An open letter to Metro’s SWAT team

By Bruce Handelman, MD

Wednesday, Oct. 8, 2014 | 3:38 p.m.

Gentlemen:

Many of you know me. I have worked with you as a tactical physician volunteer since the year 2000. I have appreciated my time there and hold you all in the highest regard. You guys have always acted responsibly and I must say that you show amazing restraint in the situations you deal with. In the year 2012, I became aware of a problem with respect to your tactical medical coverage. Since then, I have been trying to correct what I believe to be an unsatisfactory situation.

As you are probably aware, the two most common causes of death in the tactical environment are blood loss and airway emergencies. As a practicing anesthesiologist with 30 years experience, I have some expertise in airway management. All the physician volunteers are quite competent in their various medical specialties. However, some have not had the background training and experience necessary to operate independently in the tactical environment with regards to airway issues. Airway issues are rare, but probably represent the most important skill we should bring to the table. In addition, there is no hands-on experience available in the training curriculum. I believe that these are very serious deficiencies that could lead to a bad outcome in a critical situation. This would be tragic for the victim and indefensible for the physician involved along with the Metro management.

I have presented my concerns through conversations, emails and copies of scientific medical abstracts that support my assertions to your medical director. Finally, this past February, your medical director determined that I was a disruptive influence and had me fired. While private conversations with other providers find them to be in agreement with me, everyone seems to be afraid to speak up.

Since that time, I have appealed to the highest levels of Metro. They refuse to investigate. If they spoke with your medical director, I assume he assured them that everything was OK. However, asking the fox if everything is OK in the henhouse does not constitute an investigation. It would seem that your medical director is accountable to no one and people are afraid to stand up to him.

I spoke with the head of the Las Vegas Police Protective Association. While he seemed very interested, he has chosen not to investigate.

I sent a “complaint” to the Citizen Review Board. They very quickly responded that this was not in their jurisdiction.

I have been polite up to this point and very patient in the hopes that someone would step up and do the right thing. Hope is apparently not a good strategy.

Gentlemen, I am telling you in no uncertain terms, that your medical director is not providing you with the medical care he has promised. One of his comments to me was that “there has never been an officer that needed an emergent airway and no other patient has ever had medical harm from a lack of a definitive airway.” Ignoring a potential problem doesn’t make it go away. We all talk about being proactive instead of reactive. It is OK to hope for the best as long as you are prepared for the worst. We need better vetting and better ongoing training of our medical providers. I have provided solutions and volunteered to be involved in implementing those solutions. I have been continually ignored. Aren’t your lives and those of civilians who may be caught in the crossfire worth having the best possible medical care available?

I have exhausted the chain of command within Metro. According to the AMA Principles of Medical Ethics, physicians are ethically required to “strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities” and “recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient”.

In my humble and expert opinion, your medical director is engaging in unethical conduct and is not working in your best interests. His disregard for your well-being is unconscionable.

In addition, also in my opinion, with regards to this issue, there is a total lack of leadership from the office of the Sheriff. In general I would rather go along, get along and avoid controversy. I cannot in all good conscience let this go. While they may not have medical expertise, the department can certainly conduct an investigation. The health and welfare of their officers should be their paramount concern. I never wanted to go public. I just wanted the problem fixed. It is now up to you, my former patients, to demand the care you deserve and were promised.

I wish you all the best, and I’d be happy to discuss this matter with you anytime you wish.

Keep your heads down,