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Q&A: Denver Health CEO speaks to Denver7 Investigates

Interview comes after more than a year of reports on the culture in paramedic division
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Posted at 7:45 PM, Aug 05, 2022
and last updated 2022-08-06 00:52:29-04

Following more than a year of reports exposing what some current and former paramedics described as a “culture problem,” Denver Health CEO Robin Wittenstein agreed to an interview with Denver7 Investigates.

Wittenstein had previously declined multiple interview requests dating back to August 2021.

Denver7 Investigates published more than a dozen reports in the past year-plus, exposing how paramedics were pressured to bypass closer Level One trauma centers to bring critical patients back to Denver Health Medical Center.

Later reports also showed frustration among firefighters who said they were waiting on scene for Denver Health paramedics and could not provide necessary care to patients. A database obtained by Denver7 Investigates also showed that firefighters had, at times, waited in excess of 40 minutes on scene for Denver Health paramedics to arrive.

The interview with Wittenstein took place days after an interview with Denver Mayor Michael Hancock, who said that what was exposed was not acceptable.

Wittenstein is set to retire as CEO of Denver Health on Sept. 1. She will be replaced by former Colorado Lt. Gov. Donna Lynne.

Q&A: Denver Health CEO speaks to Denver7 Investigates

The interview has been edited for length.

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What's the message you want to send in this interview?

The message is really pretty simple. Denver Health has been providing EMS services to the City of Denver for forever and certainly has served the city to deliver high quality EMS services in partnership with the city of Denver. And we're incredibly proud of the work that our paramedics have done.

Have you watched our reporting over the past year plus?

I've seen some of it.

What's your takeaway? What resonated most with you?

You know, Denver Health has really focused on not just this, but in everything we do on how we can always look for opportunities for improvement. The partnership with the City of Denver has been a longstanding part of who we are and how we serve the people of Denver.

It's been nearly a year since we made our first request to sit down with you and address issues in our reporting. Why are you talking now?

As we've gone through and the requests come in, we've tried to put the people who are most best able to answer those questions. And so over time, we've put in front of you clinical and non-clinical folks. At this point, I think it's an opportunity for me to have a conversation with you and just tell you how proud of the work that we've done and the work that we will continue to do.

Our reporting has criticized the work of your paramedic division, specifically coming from paramedics, firefighters and data. What do you say to the critical reporting that has happened over the past year plus?

When you look at the performance of the Denver Health Paramedic Division, we have performance goals that we are held accountable to. Those are set using national benchmarks and they're set through the entire email system. It's not Denver Health setting goals. In the last 12 of 14 years, Denver Health has met its performance goals. One of the years that we've missed, 2019, was due to the growth of the city. … The growth of the city, the number of high-rise buildings, it impacted some of our ability to be able to meet our response times. But after we have a year where we didn't (hit our mark), we added more apartment training classes, we added more ambulances, we did things to address that. In 2021, we did not hit our performance goal. COVID has been a challenge. It's been a challenge for everybody, not just the EMS system. Although EMS systems across the country have been hit hard by COVID and staffing challenges.

How would you describe the relationship with Denver Fire? Would you say it's cordial or confrontational?

I think the relationship in the partnership with the city overall is very good. We work really closely with them on a lot of different areas.

Would you be surprised to hear that the fire department doesn't see it that way?

I've had conversations with the fire department. There are always going to be opportunities for continued conversation. I would not describe our relationship as adversarial.

Over the past year-plus, our reporting has been critical of your paramedic division. Have we reported anything inaccurate?

I believe that the reporting has not accurately reflected the performance of the Denver Health Paramedic Division.

Much of the response to date has been, as your medical director said, “we've done nothing wrong.” As you sit there today, can you say that Denver Health has done nothing wrong and that statements of paramedics and firefighters are out of bounds?

I think some of it we can clearly say we've done nothing wrong from the perspective of some of the discussions about where paramedics take patients, for example. I would never and I hope that no health care professional or executive would ever sit and say, “I've done nothing wrong.” Any time there's a concern brought up about any patient care issue, there's always opportunity to look at what's been done and what else can be done.

Have you changed anything because of the testimonials or the information in our reporting?

There haven't been specific changes that have been necessary. We continue to look, as I said, based on the response time, for example, and the publicly available information. This is not secret information about whether or not Denver Health achieves its performance goals. We're adding ambulances and paramedics. That is something that happens on a regular basis and has occurred over the years.

What do you say to the paramedics, the firefighters that stepped forward and said your culture needs to change?

We're always looking at the culture of Denver Health. We talk to our employees regularly. We ask them questions. Again, it's not different when you're thinking about how employees exist within an organization like Denver Health, and it is about how you deliver health care.

But after a year of reporting, you just said to me, nothing has changed. All those people came forward and said you have a culture problem, yet you've changed nothing?

We continue to talk to our employees to see what else do we need to do, or leadership is interacting with them regularly. In terms of the response times, we are continuing to look at that again.

We sat down with Mayor Hancock last week. He saw our stories and he said it's time for Denver Health to change. He said that not changing is not acceptable. What's your message back to the mayor?

My message is that we will approach this in exactly the same way we've always approached it, which is having conversations with the City of Denver.

In front of these cameras, will you commit to the changes the mayor is calling for?

I will commit to continue conversations with the City of Denver around what they do, how the partnership works, what they'd like to see as the city changes and evolves. As we look at our performance data, as we look at the performance data of the police, the fire and 911. Any time we see something that isn't quite what we want it to be, we absolutely sit at that table and have conversations about what's going on and what else needs to happen. And I count on my partners at the city to do the same thing.

Sources inside the city of Denver have said the fire department wants its own medical director in this contract. What's your position on allowing Denver's fire department to have its own medical director so it can better serve the people of Denver?

We're in conversations with the City of Denver right now over the way Denver Health partners with the city how things change every year. There are a few changes here and there. I'm not going to discuss and negotiate the relationship with the City of Denver through the media. We're having the appropriate conversations with the right people sitting at the table and we'll finish those out.

Fire sources tell me a medical director providing the opportunity for firefighters to work as paramedics and do advanced life support would be better for the people of Denver. Do you agree or disagree?

As I said, we're not going to discuss the way that the system works on television.

How would you describe the ongoing discussions with the city?

Oh, I think the conversations are good. Both sides have a deeply vested interest in the relationship between Denver Health and the City of Denver. I think there's been tremendous opportunities for not just a partnership over the years, but real innovation. Things have come out of our partnership that have advanced health and well-being for people who live in the city of Denver. And that's been on both sides. … I'd say the conversations are exactly what I would expect from a partner who is as deeply committed to this partnership as we are.

Do you expect this contract to be resolved under your watch, or do you think it will be under the new CEO’s basket?

The normal course of the operating agreement is that it doesn't get finalized until the end of the year, but I expect that we should have the vast majority of the contract framed out before I leave.

Back to Mayor Hancock. In our interview, he specifically cited the decisions to bypass Level One hospitals. He specifically cited response times and Mayor Hancock said what we've reported cannot continue. What do you say to Mayor Hancock?

I'd say the Denver Health Paramedic Division uses the appropriate guidelines for deciding where patients should go. Of course, the first decision criteria is what's going on at the scene. What does the patient need? What is their clinical condition? The second thing that gets considered is what does the patient want that the patient or their family want? And the third is the guidelines to bring the patient to the closest, most clinically appropriate place. And that's what our paramedics use to decide which hospital the patient should go to.

With all due respect, we've been talking for 25 minutes and it sounds like your position is the way it's been for more than a year. This hospital has done nothing wrong and everything that those firefighters and paramedics have said lacks accuracy. Am I hearing the right thing?

No, you're clearly not, because I've never said we've not done anything wrong. I’ve not said we’ve done anything wrong. What I've said is, as issues have come up, we've dealt with those, we've considered what we need to do. … You know, Denver Health takes seriously the issues that come up and we make changes as needed. So things have changed. We're adding capacity. We are coming up with new ways to deliver care. Those are a response to some of the things not that you've said, but some of the data and the information in front of us.

So the testimonials in our reporting have had zero impact on anything Denver Health has done in the past year?

I have not said that. What I've said is as information has come forward, as we evaluate it, we make changes based on what we hear.

So the paramedics that came forward, the firefighters who came forward and criticized your hospital or your paramedic division, what do you say to them?

It's hard for me to say anything. I don't know much beyond the few snippets that you happen to think were appropriate to put on on air.

(Are you) questioning the accuracy of what we've reported?

I'm simply saying that I'm not responding to the few snippets that I heard. We talked to our paramedic division, and I think if you spoke to the majority of the people in our paramedic division, they would say the same thing that I say. We are proud of the work that this division has done. They are proud to wear the Denver Health patch and they will continue to do the right thing by the people who live, work and play in the City of Denver.

Specifically in this new contract, will you allow paramedics that are Denver firefighters to treat patients?

Denver firefighters who are paramedics do treat patients now, but we're not going to have a conversation about what specifically will end up in that contract. We are at the negotiating table with the City of Denver, and we're going to have those conversations there.

But they're not allowed to do advanced life support?

We're having the conversations in the place that they belong, which is at the table sitting with the City of Denver.

If the fire department believes that makes patient treatment better, why would you not support it?

Again, I'm not going to…

You have an opportunity right now to say “if that makes patient care better, I support it.” Why would you not support that in front of these cameras?

I'm saying that we're not having the conversations about what will or will not change in the operating agreement based on media interviews. We have those conversations in the appropriate places where they should occur with the right people around the table.

In conclusion, should the people of Denver expect better service from your paramedic division?

The people of Denver get great service from our paramedic division right now, and they should expect that to continue into the future. Any changes will happen based on the growth of the city, based on changes in high-rise buildings, based on changing needs of the City of Denver. We respond to what the people that we serve need, and they will continue to see changes as their needs change and evolve.

With all due respect, you've dodged a lot of questions.

I've given you the answers that I think are appropriate and accurate. Again, the work that the paramedic division does is really amazing. And I'm incredibly proud of it. And I'm proud of the partnership with the City of Denver.

So the people of Denver should conclude that the reporting we’ve done in the past year is probably not on the mark?

I think the people of the city of Denver can come to their own conclusions.