't make sense to them. They had immigrated to the United States from Poland when their native country was still under Soviet rule. They relished their new life of freedom, while nestling into the reassuring familiarity of the thriving Polish Jewish community of Great Neck, Long Island. They doted on their American-born daughters, Vivian, born in 1973, and Julia, who came along five years later, on Feb. 17, 1978. They worked hard to provide every opportunity for their children, both of whom attended Yale. When she died, Julia was about to enter her senior year. Vivian had graduated in 1995 and gone on to medical school; today, she practices medicine in New York City.
"[Roza Rusinek] could hardly hold her head up," recalls a manager at Results, the U Street gym where Julia had worked out immediately before she collapsed, of the late-July day in 1999 when Roza and Henry Rusinek had stopped by the gym. "They were both just devastated."
The Rusineks also paid visits to the 3rd District police station house and to Engine Company 9. Neither organization provided much information; or consolation. In a personal letter to DuRoss, who had contacted him following his daughter's death, Henry Rusinek quoted from what he described merely as "a very sketchy report" he had received from the police: "Entered gym at 5:30 p.m.," the report said, and "at 5:54 observed walking (running?) southbound in the 1900 block of 16th St, observed falling face down to the ground. 6:03 call to 911, 6:05 police/fire truck arrives, ambulance arrives a few minutes later, pronounced dead at Howard Hospital."
In the same letter, Henry Rusinek described his and his wife's equally frustrating visit to Engine Company 9, on July 27, 1999: "We went to the Fire Dept. and spoke with the officer who attended to Julia [Desautels]....He said that Julia was unconscious but breathing and with heartbeat at the time he arrived. He did not want to tell us when the ambulance arrived."
Rather than filling them in on the details of their daughter's final minutes, wrote Henry Rusinek, Desautels advised the grieving couple instead to "get the report from Chief Reid." Rusinek added: "We have called Mr. Reid's office...but he did not return my call." The veteran medical researcher and radiology professor also noted, "We are still awaiting the report from the DC medical examiner."
Rusinek closed his letter to the InTowner reporter by sharing his sense of futility: "Roza and I have decided that pursuing this matter by asking for official reports will lead us nowhere."
The same day he met with the Rusineks, Desautels filed an official memo with then–D.C. Fire/EMS Chief Donald Edwards, citing Duarte and Palacios for their roles in the failed rescue attempt of Julia Rusinek. He recommended that they both be charged, under regulations codified in the District personnel manual, with "negligence in performing official duties, including failure to follow verbal or written instructions" by not responding "in a timely manner on a run as per F.D. orders" and by then responding "to an incorrect location."
Desautels also wrote in the document that Duarte, who had just come on duty for his shift as an Ambulance 1 crew member, was "standing in front of the firehouse" at 6:02 p.m. on July 15 when "several citizens arrived at Engine 9's quarters reporting a woman down on the street and unconscious, possibly not breathing, at 16th and Caroline Streets." Desautels wrote that the civilians' arrival had immediately followed a vocal dispatch made over the engine company's radio speaker system instructing Engine Company 4 (1.1 miles away, at 2531 Sherman Ave. NW) to respond to the above-mentioned address. He said that he then instructed Duarte "to respond immediately [to 16th and Caroline Streets] and to contact [Fire Department] Communications by radio so as not to delay this response." At this point, wrote Desautels, "Communications immediately dispatched [Truck 9] over the Vocal to the [same] address." Thus, Duarte by then had had three different opportunities to learn where the emergency was. He got a fourth chance when the hook-and-ladder truck, carrying Desautels and three other firefighters, "responded immediately and went on the scene" less than 200 yards from where Duarte was standing.
At 6:05 p.m., Desautels noted in the memo, the ladder truck commander "looked towards the firehouse but still no A-1." After another two minutes had passed, during which time he asked Communications to dispatch a second ambulance to the scene, Desautels finally "saw A-1 respond east on U St. and then north on 16th St. instead of south to our location." He noted that "several citizens who had gathered around the scene [had] witnessed A-1 responding in the wrong direction as well and began yelling at me. They were demanding to know where the ambulance was going."
At 6:08 p.m., wrote Desautels, he heard the crew of Ambulance 1 on the radio "asking for an address check stating they are at 16th and Kalorama Sts. and don't see T-9." At this point, Desautels asked the dispatcher to contact Duarte and Palacios and instruct them to turn around. According to Desautels, Ambulance 1 finally "marked on the scene" at 6:11 p.m. (For the record, a transcript of the 911 tape obtained from the fire department appears to corroborate Desautels' timetable. But Duarte, Palacios, and a fire department incident report all stated that Ambulance 1 actually arrived seven minutes later, at 6:18 p.m. The fire department declined to make any of the rescuers available to clarify the discrepancy.)
In a written response to Desautels, Duarte criticized Truck 9 crew member Cooper for not immediately shocking the patient with the automated external defibrillator he had taken from the truck. Desautels had defended Cooper in his memo, explaining that the firefighter/EMT had not taken this action because Rusinek "was still breathing until A-1 had marked on the scene." Desautels himself had noted that the unconscious woman also had a pulse. According to a leading D.C. emergency physician, Cooper was probably following the correct medical protocol when he did not immediately shock the patient. "You do not defibrillate somebody who's got a pulse," said the doctor, who had reviewed a detailed account of the incident before being interviewed.
For her part, Palacios; who, like Duarte, had just reported for duty when the call about Rusinek came in; provided an elaborate explanation for why she was late in joining her partner for the run. At 6:05 p.m., three minutes after Desautels and others at the firehouse had heard Engine 4 being dispatched to 16th and Caroline Streets over the firehouse speaker system, Ambulance 1 crew member Palacios; who had somehow missed the announcement; "went to the watch desk and saw that the printer was not working and started fixing it," according to a report she submitted to Desautels the day after the incident. As she puttered with the malfunctioning printer, Palacios wrote, she became aware of "a commotion going on outside" the room. Palacios wrote that she did not know what it was about. Palacios wrote that she saw Duarte get in the ambulance but thought he was merely moving it out of Truck 9's way. In fact, Duarte was preparing to go on the run, as ordered by Desautels. Rather than join Duarte, however, Palacios "went to the back [of the firehouse]" to retrieve her personal belongings, whereupon "one of the day crew people told me we had a run."
Palacios now indisputably knew what was happening. But, instead of reporting immediately to Ambulance 1, she decided to double-check its destination on the watch desk computer. "I did not see anything," she recalled in her account. Finally, Palacios, who already had delayed the run for several minutes, "went to the ambulance and found out that we had a call." According to Palacios, it was Duarte who told her that Desautels had dispatched the pair to "16th and Kalorama Road, N.W." She blamed the episode on "miscommunications on directions." She took no responsibility for the fact that she had missed the call not only on the station's speaker system but on the computer system as well, where, Desautels stated, Truck 9's location would have been shown. Nor did Palacios attempt to explain why she didn't leap quickly into action when told she had been put on an emergency run.
Desautels, however, stated in his memo to Edwards that both Palacios and Duarte had had "several opportunities to learn the correct address." The Engine Company 9 truck commander concluded that if the EMTs had responded immediately as ordered, "they would see which way T-9 went." He noted that the rear of the mammoth ladder truck "wasn't 100 [feet] from the intersection of 16th and U Sts."; when the duo drove through the intersection on their way to the wrong address.
D.C. Fire Department officials have declined repeated requests for interviews with Duarte, Palacios, Desautels, or any other official who could talk about the Rusinek rescue. Nor would officials say whether they had taken any action in response to Desautels' memo critical of Duarte and Palacios.
Just two weeks later, another patient died after riding in Ambulance 1 to Howard University Hospital. Duarte also ran that call and, once again, his actions were officially questioned. On Aug. 1, 1999, a 40-year-old homeless man reportedly suffered a seizure at the intersection of New Jersey Avenue and O Street NW. According to newspaper and television reports at the time, Duarte and a fellow EMT; neither of whom was named in any of the stories; had loaded the heavyset patient into the back of their ambulance, then allegedly failed to treat him on the way to the hospital, where the man was pronounced dead. A report published in the Washington Times on Aug. 19, 1999, said that an emergency room doctor at Howard, who had tried unsuccessfully to revive the victim, subsequently had "complained [to fire department officials that] the rescue workers should have given the patient cardiopulmonary resuscitation on the way to the hospital."
Duarte and his male co-worker; who reportedly said that the man they had picked up "appeared to be breathing normally during the ambulance ride"; were briefly suspended from ambulance runs, with pay, until they could receive "remedial training," according to the Times report. After this training, the exact nature of which the department declined to specify, and after passing a written exam, both men were reinstated to full work status, and they continue to work as EMTs today.
Nearly six weeks after Rusinek's sudden, unexplained death, the D.C. medical examiner's office finally released its autopsy report to her parents, who had requested it days after the incident. The report said a postmortem examination of the body revealed that Julia Rusinek had succumbed to a previously undetected congenital heart condition known as arrhythmogenic right ventricular dysplasia, or ARVD. In lay terms, this condition occurs when normal heart tissue in the right ventricle, or lower right pumping chamber of the heart, is gradually replaced by a buildup of fatty tissue, which interferes with the ventricle's ability to function. Relatively rare, ARVD can be either hereditary or "sporadic" (random). It most frequently manifests itself in young athletes such as Rusinek, who suffer sudden cardiac arrest while vigorously exercising or soon thereafter. Often, they experience no symptoms until the onset of the crisis; but when it occurs, if normal heart rhythm is not restored in very short order, they are very likely to either die or, if belatedly revived, suffer permanent brain damage because of prolonged oxygen deprivation.
There are cases on record of people surviving a sudden cardiac arrest brought on by ARVD. One such case; that of a 25-year-old former U.S. Olympic swimmer who collapsed during a training run in Boston; underlines the importance of providing rapid, high-level medical treatment to the victim immediately after such a collapse. Lisa Buese suddenly felt dizzy and short of breath, with a rapidly increasing heartbeat while on a training run near the Charles River. These are classic symptoms of cardiac arrhythmia, or irregular heartbeat, leading to a sudden cardiac arrest. They are the same symptoms Rusinek is believed by doctors to have experienced before she collapsed. Buese, however, was more fortunate; she was able to hail a passing taxicab, in which she then immediately slumped over, unconscious, in the back seat. The driver rushed her to the nearest hospital, where physicians using a defibrillator successfully revived her in the emergency room. After surviving a second cardiac arrest shortly after her first, Buese had a miniature defibrillator surgically implanted in her abdomen. Today, at age 36, she successfully competes in both marathons and triathlons.
According to the American Heart Association, only about one in 20 people who suffer cardiac arrest outside of a hospital today in the United States survives. However, says the association, the survival rate jumps dramatically when early CPR and rapid defibrillation are combined with advanced emergency care.
Rusinek's life ended, ironically, at the precise moment she seemed finally to have chosen a career path; no mean feat for any young adult; and was in the midst of perhaps her greatest adventure. Other than going away to Yale, in New Haven, Conn., coming to Washington in June 1999 to work as an intern for the Children's Law Center marked the first time she had been on her own in a strange city. From all indications, she was relishing her newfound independence. She had sublet an apartment on 16th Street and joined the athletic club around the corner. When she wasn't at work or at the gym, she spent time with friends from New Haven or Great Neck who also happened to be summering in the District. So, it seemed, she had the best of all possible worlds; combining the comfortable and familiar with the new and unexplored.
For the six weeks she interned at the Children's Law Center, recalls its former executive director, James Marsh, Rusinek "was just a pleasure to be around. She was attractive and very personable and not a high-maintenance person." On the other hand, says Marsh, Rusinek also was "very self-contained. She didn't share a lot about herself. But I knew she was having some financial issues, in terms of whether she should get a part-time job, make a little bit of extra money to make the summer more pleasant for her."
As an unpaid intern at the center; which provides free legal services to low- and middle-income "at-risk children" and their families; Rusinek handled multiple tasks, including helping the center's legal team in court. "We had a 14-day trial that just finished on the day that she died," said Marsh, "and she had been going to that every day, and that had interested her quite a bit. And she had told her family that she felt that she had finally found something that she wanted to do. She was seriously going to consider pursuing a law-school career to do child-advocacy work."
If serving children in need was Rusinek's vocation, running was her passion. During her four years at Great Neck North High School, the 5-foot-8, 125-pound athlete set six indoor and five outdoor school records in girls' track. She was a three-time divisional champion in the 4 x 400-meter relay and was named most valuable player of the girls' track team an unprecedented five times. As a senior, she was named Great Neck North's female Scholar/Athlete of the Year. She went to the Nassau County championships twice, placing third in the pentathlon in her junior year. In that demanding event, she competed in the 100-meter low hurdles, 800-meter race, shot put, long jump, and high jump. According to Rusinek's former track coach, Chris Omeltchenko, Rusinek also, at various times, competed in the triple jump and ran the 400-meter dash for Great Neck North. "She was the most versatile athlete I ever coached [in 14 years at the school, coaching runners of both sexes]," says Omeltchenko, who currently teaches physical education at New York's Aviation High School and coaches the track team at Queensborough Community College. He adds, "She was the star of the team, but she was also one of the most dedicated members of the team"; running on weekends, for instance, without ever being asked to do so, to make sure she stayed in top form.
In Rusinek's senior year, Omeltchenko recalls, the team's star runner effectively guaranteed her early acceptance at Yale; and a future spot on that university's women's track team; by her outstanding performance in the 4 x 400-meter relay in the high school division of the annual Yale Invitational track meet in New Haven. "I was talking to the [Yale women's track] coach while Julia was on the starting line," he recalls. "And I remember pointing her out to the coach, saying, 'That's Julia. She wants to run for you next year.' And then the gun goes off and she hands off the baton in first place, just blowin' everybody away on the first leg." He adds, "You couldn't have scripted that any better."
In the slightly more than two decades that Rusinek lived, she left many others in awe; although, say those who knew her best, never purposely. And after her death, she left a legacy: a charity race and a children's fund established in her name by family members and friends. The first annual Julia Rusinek Memorial Road Race was staged in New Haven on April 9, 2000, just nine months after the honoree died. Despite unseasonably cold weather and a light snowfall, 242 people competed in the 5K run, including Rusinek's parents and her older sister. In a fitting tribute to their lost daughter, sister, and friend, the memorial racers raised $6,000 for low-income children in New Haven. Plans are under way to hold a second memorial race this spring.
Almost one year to the day after Rusinek died, D.C. Mayor Anthony A. Williams hired a new fire/EMS chief from Augusta, Ga. Ronnie Few, a 29-year veteran firefighter named Fire Chief of the Year in 1998 by the International Association of Firefighters, became the third man to steer the department in seven months. One of the new chief's long-range goals, says Senior Public Information Officer Denise Reed, is to "cross-train" all D.C. firefighters as paramedics, so they eventually can provide skilled medical care quickly in response to every 911 call. In the short term, says Reed, Few wants to reduce the average time required for getting advanced life support to the scene of a medical emergency to eight minutes or less. Succeeding will necessitate shaving more than two minutes off the District's current average response time of 10 minutes, seven seconds. If the department reaches this goal, it will be a significant improvement, but it will still leave the District nearly three minutes behind the national average response time of five minutes, 24 seconds for advanced life support. And it will only slightly improve the chances for survival of people, like Rusinek, who fall victim to cardiac arrest in the District.
Meanwhile, the fire department also has accountability problems to address. Officials decline to say whether anyone from Medic 24's ambulance crew was ever disciplined for taking 22 minutes to respond to the July 15, 1999, urgent dispatch call to an unconscious woman, possibly not breathing, at 16th and Caroline Streets NW. Nor will the department reveal whether the unnamed emergency dispatcher who initially assigned a fire truck from a more distant firehouse to the call was ever questioned about his or her role in the deadly drama. Indeed, it appears that, other than the official slap on the wrist administered to Duarte and Palacios, nobody was ever held accountable for Rusinek's delayed rescue.
We head out to the street, stand along an imaginary starting line, jogging in place, swinging our arms, suddenly jittery because the butterflies in our stomachs have just burst from their cocoons. There is no rationale for this nervousness. Omo comes over and tells us to relax. "C'mon missies," he says, "this is the last two mile time trial of your high school career." He cannot contain his excitement. The man loves competition.
We run a hard two miles. We race past trees and grass and houses and "No Parking" signs. Cars whiz past me and I whiz past them and I feel freer and the sky feels larger and bluer above us than ever before and the sun penetrates my skin and warms me everywhere until I feel a chill down my spine and I am hurting and feeling pain overwhelm me but it is okay because more than anything I feel the pounding sensation of being alive.
from an essay written by Julia Rusinek when she was 18
A PATTERN OF FAILURE
In 1999, the year Julia Rusinek died, D.C. firefighters and emergency medical workers responded to about 120,000 medical calls. That is an average of one call every 4.38 minutes, 24 hours a day, 365 days a year. In the same year, says Senior Public Information Officer Denise Reed, it took rescuers in the nation's capital an average of 10 minutes, 44 seconds to get advanced life support to the scene of a medical emergency; nearly twice the national average of five minutes, 24 seconds.
According to the International Association of Firefighters, in the same year, rescuers in no other U.S. city of comparable size took an average of more than seven minutes to respond. In Phoenix, rescuers with advanced-care capabilities took an average of four minutes, 40 seconds to arrive on the scene. In Columbus, Ohio, they took, on average, 10 seconds less. In nearby Arlington, Va., the average response time was three minutes, 48 seconds.
In January 1999 alone, the D.C. Fire Department logged the following incidents:
- Two D.C. paramedics were suspended after it was discovered that they had collected holiday overtime pay after spending part of New Year's Day not at Washington Hospital Center, as reported to their dispatcher, but at a Mexican restaurant in Alexandria. (Source:Washington Times)
- A woman slipped on the ice and fell outside a northeast Washington bank; although a fire truck responded promptly, she lay in the freezing rain for more than an hour waiting for an ambulance to take her to the hospital. (Source: Washington Post)
- A man in downtown Washington suffering severe abdominal pains waited in vain for an ambulance for 20 minutes before giving up and taking a taxi to the hospital. A firefighter rode along with him, administering oxygen. (Source: Washington Post)
- An ambulance and fire truck got lost on the way to the home of a heart attack victim in upper Northwest; after 12 minutes of wandering through the neighborhood, they found the house, but the driver didn't know the way to the hospital. (Source: Washington Post)
Last year, the city's emergency medical system extended its dismal record:
- In August, a northeast Washington man suffered a heart attack and died while waiting for an ambulance that had gotten lost because of a typing error by a 911 operator. (Source: Washington Post)
- Also in August, the city agreed to pay $1.75 million to settle a lawsuit brought by the family of a male transvestite who had been ridiculed and denied treatment by D.C. paramedics after being severely injured in a car accident in southeast Washington five years earlier. One of the firefighters found by the court to have unlawfully withdrawn treatment from the patient was later promoted to sergeant. (Source: Washington Post)
- In September, D.C. taxpayers forfeited an additional $165,000 to the family of a 6-year-old African-American boy from Northeast who reportedly had suffered not just a severe asthma attack but racial insults from one of two white ambulance crew members. However, as in the previous lawsuit, the financial award was based not on negligence but discrimination; the court found that the patient's “human rights” had been violated by the EMT. (Under current D.C. law, it is impossible to sue a police officer, firefighter, or rescue worker for negligence in the line of duty.) (Source: Washington Post)
Copyright 2001 Washington Free Weekly Inc.