Jeremy Weyant and friends were jumping over road cones outside a Bedford County middle school on the evening of Oct. 25 when the 13-year-old stumbled, fell through a window and severed his carotid artery.
The county's 911 center was notified at 6:14 p.m. and called STAT MedEvac, a regional medical helicopter service, which dispatched its own chopper to the scene.
Rather than fly Weyant to the trauma center at Conemaugh Memorial Medical Center in Johnstown, STAT MedEvac flew him to Children's Hospital of Pittsburgh, the region's only pediatric trauma center.
By 8:15 p.m., Weyant was pronounced dead at Children's Hospital. Hospital officials would not comment on the case, but the Allegheny County coroner ruled that Weyant bled to death.
"It's inappropriate to take a 13-year-old who is dying, fly him directly over a trauma center that is only 10 minutes from the scene and take him to a hospital that is 42 minutes away," said Dr. Lee Miller, director of trauma services at Conemaugh Memorial.
"If something had been done sooner -- you can't know, but you wonder if we could have saved him."
The boy's father, Bruce Weyant, said doctors told him his son died 25 minutes into the flight. Weyant said he did not know why his son was taken to Children's and, while he respects the hospital, he doesn't know why his son couldn't have been cared for at the closer adult trauma center.
"My son wasn't a small child. He was about 5'3" or 5'4", 125 or 130 pounds," Weyant said. "He would not fit in a youth casket."
Critics say the boy's death highlights a flawed system that allows STAT MedEvac, which is owned by five hospitals, including Children's, to dispatch choppers to accident scenes in 14 counties in Western Pennsylvania. They say the incident is the latest example of how STAT MedEvac regularly puts profits before patients -- a charge the chopper company rejects.
Al Boland, spokesman for STAT MedEvac, said he could not comment on the Bedford County case because of patient confidentiality. But the service makes 600 flights a month, he said, "and there can be any given circumstance that can change the decision of medical personnel about where to go. ... Things tend to change a little bit whenever you're involving a child."
The state Department of Health is investigating the incident, but preliminary results have shown no cause for state action, said Margaret Trimble, the department's director of emergency medical services. State law requires that patients be taken to the nearest trauma center, but that rule can be broken if doctors believe the patient could be better treated elsewhere or if pilots believe weather conditions prevent the flight to the closest hospital.
The one-call system
Part of the controversy over the 13-year-old's death is the one-call system.
When a 911 operator in Bedford County needs to send a chopper to an accident scene, the operator simply calls STAT MedEvac, and the chopper company decides which helicopter to send. The one-call system spares the operator from calling several air ambulance services to see who's available.
STAT MedEvac developed the program after an incident about four years ago when 911 operators were swamped with calls from a serious accident in Clearfield County.
Miller, the Johnstown trauma physician, said that since Bedford County started using the one-call system about three months ago, calls that should have gone to his hospital's air ambulance program, Conemaugh MedStar, have gone to STAT MedEvac.
"STAT says they will send the helicopter that's the closest, yet they don't call us," Miller said.
Cathy Fackovec, director of the LifeFlight helicopter program at Allegheny General Hospital, said the same problem occurs in Armstrong County. Since Armstrong began using the one-call system in March, LifeFlight says there have been 32 incidents in which STAT helicopters were called when a LifeFlight helicopter was closer. LifeFlight presented its numbers at a meeting last month with STAT MedEvac and 911 officials in Armstrong County.
But STAT MedEvac's Boland says the numbers didn't add up; some of the flights on LifeFlight's list didn't even take place in Armstrong County.
He also argued that in Somerset and Bedford counties, both of which use the one-call program, Conemaugh MedStar had been given the majority of the flights.
Marie Mores, the 911 director in Armstrong County, said she hasn't passed judgment on LifeFlight's numbers, but is not about to give up on the one-call system. When a big accident comes in the middle of the night, she explained, two dispatchers must handle the flood of calls. Being able to hand off the helicopter calls is a great help.
Those comments were seconded by Dan Datesman, emergency services director in Bedford County, where the 13-year-old boy was injured.
After Altoona Hospital opened its trauma unit this year, a STAT MedEvac helicopter was stationed in the region Oct. 1. Conemaugh's helicopter program previously hadn't been giving great service to Bedford County, Datesman said. "But now that there's competition," he added, "the service has never been better."
Datesman alleged that Conemaugh was using the 13-year-old's death as a way to attack the new trauma unit in Altoona, which operates in Conemaugh's traditional turf.
Dueling helicopters
The debate over the one-call system is just the latest twist in the bitter rivalry among the region's helicopter services. Last year, a community-wide effort to spur cooperation between STAT MedEvac and LifeFlight quickly failed because of the bad blood.
STAT MedEvac has 11 helicopters -- nine in Western Pennsylvania, one in Cleveland and one in Baltimore -- while LifeFlight has five in the region. Bigger cities get by with fewer choppers, but the Pittsburgh Regional Healthcare Initiative couldn't even move forward with plans for cooperation, let alone consolidation of the fleets.
"This was an area where we thought the parties themselves were saying there may be an opportunity to make some rational capacity decision," said Ken Segel, a coalition leader. "But we found there was too much mistrust to make it work."
A 1995 internal memo to STAT MedEvac managers, obtained by the Post-Gazette, shows the antipathy. James Bothwell, STAT's chief operating officer, wrote that because a STAT employee had recently been hired by LifeFlight, STAT would need to take certain steps to protect its turf.
"Flight crew members should discourage flights to Allegheny General with referral sources and pre-hospital providers," Bothwell wrote. "Minimize use of Life Flight for direct referrals or in cases where a secondary aircraft is required at accident scenes."
In an interview, Bothwell disputed the idea that STAT doesn't fly patients to Allegheny General --300 people have been flown to the North Side hospital this year alone, he said.
He acknowledged that STAT MedEvac promotes its member hospitals when patients have no preference and the flight times are comparable. But he said that is no different than how other chopper programs operate.
"I think people in our program have allegiances to our member institutions," he said. "We feel the care provided at those hospitals is superior."
Denying an AGH trip
This summer, a Washington County woman named Karen Burns was in a car accident in Fallowfield, near Charleroi. Burns needed to be flown to a trauma center and a helicopter from STAT MedEvac responded.
Because she had previously been treated for a spinal cord injury at Allegheny General, Burns repeatedly asked the crew to fly her to the North Side for care. But the crew told her they couldn't fly to Allegheny, she said. Her only choices were Mercy or UPMC -- two of the hospitals that own STAT MedEvac.
"I do not understand why I was not given my right to choose the hospital where I wanted to be treated," she said in a letter to LifeFlight.
Trimble, the state Health Department official, said her office substantiated a complaint against STAT MedEvac in May 2000 for flying a patient from Venango County to UPMC rather than to a closer trauma center in Erie. The Erie hospital complained, but STAT MedEvac had addressed the problem by the time the department's investigation concluded, Trimble said.
But Bothwell, STAT MedEvac's chief operating officer, said the reports didn't fit with STAT's policy of always taking patients to the appropriate facility, taking into account both their condition and preference in hospital.
Medical personnel at Children's, UPMC, Mercy and West Penn Hospital all review STAT's performance to make sure it acts properly, added Boland, the company's spokesman.
Bruce Weyant said he didn't have a preference about where his son was treated, but trusted that his son would receive the fastest appropriate care. Weyant said he is left with at least two questions. First, why did it take more than 20 minutes for the helicopter to take off with his son? And, second, why wasn't the boy taken to Conemaugh?
"I'm saying, if he was on the ground for 20 minutes, then spent 25 minutes in the chopper, that's 45 minutes," Weyant said. "If they had gone to Johnstown, which they tell me is a 10- to 12-minute flight, that would have given the surgeons 30 minutes to actually work on Jeremy before his heart stopped.
"That's a big question, 'What if?' I have a lot of questions."
