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April 20, 2015
Wis. ambulance service reprimanded in transport of kickboxer who died
By John Diedrich
MILWAUKEE, Wis. — Regulators have taken the rare step of issuing a letter of reprimand against Curtis Ambulance for failing to follow a state rule the night Dennis Munson Jr. died in his debut kickboxing bout in Milwaukee.
Curtis did not file a special event plan with the Wisconsin Department of Health Services for the March 2014 kickboxing event the company was hired to staff at the Eagles Club. State rules require an ambulance service to file such plans under certain circumstances to alert emergency response authorities of the event.
The state reprimand letter does not comment on the care the Curtis crew provided to Munson. But in response to a reporter's question, the department said it looked into all aspects of how Curtis handled the call and found the care was appropriate.
"In our all-inclusive review of the complaint, the only direct violation of (state rules and law) was the the lack of providing a special event plan," the statement said in part. "The care provided by Curtis Ambulance was within Scope of Practice and medically appropriate given the scenario."
James Baker, president of Curtis, said he will ask the state to rescind its reprimand for the lack of a special event plan, which he called "an overreach."
He said Curtis' crew handled the Munson call correctly and the company was not required to file a special event plan under state law. Baker said ambulance companies routinely do not file such plans and it was not fair to single out Curtis. He added such plans have little value.
"It doesn't matter at all if you file or not," he said. "The care you are going to do is going to be the same."
The state reprimand of Curtis, however, says such special event plans are important.
"Timely submission of a special event plan is essential to provide quality assurance and seamless patient care in the emergency medical services system," Frederick T. Hornby II, licensing administrator in the department's EMS section, wrote in the March 31 reprimand letter.
Milwaukee County Emergency Medical Services filed the complaint in December against Curtis. The county's complaint also said Curtis did not follow county EMS policies. It said the private company's paramedics should have taken Munson, who died of head trauma, to Froedtert Hospital, the area's Level 1 trauma center. Instead, the 24-year-old was taken to Aurora Sinai Medical Center, where he died.
The county's EMS director also has said Curtis waited too long to summon Milwaukee Fire Department paramedics for a serious case, as required under private ambulance companies' contract with the city.
Reprimands such as the one against Curtis are rare, according to figures from the state.
In the past five years, the department has investigated 125 complaints against Wisconsin ambulance companies, officials said. There have been three reprimands, including the one against Curtis. In that time, there have been three letters of warning — less serious than a reprimand. There also was one suspension, more serious than a reprimand. Three cases are pending.
In the letter to Curtis, Hornby wrote the reprimand will be kept in the company's file and may be considered if violations continue.
"Additional infractions of Administrative Rule or Statute may result in enforcement action up to and including revocation of your service's license," the letter said.
Baker said the reprimand is the first filed against Curtis and that he will fight to have it removed or ask that other ambulance companies be reprimanded for failing to file plans. He said under the state's rules, plans are required when doing an event outside of a service area or when special staffing is needed. The kickboxing event were Munson died was in Curtis' area and the staffing level was routine, he said.
Munson died after officials in charge of the unregulated three-round fight failed to stop the bout despite what a dozen independent national experts who reviewed a video of the match said were obvious signs of distress in the fighter, a Milwaukee Journal Sentinel investigation found.
The video shows the ringside doctor, Carlos Feliciano, looking at his cellphone at key moments during the fight; the corner coach, Scott Cushman, propping up Munson between rounds and slapping him after the fight, just before he collapsed; and referee Al Wichgers failing to evaluate Munson as his condition deteriorated.
Munson crumpled to the mat after the final bell, but medical treatment was delayed amid what records show were questions over his care and hang-ups exiting the 1920s-era building.
Curtis paramedics wanted to give Munson oxygen but Feliciano said no, and told them to prop him up, according to Curtis records.
When Munson collapsed, the Curtis crew didn't immediately call for a Milwaukee Fire Department ambulance, required under the city's contract with Curtis, according to county and city EMS officials. Instead, another Curtis unit was called. The Fire Department unit was called later, after Munson had become unconscious.
At the direction of Feliciano, Curtis paramedics waved off the fire crew and took Munson to Sinai, records show. Baker said Curtis paramedics never saw the Fire Department ambulance and Munson was taken to the correct hospital given the circumstances.
Feliciano's actions are under investigation by the state Medical Examining Board, which received a complaint from Munson's family.
State officials did not investigate Munson's death, saying they are powerless because Wisconsin does not regulate kickboxing. The state does oversee boxing and mixed martial arts, a combination of disciplines that include kickboxing.
A bipartisan bill that would regulate kickboxing and other combat sports — but exempt youth and recreational activities — has been introduced in the state Legislature. In its original form, the Legislative Fiscal Bureau said the measure would cost $360,000 a year to oversee the fights.
Roufusport, the gym where Munson trained and the promoter of the March 2014 fight, came out against the bill, saying it went too far by including all "unarmed combat sports."
The bill's author, state Rep. Joel Kleefisch (R-Oconomowoc), has amended the measure to cover only matches where blows to the head are allowed. The cost for oversight under the amended version would be $55,000 a year, a new fiscal estimate found. No hearing on the bill has been scheduled.
Milwaukee police investigated the Munson fight, but a county prosecutor said they found no basis to file criminal charges.
The Journal Sentinel investigation found in another unregulated match in November that a novice fighter with mental disabilities was promised $50 and a medal to fight an experienced kickboxer. He was quickly knocked out.
Following the reports, Milwaukee police opened another investigation and issued $699 tickets to promoters and venue operators for violating the city's ordinance governing "ultimate fighting."
The promoter from Roufusport, Scott Joffe, and Steven Tyczkowski, a representative of the Eagles Club, have pleaded not guilty to the tickets and are due in court in June.
See the video, read the investigation
To see the video of the fight that led to kickboxer Dennis Munson's death and to read the Journal Sentinel's "Death in the Ring" investigation and follow-up stories, go to jsonline.com/kickbox