Conflict of Interest in Peoria and Boston

Murray Baker Bridge, Peoria (Photo by John Carroll)

Please consider a midwestern city in the United States with 100,000 people which has two agencies that respond to 911 calls. 

One responder is the local ambulance agency that has paramedics who are allowed to provide Advanced Life Support (ALS) at the scene. The second responder is the city fire department and its firefighter-paramedics who are not allowed to provide ALS care at the scene. And consider that both sets of paramedics have equal training and that their licenses are the same and that both are supervised by the same project medical director--the physician in charge of Emergency Medical Services. However, one big difference between the two agencies is that the ambulance company pays the project medical director and the city fire department does not. 

What would you think of this scenario? 

Would you wonder why the fire department firefighter-paramedics cannot use their paramedic skills? Would you wonder if the taxpayers in this city were getting their money's worth when they call 911 when the fire department paramedics cannot give them advanced life support which they have been trained to do? 

Would you wonder about conflict of interest?

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The Boston Globe had a recent article regarding conflict of interest when they discovered that five major Boston teaching hospital executives sit on for-profit corporate boards of companies that have ties to the medical industry. 

There are numerous definitions of conflict of interest. But a simple definition (taken from the internet) is "a conflict of interest occurs when an individual's personal interests – family, friendships, financial, or social factors – could compromise his or her judgment, decisions, or actions in the workplace. Stated another way, a conflict of interest occurs when an entity or individual becomes unreliable because of a clash between personal (or self-serving) interests and professional duties or responsibilities."

One example of many examples of conflict of interest documented by the Globe was a Boston hospital CEO who sits on the board of a major for-profit telemedicine company. And during the pandemic, this CEO used her clout to lobby Massachusetts legislators for more money for telemedicine which is an alternative to in-person visits. 

This CEO's salary from the medical center is 2.8 million dollars and she owned 8.8 million dollars worth of stock from the telemedicine company. 

Peoria is the midwestern city I referred to above. Advanced Medical Transport (AMT) is the ambulance company in Peoria which is the only ALS and transport agency in the city. It is supported by Peoria's three hospitals. The Peoria Fire Department (PFD) is a city-run public entity.

Over many years AMT has fought effectively to retain its lucrative business and AMT has been helped by its numerous relationships within the Peoria community. 

AMT receives most of its support from Peoria's largest employer, OSF Healthcare. And the project medical directors for Peoria Area EMS have been employees of OSF. And with the help of OSF and their project medical directors, AMT has argued that the PFD did not need to upgrade its care from Basic to Advanced Life Support. And so the PFD was kept at a Basic level for many years and the PFD firefighter-paramedics who arrived at the scene first were not allowed to give paramedic care to the prehospital patient who needed it. 

Was the idea behind all of this to keep the PFD as docile as possible so they did not advance their level of medical care, buy ambulances, and start transporting patients which would have cut into AMT's bottom line?

AMT definitely had to have the project medical directors in Peoria on their side because they determine the level of care agencies provide in Region II of Illinois. AMT paid the first project medical director a stipend and made him AMT's Corporate Medical Director. And these perks added to his day job of Vice-Chairman and Chairman of the Emergency Department at OSF, Peoria Area EMS Project Medical Director, Administrator of Emergency Medical Care, LLC, President of the Illinois College of Emergency Physicians, Chairman of the Illinois Disciplinary Review Board, and moonlighting in various Emergency Departments in Illinois in his spare time. 

Other people in Peoria were also placed in strategic positions supporting AMT. And like the corporate boards in Boston, the AMT board has been stacked with Peoria hospital administrators and influential business leaders in Peoria for years. AMT and the project medical director discouraged the PFD from upgrading its medical services for the people of Peoria when they addressed the Peoria City Council...who had their allegiances, as well. 

OSF has always been AMT's biggest investor in Peoria. There is an Illinois State Representative employed at OSF Healthcare System as the Vice President of Economic Development. This representative voted "present" in 2019 when Bill 1952 was passed which allowed PFD paramedics to function as paramedics while working on a BLS Engine. He is the only representative in the Illinois House who did not vote FOR the bill. (He cited family members which sit on the AMT Board of Directors as the reason for his "present" vote.)

In Peoria now the majority of Peoria Fire Department Engines are Advanced Life Support. But this took 25 years to happen. How many people in Peoria over this time period have suffered due to the EMS conflict of interest? 

Conflict of interest can be dangerous for many other reasons. What did the EMS conflict of interest in Peoria teach two decades of young resident physicians and medical students? Did they look at their physician mentors and learn about keeping the patient as the most important issue or did they learn that money was the most important thing? 

Young resident physicians in Boston did not want to be quoted by the Globe because they are afraid of repercussions against them. And resident physicians in Peoria have learned over the years to be afraid also. They have been warned to remain silent. This is what conflict of interest teaches. 

Peoria has no more conflict of interest than does Boston. But it doesn't have any less, either. I have not mentioned any names on purpose in this article. Their names are not important--but the concept of conflict of interest is.

Also, there is a large elephant in the room composed of people both in Peoria and in Boston who have nurtured these conflicts of interest. And these influential people run the show with impunity from behind the scenes. They are protected which makes conflict of interest very difficult to eliminate. 

John A. Carroll, MD

www.haitianhearts.org