She called 911 for an ambulance. She got a nightmare instead

When Pamela Hogan phoned 911 from her Seattle apartment, she was suffering from knee pain so intense she couldn’t stand up. She had been trapped in her bed all day, unable to eat, drink or get to the bathroom. Worried and alone, Hogan thought an ambulance would come quickly and take her to the hospital.

She was mistaken.

Seattle no longer is capping ambulance wait times for certain 911 patients, tracking those waits or penalizing its ambulance contractor when they run long.

Rather than send Hogan help right away, the Fire Department routed her to a nurse in Texas who determined her crisis didn’t need immediate attention.

So the 71-year-old, a retired executive assistant who loved cooking casseroles, watching “Judge Judy” and listening to The Pointer Sisters, waited one hour for a nurse-ordered ambulance, according to call recordings and court documents.

Two hours. Three hours. Four hours, phoning 911 back several times and telling the Fire Department about a heart condition. Ten hours.

By the time an ambulance arrived at Hogan’s building, it was the middle of the night and she wasn’t answering her phone. The ambulance left without her.

Weeks later, her body was found decomposing on the floor of her bedroom.

It’s not clear Hogan’s wait is what killed her, but her estate has sued and her experience raises questions about Seattle’s relationship with its for-profit ambulance contractor, American Medical Response, which also provides the city’s 911 nurse line.

“More checks and balances and accountability need to happen,” said Josephine Ensign, a professor emeritus at the University of Washington School of Nursing who called Hogan’s case concerning and upsetting. “Seattle can do better.”

Seattle and AMR have denied the lawsuit’s wrongful death allegations and say the nurse line is generally working as intended. They say it’s reducing strain on hospitals and ambulances by diverting low-level patients to more appropriate care.

But most Seattle callers triaged by the nurse line are still being sent to hospitals in AMR ambulances, rather than being diverted, program data reveals. And officials have exempted those nurse-ordered rides, like Hogan’s, from city standards that normally require the company’s ambulances to arrive on time.

It’s possible that Hogan’s experience was an aberration. But the city stopped tracking ambulance waits like hers in 2022, so officials have no way to know.

To examine these changes, The Seattle Times plumbed public records, analyzed Fire Department data and spoke to about two dozen experts and advocates across the nation, including 911 administrators, emergency medicine physicians and professionals, telephone triage specialists and health care watchdogs.

Many said Seattle’s system should be reviewed for transparency and safety. Some said that could be especially important as rising health care costs and federal cuts to social services threaten to increase reliance on 911.

“It does seem incredibly important to get to the bottom of how something like this could happen,” said Harold Pollack, a public health policy professor at the University of Chicago who co-directs the university’s Urban Health Lab.

When The Times shared results from its investigation with the Fire Department and AMR, including in a list of more than 125 bullet points, they declined to address any specific points, citing the litigation over Hogan’s death.

A Fire Department spokesperson said The Times’ reporting misrepresented the Nurse Navigation program but didn’t identify any errors. A spokesperson for AMR said the reporting was inaccurate but also didn’t identify any errors.

The audio clips in this story have been edited for brevity and clarity.