How Many More Scandals Before We Take Screening Seriously?

Scrolling through my Twitter news feeds, I cringed when a Buffalo area news station popped up with an EMT scandal.  This one took place at Twin City Ambulance, where EMT James Fagerburg was arrested for molesting a 14 year-old girl.  He allegedly met her on the internet, drove 6 hours to meet her, performed sexual acts, and gave her a cell phone to text lewd pictures to him.  Like the pyro-medics who set buildings on fire while on duty at Twin City’s competitor, Rural/Metro of WNY, he was arrested at their headquarters.

Sexual deviance and pyromania have a fairly consistent pattern that can be detected in a law-enforcement like screening process.  No process is perfect, but lighting shouldn’t strike more than a few times.  Fagerburg is not the first Twin City employee whose name was in the newspaper after being arrested for sexual assault, so apparently they have not learned enough from those experiences.  I imagine Twin City and R/M’s screening process is similar to many others across the country – not in depth.  I beat up on them because I have a personal stake in the quality of their people.  My parents, grandparents, aunts, uncles and cousins all live in areas covered by Twin City.

A few years ago I got a phone call from my mother to tell me they had called 911 after my grandfather passed out.  In the background I heard a Twin City paramedic explain to my grandfather, who had dementia and diabetes, why he did not need to go to the hospital and could call his doctor on Monday.  I told my mother to sign their refusal form, ask them to leave, and to drive him to the hospital herself.

Fagerburg’s victim was 14.  My cousin has Wolff Parkinson White Syndrome, and at age 15 was treated by a Twin City paramedic for an episode of tachycardia.  I already worry about who is going to show up at my elderly relatives’ house, now I have to worry about the adolescents too.

Where I work now, the application process is similar to the one for police applicants.  I had to explain each incidence of juvenile indiscretion, and my answers were investigated by a police background investigator.  Considering our responsibilities, and how often we operate alone with all sorts of vulnerable people, why isn’t that standard?

I know that some of the top people at Twin City are good people who do the best they can with the resources they have.  But industry wide, this is no longer good enough.  By writing this, I hope that some of my WNY readers will call their politicians and demand that applicants to their EMS service go though the same screening process that their local police applicants do.  I also hope that some of my forward-thinking EMS readers demand this from the service they work for.

Because at the worst moment of a loved one’s life, you shouldn’t have to worry about an arsonist or child molester showing up at their house.



  1. Skip Kirkwood says:

    My family also (mom and dad, brothers, sisters, nieces, nephews, grandnieces, grandnephews) all live in the same community.

    Time to get on my soapbox!!!!

    If you lead an EMS agency – you MUST perform adequate background checks on potential hires. What’s a adequate? Find out what the best law enforcement agency in your area does, then do AT LEAST that. EMSers have more, unsupervised, uncontrolled access to vulnerable people that LEOs do any day. If you don’t, be prepared to learn about the tort of “negligent hiring” and perhaps “negligent supervision” and “negligent retention.”

    You can’t prevent somebody from going bad during employment, but you can make every effort to hire people whose background includes demonstrated good character!

    Get some training!

  2. I agree with Skip. It saddens me that a place I grew up and submit within the palms of my hands the lives of my friends and family that such an atrocity would occur. It is true that any industry has its leadership all the way down to those with boots on the ground that have been a “victim” of the Peter Principle. Background checks should absolutely be a prerequisite in hiring.

    HOWEVER, New York State is incredibly backward in their lobby-driven priorities. EMS in Western NY will never be put in the same category as the any police or fire agency. The state spends BILLIONS on benefits and wages for services far less important than EMS.

    While Cuomo pontificates over casinos, a crises has been brewing over an issue as important and with the same ramifications of the hospitals, fire or police departments. I am all for free enterprise – especially in a tax-driven state like NY. But EMS is public safety and if the private agencies worry more about profit than safety (including employees, equipment, care delivery, leadership, etc) then explain to me why we fund with tax dollars pork-barrels of a million sizes while the community is deprived of one of the most maligned yet critical services for the populous. Morbidity and mortality can be determined (long and short term) by pre-hospital services. Take one look at a model such as Seattle, Austin-Travis County TX or Wake County NC and every bit of data and truth about what’s best for the citizens of Western NY lies in making EMS an integral part of allied health, supported, lead and funded properly,

    • emspatientperspective says:


      I agree with much of what you said, but you cannot say that the police and fire service is less important than EMS. They’ve united to lobby for their benefits, and I don’t want to take theirs away. I just want some more for us.

      Some of those pork-barrel projects in WNY are volunteer fire departments. Within a short walk of my grandfather’s house in Amherst, where a Twin City paramedic somehow determined that he did not need to go to the hospital after passing out, are four brand new-shiny fire engines, a ladder truck, heavy rescue truck, and BLS first response unit. There are 10 other stations just like it, but not a dime of tax money goes towards their paramedics.

      Some of my family members are lucky enough to live in the Town of Tonawanda. While not the most affluent community, somehow it supports municipal paramedics who go through a police-like application process. It’s all about priorities.

      As far as measuring outcomes, check out this article about measuring EMS system performance.. My dream is for people to go to their politicians and ask how many STEMI patients are taken to a hospital with a cath lab, how many seizure patients get a benzo, and how many CHF patients get CPAP from their EMS system.

  3. “…but you cannot say that the police and fire service is less important than EMS.” They share equality in that they’re Public Safety. You proved my point without saying the obvious… Paramedics that see a high volume of patients and areas where UHU is high should be setting the standard. Funding to a fire truck (or ambulance) that sits in a garage and looks pretty while the high volume areas use an antiquated model to deliver care is grossly unbalanced (and unethical) economies of scale. The “haves” and the “have nots” aside, it should be about a county-wide governing of credentials based on the determination of an unbiased medical director, call volume experienced by the individual and testing for written, critical thinking and skills evaluations to function in that ENTIRE system (Erie County) at ANY level. Said medical directors sole function should be the credentialling, QA and background checks (with cooperation and standards expressed to all agency chiefs and designees) for determining who should function in the system. When funding is taken away from the privates and the fifedome of the volunteers and put into the hands of the “Office of the (full time) Erie County EMS Medical Director” … My how things would change. It would initially make both sides unhappy but ultimately patient care and evidence based medicine would win. Then you would have survival statistics that are mentioned throughout the literature of the aforementioned systems. (Seattle WA, Ausstin/Travis TX, Wake County NC) THAT is what it should be about. The drama surrounding who is better and who should have the money works in the business world, but NOT in EMS. Every bit of research is finding this truth.

    • emspatientperspective says:

      Bad systems that exist in WNY and many other areas survive because the field providers allow them to. I wrote about this in my EMS Week Post. . People work 60-80 hours a week, every week, and then do EMS for free on their days off. If everyone in EMS worked no more than 48 hours a week, the broken system would break. If it’s really about the money, bar tend or deliver pizzas instead of taking overtime. EMS people also need to get educated. A bachelor’s degree would go a long way to educating the money counters about where EMS makes a difference, and why a full-time medical director is valuable. Higher salaries would follow. Finally, get involved with NAEMT. That’s our voice, and we only deserve the salary and benefits that we’re willing to fight for and earn.

  4. Skip Kirkwood says:

    This is OUR problem. If it’s gonna get fixed, WE gotta fix it. Is that possible? Or am I just wasting my energy?

    Sometimes it seems like folks are so busy talking smack about each other, etc., etc., that they won’t do anything that involves effort or some slight self-deprivation to help make EMS better.

    What’s that all about, anyway?

    • emspatientperspective says:

      I certainly hope this can be fixed. I came close to nursing or PA school several times after thinking the EMS situation was hopeless. On the other hand, I’ve met a lot of good people who are in a position to chart the course of a relatively new profession. That’s something I get excited about. With my little corner of the internet, I hope my EMS and non-EMS readers will get pissed off enough to prevent child molesters and arsonists from being put in a position of trust.

  5. emspatientperspective says:

    Check out what 9-ECHO-1 had to say about this…

  6. Julie Vega says:

    According to this article, you think if they did a background check they would have found out Jim had a record. The sick sad truth is: He didn’t. I have known him for over 20 years. He was always an outstanding young man. In the 20 years I have known him, he has NEVER been arrested, or accused of anything of this caliber or for any other reason. If they preformed a background check, it would have come up clean (and they DID perform a background check when he was hired, if you asked him you would have known that, but OH WAIT none of you have ever actually MET him.) Before people start shooting off at the mouth about people they have NEVER EVER met, You should at least LEARN about the person you are slandering. I’m not excusing what he did (or didn’t do because a LOT of what the news said was just NOT TRUE), but the ONLY person who knew WHY he did it and what actually happened, is HIM an and those who are close to him and actually KNEW him. He will do his time, like he deserves, no doubt about that. But if you didn’t live through this nightmare with the family, than shut the fuck up about things you know NOTHING about.

    • emspatientperspective says:


      My intention with this post is to point out how different the screening process at many EMS services is from law enforcement. It is not to defame the character of someone I do not know.

      Regarding the background checks, there is a difference between a check of arrest and driving records and a screening process designed to weed out people who do what the nice young man you know are accused of. I am more frustrated with my profession’s unwillingness to invest as much in screening applicants as our law enforcement colleagues do. The BTK killer (blind, torture, kill) applied to several police departments and was weeded out, but was hired as a dog catcher. If he had been certified as an EMT, there are lots of services that would have hired him.

      I generally do not approve comments with curse words, but I’ll make an exception for yours. I actually do know a few things about the service your friend worked for, and the other ambulance service in Buffalo. I used to work for one of them. I know that this is not the first publicized case of sexual predators being placed in positions of trust at those services, who were alone in the back of ambulances with vulnerable patients. I also know that one company had two people set fires to buildings while they were on duty, and then tried to cover it up. Law enforcement screening processes are designed to find these things. They aren’t perfect, but it’s better than not trying.

      I really don’t care what your friend did or didn’t do. I just want to make sure people like him don’t show up at my parent’s house.

    • No one attacked your friend Julie. Nothing above is slanderous in any way and it appears you missed the rest of the conversation in regards to the other providers who were not exactly forht coming in being a patient advocate. Your “friend” may have presented to the public a persona of being “normal” by not having a record per se…this does not mean when a background check was performed and he came up clean that he did not have a certain psychological “tell” that would have flagged anyone doing an investigation. I agree with all, a more police-like or intense form of background check to include psychological screening is completely necessary when they are to hold positions where public safety is concerned. After all, it is our practice, our oath to do no harm in whatever capacity we work in the medical field. I reckon the tables would be turned and you would not be as defensive if it had been your child who was sexually assaulted by this man with a clean record.

      Regardless, this is a forum for civil discussion…not for taking things the wrong way.

  7. Skip Kirkwood says:

    Yep. And nobody slandered anybody. Is anything anyone said above untrue? Then it’s not slander. I’m sorry if you don’t like the discussion, but it is fair discussion.

    There is more to a comprehensive background investigation than a “records check.” There is the part where a trained investigator interviews people and asks the right questions. There is the part where the applicant gets a psychological examination (which can be VERY accurate at ferreting out undisclosed psychiatric disorders).

    The point is that most EMS agencies don’t do much, if any, of what could be done to protect the public from dangerous people in positions of trust.

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