Peoria's Medical Mafia--July 2021
Peoria Area EMS--Quick Video #1
THIS IS A TWO-MINUTE VIDEO RE PAEMS. No more 15 minute videos from me. I hope to do a series of two-minute videos to explain how PAEMS has worked over the past 20-25 years in Peoria.
I want you to ask yourselves the following questions:
If you or your loved one were to call 911 today for a medical problem, would you want the arriving Peoria Fire Fighter Paramedic to use his knowledge and skills or would you want the same Paramedic to not be able to use his skills?
SOUNDS LIKE A LEADING QUESTION, BECAUSE IT IS.
Second question—ARE YOU AWARE of the fact that the PFD Paramedics were not able to function as Paramedics for the majority of the past two decades when they reached you or your loved one?
Does this make sense to you?
Does it make sense to you that these PFD Paramedics, who are licensed the same way as AMT’s Paramedics, were not allowed to provide you with Paramedic care? For example, for much of the past two decades, if you needed an IV, the PFD Paramedics couldn’t place it if they arrived before AMT.
DOES THIS MAKE SENSE TO YOU?
The explanation is only understood if you understand the culture of PAEMS. Every organization has its own culture. Churches, schools, hospitals, public services, professional sports, etc all have a culture. And I will explain in these two minute videos about the culture in PAEMS. AT LEAST AS I SEE IT.
I will end TODAY with the definition of conflict of interest.
“A conflict of interest is a set of conditions in which professional judgment concerning a primary interest (such as a 911 patient's welfare) tends to be unduly influenced by a secondary interest (such as financial gain). Conflict-of-interest rules regulate the disclosure and avoidance of these conditions.”
And this is where we will pick up on the next video regarding a Freedom of Information request I made regarding CONFLICT OF INTEREST. AND I WILL READ IT TO YOU TO SEE IF YOU THINK IT EXPLAINS AWAY THE CONFLICT OF INTEREST in PAEMS.
Ultimately, I wish to crowd source with these videos…to ask your help with changing the culture here in Peoria Area EMS. Peoria has so much to offer. But the nexus where business runs headlong into caring for patients is a dangerous intersection. And it’s dangerous not for the people responding to 911 calls but for the patients who call 911. In Peoria for much of the past two decades people dialing 911 for themselves, family members, or others have not received the care they should have received from the best trained people who arrive on the scene the quickest.
I will give some examples in the future of pre hospital patients who did not get the best care they could have in Peoria.
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May 6, 2019
During these posts I will refer to the Peoria Area EMS Project Medical Director as “Dr. X”, and the CEO of Advanced Medical Transport (AMT) as “Mr. Y”. For the last 25 years, Dr. X and Mr. Y are well known in EMS circles in central Illinois. But I think it is best NOT to use their names because it is the culture in PAEMS that is important here…not the most visible people who greatly influence EMS policy. If it weren’t Dr. X and Mr. Y in Peoria, it would be two other individuals doing the same within the PAEMS culture.
In the late 90’s and early 2000’s it was common knowledge that Dr. X was being paid by Mr. Y. Dr. X was the Project Medical Director for all the EMS agencies in central Illinois—about 70 agencies. AMT and the PFD are the two “stakeholders” here in Peoria. Dr. X was also being paid by OSF-SFMC where he was Vice-President of the Emergency Medicine Department.
It was also common knowledge that AMT did not want the PFD to upgrade their EMS capabilities. AMT’s fear was that the PFD would go into the transport business and thus take business from AMT. (AMT’s revenues were about 23 million dollars in 2018.)
In the 90’s and early 2000’s, Dr. X and Mr. Y were quoted multiple times in the Peoria Journal Star and other publications that they did not want the PFD upgrading its services for the people of Peoria. What was not publicized at that time was that Dr. X was being paid by AMT.
In the early 2000’s, I requested under the FOIA the conflict of interest statement made by AMT regarding the fact that Dr. X was being paid by AMT.
Here are excerpts from the document I obtained from the Illinois Department of Public Health stating that Dr. X was receiving a salary from AMT---
“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” is the AMT Board of Directors because there are no other ambulances in Peoria. Why did this statement not identify “AMT Board of Directors?”
No potential for conflict of interest? I think there was great potential for conflict of interest.
This is truly an amazing document. Locally and nationally, people in EMS believed that Dr. X’s financial arrangement with Mr. Y and AMT represented conflict of interest. No other agency in central Illinois was paying Dr. X for his services except AMT and OSF-SFMC.
In the summer of 2003 I picketed OSF-SFMC with a sign stating that OSF and AMT had a monopoly of paramedic services in Peoria. Sue Wozniak, CFO at OSF and AMT board member, scolded me one afternoon as she was leaving work as I picketed the hospital. I asked her what she thought about Dr. X receiving a salary from AMT when he was director of ALL ambulances in central Illinois. She said it was a good idea that Dr. X “stepped away from this” when he gave up being Project Medical Director and 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.
This was all amazing to me.
What is even more amazing is that today in 2019, Dr. X is still the “AMT Corporate Medical Director”, and he is still a salaried employee of AMT and OSF-SFMC. And Mr. Y is still CEO of AMT in Peoria. Unfortunately, both men still significantly influence EMS in Peoria in 2019.
This is the culture of PAEMS.
How does all of this sound to you? Does this sound like a healthy relationship for the 20,000 people who called 911 in Peoria last year? Do you think it is a good thing that for the past 25 years that the majority of the time that the PFD Paramedics arrived first on scene at a 911 call that these Paramedics could not function as Paramedics?
Is this good?
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Next post I will describe how the PFD had to trade a proposed upgrade of their EMS services for defibrillating the patient’s heart. Not kidding.
John A. Carroll, MD
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May 6, 2019
You are not going to believe this.
Did you know that in 1996 Mr. Y, the CEO of AMT, and Dr. X, the Project Medical Director for Peoria Area EMS, were both opposed to the efforts of the PFD upgrading from Basic Life Support (BLS) to Intermediate Life Support (ILS)?
Mr. Y from AMT was quoted as saying that the PFD should “spray the white stuff on the red stuff” and leave higher EMS support to AMT. And Dr. X was telling the Peoria City Council and the Journal Star that it would be “duplication of services” if the PFD upgraded.
Did you know that Dr. X was being paid by Mr. Y from AMT?
Did you know that Ernie Russell was PFD fire chief in 1996 and that some sort of a deal was pitched to Chief Russell that if the PFD stopped their efforts to upgrade their services, then the PFD would be allowed to electrically defibrillate (shock) prehospital patients in Peoria for the first time in PFD history? Chief Russell smartly chose the later and stopped attempts to upgrade the PFD to Intermediate Life Support. The most important modality, shocking the person in cardiac arrest, finally reached the PFD Paramedic who was most often the fastest arriving Paramedic at the patient’s side.
Many municipal fire departments in Illinois and in the nation were shocking patients and saving their lives for years before the PFD. Why? And AMT in Peoria was shocking patients also. Why wasn’t the PFD shocking patients prior to 1996? Where was Dr. X insisting that the PFD needed to save these lives, too?
Why were Dr. X and Mr. Y opposed to the PFD upgrading? I think the answer was that Dr. X and Mr. Y were worried that the PFD would expand even further and transport patients in Peoria. And as you may know, even today in 2019, the PFD still does not own an ambulance and cannot transport people. And Dr. X and Mr. Y are still important players in this scheme.
Does all of this sound good to you? How do you like the “culture” here in Peoria?
John A. Carroll, MD
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May 6, 2019
Can you imagine?
Can you imagine if an Emergency Department Ethical Morbidity and Mortality (“M and M”) Conference were to occur at OSF-SFMC regarding EMS policy creation in Peoria?
Medical departments in medical centers have monthly Morbidity and Mortality Conferences and discuss the management of patients who have had sickness and death while in the hospital. The case is presented and the outcome is stated. Ideas are shared by different attending staff and faculty members on the management of a case. The idea is to learn something and benefit patients in the future who may suffer from similar medical problems.
What if the Emergency Department at OSF-SFMC had an Ethical M and M Conference regarding Conflict of Interest and EMS in Peoria?
Someone responsible and independent would have to ask tough questions regarding how policy was made determining the level of care the Peoria Fire Department would provide during the last 25 years. Unfortunately, there is so much money involved with this topic that this Ethical Morbidity and Mortality Conference will never take place in Peoria.
John A. Carroll, MD
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Are you still with me?
The late 90’s turned into the 2000’s and Advanced Medical Transport (AMT) continued to rule the roost as the only Advanced Life Support and Transport service in the City of Peoria. AMT would obtain contracts with the City of Peoria over the years that guaranteed this monopoly would continue until the mid-2020s.
During the same time period. the PFD Paramedics were kept at Basic Life Support-Defibrillation with no ambulance and no transport. The PFD Paramedics could not function as Paramedics at a 911 call even when they arrived before the AMT Medics. Most importantly, the patient had to wait, too.
In 2004, the City of Peoria hired Matrix Consulting for 79 thousand dollars to come to Peoria and study our EMS. Matrix and AMT had been good friends for years and so this allowed things to “stay in the family”.
All things were going as planned.
But before I tell you some of Matrix’s recommendations, let me tell you what happened in 2005.
One day a man in Peoria was at one of our restaurants and he dropped over in cardiac arrest. 911 was called and one of the PFD Engines in the area responded quickly with a PFD Paramedic on board.
The PFD Engine arrived at the restaurant before AMT--which was not unusual. CPR was started on the individual. The PFD Paramedic on the Engine immediately assessed the man and shocked him because he had one of the “shockable rhythms”. The patient subsequently developed a pulse. However, even though this PFD Paramedic worked part-time for AMT as a Paramedic, due to the rules in PAEMS, he was not allowed to intubate the trachea with a breathing tube.
Why wasn’t the PFD Paramedic allowed to insert the breathing tube? Rick Miller was Project Medical Director in 2005 and he had made a recent announcement that PFD Paramedics could not function as Paramedics--they could function only at Basic Life Support-D. When AMT arrived, AMT attempted to intubate the trachea of the patient but were unable to so. They asked the PFD Paramedic to intubate, but he declined, in large part due to Miller’s threats. Even though the PFD Paramedic worked with AMT on weekends, he couldn’t even start an IV on the man down at the restaurant. Eventually, the patient was intubated, but it took some time.
The man did not survive.
I am not saying he would have survived even if his trachea been intubated quickly. I wasn’t there. But I don’t think Peoria’s EMS treated this patient fairly as he was having the worst day of his life. I thought that business had won out over medical ethics and common sense.
I presented this case to the Peoria City Council. Not long after my presentation, Rick Miller was quoted in the Journal Star stating that I made inflammatory remarks about the Peoria Fire Department. I had done no such thing, of course. Miller was spinning the situation as much as he could. The public would be confused as to what actually occurred. Miller was the Project Medical Director who controlled what the PFD could and couldn’t do regarding establishing a definite airway.
And then a few weeks later after the man had died, lo and behold, behind the scenes Dr. Miller changed his own rule and stated that the PFD Paramedics could intubate patients in the future only if asked to do so after AMT had arrived at the scene. Miller’s new rule was never published in the Journal Star. I wonder why?
And in the years to come, Miller’s rules were to change again. But in 2005, Miller was doing his job--keeping the PFD as docile as possible.
Back to the Matrix study in 2004—
One of the recommendations of Matrix in 2004 was that four of the PFD’s Fire Stations could upgrade to Advanced Life Support (ALS) in order to decrease the time to arrival before ALS was provided to the patient.
So what do you think happened? Nothing happened for five years until Fire Station 12 on North Adams became the first Peoria Fire Station ever to be staffed 24/7 with PFD Paramedics who were allowed to function as Paramedics even when AMT had not yet arrived on scene. Over the next few 4 to 5 years, Stations 20 and 4 were also upgraded to ALS.
So, all in all, it only took 10 years to partially accomplish what Matrix recommended in 2004. Why so long do you think?
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Is any of this important in 2019. Yes. Some of the same characters influencing EMS policy 20 years ago are still influencing policy today. And Peorian’s still do not get the EMS care they deserve in 2019.
More to come.
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What would you think if I told you that, from a very good source--an excellent source--I was told about the Peoria physician who tried to buy off the PFD? The physician proposed to the PFD the following: If you hire me as your EMS Medical Director, I will make sure that the PFD upgrades to ALS.
Can you believe this? A second job and money for this physician seemed to be more important than the PFD’s ability to respond as ALS providers for 113,000 people.
Who woulda’ thought?
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So what has to happen to improve the culture of Peoria Area EMS?
First, people have to understand there is a problem with the culture of Peoria Area EMS.
But if understanding is achieved, and nothing is done, what have we accomplished for the 20,000 people in Peoria who dial 911 each year? Nothing.
People have to act. And this is hard to do in Peoria.
I believe that the main reason for inaction the last 25 years is fear. There is a culture of fear that has been created by the leaders of our health community. And this is bad.
People are afraid of losing their jobs, their health insurance, and their family and friends who are in the business community at large.
Keith Steffen, retired CEO of OSF-SFMC, told me years ago in his office that fear is a good thing amongst OSF employees. Steffen tried to intimidate OSF nurses and visitors in the medical center when he thought he could get away with it. I know this because they told me.
And when the top Sister of OSF Corporate heard some of what Steffen had to say, she was visibly nervous and walked around her Corporate Office like a squirrel caught in a trap. She was definitely cornered and nervous and she knew she had no good way out at that point. Sister’s soul was slowly being devoured and her Mission philosophy was being trashed by her suits down the street.
Many years ago Dr. X, who had been Project Medical Director and was receiving a salary from Advanced Medical Transport and OSF, stood in front of a room of young resident physicians with another attending physician at his side. Dr. X, not wanting to be quoted, had the other attending physician do the speaking. The other attending physician, who is now an administrator in 2019, told the group of scared residents that if any of them disagreed with my departure from the Department, they needed to keep it to themselves or suffer serious consequences. Dr. X nodded his head in agreement. None of the young residents were wild about losing their careers in Emergency Medicine. Who would be?
What happened to “open and honest communication” at OSF-SFMC?
The PFD firefighters have recently been warned not to like or share these stupid FB posts of mine. They like their jobs just as well as the young resident physicians at OSF liked theirs. And so more opinions in Peoria have been effectively snuffed out.
And I doubt that most AMT employees or people who have been associated with them in the past are wild about going public about AMT’s deepest secrets. Many are very afraid of seeing AMT in court.
Even people who have lost a loved one in a bungled resuscitation attempt fear OSF. They know what an extended lawsuit would do to their family and their kids in the “Young Republican Party”. It wouldn’t be pretty. They have told me.
I have found during the past 20 years, that almost everyone will talk when the elevator door closes. But once the floor is reached and the door reopens, all talking stops.
Elie Wiesel--
“We must take sides. Neutrality helps the oppressor, never the victim. Silence encourages the tormentor, never the tormented. Sometimes we must interfere.”
John A. Carroll, MD
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I don’t know if you have noticed or not…but big businesses rarely admit mistakes. And this includes OSF in Peoria. OSF is a very big business.
Advanced Medical Transport (AMT) in Peoria is a big business also. And its main investor is OSF. Secondary investors are Methodist and Proctor.
In 2000 when Mr. Y and AMT found themselves in some doo-d00 with the Federal Government for alleged Medicare fraud (billing issues/upcoding/ #notclericalerrors ), I don’t think that AMT or OSF ever admitted guilt. Never said they were sorry to the public. Didn’t admit any wrong doing. But OSF and Peoria’s two other fine hospitals contributed 750,000 dollars apiece to pay the AMT fine of 2.1 million dollars. As part of the settlement, AMT entered into a three-year corporate integrity agreement with the U.S. Department of Health and Human Services. AMT also agreed to cooperate in further investigations and reimburse the government for other improper bills if they were identified.
And Mr. Y kept his position as CEO of AMT. All was good.
In the early 2000s when I realized AMT and OSF were in bed together, I spoke with Joe Piccione who is OSF Corporate’s Catholic Medical Ethicist.
Joe was hired by the nuns at OSF in the early 90s to fashion ethical loopholes in order to allow OSF’s physicians in the entire OSF network to prescribe oral contraceptives for birth control. OSF did not want to lose any business (money) if their OSF physicians were forced to adhere to pesky Catholic doctrine regarding contraception. Joe took his new job and paycheck seriously, and along with some gentle negotiation with the Bishop of Peoria, he adeptly crafted a way for OSF physicians to prescribe birth control. Joe’s policy is still working nicely today.
When I spoke with Joe in his office about conflict of interest between players within OSF and AMT, he seriously told me that as an OSF employee I was mandated to submit my concerns regarding this. When I left his office that day in the fall of 2001, I thought Joe’s words were convincing but his body language betrayed him.
Anyway, I wrote to five people at OSF Corporate asking to meet with them to discuss the conflict of interest between OSF and AMT. However, believe it or not, I never heard back from any of the five recipients…including Ethicist Joe. So it appears that I was mandated to submit my concerns but that OSF Corporate and Joe's Ethics Committee were not mandated to respond. I never did figure this out for sure.
My submission of my ethics concerns was much like David trying to talk Goliath into a nice conversation in the desert. I just didn’t know it at the time. So I pressed forward thinking someone must care.
In 2003 I wrote a letter to the Diocese of Peoria expressing my concerns regarding the “AMT monopoly of Paramedic and Transport Services in Peoria”. I was sent an answer from the Diocese advising me that Bishop Jenky would not be able to help out. (As it turns out, poor Bishop Jenky was deathly afraid of OSF also.) But the cheery part of their response was their advice to me to contact Pope John-Paul II regarding the “alleged monopoly”.
In the end, I didn’t follow the Diocesan advice because I figured that the Pope may not care much about our ambulance monopoly in Peoria, Illinois.
In order to continue my streak, several years later I contacted the Peoria Medical Society and told them of my concerns regarding the AMT monopoly and the fact that the PFD Paramedics were being restrained from helping 911 patients.
I received an email from the President of the Peoria Medical Society assuring me that all was good with EMS in Peoria and no changes to the system were necessary. And at the bottom of his letter was a sentence telling me not to reproduce any part of the letter.
Wow. This seemed odd to me. Why would he say this? Didn't he believe what he was stating in his letter? A few years later, PFD Engines began upgrading to Advanced Life Support so people with major emergencies could be treated with Paramedic care more quickly. I guess all was not just fine with the EMS system as the President stated.
All kind of embarrassing. But for whom?
So as the 2000s rolled along, Peorians probably died unnecessarily in part due to the fact that the earliest arriving Paramedics (the PFD) were not allowed to treat patients with Advanced Life Support in a timely fashion. The influential people in Peoria, who should have been more interested in this issue, were protecting turf.
Today in 2019, 8 of the 11 PFD Stations/Engines are Advanced Life Support. Three Stations are not.
More later.
Thanks for reading.
John A. Carroll, MD
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Peoria Area EMS--Quick Video #8
In 2015, I gave a five-minute talk to the Peoria City Council at Citizen's Forum. The Mayor allows random nut jobs in the gallery to address the Council about issues in Peoria. But we’re supposed to keep it to five minutes or under.
I cited the case of a witnessed full cardiac arrest in Peoria that was responded to by Engine 19 on Peoria's northwest side. When Engine 19 arrived, they found the patient's wife performing CPR. Engine 19 was Basic Life Support (BLS) in 2015 and, even though there were Paramedics on Engine 19, the Paramedics could not use their Paramedic skills because AMT had not yet arrived. The PFD Paramedics couldn't even start an IV on the gentleman because that is considered Advanced Life Support in Peoria Area EMS. AMT arrived some minutes later and the patient was eventually pronounced dead.
My point in presenting this case to the Council was to point out again that another Peorian had not received the best care that Peoria had to offer. He may or may not have lived. But he didn’t get our best. I wondered how many cases like this there had been in the previous two decades and how many would it take to change policy?
The Project Medical Director (PMD) became quite angry with the fact that that this case was brought up in public. He eventually addressed the Peoria City Council and stated that it was not necessary for Engine 19 to upgrade to ALS. Once again, Peoria was being assured by our experts that everything was fine in the Peoria EMS System. (On January 1, 2019, Engine 19 was upgraded to ALS with the blessing of the same Project Medical Director.)
So a couple of more years passed. The PFD firefighters were threatened in creative ways and turf was protected as much as possible. However, in 2017 an interesting thing happened in the State of Illinois. Bill 1952 was signed into law in August by Governor Rauner in Springfield. Please read my Letter to the Editor (below) explaining what Bill 1952 was and its importance for the people in Peoria.
Letter to Editor--January 2018:
On January 1, 2018, Peoria Fire Rescue 1 on Monroe and Engine 3 on Armstrong became Advanced Life Support First Response. They join three other Advanced Life Support Engines in Peoria--Engine 12, Engine 20, and Engine 4. This is the first time Peoria firefighter paramedics from Rescue 1 and Engine 3 have ever been able to provide independent Advanced Life Support when they arrive at a 911 call. Sick and injured patients no longer need to wait precious minutes for Advanced Medical Transport (AMT) to arrive.
Why did our local Project Medical Director, Matt Jackson, MD, just allow these two Peoria Fire Engines to upgrade to Advanced Life Support First Response? During much of the last two years, Dr. Jackson had opposed ANY PFD engine upgrade from Basic Life Support to Advanced Life Support.
In August 2017 Illinois House Bill 1952 was signed into law by Governor Bruce Rauner in Springfield. This bill states that the “ambulance assistance provider (such as a Peoria Fire Engine) shall be authorized to function at the highest level of EMT license…held by any person staffing the ambulance assistance vehicle.” This means that if there is a Peoria Fire Paramedic on a Basic Life Support Engine, and if Dr. Jackson "signs off" on the Engine, this paramedic can now provide Advanced Life Support immediately upon arriving at the scene of a 911 call.
This law should help level the playing field in Peoria between AMT, which is supported by the powerful medical and business communities, and the shackled Peoria Fire Department which wants to provide Advanced Life Support for all the people of Peoria.
The two-decade EMS saga in Peoria shows how medicine, politics, and money intersect at a dangerous point. There were over 19,000 medical 911 calls last year in Peoria. Peoria Fire has enough paramedics to staff all 12 Engines. The Project Medical Director in Peoria should keep money and politics out of the equation and allow all of the remaining Peoria Fire Engines which are Basic Life Support to become Advanced Life Support.
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So after 20 years and with numerous health care leaders in the City of Peoria telling the media that no changes were needed in Peoria Area EMS, five PFD Engines/Stations were ALS by early 2018. Many PFD Paramedics had been working for the PFD for years. Why were they getting to be big boy Paramedics now for the first time? Why the changes in EMS policy?
More later on the origin and passage of Bill 1952 and how it has "played in Peoria".
John A. Carroll, MD
Does it make sense to you that half the people of Peoria are served by PFD Paramedics who can offer you Advanced Life Support when they arrive at your house on a 911 call? But if you are part of the other half of the population, the PFD Paramedics can’t provide you with Advanced Life Support until Advanced Medical Transport arrives?
I didn’t think so.
What’s up with this?
If you lived anywhere in Rockford, you would have received Advanced Life Support from the earliest arriving Rockford Fire Department Paramedic for many years now.
What is going on?
Why the difference between Peoria and Rockford?
John A. Carroll, MD
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Transparency? I don’t think so.
Another problem with Peoria Area EMS is that AMT does not need to release its response times to people like me. And apparently, AMT does not need to release its response times to the City of Peoria.
Last year I made a FOI request to the City of Peoria for the PFD response time and AMT’s response time to a full cardiac arrest in Peoria. The City responded with the PFD response times but the City told me that they did not have AMT’s response time and advised me to contact AMT and ask for this information. When I called AMT, they would not release their response times.
What does PAEMS think of this? What does the Project Medical Director think of this? Does he think it is a good thing that AMT does not release their response times even though AMT is performing a government function for the City of Peoria?
When Fitch Consulting came to Peoria in 2018 to study EMS, somehow they seemed to know AMT's response times which were noted to be on average about two minutes slower than PFD's response times. Why did Fitch have access to these times, yet the City of Peoria and the common peasant does NOT have access to these times?
Anybody have any idea what is going on here?
The reality of our situation in Peoria is that AMT can act with impunity under the not-so-watchful eye of the Project Medical Director (PMD). And the PMD is king and unquestioned here in Peoria and in Region II in the state. What he says goes.
Not much in the way of checks and balances here. This is not healthy.
I submitted this Spotlight Forum article to the Journal Star which was published in November, 2018:
Peoria EMS Needs Transparency
This spring in Peoria a person suffered a cardiac arrest. Fortunately, there was a good outcome for the patient and local media reported on this success story.
On June 19, I FOIA’d the City of Peoria for response times of the Peoria Fire Department (PFD) and Advanced Medical Transport (AMT) to this incident. The City answered my FOI request and included the arrival time of Engine 19 to this cardiac arrest. However, written in red ink on the City’s response was a note for me to contact AMT to obtain AMT’s response time.
Shortly after that I called AMT and asked for their response time for this incident. AMT told me that they would not give me their response time.
I followed up with an email to the Public Access Counselor who is an Assistant Attorney General in Illinois. I explained to the Assistant Attorney General that AMT is contracted by the city to be the exclusive provider of ambulance transport in Peoria. Therefore, the City needs to release AMT’s response times.
In response to my email, on July 5 the Assistant Attorney General emailed the City and cited a previous similar request as mine by another requester in 2017. The Assistant Attorney General determined in 2017 that “the records in possession of AMT describing response times to incidents involving the Fire Department (the City) are the public records of the Fire Department (the City) pursuant to FOIA and therefore the Fire Department (the City) must obtain these records from AMT when requested in a FOIA request.” (The City of Peoria never complied with the 2017 request.)
In mid-July, the City’s attorney answered the above email from the Assistant Attorney General stating “…we do not have the records of AMT in our possession and cannot provide such…” The City attorney continued “…we do not have any better access to those records than the requester (John Carroll) does.”
It is now mid-November and the City has not provided me with AMT’s response time that I requested in June. It appears that the City has once again ignored the advice of the Attorney General of the State of Illinois regarding complying with FOIA requests.
In hopes of balancing the budget, the City recently announced that approximately 20 firefighter positions will be eliminated and there is a proposal to take Rescue 2 and Engine 2 out of commission and consolidate 2 South Peoria Fire Stations. The PFD responds to nearly 20,000 EMS calls annually. With these cuts, projected response times are longer.
Only five of the current twelve PFD Stations are Advanced Life Support. Due to the lack of transparency from the City and AMT regarding AMT’s response times, and the anticipated changes mentioned above, I believe it is vital for all of the PFD Stations to be upgraded to Advanced Life Support so all PFD Paramedics can function as Paramedics when emergencies occur.
John A. Carroll, MD
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One month later in January 2019, PFD Engines 10, 16 and 19 were all upgraded from Basic Life Support to Advanced Life Support.
Any idea why this happened?
Will tell you next time why this upgrade came too late for a lady in Peoria whose family called 911 on Christmas Day. Here is the FB Video describing this case.
John A. Carroll, MD
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On Christmas Day 2018 a lady in Peoria did not feel well.
She asked her son to call 911 for help. Both the son and lady spoke with Dispatch and told Dispatch she was short of breath.
Dispatch told the lady that they would send help right away. One can hear this lady thank Dispatch for their help.
Peoria Fire Engine #10 arrived in about 5 minutes. The Paramedics on Engine #10 evaluated the lady quickly and realized they had a sick patient on their hands.
The Dispatch audio recording documents the difficulty encountered in getting AMT to the lady's side. It took 26 minutes for AMT to arrive.
Because Engine #10 was BLS on Christmas Day, the PFD Paramedics on Engine #10 could not function as Paramedics until AMT arrived on the scene. In other words, the PFD Paramedics could not even start an IV on this lady.
After AMT arrived, the sick lady went into cardiac arrest and died.
There were two types of error made here. Number 1, AMT's arrival time was long. Number 2, there was systemic error. For over two decades, the PFD Paramedics have been told that they cannot function as Paramedics at a medical scene until AMT arrives on scene.
I do not concentrate on errors or oversights getting to the scene or errors on scene. I concentrate on systemic problems, which are huge drivers influencing patient care. Paramedics on the street, both PFD and AMT, must function under the rules made by our EMS health care leaders. And pre hospital patients live or die with the same set of rules.
I was not with the sick lady on Christmas Day. I have a good idea what her problem was, but that is not important now. The two teams of pre hospital medical providers (PFD and AMT) were doing the very best they could possibly do to help this woman. But I can say for sure, that this woman did not receive the best pre hospital care available to her on Christmas Day.
Just a week later, on January 1, 2019, Engine #10 was upgraded to Advanced Life Support. What this means is that the Paramedics on PFD Engine #10 will now be able to function as Paramedics before AMT arrives on scene. The PFD Paramedics have the same education and license as the AMT Paramedics. There is no reason that Peoria taxpayers should be denied their care.
Eight of eleven PFD Engines/Stations are now Advanced Life Support. What about the last three PFD Engines/Stations? Why are the people in these three areas of Peoria still denied care by the quickest arriving PFD Paramedics?
What is Bill 1952 and where did it come from? Next post.
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So what exactly was Illinois Bill 1952?
Bill 1952 originated from Peoria in 2017 and was written for the benefit of the Peoria Fire Department (PFD) and for the 20,000 people in Peoria who call 911 each year. Bill 1952 proposed that any EMS Engine in Illinois could function at the level of the highest trained medic on the vehicle.
So how would this help the Peoria Fire Department?
Bill 1952 was written to allow Peoria Fire Engines responding to emergency medical calls to function at the Paramedic level if a PFD Paramedic was on board the Engine. Therefore, a Basic Life Support Engine could function as an Advanced Life Support Engine if a Paramedic was on the vehicle. As stated above, this bill would cover not only Peoria but the entire state of Illinois.
Bill 1952 was proposing what I have been advocating for the past two decades--Allow PFD Paramedics to function as Paramedics at the scene.
Did you know that this bill was unanimously voted for by all of the House of Representatives of Illinois except for one? Ryan Spain of Peoria voted "present". Ryan is Vice-President of Economic Development for OSF HealthCare. And he has relatives on the Community Advisory Board of Advanced Medical Transport (AMT).
I assume Ryan believed that OSF and AMT would be in opposition to Bill 1952. Why would Ryan think that OSF and AMT would NOT want the responding Paramedic on the PFD Engine to be able to offer Paramedic care on a 911 call?
And believe it or not, there was a lobbyist in Springfield hired to OPPOSE Peoria being covered in the bill. In other words, the lobbyist wanted to carve Peoria and the Peoria Fire Department out of Bill 1952. She was ok with Bill 1952 for the rest of the state, but not Peoria.
Can you believe this?
Who paid this lobbyist to oppose Peoria Fire Department Paramedics?
Well, the lobbyist works for the Illinois College of Emergency Physicians (ICEP). ICEP is the state medical specialty society representing more than 1,340 emergency physicians in Illinois.
According to ICEP's website, “ICEP is dedicated to the support of quality emergency medical care and committed to the interests of emergency physicians. ICEP provides its members with significant benefits through active committees, continuing medical education programs and other activities including legislative lobbying.”
This same lobbyist sits on an ICEP board regarding the Political Action Committee (PAC) and works with legislators in Illinois.
Why would the biggest Emergency physician society in Illinois be opposed to licensed PFD Paramedics in Peoria giving care in Peoria?
Any ideas?
Are there ties between ICEP and Peoria and Bill 1952?
Well, there might be. The past president of ICEP is none other than Dr. X referred to earlier in these Notes. Dr. X was Vice-Chairman of the OSF Emergency Department and was Project Medical Director (PMD) in Peoria for many years. He helped determine which EMS agencies were Basic Life Support and which were Advanced Life Support. And during his years as PMD, Dr. X received a "stipend" from Advanced Medical Transport and a salary from OSF. Dr. X still works at OSF and is the Executive Director of the Corporate Board of AMT. And while Dr. X works in Peoria, he still finds time to sit on the ICEP EMS Committee. This Committee develops, supports, and implements ICEP positions on EMS issues. Therefore, Dr. X would have known about Bill 1952 and would have known that ICEP had their lobbyist oppose the bill. This is the same Dr. X who used to address the Peoria City Council in the 90s and tell them that it would be a “duplication of services” if the PFD were to upgrade from BLS to ALS.
So, Dr. X., unless you were asleep at your EMS meetings at ICEP, you must have known that your own lobbyist opposed Bill 1952...at least the Peoria part of the bill. Please respond to this and show us your formal communication with ICEP where you opposed this lobbying activity. And if you did not oppose it, why? You wouldn't have supported it, would you?
Bill 1952 was signed into law in August 2017. Even with the opposition in Peoria and in Springfield, common sense and beneficent medical ethics prevailed.
Several months later on January 2, 2018, PFD Engines 1 and 3 were upgraded to Advanced Life Support.
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I recently submitted a Freedom of Information request to the City of Chillicothe for the at scene time of Advanced Medical Transport (AMT) to a recent medical call in the Chillicothe district. The City responded with the Chillicothe Fire Department's arrival time but told me that they do not have AMT's at scene response time.
I contacted AMT twice with emails for their response to this 911 call. AMT did not answer.
I contacted the Emergency Communications Center and they told me that they do not have AMT’s response times either. (ECC is the dispatch center in Peoria that receives 911 calls from the Peoria area.)
During the past few years, I have asked the City of Peoria for the AMT arrival time at certain 911 calls in Peoria. I was given the same response from Peoria as from Chillicothe--Peoria does not have AMT's times either.
With AMT having a contract with both cities and performing a government function for both cities, I would have thought that both cities would have AMT’s arrival times at medical calls. Apparently I was wrong.
Why is this time so guarded by AMT? I am not asking for specific medical care provided the patient at the scene. I am not even trying to ascertain whether AMT’s times are padded. In other words, I am not asking if AMT’s times are valid. I am simply requesting the AMT arrival time.
It is important to know AMT’s arrival time for different reasons. One reason is that for two decades all the PFD Paramedics have not been able to provide ALS care at the scene of a 911 call until AMT arrives. The CEO of AMT was adamant about the PFD not upgrading their care from first responder to a higher level. And for many years AMT paid the Project Medical Director (PMD) at Peoria Area EMS for his services in influencing the level of care given by AMT and the PFD. Since the PFD has been stopped from giving ALS care even by some PFD Paramedics, I think it is important to know when AMT arrives on scene. This time would reflect when the patient first received ALS care.
So how did AMT originate in Peoria and how has it been supported and sustained?
AMT was established in September of AMT was established in September of 1991 with the support of Peoria’s three hospitals. OSF, which is the home of Peoria Area EMS, is considered to be the . OSF, which is the home of Peoria Area EMS, is considered to be the “biggest investor” in AMT. And from AMT’s website: “AMT deployed as a high performance, full service, all advanced life support program in the fall of 1991. Merging all of the ambulance services together, AMT put a paramedic on every ambulance, responded paramedics to every call…” The AMT Board wanted “to modernize the EMS system for the future…”
However, with AMT’s quest to improve EMS in Peoria, they also wanted to be the ONLY ALS and transport service in Peoria. And so AMT and Peoria’s three hospitals did what they had to do—involve as many city and state leaders, influential business people, and physicians to be advocates for AMT and their objectives.
When the PFD attempted to upgrade their status from first responders to Intermediate Life Support (ILS) in the mid 90’s, AMT was not happy with this and enlisted others to be unhappy also. After much discussion at the City level, a deal was finally made. The PFD traded their desired upgrade to ILS for the ability to use electricity to shock patient’s hearts back to life. Patients around the world had been shocked since the early 1960s, and electricity was the only proven modality to influence mortality in out of hospital cardiac arrest. Why was the PFD so late in using electricity when AMT had been using electricity for the previous five years in Peoria? And why did the PFD have to trade their upgrade to be able to use electricity to save lives in Peoria?
Over the past three decades, AMT has continued to incorporate Peoria’s leaders into their Over the past three decades, AMT has continued to incorporate Peoria’s leaders into their “world view” quite well. Select city government leaders in both Peoria and Chillicothe have supported AMT’s efforts. Administration from the three hospitals support AMT. And the firefighters in both cities have been told to be quiet regarding 911 care and AMT’s arrival times. Just ask a fire fighter sometime when AMT responded to a certain call and see how that goes.
There is definitely fear in the community to criticize AMT in any way. No one wants to hurt their influential friends who support AMT because that could end up hurting their own families and kids growing up in the Peoria area. And Peoria’s main stream media will not take on the number one occupation in Peoria--the health care industry.
So where does that leave us? It leaves us with social media such as this to tell the story. And this platform is better than nothing. I will open source this important subject to you for any ideas or anecdotes you may wish to share.
In the future it will be hard to believe that Peoria Area EMS functioned as it does today.
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Update--10/29/1019
I ran across this article today. From South Carolina, a state we know and love.
Bill to open EMS response-time records heads to governor’s desk--
BY PATRICK DONOHUE
PDONOHUE@BEAUFORTGAZETTE.COM
MAY 06, 2010 12:00 AM, UPDATED MAY 06, 2010 07:28 PM
The public might soon be able to review EMS response times, incident reports and other operational data previously off-limits under state law.
A bill making such EMS data available to the public was ratified by both chambers of the state legislature Thursday and has been sent to Gov. Mark Sanford for his signature. The bill, S. 907, was introduced in December by Sen. Harvey Peeler, R-Cherokee, to repeal provisions of a 2004 law that restricts public access to nearly all EMS data.
Sen. Tom Davis, R-Beaufort, who supported the legislation, said the bill improves government transparency.
"Information is power and ... the power belongs to the people," Davis said. "Public officials who want to keep information secret have a very high burden to meet, and it cannot be met in this case. The people have the right to access information bearing on the effectiveness of our EMS rescue teams. This bill ensures they will."
John A. Carroll, MD
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“I would think that workers trained to spray the wet stuff on the red stuff are not trained to meet the standards of our people who use very skilled procedures to insert tubes in patients’ lungs, needles in their veins, apply electricity to their hearts and administer lifesaving medications and other treatments. This is hardly an extension of putting out a house fire. The medical training of fire personnel is minimal in comparison to an advanced life support system. The services they provide presently include basic CPR, bandaging and minor splinting. In the grand scheme of an acute life-threatening injury or emergency, the firefighter’s role is very brief and limited.”(Andrew Rand, AMT CEO, Peoria Magazines, 1990s)
This is what Andrew Rand said about the Peoria Fire Firefighter Paramedics attempting to provide improved medical care at a 911 call in Peoria. (Whether he believed this or not is another story.) The PFD Paramedics were licensed the exact same way AMT’s were licensed but the PFD Paramedics were very restricted by what level of medical care they were allowed to give. In other words, even though Mr. Rand was stating the benefits of Advanced Life Support, it appears that he did not want the PFD Paramedics offering Advanced Life Support to Peorians with a medical emergency.
In order to help keep AMT as the only ALS and transport agency in Peoria, Mr. Rand paid the Project Medical Director at the time, George Hevesy, a stipend. Dr. Hevesy ran with the ball and told the Peoria City Council that it would be a “duplication of services” if Peoria Fire responded to 911 calls in Peoria with Advanced Life Support. (Dr. Hevesy still works for AMT and OSF and is well placed sitting on the AMT Corporate Board of Directors.)
It took until 2009 for Peoria Fire to be able to use their Paramedics at the scene before AMT arrived. Engine 12 on North Adams became the first ALS Engine in Peoria history. (Today there are 8/11 PFD Engines which are ALS.)
Did anything illegal happen in Peoria by keeping the PFD at First Responder and Basic Life Support for years? Not that I know of. But I do think that conflict of interest in Peoria Area EMS was and is occurring. And this conflict of interest is at multiple levels in Peoria.
In conclusion, I do not believe that the people of Peoria have received the best pre hospital medical care that they could have received during the past 25 years.
John A. Carroll, MD
Today Peoria had its 12th homicide of 2019. Another person shot and killed in Harrison Homes.
Advanced Medical Transport (AMT) is the only Advanced Life Support (ALS) and transport agency in Peoria. AMT has done all they can do to make sure that they are the only providers of transport in Peoria. AMT has a 20 year contract with the City of Peoria and was the agency that transported Peoria’s gunshot victim today.
For several decades, AMT has been supported by Peoria’s three hospitals, by Peoria Area EMS and it’s Project Medical Director, by the Peoria City Council, by the influential Peoria business leaders, and by state reps from Peoria working in Springfield.
With the help of the people and institutions listed above, for over 20 years AMT has greatly influenced policy regarding what the Peoria Fire Department (PFD) Paramedics are allowed to do when arriving at a 911 scene. For years in Peoria no PFD Paramedic could function as a Paramedic until AMT arrived on scene.
In the mid-2000’s the surgical trauma staff at the University of Pennsylvania retrospectively looked at victims of penetrating trauma—gunshot and knife wounds—who were quickly thrown in the back seat of police cars and transported to the Emergency Department or who were transported by conventional EMS. They wanted to know if transport by police helped or hurt these injured people.
They found over 2100 penetrating injury transports during this time frame, and roughly a quarter of those (27%) were transported by police. About 71% were gunshots vs 29% stabbing victims.
When the Index of Severity Score (ISS) was used to compare similarly injured patients in both groups, the patients transported by the police did just as well as the patients transported by ambulance.
This was not a perfect paper but it did lead credence to the concept that less is better in the field with penetrating trauma. And what really saves the patient is definitive control of bleeding which neither the police or paramedics can provide.
Therefore, if we use this paper as “Evidence Based Medicine,” if I am shot tonight my chances in Peoria of surviving are the same if the police transport me or if AMT transports me to OSF-SFMC.
And since AMT is about 2 minutes slower to arrive than the PFD, I would prefer that the PFD transports me in ANY vehicle with a load-and-go transport philosophy. (The PFD does not own a functioning ambulance.)
But we all know that AMT and the powers that be in Peoria will not allow this to happen. AMT (and its medical director) like to use Evidenced Based Medicine only if “the evidence” will positively influence AMT’s financial goals.
John A. Carroll, MD
July 1, 2019
Several years ago I sent a FOI request to the City of Peoria for EMS incidents responded to by the PFD from November 2015---October 2016 (11 months).
Here are some numbers I received from the City:
- The PFD responded to 18,393 total EMS incidents.
- The PFD responded to 948 Advanced Life Support incidents.
- The PFD responded to 17,445 Basic Life Support incidents.
Engine 4 on Jefferson St. has been Advanced Life Support since 2013. Engine 4 covers much of the 61605 zip code…one of the poorest areas in the United States. Engine 4 responded to 2,142 EMS incidents on the south side of Peoria from November 2015—October 2016. And of all the Fire Engines in Peoria, Engine 4 responds to the most ALS calls in the City of Peoria.
You may be wondering, so what?
Well, before Engine 4 became Paramedic/ALS in 2013, even though the PFD had enough Fire Fighter Paramedics to staff Engine 4 24/7, when Engine 4 was at scene before AMT, the PFD Engine 4 Paramedics could NOT function as Paramedics for the people on Peoria’s south side until AMT was on scene. So with shootings, stabbings, heart attacks, drug overdoses, sick children, severe breathing problems, etc. the PFD Paramedics on Engine 4, even though they were licensed the same way as AMT Paramedics were licensed (and frequently had been practicing much longer that the AMT Paramedics), the PFD Paramedics could not even start an IV on critically sick or injured Peorians until AMT arrived.
So you may wonder when did AMT arrive on these calls? We don’t know because the City of Peoria states they do not have AMT's arrival times.
Fitch and Associates was hired to study PAEMS in 2018. Fitch has a friendship of sorts with AMT and the City and OSF paid $25,000 a piece for this study, so take it for what it is. Fitch reported that the PFD arrived 2 minutes faster on average than AMT. (Whether this time is correct or not, we will never know. Fitch collected their data from AMT.)
So, this begs the following question: Is this two minutes clinically significant for the patient? In other words, does this extra two minutes it took for AMT to arrive hurt the patient? It depends on the medical case and the amount of time it took until ALS could be provided. Some people can wait the extra two minutes before ALS care. But what about serious emergencies when time was critical and AMT was not there and the PFD Paramedics who were there were not allowed to use their skills for the patient in extremis.
Finally, the most important question that almost no one wants to ask (or to answer):
Prior to 2013, why was Engine 4 NOT able to practice as PARAMEDIC even when they had licensed PARAMEDICS on the engine for sick and injured patients on the south side of Peoria?
John A. Carroll, MD
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Yesterday, the Journal Star ran an article describing the special Peoria City Council meeting from the night before (2/18/2020).
Fitch and Associates, a consulting company, was hired by the City several years ago to assess the PFD and AMT’s response times to medical emergencies in Peoria. The genesis of the study, as explained by City Manager Patrick Urich, was a concern that too many resources, that being the Fire Department and AMT, were going to too many of the same emergencies or emergencies of lower acuity.
According to the Journal Star article, “Adding more dispatchers and switching how they assess medical emergencies could allow the city to absorb possible cuts in staffing without anyone really noticing.”
A revised protocol was discussed which would “reduce the number of less urgent calls that the PFD responded to by 15%.” And according to the Journal Star, “Switching to a more advanced software system that will allow dispatchers to categorize calls faster could, in theory, mean that either AMT or the fire department is sent out faster than they are now, even with less equipment at the fire department. One of the consultants said the city should save its most valuable resource — the paramedic at the station — for its most serious emergencies.”
And from WEEK NEWS, “The city and Fitch said that will allow the fire department to respond to the high priority calls where their skills are best suited. Another step in the process, Fitch also recommended altering an agreement between City Hall and AMT that requires less than nine minutes for a response time. Currently 95% of the time AMT has to be on scene within eight minutes of the call, under this new EMS protocol that would change to under eleven minutes.
My ideas regarding this important council meeting--
1. The City, OSF, and Unity Point-Methodist all paid the fee to hire Fitch--$50,000. OSF and Unity Point are two big investors and supporters of AMT and so this makes one wonder about a non biased conclusion from Fitch. Plus, Fitch and AMT already had a “relationship” which further makes one wonder.
2. The PFD paramedic at the station was referred to by the consultants as the “most valuable resource” in responding to major medical emergencies. For years, George Hevesy, AMT’s medical director, and Andrew Rand, CEO at AMT, opposed the PFD Paramedics functioning as Paramedics before AMT arrived at the scene. Why? I think we know.
3. Currently, AMT has an agreement with the City to respond to 95% of medical emergency calls in less than eight minutes. Under the new protocol, AMT’s response time would increase to eleven minutes. Fitch favors AMT once again.
4. Conflict of interest at many levels in Peoria has enveloped this EMS debacle for 25 years. And there is no end in sight.
John A. Carroll, MD
Well, it took a while, but all PFD Engines (besides Engine #15) are Advanced Life Support in Peoria.
For decades the powers that be in Peoria resisted any PFD Engine upgrading to Advanced Life Support. Advanced Medical Transport did not want any competition from the PFD.
The current Project Medical Director had to “ok” the PFD Engines upgrading. And he had to get the “ok” from the local business leaders who sometimes masquerade as health care providers in Peoria.
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