On Jan 9th the headlines in a PJS column were “Paramedic Sees System Failure”. The paramedic was Jeff Lickiss. Jeff was frustrated with the fire/ambulance sevice in Peoria after his 16 year old daughter was one of five people involved in a MVA. She was trapped in the vehicle for a long period of time and in severe pain. Jeff, who is a paramedic and employe at AMT and OSF, stated that “AMT will send one ambulance and then decide if they want to send another one. Sufficient support wasn’t dispatched. The one paramedic on the scene handled all five patients and not in a timely fashion.”
According to the article, Jeff had no problem with the PFD stating, “They only did their job “with the tools provided.”” The keyphrase is “with the tools provided.”
Ten years ago, on May 1, 1996, another article in the PJS was headlined “Ambulance Plan Abandoned—Fire Department to Add Defibrillation Program”. The article reported that AMT was worried that the PFD would go into the ambulance and transport business. Fire Chief Ernie Russell stated, “When we started looking at this the question we had to answer was the service being offered now at a quality we wanted. We said “no”. We wanted quicker response and defibrillation ability”.
That is what Jeff Lickiss said regarding his daughter 10 years later regarding the response time. After the Chief Russell interview, the decision was made to keep the PFD at the basic level and the PFD bought their own defibrillators through the Foreign Firefighters Fund. Please keep in mind, the American Heart Association, in 1992, had recommended that all BLS units in the US, including Peoria, should have defibrillation capacity. Why didn’t Peoria? Where was the doctor in charge of the ambulances and his directives insisting that the PFD had to be able to electrically defibrillate (shock) people during a cardiac arrest? AMT was shocking people from the time they became a business years before. Why wasn’t the PFD?
Near the time of Chief Russell’s comments 10 years ago, an editorial appeared in the PJS stating that the physician in charge of emergency medical services at OSF and director of all EMS in the Peoria area feared the city run service would lack the expertise, funding, and medical supervision to provide high quality care. What the PJS editors left out was that this physician was on the AMT payroll as well as OSF’s payroll and that he was the medical supervisor for the PFD already, and if the PFD lacked expertise or medical supervision or if the PFD lacked an advocate to advance their service for the people of Peoria, it was under his watch.
So the years slipped by in Peoria, and the PFD stayed at BLS nontransport and weren’t even allowed to give basic drugs like aspirin for chest pain/heart attacks, nitroglycerin for angina, and abuterol inhalers for asthma or adrenalin for allergic reactions. These were more tools that Jeff Lickiss was referring to several weeks ago.
On Dec 8, 2002, The PJS had and excellent article entitled “City Explores giving PFD More Power”. In that article the executive director of AMT would agree that the PFD advance to ILS so the fire department could provide a more comprehensive service. But AMT did not want the PFD to transport patients. AMT did not get the 10 year contract with the City in 2002 and the PFD remained at BLS and non transport. So Jeff Lickiss’s 16 year old daughter sat trapped in the vehicle as the PFD offered basic care and couldn’t transport her to one of the local hospitals. And if she or any of the other 4 in the accident needed a more secure airway, in otherwords a tube put in the airway, the PFD paramedic would only have been able to do this if the one AMT paramedic on the scene requested their help. That seems ludicrous that the PFD paramedics cannot use their skills at the scene when oxygen is very important and minutes count.
For physicians or for anyone to have a conflict of interest is not immoral or unethical. It is however unethical to act on the conflict in a way that cannot be justified ethically and that violates trust. Conflicts of interest can be “institutional weeds”. The take root below the surface and become pervasive problems long before they show their ugliness. The weeds in this case expose physicians to powerful temptations to make money at the expense of their patient’s welfare.
I would recommend that the PFD have its own medical director whose job would be to protect Peorians when they dial 911 ten thousand times each year for medical reasons. He or she would strongly advocate that the PFD advance from its basic life support status to intermediate or paramedic.The fire department medical director would insist that the firefighter/paramedics be allowed to act as paramedics at the scene and not have to wait to be asked to do so by AMT.
A few dedicated fire department ambulances staffed with advanced life support equipment carrying PFD paramedics would be very useful as the Matrix report from 2004 indicated. If they do these common sense things in Joliet, Rockford, and many cities in the US why not Peoria? The medical director would be active at IDPH in Springfield as advocates for the firefighters and would meet with you, the city council, regarding policy decisions, so you could hear another voice rather than the two project medical directors for the past two decades with very close ties to AMT. Who would pay this physician? No one. It would be voluntary so there would not even exist the possibility of conflict of interest regarding this very important job.
Thank you for your attention.
John Carroll, MD
On March 3, 2006 this article was printed in the Peoria Journal Star---
Friday, March 3, 2006
By DAVE HANEY
OF THE JOURNAL STARDUNLAP - A split-second decision to take an injured firefighter to the hospital may cost the fire chief his emergency medical technician's license and censure of the department where he's volunteered for 30 years.
Chief John Doering says he was just using common sense when he ordered the firefighter put in the back of his department's rescue truck and transported to a nearby hospital: There was no ambulance nearby. The Peoria-Area Emergency Medical System, however, says Doering's decision violated state law. Dunlap is not a licensed transport provider.
The mess evolved from a cardiac emergency call the all-volunteer squad got more than three months ago. Eleven members of the Dunlap Fire Protection District, including Doering, arrived. As the crew wheeled the patient out to a waiting ambulance, one of the firefighters collapsed. Doering called over the radio to ask whether another ambulance was nearby. When he was told "no," Doering ordered two of his EMT-trained firefighters to take their fellow firefighter, who by then had regained consciousness, to the hospital.
Part of what's at issue: At what point does a firefighter or other emergency personnel become a patient?
"This is about making a common-sense decision," Doering said. "If we would've thrown this firefighter in a pickup and taken him in, no one would've said anything, but because he was put into a district-owned vehicle and given a higher level of care . . . they claim we violated (procedure)."
Doering says the situation is rare, happening "maybe once every four or five years," adding that the decision follows his department's policy and feels it's akin to any employer taking a hurt employee to the hospital in a company vehicle.
"You are talking about people who give up their personal time for nothing but to help make a difference in their community," Doering said of his volunteer department. "I would not hesitate to do it again if the situation merited it."
The Dunlap firefighter was later released after receiving tests at Methodist Medical Center. Dr. Matthew Jackson, director for PAEMS, declined to comment on the issue Thursday, but in a letter penned last month to fire chiefs throughout Peoria County said he doesn't disagree with the need to take the individual to the hospital, nor in a non-transport vehicle.
"This incident is clearly different than merely giving an injured employee a ride to the hospital . . . as emergency medical care was rendered to the patient prior to and during transport," Jackson wrote.
PAEMS, a local arm of the Illinois Department of Public Health, advises and regulates emergency medical services, EMT training and licensing as well as insuring quality pre-hospital care is provided.
"The crew, under Chief Doering's order, used their rescue truck as an ambulance, a practice for which neither the vehicle nor the agency is licensed for," Jackson continued. He adds that Doering made the problem worse: "This whole incident could have been averted if he would have merely given us his assurances that he would either not transport pre-hospital patients in the future, or seek the appropriate licensure and waivers necessary to transport patients in the future."
Both men said Thursday they hope the dispute comes to an amicable conclusion soon. Both sides have attorneys discussing the issue.
"They (PAEMS) have rules they want to enforce," Doering said. "We just want to make sure that a firefighter gets the care he needs."
The Journal Star published the following editorial on March 10, 2006---
Dunlap fire chief right to bend rule
Friday, March 10, 2006
Dunlap Fire Chief John Doering had to choose between breaking state rules or ensuring the safety of one of his men. He chose the latter. It was the right call.
Unfortunately, now Doering and his volunteer department are being threatened with punishment by a local group that enforces state law concerning emergency transportation of patients.
The dispute dates to Nov. 13 when 11 Dunlap firefighters, including Doering, responded to an emergency call. While taking a cardiac patient to a waiting ambulance, one of the firefighters collapsed. No other ambulance was nearby and Doering, despite his department lacking a license to transport patients, instructed two EMT-trained firefighters to take one of their own to the hospital. Turns out he was fine.
Soon thereafter, the Dunlap Fire Department was informed by the local medical group that enforces state law for the Illinois Department of Public Health that Doering and Co. exceeded their authority by taking a patient to the hospital. Doering's license was threatened and the department faces censure.
If the firefighters had driven their colleague to the hospital in one of their private vehicles, they would have avoided any rebuke. But they violated state regulations by using the rescue truck, which has life-saving equipment. Go figure.
The whole thing gets even more curious in light of the local medical panel telling Dunlap and other volunteer departments last September that they might be needed to transport Katrina victims who were expected to overwhelm local ambulances. So it was OK to use unlicensed rescue trucks as ambulances in that emergency, but not this one. Again, go figure.
No, unauthorized first-responders shouldn't be driving around the injured or sick as a routine practice. Licensing is important. But sometimes you have to bend the rules to save a life. Imagine the outcry if this person had died waiting for the right vehicle to come along.
Beyond that, Doering is being singled out because he wouldn't promise not to transport patients again if confronted with the same situation. The state should give him a break.
Comment from me about above editorial:
The local medial panel that the Journal refers to are the EMS doctors that control the ambulances in the area for approximately 70 EMS agencies. The EMS doctors are based out of OSF which is the resosurce hospital for all of EMS in the area. The director of the Emergency Department is Dr. Hevesy who is also Corporate Medial Director of AMT and the previous project medical director for all of these agencies. He is paid by both OSF and AMT. AMT is the only transport and paramedic agency in Peoria. The Journal editors left this out of the above article.
I submitted a forum article to the Journal about one week before their editorial above was in the paper on March 10. They put in my forum article the next day (March 11, 2006), but edited out part of my sentence below mentioning OSF. OSF is being protected. Also, if the EMS physicians employed by OSF supported the PFD upgrading and going into transport, that could happen if the Peoria City Council made it policy and the State of Illinois would agree if they knew the local EMS doctors were supportive. So the State should not be blamed for the Dunlap debacle. The blame should be local.
Please see my forum article below:
March 11, 2006
Kudos to Dunlap’s fire Chief John Doering for making the decision to transport his sick firefighter in the Dunlap rescue vehicle. After his efforts to locate an Advanced Medical Transport ambulance failed, what other safe and quick options existed? Chief Doering used good common sense and made the right decision.
It is very interesting that the Dunlap agency was considered for an “emergency field upgrade” to transport Hurricane Katrina victims. However, the same agency got into serious trouble with Peoria’s Emergency Medical Services (EMS) leaders for transporting one of their own firefighters to a Peoria hospital. Does that make any sense?
Last year, the EMS physician in charge of all ambulances in the Peoria area, did not support the Peoria Fire Department (PFD) equipping or using the only ambulance they owned. Because it sat unused in a garage, the PFD sold it. Maybe this ambulance could have been used to help the Dunlap firefighter and intercepted the Dunlap vehicle as it headed for Peoria. And most likely, the same PFD ambulance would have helped many Peorians for the last several years after they dialed 911.
The issue here is being diverted and should not be about Chief Doering and whether he should lose his emergency medical technician license as he protects his firefighters and his city. The real issue is whether the Peoria physicians that control EMS and their “resource hospital” (OSF) are acting in a responsible, moral, and beneficent fashion for the people of central Illinois. I believe they are not.
Until this conflict of interest is exposed and issues made transparent to the public, the Peoria ambulance monopoly will continue and suboptimal care delivered to those who need it most in an emergency.
John Carroll, MD
On March 21, 2006 the following article appeared in the PJS Forum:
Monday, March 21, 2006
Doeering Put Safety First
I was absolutely appalled to read a recent article regarding Dunlap Fire Chief John Doering and the criticism he was coming under for transporting an injured firefighter.
As the sister of one of these volunteers and the wife of a physician, I think that most people would want whatever help was available to assist an injured loved one.
Maybe the powers that be need to consider that the first responders are almost always the firefighters. What does that say about the state of our ambulance service and the patient care they provide?
I am thankful that Chief Doering puts his volunteers' safety above Peoria politics.
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March 23, 2006---Peoria Journal Star
Fire, EMS crews work out dispute
Sides discuss transport protocol for injured
Thursday, March 23, 2006
By DAVE HANEY
OF THE JOURNAL STAR
DUNLAP - Officials with the Dunlap Fire Protection District and the Peoria
Area Emergency Medical Services System are trying to mend a dispute that
arose after the Dunlap fire chief ordered an injured firefighter be
transported in a department vehicle not licensed to do so.
Officials met Wednesday during a special meeting at the Dunlap fire house
where attorneys for both sides said they would be exchanging "language" in
coming weeks so that both sides will have an "understanding of protocol in
"We just want to be able to deal with the situation were it to arise
again," said James Sinclair, an attorney for the Dunlap fire department.
The contention derives from a cardiac emergency call the all-volunteer
Dunlap fire squad received in November. As the crew there, including Fire
Chief John Doering, wheeled the patient out to a waiting ambulance, one of
the firefighters collapsed.
When Doering learned no other ambulance was nearby, he ordered two of his
EMT-trained firefighters to take their fellow firefighter, who had already
regained consciousness, to the hospital.
Doering has said the move was "common sense."
Officials with PAEMSS - a local arm of the Illinois Department of Public
Health that advises and regulates emergency medical care, among other
services - have said the move violates state law since Dunlap is not
licensed to transport patients.
Douglass Marshall, an attorney for the PAEMSS, said both sides had a
mutual understanding, although IDPH would have to approve any agreement
Dave Haney can be reached at 686-3181 or email@example.com.
After reading the above article, I wrote the following e-mail to the Director of the Ethics Committee at OSF:
Dear Gerry, Joe, Sister Judith Ann, and Bishop Jenky,
Dr. McShane, as Director of the Ethics Committee at OSF, please allow me to address the Committee regarding the negative conflict of interest I feel is occurring in the Peoria area regarding pre-hospital care.
As you probably have heard, there has recently been discussion between a local EMT agency and PAEMSS regarding transport of a patient. PAEMSS has a website under OSF and it appears that the leaders of PAEMSS are OSF employees with OSF phone numbers, OSF e-mails, and OSF faxes. Doug Marshall, OSF attorney, represents OSF and PAEMSS in discussion with the local EMT agency in question. If PAEMSS is an arm of IDPH, why isn’t PAEMSS represented by an attorney for the State rather than by OSF’s attorney, Mr. Marshall? What does OSF have to gain or lose having Doug Marshall represent PAEMSS? Do you believe there is the potential for negative conflict of interest with Dr. Matt Jackson, Project Medical Director, being employed in the Emergency Department at OSF and directly supervised by Dr. George Hevesy, Director of the Emergency Department at OSF and Corporate Medical Director of Advanced Medical Transport which is the only Paramedic and transport agency in the city of Peoria? Do you think that Dr. Jackson can make clear non biased decisions regarding EMS issues in the Peoria area? What ever happened to Dr. Jim Hubler…he didn’t last long as Project Medical Director. Why not?
The most important question I have for you, Dr. McShane, are the medical needs of residents in central Illinois (for example,people in Dunlap), being best served by the above arrangements?
Mr. Piccione, OSF Corporate Ethicist, has stated and written that it is the individual’s right and duty to present topics of concern to ethics committees. In fact, Mr. Piccione stated that we are “mandated to report”.
I will await your response.
John Carroll, MD
(As of today, April 4, 2006, I have not received a response from anyone of the above at OSF or the Catholic Diocese of Peoria.)
May 18, 2006
In early May, the Peoria Journal Star ran an article about the Ottawa Fire Department responding to a house fire and pulling a little girl to saftey. They transported her immediately to Ottawa Community Hospital. The Ottawa firefighters respond with a higher level of training than the Peoria Fire Department. They can also transport patients. The physician in charge of the Ottawa Fire Department (Project Medical Director) supports this increased level of service. Peoria remains mired at the Basic level of training and cannot transport patients.
I sent the following forum article to the Peoria Journal Star attempting to compare the two fire departments and policies that control emergency medical systems in Peoria and Ottawa.
The Peoria Journal Star did not print this Forum submission.
Date: Tue May 9 21:45:07 2006
From: "John Carroll, MD"
Subject: Forum Submission
Please consider for the Forum : Regarding the Journal Star article
describing the heroic efforts of the Ottawa Fire Department, May 6, 2006.
The Ottawa firefighters did a great job finding the three year old girl
trapped in the house fire and extricating her. According to the article,
the firefighters fought through dense smoke and severe heat, found the
little girl, and pulled her to safety. They also gave her CPR and
transported her from the scene to the hospital emergency room in Ottawa in
the fire department ambulance. Their time from arrival at the house fire
until arrival at the emergency room was an amazing six minutes.
The Emergency Medical System in Ottawa is obviously more efficient than in
Peoria. Even though Ottawa’s population is one-fifth the size of Peoria,
their firefighters offer more advanced care (Intermediate Life Support)
than the Peoria Fire Department (PFD). When necessary the Ottawa
firefighters immediately secure an excellent airway with a breathing tube
and and are able to give intravenous medications to restart the heart.
They “load and go” in their ambulance and transport rapidly.
Unfortunately, in Peoria, the PFD can only give Basic Life Support-
Defibrillation and some basic drugs and cannot put in a life saving
breathing tube unless asked to do so by Advanced Medical Transport. Also,
the PFD cannot give intravenous medications to restart the heart, and has
no ambulance to transport patients.
Why the difference? Each community is unique as are their policies that
guide their standard of care. However, obstacles that have been placed in
front of the PFD by our local private sector need to be removed by
physicians and policy makers who have the power to do so.
Our firefighters must be allowed to provide a higher standard of
medical care when Peoria's three year olds are emergency victims.
John Carroll, MD
Today, May 18, the following article appeared in the Journal Star. It needs to be read slowly and carefully. This article is not a joke. It is reality in Peoria and Dunlap. Wonder why PAEMSS and the local official of the IDPH could not be reached for comment?
Thursday, May 18, 2006
By DAVE HANEY
OF THE JOURNAL STAR
DUNLAP - Firefighters with the small, all-volunteer Dunlap squad still will be able to catch a ride to the hospital in one of their department's vehicles, so long as their injury or medical ailment is not serious.
That's the hitch in a tentative agreement between the Dunlap Fire Protection District and the Peoria Area Emergency Medical Services System which appears to end a dispute, now six months long, that arose after the Dunlap fire chief ordered an injured firefighter be transported in a department vehicle not licensed to do so.
While members of the PAEMSS have not officially signed off on the agreement, attorneys for both sides drew up the papers that were approved Wednesday evening by the Dunlap Fire Protection District trustees.
"This clears up the rules so everybody knows how the game is played," Dunlap Fire Chief John Doering told the three-member board.
PAEMSS officials and the local Illinois Department of Public Health coordinator could not be reached for comment Wednesday afternoon.
According to the "plan of correction," Dunlap firefighters are prohibited from using district vehicles as an ambulance. If a firefighter is injured or has a medical problem at the scene of any event and does not require the services of an ambulance, that person can be taken for treatment in a district vehicle. However, if it is deemed the injured requires an ambulance, command personnel will call for an ambulance, and the individual will be provided with emergency medical care.
A separate provision allows the Dunlap fire squad to move an injured person if they are located in a potentially hazardous environment.
Contention between the entities derives from a cardiac emergency call the Dunlap fire squad received in November. As the crew there, including Fire Chief John Doering, wheeled the patient out to a waiting ambulance, one of the firefighters collapsed.
Doering learned no other ambulance was nearby and ordered two of his EMT-trained firefighters to take their fellow firefighter, who had already regained consciousness, to the hospital.
Doering has said the move was "common sense." On Wednesday, Doering said he may have done differently had he known what he knows now of the firefighter's condition.
PAEMSS officials have said the move violated state law since Dunlap is not licensed to transport patients. The PAEMSS, a "resource hospital" under the IDPH, advises and regulates local emergency medical services, EMT training and licensing as well as insuring quality pre-hospital care is provided.
"We just want what's best for our citizens," said Ann Joyce, a Dunlap Fire Protection trustee following the vote.
Dave Haney can be reached at 686-3181 or firstname.lastname@example.org.
This is truly an amazing article.
The first sentence states, “Firefighters with the small, all volunteer Dunlap squad still will be able to catch a ride to the hospital in one of their department’s vehicles, so long as their injury or medical ailment is not serious.”
If a firefighter suffers a serious injury or medical problem, a transport ambulance (Advanced Medical Transport), must be called for transportation and medical care. What if AMT doesn’t arrive in a timely manner?
A logical and safe approach would be for Dunlap to have the option to transport an injured firefighter towards a Peoria hospital in order to intercept with AMT if AMT is not available in Dunlap when needed. This would allow multiple important minutes to be saved and the AMT paramedic could jump on the Dunlap vehicle with his/her equipment and continue treatment while en route with the injured/sick Dunlap firefighter.
Was this option discussed by PAEMSS with Dunlap? Firefighters lives may be saved without draconian measures to keep Dunlap cowered in fear of the powers in Peoria that control the EMT licenses of the volunteer Dunlap Fire Protection.
Also, I think attention was directed away from the more common scenario and diverted to the firefighters. What happens if there are two or more people in Dunlap (not firefighters) with serious injuries or medical problems that quickly overwhelm AMT? By the “understanding” that seems to be evolving between PAEMSS and Dunlap, the Dunlap Fire Protection will not be able to transport the second or third victims. Then what? Do the people of Dunlap have to wait like the people of Peoria do when needing quick comprehensive pre hospital care and transport? The answer will be yes and the outcomes may not be good.
The article mentioned that PAEMSS officials and the local Illinois Department of Public Health coordinator could not be reached for comment. Why? Where are these people? They are in control. The people of Dunlap need to hear from them.
By way of review, PAEMSS is listed on an OSF website and many employees of OSF work for PAEMSS. PAEMSS attorney is Douglass Marshall who is also OSF’s attorney. Marshall is part of Hinshaw-Culbertson--- a large and very powerful national law firm that represents OSF, which is Peoria’s 1.6 billion dollar health care industry. (I believe that Marshall represented AMT a few years ago near the time AMT was fined over 2 million dollars for Medicare fraud.) AMT is an “affiliate” (my words) of OSF.
It gets a little stickier. OSF is considered the "resource hospital" for all of Emergency Medical Services (EMS) in the area. Dr. Matt Jackson is in charge of all the area ambulances and is called the Project Medical Director. However, Dr. Jackson works in the Emergency Department at OSF and Dr. George Hevesy is his boss. Hevesy is Director of the Emergency Department at OSF and the salaried Corporate Medical Director of AMT. Jackson’s decisions regarding EMS, level of care, transportation, etc are very carefully reviewed by Dr. Hevesy, OSF, and AMT. AMT brings in millions of dollars each year. AMT is the only provider of paramedic care and transportation in Peoria.
Are you confused yet? You are supposed to be by this point. You are not supposed to understand the negative conflict of interest that may exist with millions of dollars at stake in the pre hospital arena in Peoria.
The Illinois Department of Public Health is supposed to be watching all of this. When I spoke with the local IDPH person in Peoria several years ago, he told me he had no data regarding quality of care given in Peoria. As mentioned above, the local IDPH representative did not comment on the Dunlap situation. Don’t think that OSF in Peoria does not have a significant level of influence at the level of IDPH in Springfield.
None of the little towns and villages in central Illinois with their volunteer fire departments want to go against the people and institutions mentioned above. The larger municipal fire departments do not want to take them on either. Who would? However, the Dunlap people that live “downstream” from where these important decisions are being made, may be waiting precious minutes to be transported with the policy that is currently being being worked out with PAEMSS.
This is power, politics, and most importantly, money.
Some day, it will seem incredible that the Peoria area was treated this way regarding emergency medical services. Things will change…maybe not tomorrow, but it will happen. When disaster strikes the wrong person, it may be too late for that person, but maybe his or her family will try to effect change. Most people are too confused, afraid, and distracted to act. Too bad progress has to be so laborious. Issues are diverted constantly, so we lose our focus regarding what is important. Also, when good people see the problem, and look the other way, then deception will continue.
The last sentence in the article quoted a Dunlap Fire Protection trustee when she stated. “We just want what’s best for our citizens.” Too bad “the best” is not being allowed to happen in Dunlap.