In August 2014, 37-year-old Tiffany Tate suffered a stroke while she was at work.
She was just 0.2 miles away from one of the top-ranked stroke centers in Milwaukee, Wisconsin – a three-minute drive – but her ambulance didn’t take her there.
Instead, the mother-of-two was taken to a hospital three miles away – an eight-minute drive – that provided limited stroke care.
Doctors were unable to treat her stoke and she was eventually placed in a nursing home. Four months after her stroke, Tate died.
Her death is now shining a light on a controversial practice in which patients in ambulances are turned away from ERs that deem themselves too busy.
An investigation from the Milwaukee Journal Sentinel found that so-called ambulance diversion still occurs in some of the nation’s largest cities, often leading to fatal consequences.
Tiffany Tate, 37 (pictured, right, with her daughter Octayvia Fountain), from Milwaukee, Wisconsin, suffered a stroke in August 2014 while at work at the Medical College of Wisconsin
The cafeteria was 0.2 miles away from Froedtert Hospital, one of the best-ranked stroke care centers in the state. But Froedtert was on ambulance diversion, so Tate (left and right) was taken to a hospital with more limited care that was three miles away
On the morning of her stroke, Tate was at work at the cafeteria at Medical College of Wisconsin in Milwaukee, reported the Journal Sentinel.
Around 8.15 am, she began showing the first signs, including slurred speech and left-sided facial droopiness. Paramedics didn’t arrive until nearly 45 minutes later.
The cafeteria was on the grounds of the Milwaukee Regional Medical Center and 0.2 miles away from Froedtert Hospital, one of the best-ranked stroke care centers in the state
Froedtert was just a seven-minute walk and a three-minute drive away. But she wasn’t taken there.
The ambulance took her to Aurora West Allis Medical Center, which was about three miles away – an eight-minute drive and an hour-and-nine minute walk.
She arrived at 9.23am, more than an hour after she showed her first signs of the stroke.
Tate was victim to a practice first introduced in the 1980s known as ambulance diversion.
When hospitals determine they are too busy to see any additional patients, they temporarily close their emergency departments to incoming ambulances.
That means an ambulance may not always take a patient to the nearest available hospital.
In the US, under federal law, patients who arrive in the emergency room are required to be treated – but the law does not apply should you arrive in an ambulance.
HOW CAN F.A.S.T. SAVE YOU DURING A STROKE?
The main symptoms of stroke can be remembered with the word F.A.S.T.
This will help you more quickly identify someone having a stroke.
- Face: Ask the person to smile and see if their mouth or eye droops
- Arms: Ask the person to raise both arms. They may not be able to lift both arms and keep them there because of weakness or numbness
- Speech: Ask the person to repeat a simple phrase and see if their speech is slurred or garbled
- Time: If you observe any of these signs or symptoms, it’s time to call 911 immediately
Source: National Stroke Association
Doctors at West Allis tried to administer a drug that breaks up clots via an IV but stopped when bleeding was detected in her brain.
The Journal Sentinel reported that the hospital’s policy was to transfer patients suffering a serious stroke to a hospital with more advanced care: Froedtert, Aurora St Luke’s Medical Center or St Mary’s Hospital.
Because Froedtert was on diversion, hospital staff determined St Luke’s – which was five miles away – was the closest.
By the time a private ambulance arrived to transfer her, she was unconscious.
She didn’t arrive until 11.55am, nearly four hours after her stroke occurred.
There, doctors tried to use a small catheter to remove the clot, but they were unsuccessful.
They also tried to remove part of her skull to relieve the pressure from the bleeding in her brain.
Nothing worked. The effects of the stroke couldn’t be reversed.
Tate was first transferred to a long-term care facility and then a nursing home in Glendale – about 12 miles away from Milwaukee.
She died on December 9, nearly four months after she first suffered her stroke.
Dr Maria Raven, an emergency medicine physician University of California San Francisco, told the Journal Sentinel that the ambulance should have been allowed to take Tate to Froedtert.
‘To my mind, they shouldn’t be a Comprehensive Stroke Center if they can close,’ she said. ‘Either you can be one or can’t be. People can’t control when they have their stroke.’
Froedtert began its diversion at around 2am, only allowing exception for women in labor and trauma victims. It didn’t lift until after 7pm, according to the Journal Sentinel.
Doctors later sent Tate (pictured) to a more advanced center, but the stroke caused irreversible damage. Tate was transferred to long-term care facility and then a nursing home, where she died in December 2014
Ambulance diversion occurs when hospitals determine they are too busy and temporarily close their emergency departments to incoming ambulances. On the day of Tate’s stroke, Froedtert (pictured) was on diversion from 2am to 7pm
The newspaper found that six other hospitals in Milwaukee went on diversion for at least part of the day – even though the practice ended in Milwaukee County in 2016.
Additionally, its investigation found that 16 of the 25 largest cities in the US allow some form of ambulance diversion.
This can lead to devastating consequences.
A 2017 study from the University of California at San Francisco found that black patients were more likely to die than white patients from a heart attacks because hospitals in minority neighborhoods were more likely to be in diversion.
It can never be known if Tate would have survived if she had gone to Froedtert, but both her family and doctors believed her chance of survival would have increased.
‘Why are they turning away ambulance patients when people like my sister are having a stroke?’ her brother, David Tate, told the Journal Sentinel.
‘It didn’t make any sense to me. Damn, she was at Froedtert. She works there. She was right there.’