By A.C. Thompson

First the beer mug incident and now this: A new report shows the San Francisco Fire Department is having some serious quality-control problems in its Emergency Medical Services Division.

The July report, which was leaked to the Bay Guardian, scalds the department for "critical deficiencies" in three key areas, including failing to make sure that all paramedics and emergency medical technicians (EMTs) have proper licenses and certifications. The 11-page document, compiled by the city's health department, also suggests fire department staffers may be improperly caring for the patients they pick up, and haven't come up with a quality improvement plan.

"The public ought to be greatly concerned," Dr. Douglas Goldman, a former fire commissioner and expert on emergency care, told us. "It's appalling."

According to the report, the fire department lacks a "mechanism to ensure current certification of all personnel," and didn't turn over a list of employees lacking proper certification to the health department auditors. EMTs and paramedics undergo different levels of schooling, but both must pass state exams before climbing aboard an ambulance.

At the fire department, Glenn Ortiz-Schuldt, an assistant deputy chief, said as far the certification issue goes, "There's no reason to be alarmed. Everyone is current, everyone is certified." According to Ortiz-Schuldt, the department has improved its database software to better track personnel issues and make sure the credentials of the city's 350 paramedics and 1,200 EMTs haven't lapsed.

The report indicates that record-keeping – a central part of any health-care system – is alarmingly lax among fire department staff. The documentation is so spotty that it's impossible to determine whether or not patients received the treatment they needed in dozens of cases.

The auditors randomly inspected 150 patient files from January 2005. Their findings don't exactly inspire confidence, notably:

• Only 10 percent of the medical charts were complete, "compared to 44 percent in 2004."

• "Overall clinical performance standards were not met for 56 percent of the 50 patients transported to" emergency rooms.

• In 70 percent of cases, there were "treatment protocol errors or omissions."

The sloppy charting, Goldman said, could be "lethal in a small minority of cases." It means doctors "are working in a black hole."

"It is disturbing," Ortiz-Schuldt admitted. "It doesn't necessarily mean that care isn't being rendered; it means it's not being recorded.... As far as we can tell, it's a paperwork issue."

Dr. John F. Brown conducted the audit for the health department. "You need to have accurate record keeping. It's an important aspect of patient care," Brown told us, adding that sloppy charting means the city may not get reimbursed by insurance companies for the medical treatment ambulance crews dispense.

The civil grand jury alluded to similar issues in 2004, arguing "there should be stronger medical oversight of the SFFD Emergency Medical Services," and in recent weeks the San Francisco Chronicle has reported on an incident where an ambulance crew allegedly talked a man out of going to the hospital. He died 16 hours later.

There is some good news, though. The July report is a follow-up from a previous audit that identified 10 major problem areas, including a "lack of training" and "violations of state law and local policies." "I think the fire department is working very hard on this. I'm encouraged by the improvements I've seen," Brown said.

E-mail A.C. Thompson at acthompson{at}hushmail{dot}com.