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Friday, March 03, 2006

Peoria Journal Star Articles

PJS Articles

On December 8, 2002, Catharine Schaidle wrote a very good article in the PJS entitled “City Explores Giving Fired Department More Power.”

“The city of Peoria wants to upgrade its fire department from offering basic life support services as it does now to becoming an intermediate service that can also administer medication in emergency situations.”

My comments: There are 3 levels of prehospital care: Basic, Intermediate, and Advanced. Advanced is the same thing as paramedic care. The PFD still is just basic which is the lowest level. Up until just several years ago, the PFD couldn’t even give an aspirin at the scene of a heart attack when aspirin is most useful when given early and can decrease mortality up to 40%. The project medical director was Dr. George Hevesy for most of the 90’s and he was on AMT’s payroll as well as OSF’s. AMT is the only paramedic provider in Peoria even though the PFD has firefighters who are paramedics and intermediates. More on this later. You won’t believe how this played out this summer (2005).

The article went on to say that most ambulance services are certified to provide advanced life support services (paramedic). However…"for years AMT has balked at the fire department entering this arena". Andrew Rand, director of AMT, stated that AMT is willing to help the fire department advance to the Intermediate level, but it (AMT) does not want the department to transport patients. Rand went on to say, “They can provide more comprehensive care than they do now (in 2002)”.

My comments: Why would Mr. Rand be stating this? He did not want to lose the transport business to the PFD. Where was Dr. Hevesy in this? He was being paid by AMT. So, as it turned out, because AMT did not get the 10 year contract that they wanted several weeks later, the PFD is still at basic life support and cannot transport, and cannot give life sustaining drugs during a cardiac arrest in 2005. I would like to see Dr. Hevesy’s written directives that the PFD must increase its level of services to the citizens of Peoria. Did he write any or did he just support AMT as the only paramedic providers in town as he picked up his check from them as their “Corporate Medical Director”.

The Journal Star continued: “Proponents of letting the fire department transport patients argue that the fire department should be in the ambulance business because it is usually first on the scene of an emergency situation and provides basic life support. They argue that two or three minutes can make a difference in saving a life. In addition to transporting patients, proponents want the firefighter to be able to administer the necessary drugs and bill the patient for the service.”

My comments: Medical studies have shown that advanced life support definitely helps with chest pain patients and patients who are short of breath. The PFD gets thousands of these 911 calls per year and can only give basic life support with very basic medications. This seems like a travesty to me but most people just simply don’t understand this and when they see the PFD truck with RESCUE painted on the side, they believe it. Frequently firefighters do RESCUE people, but not with the advanced life support drugs they should be able to carry and use. Dr. Rick Miller is now the current project medical director (and former director of the OSF ED) and the PFD is not advancing its care rapidly under his guidance either. (Dr. Hevesy is now the director of the OSF ED.) Surprise. I have spoken to many people involved in emergency medical systems in the state of Illinois, and they know how it plays in Peoria. A fire chief of a very large city in Illinois told me “you have a very unfortunate situation at OSF…(regarding prehospital care and its directors).

The Journal Star article continued: “Rand disputes that the fire department is usually the first responder.”

“That is absolutely false,” Rand said.

My comments: Rand was proven wrong two years later by the Matrix study done in 2004 which showed that the PFD arrived approximately 2 minutes quicker to the scene involving life threatening situations.

Coucilman Ardis went on to say in the PJS article,”If we want to have a highly trained fire and medical department in the city , there is nothing that AMT can do to prevent us from doing so”. “I don’t think that anyone can make the argument that anybody would not want the best trained people to be there for them all the time in case of an emergency. Why would you not want that?”

My comments: Councilman Ardis (now Mayor Ardis) was exactly right. Unfortunately, the situation still stays about the same in Peoria in 2005. The EMS system in Peoria is shrouded in conflict of interest. In early 2003, AMT lost the vote for the 10 year contract they wanted, but they continue to monopolizing paramedic industry in Peoria with the help of OSF and the physicians who should be protecting you in a 911 crisis. Most people don’t care until the crisis involves them or their family.

I sent a letter regarding this conflict of interest to OSF leaders including Jim Moore, Sister Judith Ann, Gerry McShane, Joseph Piccione, and Howard Wiles (the compliance officer for OSF Corporate) in May of 2002 (approximately 7 months before the PJS article above). I received no response from anyone of the above. (Joe Piccione, the OSF corporate ethicist told me in the fall of 2001 that I was mandated to report conflict of interest, but when I did, no one responded.)

OSF is of course one of the main supporters of AMT and the base station for all emergency response services in Central Illinois. I picketed OSF with a sign stating that OSF and AMT had a monopoly of paramedic services during the summer of 2003. Sue Wozniak, CFO at OSF and AMT board member scolded me one afternoon as she was leaving work for picketing the hospital. I asked her what she thought about Hevesy receiving a salary from AMT when he was director of ALL ambulances in Central Illinois. She said it was a good idea that Hevesy “stepped away from this” as he was PROMOTED to director of the Emergency Department at OSF. Incredibly, she stated that Hevesy was still paid by AMT. I couldn’t believe that she would admit this. I thought that she would require that I go through the Freedom Of Information Act again to get this information. (St. Francis poor chaplain who is a nice man and traveled to Haiti with me once, even came out onto the sidewalk and berated me for picketing OSF. He told me out of the blue that Keith Steffen (CEO at OSF) is a good guy…..The more I looked at this man and talked with him, the more his face fell and he calmed down, because I think he understood his erratic behavior.)

When I didn’t think many more people could abandon the cause, I kept the Catholic Diocese of Peoria informed regarding this conflict of interest. I believed then and believe now that it needed the pastoral care of Bishop Jenky and that he should stop this at OSF and its “affiliate” AMT. If OSF wouldn’t provide checks and balances for itself, maybe the Bishop would. I presented this to Monsignor Rohlfs and Patricia Gibson in the Monsignor’s office in the spring of 2003. I told them that I wanted to petition the OSF Sisters for a Catholic tribunal court. Patricia Gibson and Monsignor had helped me write one petition in December of 2002. Monsignor Rohlfs told me that if I petitioned the Sisters for ANYTHING, the Diocese would come out against me in the media. I asked him what he meant by this and he replied that the Diocese would “come out against Haitian Hearts in the media.” I told him that I needed to do this and presented this to Bishop Jenky the next day at the chancery. The Bishop told me “there will be no tribunal against OSF….it is a $1.6 billion industry, doctor.” True to form, after I filed the petitions for the tribunal court (one being for conflict of interest regarding emergency medical services),the Diocese advised me to go to Rome to solve this problem and the Diocese pulled their nominal support for the Haitian Hearts on a front page Journal Star article while I was working in Haiti mid-July, 2003.

Let Peoria firefighters give emergency health care
November 17, 2002

Picture this: you're at home and your father grabs his chest, collapses and becomes unresponsive. You run to the phone and call 911.

A rescue truck from your local fire department arrives, and firefighters begin administering care. They work courageously but are only allowed to provide basic life support, which limits what they can do. The paramedics in the ambulance, which will arrive a few minutes later, are licensed to provide advanced life support, which is the most comprehensive pre-hospital emergency care available. The extra time your father has to wait is critical.

As your father deteriorates,.lt is obvious he needs to be transported to the hospital. However, the firefighters can't do that either; only the ambulance can transport.

Unfortunately, the above is not an uncommon scenario in central Illinois. The knowledge of this reality caused me to read with skepticism and dismay an advertisement touting Advanced Medical Transport's (AMT) perfect score from an accrediting commission. Central Illinoisans should not be deceived into thinking that we have ideal emergency response services. AMTs local monopoly does not serve us well.

In many other Illinois communities, such as Rockford, municipal fire departments, which frequently arrive before the private ambulance, are certified to begin advanced life support immediately. They are able to provide the critically ill patient with life-saving medications, airway management and treatments not available to units that are relegated to basic life support capability.

In Peoria paramedic advanced life support is provided exclusively by AMT. Precious minutes spent waiting for advanced life support to arrive may decrease the survival odds for the critically ill patient.

There are many unanswered questions regarding this dangerous situation. Why can't Peoria's firefighters be certified at a higher level? Why have obstacles been created when the Peoria Fire Department has attempted to upgrade its level of service during the last decade? Why don't the hospitals insist that the Peoria Fire Department advance its status? Why should a Peoria-area heart attack victim have to wait additional minutes for a private agency to arrive to receive advanced life support?

Some Peoria firefighters do have advanced life-support training but are not even permitted to use their training to help a fallen cOlleague at the scene of a fire. Does this make sense? Is "duplication of services" a valid argument against fire departments receiving advanced life-support training when it is, in most cases, AMT that would be doing the duplicating? The three local hospitals helped create AMT. Is there a conflict of interest here?

As a physician who worked at OSF St. Francis Medical Center for 20 years, I know that the AMT paramedics, municipal firefighters and volunteer fire departments do their very best under difficult circumstances in urban, suburban and rural areas. The many firefighters I have spOken to have been frustrated that they have not been permitted to attain and use these life-saving skills. Lives hang in the balance during these crucial minutes, and care that is late or sub-optimal contributes to poor outcomes. The Peoria firefighters know this all too well, as they have witnessed patients deteriorate when they couldn't even "load and go."

With the budgetary crisis in the city of Peoria, it would behoove all of us to take an unbiased look at another scenario. If the Peoria Fire Department were allowed to upgrade its pre-hospital care, a valuable service would occur and possibly a new source of revenue for the city. AMT says it took in $7 million in the year 2000.

Pre-hospital patients cared for. by Peoria Fire Department paramedics would be billed in the same manner as AMT bills its patients - insurance, Medicare and Medicaid. If initial capital expenditures, mostly In ambulances, were deemed prohibitive, the Peoria Fire Department could provide advanced life support for the emergency victim at the scene, then turn to a private agency to transport the patient to the hospital. The cost-benefit ratio would be on the patient's side.

However, the will has to exist to implement change. The hospitals' boards of directors and the City Council need to be given accurate data to make the most prudent decision as to what is really best for the pre-hospital patient. Unfortunately, the majority of Peoria's medical community has no idea how and why important decisions have been made regarding these emergency medical services. They need to know.

Saving lives, not monopolizing emergency medical services, should be the goal.

Dr. John Carroll formerly worked in the emergency department at OSF St. Francis and is founder of the Haitian Hearts program.

(Please read forum article July 14, 2005 down the blog further. In 2005, three years after the above op-ed, and a man's death in a Peoria restaurant, Dr. Miller changed the policy allowing a PFD firefighter/paramedic to put in a breathing tube in a patient ONLY if AMT asks the firefighter to do so. This seems extremely bad. The PFD is STILL a Basic-D unit giving BASIC drugs only as I write this today--April 4, 2006.)

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