An account of how a large Catholic medical center has lost its way. Go to pmmdaily.blogspot.com to see recent updates.

Wednesday, March 01, 2006

Peoria's Greed

Peoria’s Greed

The Peoria Journal Star reported on December 31, 2005, that OSF will receive over $500,000 from the government for being the main local hospital to take care of disasters or terrorist attacks.

This seems so ironic that they are granted this money when OSF’s past project medical director, Dr. Rick Miller, did not sanction the use of the ambulance that the Peoria Fire Department purchased with the Foreign Firefighters Fund. (The PFD sold the ambulance in 2005 because it was sitting unused.) This ambulance could have been used every day in Peoria by the PFD for daily emergencies if Miller had agreed. OSF has protected Advanced Medical Transport as the only advanced life support providers and transport agency in Peoria. Miller, who is employed by OSF would not even allow the PFD paramedics to secure the airway of a patient unless AMT asks them to do so.

Unfortunately, if Peoria is has a disaster, the PFD can only give basic life support and cannot transport the patient or even give the patient a secure airway (unless asked to) …and OSF is granted half a million dollars for being the hospital in charge.

The greed in Peoria is deadly.
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June 4, 2006

The PAEMSS (Peoria Area EMS System) has a website at www.paems.org/studenthandbook. The PAEMSS is controlled mainly by OSF-SFMC and they have a curriculum educating emergency medical technicians to become Basic, Intermediate, or Paramedic. Dr. Matt Jackson, is in charge of this education as the website states. Dr. Jackson works for OSF-SFMC in the Emergency Department and is Project Medical Director (doctor in charge of all ambulances) for this area. His boss is Dr. George Hevesy who is Director of the ER at OSF and Corporate Medical Director of Advanced Medical Transport (AMT). Dr. Hevesy is salaried by AMT and OSF. Dr. Hevesy is in charge of EMS ZONE II in the State of Illinois---a position he obtained through the Illinois Department of Public Health (IDPH).

The training of these emergency medical technicians is a money making endeavor.

The Peoria Fire Department (PFD) firefighters only function at a Basic level. They cannot transport patients. AMT is a thriving business in Peoria. They are Peoria’s only functioning paramedics and transport business. They are supported by Peoria’s hospitals and much of the business community.

It seems to me that the Peoria firefighters that are licensed as Paramedics or Intermediates should be able to function at these levels at the scene of an emergency. In other cities in Illinois, firefighters with advanced status can function as such even if their fire department is at a lower status. Why can’t the Peoria firefighters do the same? That way, Peorians wouldn’t have to wait valuable minutes when AMT is not present to give advanced and, at times, life saving care.

Also, a more important question is, have the project medical directors from OSF over the past decade insisted that the PFD upgrade its service to provide Intermediate or Paramedic service in the Peoria area? If not,why not?

The above website clearly states that Intermediate trained EMT’s can intubate, and can give very important drugs including intravenous epinephrine, lidocaine, atropine, lasix, and adenosine. These are key drugs in cardiac arrest, cardiac arrhythmias, and congestive heart failure that the PFD cannot give. Paramedics can give even more medications, but Intermediate abilities are definitely better than Basic level abilities.

It would be great if the Peoria Fire Department could advance to at least Intermediate and function as such. The PFD firefighters that are Paramedics now should be able to function as such now. Peorians would be helped immediately at the scene with key drugs if OSF and PAEMSS and IDPH helped out and supported this.

OSF-SFMC and its affiliate PAEMS should train the Peoria firefighters at no cost or at a reduced cost to advance to Intermediate. Both OSF and PAEMSS could show what good neighbors they are for Peorians with this gesture. If OSF-SFMC and PAEMS were serious about EMS, this would happen.

But I believe the fear at OSF and AMT is this would be the first step in taking business away from AMT. So Peoria stays mired in the mud of confusing EMS lexicon and the greed of a big institution.
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June 19, 2006

Even though OSF really is the control and "resource hospital" for EMS in the Peoria area, Methodist and Proctor have a strong affiliation with AMT and have well placed hospital administrators on the AMT board of directors.

Methodist Medical Center's Emergency Department Chairman wrote an article published in the Journal Star Forum.

I submitted the following:

Date: Fri Jun 9 17:53:20 2006
From: "John Carroll, MD"
To: forum@pjstar.com
Subject: forum submission
Please consider for publication in the Forum:

Dr. Elsburgh Clarke, Chairman of the Department of Emergency Medicine,
Methodist Medical Center in Peoria wrote an article in the Journal Star
Forum on 6-8-06. He stated that he recently had the distinct honor of
riding with the Peoria Fire Department.

He also added that he had “never seen such dedicated professionalism as
these firefighters exhibit attending to the residents of Peoria, who
require quick medical care”. I and others completely concur with Dr.
Clarke’s observations about the PFD. Indeed, the consultants that reviewed
Peoria’s Emergency Medical System two years ago stated that the PFD
responds 2 minutes quicker to life threatening events than Peoria’s
Advanced Medical Transport (AMT).

What Dr. Clarke omitted was the fact that the Peoria firefighters are not
allowed to fully utilize their training as paramedics and—like Dunlap
firefighters—cannot transport patients. Doesn’t it make sense to allow
the first responders, whether Peoria firefighters or AMT employees, to use
all their skills and training in saving people’s lives?

So, despite the excellent performance of the Peoria Fire Department, the
pre-hospital care in Peoria is far from ideal.

John A. Carroll, MD
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I thought my Forum submission was reasonable and gave my opinion which was definitely not the same as Dr. Clarke’s. Why he would ride with the PFD for the first time after five years in Peoria and then write about it, remains mysterious. Dr. Clarke published no health care statistics regarding how Peoria’s pre hospital patient is doing. But his conclusion was that everything was fine…kind of like the Peoria Medical Society last year. Why are all these doctors digging in their heels so hard in Peoria?

The issue, as I see it, is not whether the PFD is doing a good job providing rapid basic life support. I thought Dr. Clarke’s article was misleading and stressing the wrong issue. The issue, as I see it, are the powers that control Emergency Medical Services in Peoria allowing the PFD to do enough for Peoria’s residents?

Over the years, people have told me privately, how the PFD arrived at their home quicker than AMT after they called 911. Recently, a good friend told me the story of a man that suffered a full cardiac arrest in Peoria, the PFD arrived in two and one-half minutes, AMT arrived significantly later after getting lost on the way to the house, and the man was pronounced dead in one of Peoria’s emergency rooms a short while later. He was in his early 50’s. I don’t have any documentation for this, like run sheets, so the above anecdote needs to be taken for what it is without proof. But I will say, it is not an uncommon story for the PFD to arrive sooner than AMT.

Now AMT probably would not want you to know this, but the medical literature is all over the board regarding whether paramedic support in the field helps people in the field. Advanced life support has been proven to help victims with shortness of breath and chest pain, but MAY not help people that have suffered full cardiac arrest in the pre hospital setting. So maybe it didn’t make any difference for the gentleman that died that AMT was much slower than the PFD in the anecdote above. We will never know and neither will his wife. Common sense and intuition are not always supported by the medical literature.

But if it were your husband or wife or child, you don’t really care what the “medical research” says at that point. If your loved one is not breathing, do you want him/her to go two more minutes without sufficient oxygen? Do you want him/her not receiving advanced life support drugs because they have not been PROVEN to help in some circumstances? When AMT arrives, the patient DOES get those drugs and a breathing tube if necessary, even though in some cases, they have not been PROVEN to help. So why should the PFD not be able to give the same drugs if they are trained to do so? That is the "standard of care" in the United States. The first few minutes are the most important. Then if AMT transports a live patient, the patient and family are happy, and AMT is happy too because they have made big money.

Several days after submitting the forum article above, an associate editor for the Peoria Journal Star sent me an e mail asking me to send "clarification" that the PFD responded two minutes quicker than AMT to life threatening emergencies. The editor said they were going to hold my article until receiving the data and were looking forward to the statistics.

So I scanned page 53 of the Matrix Consulting Firm that studied Fire and EMS services in Peoria two years ago and e mailed it to the editor. The box graph on that page depicted that in 2003 the PFD arrived almost two minutes quicker (“mean response time”) than AMT to life threatening events.

Well, guess what? I never heard from the editor again and my forum submission was not printed by the Journal Star. (See below.)

As mentioned above, the final scientific answer is not in regarding EMS care. However, try to talk OSF, PAEMSS, AMT and countless other similar agencies across the country into NOT using advanced life support teams. And try and convince the spouse at her husband's funeral that advanced life support may not have helped if provided or provided SOONER when he suffered his fatal cardiac arrest.

So I continue as a little voice thanks to the web. What I am doing is very little, but I hope I am at least asking the right questions. I love printed newspapers to read in the morning with coffee. I just wish the main stream media in Peoria was not so driven by advertising by the three hospitals and other businesses that support AMT.

Some day in the future, we are not going to believe the smoke and mirrors that have been used in Peoria regarding EMS for so long. I don’t sound like it, but I am really an optimist and firmly believe things will change for the better in Peoria. It won’t happen today, but it will happen.
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June 27, 2006

The Journal Star did publish my forum article today. They left out the phrase "life threatening events" which I believe was important to include. The fact that the PFD responds two minutes quicker to "life threatening events" than does Advanced Medical Transport seems to be more important than if the PFD responded two minutes quicker than AMT to people that drop bowling balls on their feet. Not all 911 calls are the same and response time importance to the pre hospital patient varies according to the reason for the call.
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4 comments:

Anonymous said...

Dr. Caroll, I;ve seen in the past You protesting on street corners. But never understood the full view. Now present with issues I stumbled accidently onto your site. I read alot of it & amazed. I think You will find it interesting to know of current situations @ hand. PAEMSS is threatening local volunteer fire departments & fire protection districts with shutting down & or down grading license to operate. The c/o poor response times. Poor response time is not sufficient reason for the actions being used to threaten these agencies. I feel personally it;s because they depend on us to cover thier ass. Thus because of lack of numbers of AMT rigs on the street on given times. I hope You can quietly check around to what is going on. Maybe talk to Peoria Assoc. of Fire Chiefs, some Chiefs like West Peoria,Limestone, Chillicothe, Peoria Heights Ambulance service Co-Ordinator & Rescue 33. I feel this is all because of AMT needing/wanting more income, thus eliminating these other agencies would allow for more staff & more rigs on the street for AMT's benefit money wise & power wise!

spydawg said...

Any hospital that is "eligible"for Federal Funds of any kind should be following stricter guidlines than what St. Francis Medical Ctr has been. They are NOT totally "self-sufficient" which should be enough in of itself for the feds to have more control and say over their "business" No matter what "area" the federal funds are granted in.What has been going on with the ambulence system is a VERY good example.If Hevesy were a civil service employee he would have ALREADY been up on charges.What OSF ST Francis needs desperately is a thorough investigation from Internal Affairs.

Anonymous said...

Excellant point, if OSF takes federal money that came from us any way they should be subject to an internal investigation. However, I feel very strongly that Keith has covered all political bases, (maybe not) The internal investigation is long over due.

Anonymous said...

nice post. thanks.

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