Honolulu EMS sued for negligent homicide in connection with ambulance fire in Kailua

The estate of a 91-year-old patient who died in an ambulance fire in 2022 has filed a wrongful death lawsuit against the Honolulu Emergency Services Department.

Fred Kaneshiro of Waimanalo died after an oxygen tank malfunction caused an explosion in the back of an ambulance as he was being transported to Adventist Health Castle Hospital in Kailua on August 24, 2022.

The lawsuit accuses Honolulu EMS of failing to provide a safe environment for patients, improperly using medical equipment, and failing to adequately train its employees in the use of oxygen cylinders and tanks.

The paramedics who manned the ambulance carrying Kaneshiro were also named as defendants. The complaint states that they failed to “protect, assist and/or rescue Mr. Kaneshiro from injury, harm and/or death.”

Ambulance fire report, ambulance oxygen equipment, Honolulu EMS Director Dr. Jim Ireland, Honolulu Police Chief Arthur "Joe" Logan and Ocean Safety Lifeguard Association Deputy Director Ian Santee explain the oxygen equipment found in Honolulu ambulances. — Honolulu EMS Director Jim Ireland (right), Honolulu Police Chief Joe Logan and Honolulu Deputy EMS Director Ian Santee (left) explain the oxygen equipment used in the city's ambulances after the deadly fire in 2022. The deceased patient's estate has accused Honolulu EMS of negligence and wrongful death. (David Croxford/Civil Beat/2022)

The lawsuit also names several medical device manufacturers as defendants, claiming they failed to develop safe devices and adequately warn about the dangers of their products. The companies, ProRack Gas Control Products, Airgas Inc., Air Liquide, Bound Tree, Meret USA and Rescue Safety Pacific Inc., did not respond to calls and emails seeking comment.

Honolulu Emergency Services spokeswoman Shayne Enright said the department had not yet received the lawsuit and declined to comment. Attorneys for the paramedics were not listed in court filings.

The fire occurred after paramedics Peter Matsuura and Jeffrey Wilkinson were called to the Windward City Shopping Center in Kaneohe to assist Kaneshiro with a medical issue, according to the complaint filed Friday in First Circuit Court on Oahu.

They said they gave him oxygen through a non-rebreathing mask connected to a portable oxygen cylinder, strapped him to a stretcher and loaded him into the ambulance.

On August 24, an ambulance caught fire in front of the Adventist Health Castle in Kailua. — Kaneshiro was strapped to a stretcher in the ambulance when the patient compartment burst into flames. (Hawaii News Now/2022)

On the way to the hospital, Wilkinson changed Kaneshiro's oxygen source from the non-rebreathing mask to a different type of mask that got its oxygen not from a portable cylinder but from a system in the ambulance.

As the ambulance approached the hospital parking lot, Wilkinson began reconnecting Kaneshiro to a portable oxygen source to take him to the emergency room. As Wilkinson held the ambulance oxygen source connector to the portable source's hose, an explosion occurred, followed by a bright flash and a “violent fire” in the ambulance's patient compartment, the complaint states.

A plexiglass panel separating the driver's compartment from the patient compartment blew out and black smoke filled the driver's cabin. The valve on the portable oxygen cylinder had been left open and the gas fueled the flames. It “acted like a large flamethrower and easily and quickly ignited surrounding materials,” the complaint states.

Wilkinson jumped out of the vehicle and ran to the emergency room while Kaneshiro remained “helpless and trapped” and strapped to the stretcher inside, according to the indictment.

His death was pronounced later that day. Wilkinson suffered severe burns.

City officials said the fire was an accident.

In March of the following year, Honolulu EMS released the results of a study conducted by the nonprofit medical advisory organization ECRI.

Fred Seiko Kaneshiro lived on a farm in Waimanalo from the early 1950s until his death. (Courtesy of Roberta Kinoshita)

Investigators concluded that contaminants such as oil, grease or dirt in the oxygen tank or valve could have contributed to the explosion. They put forward two theories as to the possible cause of the explosion.

One of them was adiabatic compression, or “gas hammer effect,” which occurs when oxygen enters a device’s regulator or hose, causing a momentary increase in pressure and heat, potentially igniting contaminants in the system.

The other explanation was particle impact, which can occur when oxygen leaves the bottle too quickly, pushing out contaminants and metal shavings that collide with other surfaces.

Honolulu Emergency Medical Services changed its policy after the incident, instructing paramedics to open oxygen cylinders slowly, turn on an exhaust fan when using the gas, and change patients' oxygen cylinders only when the ambulance is parked and the doors are open.

Kaneshiro's niece, Roberta Kinoshita, described her uncle in an email as “quiet, soft-spoken and reserved.”

He was born on Maui and had three sisters and two brothers, she wrote. In the early 1950s, he purchased a farm in Waimanalo where he and his mother grew watermelons, winter melons, corn, soybeans, bananas and papayas. He lived on the farm until his death.

The lawsuit demands damages of an unknown amount.

Read the complaint below: