Seattle, WA
Seattle patient’s 10-hour wait for ambulance raises concerns about 911 triage systems
By Daniel Beekman
The Seattle Times
SEATTLE — A Seattle woman’s nightmarish ambulance wait in the days before her death might have played out differently in another community, because U.S. cities have set up their 911 systems and nurse lines in various ways.
Many cities, like Seattle, have added 911 nurse lines in recent years to divert low-level patients away from crowded hospitals. But some have equipped their systems with more protections against extreme delays, like the 10 hours a woman named Pamela Hogan waited for a nurse-ordered ambulance in 2022.
| EARLIER: 10-hour ambulance delay puts Seattle’s 911 call triage under scrutiny
It’s not clear that Hogan’s wait is what caused her death, but her estate is suing and her ordeal is raising questions about the city’s 911 medical system.
As Seattle leaders like new Mayor Katie Wilson deal with scrutiny over Hogan’s case and as additional communities consider adding 911 nurse lines, they may be able to learn from choices by policymakers elsewhere.
The Seattle Fire Department and its ambulance contractor, American Medical Response, say they’re generally guiding 911 patients to appropriate care. They declined to comment on Hogan’s case and a Seattle Times investigation.
But in Washington, D.C., as well as closer to home in Washington state and in other places, there are examples of more cautious approaches, say independent experts, including emergency response leaders and health care watchdogs.
“When we call our local Fire Department, we don’t expect to be passed off to a multibillion-dollar corporation without public oversight or transparency,” said Emily Brice, co-executive director of Northwest Health Law Advocates.
In Seattle
Seattle’s Nurse Navigation program went live in 2022 and is operated by the parent company of the city’s for-profit ambulance contractor, AMR.
When someone phones 911 with a low-level medical problem, Fire Department dispatchers can now route the call to a nurse. The nurse can try to resolve the problem with options like telemedicine or an Uber ride to a clinic.
Or the nurse can order an ambulance from the company’s dispatch office.
| Nurse Navigation Program
AMR was already providing ambulances for Seattle, but the nurse line was new. Before it launched, AMR was racking up financial penalties for violating the city’s contractual time standards, which said ambulances had to arrive within an hour.
Seattle and AMR officials promised the nurse line would relieve pressure on ambulance crews and thereby reduce delays to patients with more serious needs. They didn’t publicize some important details, however.
AMR’s nurses are located at a call center in Texas. They order ambulances for most patients they triage: more than 4,600 last year. And Seattle officials have excluded the nurse-ordered ambulances from the city’s time standards, giving the company more operational flexibility and shielding it from late penalties, experts say.
Patients like Hogan can’t update the nurse line directly as their conditions evolve, their AMR ambulances aren’t subject to contractual penalties for delays and the Fire Department doesn’t document how long the rides end up taking.
Those details and staffing issues may help explain why Hogan waited so long on a busy night, despite a nurse recommending she get care within four hours and despite Hogan calling 911 back multiple times, some experts said.
“If you don’t track it, you don’t know what’s happening,” added Cheryl Kauffman, who owns the health care consulting service Seattle Patient Advocates, describing the city’s setup as “a perfect recipe for poor outcomes.”
In other cities
Nurse lines and 911 systems vary from place to place. For example, Spokane uses AMR and exempts nurse-ordered ambulances from strict time limits, like Seattle does. But Vancouver, Wash., also uses AMR and doesn’t do that.
When the nurses order ambulances for Vancouver patients, the city’s time standards apply, the wait times are tracked and AMR can be penalized for delays, said Michelle Bresee, an emergency medical services analyst at the city.
“They’re still a person waiting for service and we want to make sure that person gets a response in a reasonable amount of time,” Bresee said.
Washington, D.C., also maintains ambulance wait standards and reporting, directing nurses to bounce patients back to 911 for ambulance dispatching.
“We want every call to have the same response standards,” said David Vitberg, the district’s Fire Department medical director and the lead editor of a textbook on emergency care and transportation. “There’s an inherent risk in not holding (ambulance) units to some sort of response time metric.”
D.C. requires AMR’s parent company to embed a nurse in the district’s 911 center, integrate its computer system with the district’s and check medical histories to help triage patients. Seattle’s contract lacks those guardrails.
In Fort Worth, Texas, the 911 agency maintained time standards for nurse-ordered ambulances and built its nurse line in-house to guard against potential communication gaps, said former administrator Matt Zavadsky, who set up that system. Seattle couldn’t afford to do that, the Fire Department said.
Fort Worth automatically upgraded its responses based on triggers like repeated callbacks or unexpected ambulance delays, sometimes routing a patient back to a nurse or sending a paramedic to check on them, said Zavadsky, now a nationally recognized consultant on emergency medical systems. Seattle’s system has no such automatic triggers, the Fire Department said.
There are other considerations, said Conrad Fivaz, medical director for Priority Solutions, another nurse-line vendor that operates internationally.
Priority Solutions only works with 911 agencies that employ nurses in-house, integrate their computer systems and are accredited by the International Academy of Emergency Dispatch, Fivaz said. Seattle doesn’t tick those boxes, he said.
Priority Solutions also only works with registered nurses, Fivaz added, whereas AMR has used less-qualified nurses for some patients. Josephine Ensign, professor emeritus at the University of Washington School of Nursing, said she believes nurses assigned to triage vulnerable 911 patients should hold Bachelor of Science degrees in nursing with training in public and community health.
“You have to put things in place to mitigate the risk,” Fivaz said.
What’s next
Ken Miller worked with AMR to launch a nurse line when he served as medical director for the 911 system in Santa Clara County, Calif.
His system agreed to a contract like Seattle’s, exempting nurse-ordered ambulances from time standards, said Miller, who’s since left the county.
But Miller was “never satisfied I had enough transparency,” he said, describing what happened to Hogan in Seattle as his “nightmare” scenario.
“This goes beyond Seattle,” as cities across the U.S. continue experimenting with nurse triage lines to reduce strain on 911 systems, said Miller, who has served on the National Emergency Medical Systems Advisory Council.
A nurse-ordered ambulance should at least be required to reach a patient within whatever period the patient’s nurse recommends, some experts said.
“If your own staff say the patient needs care within this time frame, you should provide that,” said Amber Sabbatini, an associate professor of emergency medicine at the University of Washington who researches health care systems.
Seattle just missed a potential opportunity to secure more accountability, because officials signed a new, five-year contract with AMR in September and chose to continue exempting nurse-ordered ambulances from oversight.
But with a new mayor, city attorney and two new City Council members, it’s possible Seattle leaders will revisit the matter.
Kevin Mackey, medical director for the Sacramento Fire Department, said Seattle’s 911 system enjoys a stellar reputation; its Medic One program broke ground decades ago by training firefighters as paramedics. Yet he agreed with other experts that Hogan’s case and Seattle’s guidelines are worthy of review.
“The public expectation should not and cannot be perfection,” Mackey said. “But it also should not and cannot be that people are going to die.”
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First Due named to Government Technology’s 2026 GovTech 100 for second consecutive year
Seattle, WA
VIDEO: Mayor Wilson proposes renewing, expanding Seattle Transit Measure by doubling the sales-tax percentage that funds it.
Through the end of this year, 0.15% of the sales tax you pay funds the voter-approved Seattle Transit Measure. That would double to 0.30% if the City Council and Seattle voters approve the renewal/expansion that Mayor Katie Wilson officially introduced this afternoon. She said it’ll make living in Seattle more affordable by enabling more people to “live car-free or car-light.” She acknowledged that raising the sales tax isn’t ideal but noted that it’s one of the few revenue-raising tools available under state law. Besides paying for more transit – 280,000 additional Metro bus trips a year, 100,000 more than the current measure funds – it also would pay for 22,000 free ORCA transit passes, more than double what the city provides now, said acting SDOT director Angela Brady during the announcement event at City Hall. The passes are now available to Seattle Promise scholars, low-income Seattle Preschool Program families, and Seattle Housing Authority residents. The measure’s renewal/expansion would also make those passes available to Housing Choice Voucher participants.
The mayor’s announcement says the Transit Measure isn’t just about buses: It also would “support the design and delivery of Sound Transit’s West Seattle Link Extension, Ballard Link Extension, and Graham Street Station.” The 0.30% sales tax would generate an estimated $138 million average per year for the 10 years of this measure, which is proposed to go to voters in November. Council review starts this Thursday and will be led by District 1 City Councilmember Rob Saka, who chairs the council committee that oversees transportation. We’ll add the specific text of the proposal when we get it; the slide deck for Thursday’s council meeting is now available, and we’ll add some highlights from that soon.
SEATTLE — With less than two weeks before Seattle hosts matches during the 2026 FIFA Men’s World Cup, Seattle City Council Public Safety Committee Chair Bob Kettle is escalating his criticism of Mayor Katie Wilson’s decision not to activate newly installed CCTV cameras in the Stadium District and suggesting she is violating established law.
In a sharply worded letter sent Monday, Kettle argues that the mayor’s decision to pause activation of the city’s Technology-Assisted Public Safety Pilot Program is inconsistent with city law and the ordinances approved by the Seattle City Council.
RELATED | Mayor Wilson hosts discussion on surveillance and security, takes questions from public
“I believe that she is not operating according to the ordinances, the law with respect to the stadium ordinances, and her duties under the charter,” Kettle said in an interview on Tuesday.
The dispute centers on 22 CCTV cameras that have already been installed in and around Seattle’s Stadium District but remain inactive as city leaders debate privacy concerns and the circumstances under which the system should be used.
Kettle said the approaching World Cup is what prompted him to send the letter.
“Basically, we’re less than two weeks out from the World Cup, and we’re not ready,” Kettle said. “We have capacity with these stadium cameras, they’re up, they’re installed, but they’re not turned on.”
In his letter, Kettle argues that the council already approved the surveillance technology through council-approved ordinances, specifically outlining the limited circumstances under which the program can be paused.
According to Kettle, those conditions include situations where the city is compelled to release camera data for civil immigration enforcement, gender-affirming care investigations, or reproductive healthcare matters, or when city leaders determine the technology is being used for those purposes.
RELATED | City leaders say Seattle ready for World Cup, despite concerns with surveillance, drones
“Neither condition has occurred that would merit a temporary program pause,” Kettle wrote.
The councilmember contends that the Seattle Municipal Code and the approved surveillance impact report provide no authority for the mayor to indefinitely delay the program’s implementation beyond those specified exceptions.
The mayor’s office has defended its position, saying activation decisions will be guided by public safety experts and intelligence assessments ahead of the World Cup.
“Mayor Wilson continues to consult public safety officials regarding circumstances that might warrant use of the expanded set of cameras during the FIFA World Cup,” the mayor’s office said in a previous statement. “We appreciate councilmembers’ perspectives, and those will be part of ongoing discussions.”
The previous statement continued:
“With regard to credible threats: Identifying a credible threat involves multiple experts from federal, state, and local agencies monitoring and assessing various streams of information. In collaboration with one another, they weigh incoming intelligence and jointly recommend whether to elevate security operations. Mayor Wilson’s decision whether to activate the Stadium District cameras will be informed by this group’s recommendation.”
The mayor’s office has been asked if there is a change in perspective given Kettle’s letter. In a new statement obtained by KOMO News on Tuesday, the mayor’s office said Wilson’s position remains “unchanged.”
“Per our legal review, we believe council has the authority to pause the use of adopted surveillance technology but cannot require its use,” the mayor’s office said in Tuesday’s statement. “The Mayor is ensuring that our use of surveillance technology is protective of civil rights, liberties, and privacy and provides sufficient data privacy safeguards. The Mayor has a duty to make sure our use of these technologies is responsible.”
Kettle argues that waiting for a specific threat before activating the cameras misunderstands modern security planning.
SEE ALSO | Seattle mayor’s verbal missteps prompt national and viral attention, leadership questions
“There are credible concerns,” Kettle said, citing worries about drones and other security issues surrounding a major international event.
He pointed to examples, including the 1996 Atlanta Olympic bombing and the 2013 Boston Marathon bombing, arguing that public officials often do not receive advance warning before attacks occur.
“This idea that you’re going to get a credible threat warning is not right. It’s not the professional standard,” Kettle said. “The 22 cameras are installed, they’re ready to go, they just need to be turned on.”
Opponents of the camera expansion have raised concerns that footage could potentially be sought by federal immigration authorities or used in ways that conflict with Seattle’s sanctuary city policies.
Kettle dismissed those concerns, arguing that the council built extensive safeguards into the legislation governing the cameras.
“We don’t have facial recognition,” Kettle said, noting the city established restrictions and oversight measures as part of the technology program.
He also argued that federal agencies have their own surveillance capabilities and do not need Seattle’s camera network to conduct enforcement operations.
Kettle said he sought legal guidance before sending the letter and believes the mayor’s decision is inconsistent with the ordinances governing the program.
“I asked the question, if Mayor Harrell had to do all this in terms of ordinances, why is it that Mayor Wilson does not?” Kettle said. He said attorneys reviewing the issue identified concerns centered on the language governing when the program may be “paused.”
While Kettle stopped short of calling for legal action against the mayor, he said he wanted to publicly highlight what he views as a conflict between the administration’s actions and council-approved law.
“Her move related to the pause is not right, and essentially a violation,” Kettle said.
Kettle said Seattle is the only one of the 11 World Cup host cities that does not have its full camera system operational and warned that the city is running out of time.
“We have to take action now to get ourselves ready for the World Cup,” he said. “That is ensuring that we have all the pieces in place, and that we’re using the capacities that we have to their full ability.”
Kettle said he was scheduled to meet with members of the mayor’s team on Tuesday and hopes a resolution can be reached before the first World Cup matches arrive in Seattle.
Seattle, WA
Melinda French Gates is done ‘cheering on Seattle from the sidelines’ — she’s buying into the bet to bring the Sonics back | Fortune
Melinda French Gates, a billionaire philanthropist and businesswoman, will join the Seattle Kraken as a minority investor, pending NHL approval.
French Gates, 61, is the ex-wife of Microsoft co-founder Bill Gates. She and her $30 billion net worth, according to Forbes, join an ownership group headlined by majority owner and managing partner Samantha Holloway, as well as investors David Wright, Andy Jassy and longtime Hollywood producer Jerry Bruckheimer.
“As a longtime Seattle resident, it means a lot to me to have the chance to make this investment in our city and its future,” French Gates said in a statement. “I’m a big believer in the power of sports, and after many years of cheering on Seattle from the sidelines, I’m excited to have an even deeper connection to the Seattle sports community.”
French Gates has never previously had an ownership stake in a major professional sports franchise. She will do so at a time when the Kraken ownership group is positioning itself to own an NBA franchise should the NBA return to the Emerald City for the first time since the SuperSonics were relocated to Oklahoma City nearly 20 years ago.
In March, the Kraken ownership group announced the creation of One Roof Sports and Entertainment, which serves as the umbrella brand of the organization to “oversee a growing portfolio of properties and fuel new opportunities.” At the time, Holloway announced that One Roof would pursue an NBA team in Seattle, should the league move forward with expansion.
Holloway also announced in March that the group had entered an agreement to purchase additional equity in Climate Pledge Arena from Oak View Group, and would make the organization the majority owner of the building. OVG has retained a minority stake.
French Gates, who grew up in Dallas and received a bachelor’s degree in computer science and economics, as well as an MBA from Duke, currently heads Pivotal, a group of organizations she founded to accelerate the pace of social progress for women and young people in the United States and around the world.
French Gates previously founded and co-chaired the Gates Foundation, the world’s largest philanthropy.
“I am excited to welcome Melinda to our ownership group,” Holloway said in a statement. “Melinda is an impressive business leader, philanthropist and importantly, a Seattle sports fan. We share many of the same values, including a deep commitment to Seattle and a belief in building organizations that create lasting impact.”
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