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Tuesday, March 14, 2006

Conflict of Interest

Conflict of Interest

During the fall of 2001 many people told me that Dr. George Hevesy was receiving a salary from Advanced Medical Transport (AMT). This seemed unbelievable to me. They usually followed up their statements with, “You know this is conflict of interest”. Another physician in the OSF ER screamed at me in anger about Hevesy’s conflict.

Hevesy was wearing many hats. He was the newly appointed Director of the ER at OSF and had been the Project Medical Director (PMD), for about 10 years. As PMD he was in charge of all the ambulances in central Illinois—approximately 70 agencies. Hevesy was (and is) Corporate Medical Director of AMT. The following year, OSF-SFMC would appoint him as President of the Medical Staff at OSF.

I filed under the FOIA at the Illinois Department of Public Health in Springfield for a conflict of interest statement. The document arrived after many months of trying.

Below are some excerpts from the IDPH statement regarding conflict of interest. It is not signed. It begins,

“In accordance with Section 515.320 j Scope of EMS Service, the Peoria Area EMS System is herein notifying the Department of a Stipend received by the EMS Medical Director from an EMS Provider in the System. Specifically, the Peoria Area EMS Medical Director, Dr. George Z. Hevesy, receives a stipend paid by an ALS provider, Advanced Medical Transport of Central Illinois.The stipend is justly provided to the EMS Medical Director for oversight and consultation provided to this comprehensive EMS provider. This EMS provider accounts for the majority of the System’s EMS responses and interfacility transfers. Additionally, this EMS agency provides a unique regional critical care (inter-facility) transfer service under the direct medical control of the EMS Medical Director.

This stipend does not create an agreement or atmosphere which makes the EMS Medical Director answerable to or directed by the EMS provider. Nor has it influenced the Medical Director’s assistance of other providers.

The Peoria Area EMS Medical Advisory Board and the Ambulance Board of Directors, consisting of representatives of the Peoria area hospitals, have reviewed the stipend and believe there is no potential or actual conflict of interest.”

The “EMS provider” stated above is AMT. I wonder what the PFD would say about influencing the medical director’s assistance with regards to the PFD? The Ambulance Board of Directors must be the AMT Board of Directors because there are no other ambulances in Peoria.

This is truly an amazing document. (Please see last post in this blog regarding Doug Marshall's comments regarding PAEMSS and IDPH and the confusion that is created by the statement in the Journal Star that PAEMSS is an arm of IDPH. Doug Marshall is OSF attorney and PAEMSS attorney.)

Locally and nationally, people in EMS told me this represents conflict of interest. Firefighters stated that they “tap their toes nervously” and wait for AMT to arrive when they have a patient with severe breathing problems and are unable to help the patient other than give basic life support, even though the PFD had firefighters with advanced skills (Intermediate and Paramedics). Many firefighters in the Peoria area, told me that Hevesy “obstructed” their departments when they attempted to upgrade their services for their citizens. The municipal fire departments are not paying Hevesy; AMT is. AMT is the only paramedic and transport service in the city of Peoria.

Three are two fundamental ethical premises that guide prehospital medical care. The principle of justice implies that the system be fair and equitable. The principle of beneficence requires that actions and intentions are in the best interest of the patient.

In the April 5, 2005 Annals of Internal Medicine a Position Paper regarding medical ethics stated the following: “The physician must seek to ensure that the medically appropriate level of care takes primacy over financial considerations imposed by the physician’s own practice, investments, or financial arrangements. Trust in the profession is undermined when there is even the appearance of impropriety.”
“…Physicians must be conscious of all potential influences and their actions should be guided by patient best interests and appropriate utilization, not by other factors.”

Do you think this constitutes conflict of interest?

In December 2002, my brother and I met with Monsignor Rohlfs and the Canon Law Lawyer for the Diocese of Peoria, Patricia Gibson. We met with them in Monsignor Rohlfs office. We expressed our concern with the conflict of interest regarding our EMS system as described above. They helped us draft a letter of petition to the OSF Sisters requesting a Catholic tribunal court against OSF because of OSF’s association with AMT and Hevesy.

However, in February of 2003, when I met with Monsignor Rohlfs and Patricia Gibson, they told me that if I pursued a tribunal regarding OSF’s role in this matter, the Diocese would withdraw its support from Haitian Hearts. They also stated that they would blame me in the media for the failure of the program. I was stunned to hear Monsignor Rohlfs say this. The Diocese effectively held the Haitian kids who needed heart surgery hostage to protect OSF from a Church tribunal. This was very hard to accept.

I filed the petition anyway with Bishop Jenky, who refused to consider it. (See his written response below.)


July 27, 2013

The Peoria Journal Star reported today that Peoria Fire Department Engine 4 will be upgraded to advanced life support and transport.

See this post.

Where are Drs. Hevesy and Miller now? They were not at the press conference.

Conflict of interest in Peoria is rampant regarding EMS.

Will they ever admit they made a mistake? We will see.


November 1, 2013

Hi everyone.

This was posted a couple of days ago regarding physician conflict of interest.


January 3, 2017

Dear Everyone,

I posted this article in the Journal Star Spotlight section of the editorial page on December 10, 2016.

President-elect Donald Trump does not have a monopoly on conflicts of interest. Unfortunately, there are significant conflicts in Peoria regarding Emergency Medical Services (EMS).
For several decades Advanced Medical Transport (AMT) has been the sole provider of paramedic care (advanced life support) and transport in Peoria. The Peoria Fire Department (PFD) has 12 stations with 50 paramedics and responds to 15,000 EMS calls each year. However, only three of the 12 stations can provide advanced life support and none can transport because the PFD has no ambulance.
This year the PFD made attempts to have Station 19 on Peoria's northwest side become advanced life support. But as usual, the PFD is receiving considerable pushback from local powers.
Most of the time the PFD arrives at a 911 call before AMT. If the responding PFD engine is basic life support, they provide only basic care and must wait for AMT to arrive to provide advanced life support. In contrast, when one of the three PFD engines providing advanced life support arrives at a medical call, they immediately assess the patient and may begin advanced life support if necessary before AMT arrives.
Currently, the PFD is being asked to "prove" that PFD Station 19 should be able to provide advanced life support. How does one prove this?
It seems to me the PFD's paramedic knowledge is always needed because the patient's clinical condition frequently changes and medical decision-making is a dynamic process. Upon arrival at a medical call, PFD paramedics assess the patient in a narrow time frame, determining how sick the patient is and beginning either basic or advanced life support. If basic care is started, PFD paramedics do all they can to improve the patient and thus prevent the need for advanced life support. But if more advanced care is needed, the PFD paramedics can give it.
When AMT arrives at the scene, they come with one paramedic. If the PFD paramedic is already present, this results in two providers with advanced knowledge and skills working together to help the patient.
At the end of the day, the pre-hospital patient deserves the quickest treatment provided by the most knowledgeable medical personnel at the scene. This can happen most effectively when PFD paramedics are allowed to provide advanced life support.
Conflicts of interest by AMT "investors" have chronically afflicted Peoria's EMS system. The PFD should not have to fight to do what they are trained to do - provide better care for Peorians who call 911. Station 19 should be able to provide advanced life support.
This conflict of interest needs to end.
John A. Carroll is a medical doctor. He lives in West Peoria.
On December 30, 2016, Rick Waldron President of PFD Union 50, published this article in the Journal Star. 

Over the years, in an effort to serve local citizens better, the Peoria Fire Department has become a "jack of all trades" in the world of emergency response.
We are a highly trained and skilled department proficient in fire suppression, technical rescue, hazardous material mitigation, dive/swift-water rescue and, last but not least, emergency medical services (EMS).
For the last eight years, we have worked diligently to provide the highest possible advance life support (ALS). This means a paramedic shows up on your fire engine, equipped and trained to the highest standard of pre-hospital care.
As of July 11, 2013, we have staffed three engines with paramedics - Engine 4 and Engine 12 in the First District and Engine 20 in the Fifth District. In that three years, we have been training and certifying more firefighters to the level of paramedic, bringing our paramedic staffing to 46.
The city of Peoria has 17 fire engines, trucks and rescue squads responding 24 hours a day, seven days a week. With the exception of Engines 4, 12 and 20, the rest are equipped to the level of basic life support (BLS). Peoria Fire usually arrives before or at the same time as the private ambulance company Advanced Medical Transport (AMT). If PFD arrives first, we begin stabilizing the patient until AMT arrives. At that point PFD and AMT work together to provide the patient with appropriate medical care.
If you live in a territory with an ALS engine, no matter who shows up first, you are provided with the highest level of care immediately. As a paramedic for over 10 years, I can tell you that one paramedic can get a lot of life-saving done. But studies show that having more than one paramedic on scene leads to quicker task accomplishment and transport to the Emergency Department.
So why, with a paramedic count of 46, can we only staff three engines to ALS?
That is the question we have asked city leaders for three years. We understand that cost is always a concern. However, with a start-up cost of only $5,000, we do feel multiple ALS machines are justified. We have proposed E-19, on Frostwood Parkway, covering a large portion of the Fourth District become our next ALS engine, and progressing from there as our budget allows.
The men and women of the Peoria Fire Department are asking to do more for Peorians at minimal cost to them. We have one concern: how to better serve those making up this great city! Help us fight to improve your pre-hospital care by telling your representatives you want an ALS engine in your neighborhood.
Rick Waldron is president of Peoria Firefighters Local 50
February 14, 2017
Peoria City Council Meeting

Tap on video and you will see a little curved arrow at the top. Tap on arrow and it will lead to video on my FB page.

Concerning the fire department, I think a plan should be made to implement Advanced Life Support into all Fire Houses. We currently have three locations in our city. The cost is only $4500 to purchase equipment and life-saving drugs. Many of our firefighters, about 48, are already certified paramedics and we should be using their skills. There have been two incidents recently, when our firefighters were first on seen by at least five minutes before AMT, and did not have the ALS equipment and drugs to provide the proper care. Both incidents resulted in death. The city should be getting reimbursed for services when it applies to insurance and other means.

Jim Montelongo


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