Ambulance report shows Davis inmate was unresponsive when rescuers arrived

Saturday , March 11, 2017 - 5:15 AM

MARK SHENEFELT, Standard-Examiner Staff

FARMINGTON — A woman who died of a torn spleen apparently suffered in the Davis County Jail was medically unresponsive when Farmington City rescuers arrived, and she suffered a cardiac arrest en route to an Ogden hospital, an ambulance report shows.

Jail personnel told Farmington emergency medical technicians on the night of Dec. 21, 2016, that Heather Ashton Miller, 28, of Kearns, “had a possible seizure falling from the top bunk bed” in her cell, according to a Farmington City Fire Department report obtained by the Standard-Examiner.

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Jailers also told responders Miller “had a history of drug abuse and was experiencing withdrawals in the jail,” the report said. But the jail could not provide further medical history or information on any current medications, it said.

An autopsy later showed Miller had no head injury, but her spleen was nearly split in half due to blunt-force trauma and her abdomen contained almost 1 ½ liters of blood. Miller’s body contained traces of methamphetamine and marijuana, the autopsy report said.

Details of the emergency response come as the Utah Attorney General’s Office and the Weber County Sheriff’s Office collaborate on a re-opened investigation into Miller’s death. The Davis County Attorney’s Office completed its review of the case in January and referred it to the state for further investigation, possibly including screening for potential criminal charges.

Davis and Weber officials have denied open-records requests for investigative reports and other documents related to Miller’s death. They have invoked a clause in the Utah Government Records Access and Management Act that allows entities to withhold public records if their release could “reasonably be expected to interfere with” investigations or enforcement proceedings, or disclose investigative techniques.

The Davis County Attorney’s Office also cited as a reason for withholding the records a fear that release of details about jail operations could threaten the security there. 

“I have also determined that the interest in restricting access to the records requested in the appeal outweigh the public’s interest in access to such records,” Davis County Commissioner Jim Smith, the county’s chief GRAMA appeals officer, said in a letter Thursday, March 9, 2017.

But the Farmington ambulance report illuminates what happened in the 38-minute period in which the Farmington EMTs and Davis County sheriff’s paramedics evaluated and treated Miller, and delivered her to McKay-Dee Hospital in Ogden.

Weak pulse, shallow breathing

EMTs reached Miller in the jail at 8:48 p.m., having received the emergency call at 8:41, the report said. She was pale, with fixed pupils, a weak pulse and shallow breathing, it said.

Jail personnel had placed a non-rebreather oxygen mask on the inmate, who was moaning and randomly moving her extremities, the report said.

The ambulance left the jail at 9:03 p.m. and arrived at Ogden’s McKay-Dee Hospital at 9:26, the report said.

During the trip, Miller’s heart rate dropped to 48 beats per minute and her blood pressure dipped to 59/39, both well below normal. At 9:095 monitors showed Miller’s heart was going into distress and EMTs started CPR at 9:09.

“Drive 10-40”

At 9:15 p.m., Miller’s heart suffered ventricular fibrillation, which is a frequent cause of sudden cardiac death.

Sheriff’s paramedics on board the ambulance told the driver to alert McKay-Dee to an incoming cardiac arrest “but to still drive 10-40 to the hospital,” the report said. The 10-40 radio code signifies running without emergency lights and sirens activated.

Medics were unable to begin an IV in either of Miller’s arms, but they installed an IO infusion tube, accomplished by drilling into the patient’s tibia bone marrow. Miller showed no response to the drilling, the report said.

Through the IO line, the medics administered epinephrine, which increases heart rate, blood pressure and respiratory rate, at 9:22 p.m.

By 9:25 p.m., Miller showed no pulse or blood pressure. CPR continued at the hospital until doctors pronounced her dead after 10 p.m.

The Farmington report said the McKay-Dee emergency room could not find a new IO kit, but a Roy Fire Department unit that happened to be at the hospital had one and gave it to the ER staff for use on Miller.

Woman’s mother criticizes jail

Miller’s mother, Cynthia Farnham-Stella, said the ambulance report underscores her suspicion that her daughter suffered a critical injury and jailers failed to render adequate aid.

“She was in distress and they (the jail) didn’t do anything to help her, and when it was too late they called” emergency responders, Farnham-Stella said in a phone interview Tuesday.

“She was dead and unresponsive before they even picked her up,” she said. “She didn’t even respond to them drilling into her tibia anyway. They were just artificially keeping her alive until someone pronounced her passed.”

Farnham-Stella said she was angered that the jail told EMTs Miller had a possible head injury and was in drug withdrawal.

“Had they been truthful about what had happened they may have had a chance to save her,” Farnham-Stella said. “Since no one was honest and waited to the very last minute to get her help, she died. They gave the wrong information regarding what had happened and treated her with a head injury.”

The sheriff’s office has declined to comment on the case, other than to say Miller “was having a medical issue” and she was “released with a court date to be transported to the hospital via ambulance.”

Farnham-Stella has said she intends to file a wrongful-death lawsuit against the county.

Lights and sirens explained

Farmington Fire Chief Guido Smith said his office is reviewing the ambulance response and activities, a routine process. He said all medical calls are reviewed.

“Everything appears appropriate as far as treatment that has been rendered,” Smith said of Miller’s case.

Emergency crews have latitude on whether to use emergency signals, Smith said.

“There is no protocol that says we have to go lights and sirens,” he said.

When silent runs are made, he said, “it’s typically a safety consideration. There may be poor weather, the route is not safe, or we cannot get through traffic even with lights and sirens.”

With lights and sirens, “periodically we can create a greater hazard or endanger the safety of the crew,” Smith said.

The ambulance crew followed local and state protocols by taking Miller to McKay-Dee, the closest Trauma 2-level hospital, Smith said, rather than Davis Hospital and Medical Center in Layton, It’s a 15.7-mile drive to McKay, compared with 9.6 miles to Davis Hospital.

Smith said a Trauma-2 hospital is better suited to treat traumatic injuries, so if a patient is stable — as Miller’s condition was considered when the ambulance left the jail — protocol dictates that destination.

If a patient’s condition is considered unstable, protocol says she should be taken to the closest hospital, Smith said. Miller did not become unstable until the ambulance was well on its way to the Ogden hospital, he said.


HEATHER MILLER EMERGENCY RESPONSE TIMELINE

Sources: Farmington City Fire Department, Davis County Sheriff’s Office, Utah State Medical Examiner’s Office.

December 21, 2016

8:41 p.m.  — A Farmington Fire Department ambulance is dispatched to the Davis County Jail in Farmington.

8:46 p.m. — Ambulance arrives at the jail.

8:48 p.m. — Farmington crew of advanced life support EMTs reaches Miller inside the jail

8:48 p.m. — Miller is unresponsive. Blood pressure 80/50, heart rate 50.

8:54 p.m. — Davis County Sheriff’s Office logs Miller out of jail custody.

8:55 p.m. — BP 86/53, HR 60. 

9:00: p.m. — BP 63/44, HR 54.

9:03: p.m. — Ambulance leaves jail.

9:05 p.m. — Miller experiences sinus bradycardia, a heart function disturbance.

9:09 p.m. — BP 83/49, HR 48.

9:11 p.m. — BP 59/39, HR 50.

9:15 p.m. — Miller experiences ventricular fibrillation, a serious heart rhythm problem that requires CPR.

9:22 p.m. — Medics administer epinephrine through an intravenous tube. The medicine is used to stimulate heart rate, blood pressure and breathing.

9:25 p.m. — No blood pressure or pulse.

9:26 p.m. — Ambulance arrives at McKay-Dee Hospital in Ogden.

9:27 p.m. — Miller’s care is transferred to the hospital ER staff.

10:06 p.m. — Miller is pronounced dead.

You can reach reporter Mark Shenefelt at mshenefelt@standard.net or 801 625-4224. Follow him on Twitter at @mshenefelt and like him on Facebook at www.facebook.com/SEmarkshenefelt.

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