Peoria City Council Citizens Forum–June 2005

 

Peoria City Council Citizens Forum–June 2005

I had the opportunity to speak to the City Council when citizens have their five minutes to address the City Council at the end of the open session. Here are some comments that I made to the Council:

I started out with some key vocabulary and some background information of Emergency Medical Services (EMS) in Peoria. The physician in charge of all pre-hospital care in the Peoria area is called the Project Medical Director. The Project Medical Director is in charge of approximately 70 pre-hospital EMS agencies in Central Illinois.  The Project Medical Director now is Rick Miller. Miller is an ER physician at OSF and was director of the ER for many years, stepping down in August 2001. The base station and resource hospital for all pre-hospital (EMS) in Peoria is OSF. Miller’s immediate supervisor is Dr. George Hevesy who is Director of the ER at OSF. Hevesy also holds the position as Corporate Medical Director of AMT. Hevesy was Project Medical Director for approximately a decade before Miller and Hevesy was on AMT’s payroll and OSF’s payroll. Heresy and Miller have controlled EMS in this region for the majority of the past 20 years.

AMT is Peoria’s private ambulance company. It is supported by Peoria’s three hospitals. Administrators from all three hospitals sit on the AMT board of directors along with very influential members of Peoria’s business community. Administrators from all three hospitals attend City Council meetings when AMT is attempting to obtain the contract with the City of Peoria to be the only paramedic and transport agency in the city.  Several years ago AMT grossed over $7,000,000 for their services in the Peoria area.

The PFD responded to greater than 9,000 health-related 911 calls in 2003. They can provide only BLS at the scene and cannot transport. Even though the PFD has paramedic firefighters, they are not allowed to use their skills in Peoria. 

With that background, consider the following vignette and put yourself in this patient's place. 

Several weeks ago, a man in Peoria who was eating in a Peoria restaurant, collapsed, and bystander CPR was started. 911 was called. The PFD arrived with at least one firefighter paramedic and shocked the patient who was pulseless His pulse returned. AMT arrived and attempted to place a breathing tube to help the man breathe and protect his airway. For one reason or another, this was not accomplished. Insertion of tubes can be very difficult in emergent situations. The PFD firefighter on the scene was not allowed to attempt the tube-a memo had been released that very morning stating that firefighters can only provide Basic Life Support even if they are paramedics. Another firefighter had recently been placed on a 90-day suspension when he put a tube in another patient several weeks prior. 

The patient described above in the restaurant died.

Just think if that person was a family member of yours.

Here are questions that the family of this gentleman or anyone with an interest in EMS in Peoria could ask--

1. Why wasn’t the PFD paramedic allowed to help in the restaurant with his ALS skills? Paramedics in the Peoria Area EMS who work outside of Peoria can use their advanced skills. What is going on here in Peoria?

2. The family of the deceased man should ask Andrew Rand, Director of AMT, why he stated in a PJS article (Dec. 8, 2002) that he did not want the PFD in the ambulance business. When the PFD shows up earlier than AMT at the scene, shouldn’t they be able to offer the best possible care to the patient?

3. Miller and Hevesy need to be asked why Joliet, Rockford, and Springfield firefighters can act as paramedics while at work and the firefighters in Peoria cannot.

4. The family of the man that died needs to review the run sheets concerning the care given to their father. And we all need to ask how Peorians are doing over the last 13 years since AMT was formed and supported mainly by OSF and OSF physicians. We need to know health care statistics. When I called the EMS office at OSF, I was told by the director that there were no aggregate data. When I called the district office of IDPH in Peoria they told me that they had no generalized data from AMT. When two FOIA requests were made to IDPH in Springfield, no meaningful help was given me from the State. The $79,000 consulting study from California (Matrix) reported no meaningful health care statistics regarding how AMT and Peoria are doing when they reviewed AMT last summer. Dr. Miller and Hevesy need to be asked about this. Where is this data that the public can review? AMT has a contract with the City and therefore their run sheets should not be hidden from the public.

5. On page 52 of the Matrix report, they state that studies have shown that paramedic care is proven to be statistically significant in improving positive outcomes in patients with chest pain and problems breathing. As mentioned earlier, the PFD responded to more than 9000 calls in 2003. Interestingly, 1900 of these calls were for breathing problems and 900 were for people with chest pain. The PFD responded an average of almost 2 minutes quicker to life-threatening emergencies than did AMT, yet the PFD cannot offer Advanced Life Support.

In conclusion, valuable time should not be wasted at the scene of a 911 call when the PFD arrives before AMT while the firefighter-paramedic is prevented from using his/her advanced life support skills.

Thank you.

John Carroll, MD

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PJStar.com - Journal Star Opinion

John A. Carroll, MD

Let Peoria firefighters give enhanced aid at emergencies
Thursday, July 14, 2005

Re. July 7 article, "Rescue services get some criticism":

Dr. Rick Miller, OSF emergency physician and medical director of emergency response services in Peoria, should allow the Peoria Fire Department to use its advanced life support skills at the scene of an emergency. This is such a basic public service issue, it shouldn't be a point of debate.

Contrary to what the Journal Star led readers to believe, firefighter/paramedics cannot protect the patient's airway with a breathing tube or administer advanced life support medications to the critically sick or severely injured. With Dr. Miller's support, Advanced Medical Transport, (AMT) the private ambulance company that is the only provider of paramedic and transport services in Peoria, can do both.

I don't believe that the director of AMT, Andrew Rand, has to worry about losing his company's lucrative monopoly on patient transport. Does Mr. Rand realize that for each minute a critically injured patient is not transported from the scene, the patient's chances for survival decrease by 5 percent? Those minutes can add up quickly. Hopefully, a mass casualty will not occur in Peoria which would overload our deficient emergency medical system.

With the intense local corporate support of AMT and the Journal Star's inadequate reporting of the real problems, our local health care leaders will probably tweak the system, but I doubt change will occur that will significantly help Peorians who suffer a prehospital emergency.

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In 2005, I sent the President of the Peoria Medical Society (PMS), Rich Anderson, MD, a couple of emails detailing my concerns regarding EMS in Peoria. I stressed that the Peoria Firefighter/Paramedics were not able to use their skills in Peoria. (My email is lightly edited below.)

Subject: Peoria EMS

Dear Rich,

Your May 18, 2005 letter stated that if I have any additional specific information regarding the health or general welfare of the public in Peoria to communicate with the Board of the PMS and that the Board would be happy to reconsider its position.

Please explore the following situation to confirm or refute its accuracy. 

A very good source recently told me that a PFD firefighter spoke with Rick Miller, Peoria's current Project Medical Director. The firefighter told Dr. Miller that he was very concerned about the lack of airway control on the recent 911 calls in Peoria. The firefighter warned Dr. Miller that there could be an "explosion" if this news got out or if the problem persists. In one of the airway cases a man collapsed at a restaurant and CPR was started by bystanders. An advanced airway was attempted by AMT but was not successful. The Peoria firefighter/paramedic told me that he did not attempt to intubate the patient because he is not allowed to. Even though this firefighter/paramedic works at AMT when he has some free time and intubates patients as needed during his moonlighting, he knew Dr. Miller would not be happy with him for any attempts he made to intubate the man in the restaurant while working as a firefighter and thought that he may suffer the wrath of Dr. Miller if he tried. 

The man in the restaurant died. 

After this unfortunate scenario in the restaurant, behind the scenes, Dr. Miller allegedly told the firefighter that the PFD could begin intubating patients if they were qualified (ILS/ALS), and if AMT asked for their help.   If this is true, I wonder what will happen when AMT is late arriving at the scene and the firefighter/paramedics find themselves with a critical patient. 

As a physician and surgeon, I assume you understand very clearly the importance of an early, secure airway. Why haven't the PFD firefighters that are ILS or ALS trained been able to use their intubating skills for patients in the field in extremis? These same PFD firefighters/paramedics do use their ALS skills when they moonlight in surrounding communities without asking permission first. ..

Rich, in Joliet, the municipal fire department has 189 firefighters with 140 of them certified paramedics. They give Advanced Life Support at the scene and do not need to ask their local private ambulance company permission to do so. Why is there so much difference between Joliet and Peoria? Joliet is only 2 hours from here and about the same size as Peoria. Are the citizens of Peoria more resistant to hypoxic conditions than the fine people in Joliet?

Please let me know what the Boards position is when you reconsider this important EMS issue in Peoria.

Sincerely,

John

(Dr. Anderson answered this email. In general terms, he stated that everything was fine with Emergency Medical Services in Peoria. He also advised me not to reproduce his letter.)

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June 26, 2006

Last year, when I spoke at a Citizens Forum of the Peoria City Council, I told the story of the gentleman who collapsed at a Peoria restaurant. The Peoria Fire Department was not able to give advanced life support and the man died. 

It is interesting that after this was exposed, behind the scenes, Rick Miller changed his policy and he is now allowing the PFD Paramedics to function as Paramedics when AMT is present. This was a step forward for the PFD and wouldn't have happened if it were not for the man dying in the restaurant and his story told. 

A year has passed, and the PFD still stays mired at Basic-D level with only basic medications to provide Peoria's public. The following entry is from Terry Carter and was written last year after this unfortunate event happened and was exposed. I am in agreement with Terry that the problem is not with the medics on the street. It goes much higher. (When I spoke to the FBI in Peoria in 2001 about their successful prosecution of AMT for Medicare fraud, they advised me that the "problem goes all the way to OSF's Board of Directors".)

Terry Carter 

July 15, 2005

Just an update, Dr. Miller, the medical director for the Peoria Area EMS system has now approved for Paramedics, employed by the Peoria Fire Dept. and licensed within the Peoria system, to have the power to perform ALS (Advanced Life Support) interventions while operating with the PFD. This went into effect yesterday 7/14, I believe. It’s a step in the right direction, BUT…here’s another hitch. PFD is still only licensed as a Emergency Medical Technician – BASIC service. This means they cannot carry meds, IV’s, breathing tubes, etc. on their apparatus. So, Dr. Miller’s new rule is kinda like telling a furniture builder they can build furniture, but not provide them any tools. Get it?? Not for profit…don’t make me chuckle. AMT’s administration has salaries and bonuses that reflect their ability to have the corporation bring in $$$, just like any other company. The more stuff the fire department does, that AMT can’t charge for, is money out of those peoples’ pockets…kinda makes ya go hmmm…dunnit?? AMT just purchased seguays...you know…those fantastic new devices that take the place of WALKING?? (don’t get me started on out of shape Americans). Why did they buy them? They really serve no great purpose in emergency medicine, can’t haul equipment on them, can’t transport patients on them. Gee…maybe it was a way to spend extra money in order to NOT SHOW A PROFIT? It’s just a guess…Finally…yes, PFD has medics that have been medics for years. They have a lot of experience vs. newer medics that work for AMT. But, AMT is the only show in town for new medics so they can’t be blasted for their turnover rate. AMT is where most Peoria medics get time under their belts. PFD only has to cover the city proper and are strategically placed. AMT covers most of Peoria County, and a lot of Tazewell, along with transports to other hospitals, etc. So yes, they are spread thin and can’t respond as quickly as the PFD. The medics of AMT are not to blame for this AT ALL. Most of them have a wonderful working relationship with the fire professionals of the Peoria Fire Dept.