Corruption in EMS

[Asysin2leads]

I don't get people. On one hand they scream that any regulation or enforcement actions are an intrusion into the free-market economy, then they complain when that same lack of regulation and enforcement results in people writing "ambulance" on the side of a van and having all sorts of fun and hijinks. It happens every single time. Deregulate banks, Wall Street fraud and toxic mortgages happen. Deregulate medical systems, and horrible patient care happens. Deregulate food standards, and allowable insect parts per scoop of ice cream increases. The argument that a free-market would self-regulate this by allowing intelligent consumer choices to favor the superior product is not valid. A consumer cannot be expected to know what drugs need to be administered and when to their family member, nor can they be expected to be able to detect if each and every one of those specks in their ice cream is a piece of vanilla or a piece of cockroach. In my mortgages and lending example, even I would argue that getting a 30 year mortgage when you have no job is a really stupid idea and you only have yourself to blame when you can't make payments is your own damn fault, but it should be clear that the problems we had with Wall Street happened after banks were allowed sweeping deregulation. Whether an entity is public or private, if they provide a public service they need to be directly accountable to the public, whether its the KCFD or AMR.

[ambodriver]

You know man, we all get that you have your deep seated Liberal hatred of the privates, but if you want to be taken seriously you should really make some effort to support these types of statements.

Dwayne

I work an 8 hour shift every few months for a private to be part of a different system and too see how things are over there. The nursing home residents who frankly have no reason to be in the nursing home. The so called pysch facilities with felons living in them. The so called pysch facilities where the same pt. population gets sent out for pysch. evals once a month.... It's obvious fraud. And yes I hate privates, but that is only because of my experience with them in this area. Maybe they are better elsewhere.

The nursing homes sends the pt. out for a pysch eval. because a pt. acts up. I went to a NH where the RN/LPN/volunteer/whatever at the desk told me the pt. wanted to "kill himself". When I walked into the room the pt. had an obvious mental impairment and couldn't even talk. These pts get shuffled around for a profit.

The ambo company profits

The doctor the pt. gets sent out to profits

Having them leave the facility makes the medicare timer restart so they profit as well.

It is soooo blatant and obvious it makes me want to vomit.

Yep, pretty stupid statement all right. I work for the evil empire in a flagship division and I am proud of it and them. We are an example of unparalleled professionalism and fiscal responsibility that is enforced by the market. Unlike fire departments who are now at the mercy of city councils, and volly squads at the mercy of vollies, we keep doing what we do. I will be the first to admit that a high degree of scrutiny by regulatory bodies and the public are absolutely necessary to keep the profit motive in check; but hey, our country is founded on a system of checks and balances, and when it works it is a beautiful thing.

Transparency in operations would prevent a lot of this BS.

Do you work for superior ambulance based in elmhurst il? That is the evil empire in this area. They don't do any 911. They do inter-facility transports. Turnover is high. Pay is just above poverty level. Benefits are horrible and there is no pension. While I am sure there are many good medics at superior, 911 response (which is fire based around here) generally runs circles around their crews. They have an in system medic school where people do their ride time on the privates, never doing 911 responses. You can works 5 years from Basic to Medic and never work an arrest, never intubate anyone or never work on a peds. pt.

I am glad you are proud of your work. I'm sure you are a great medic, however the widespread fraud that private ambulance companies in this area commit (as described in most above) is sickening.

[ambodriver]

I have to agree crapmagnet, private services are the wave of the future, as the economy worsens. AMR and RM can usually provide EMS at half the price of county services who pay people to sleep.

are you being sarcastic? The paid to sleep stuff is such BS. My all time record ins 28 calls in a 24 hour shift. Wanna come do ride time with me and see if you can even hang?

[HERBIE1]

I have to agree crapmagnet, private services are the wave of the future, as the economy worsens. AMR and RM can usually provide EMS at half the price of county services who pay people to sleep.

Not sure where you are, but in this area, NOBODY sleeps in EMS. The majority of the rigs do 6-7K calls/month. Do the math- that does not leave a whole lot of down time. As for privates taking over- they work in some areas, and fail miserably in others. Years ago AMR thought they could steal 911 response from the FD. They flooded the market with tons of rigs and pushed a bunch of privates out of business. They set their sites on taking over, but soon realized it is NOT a money maker with a 30-40% reimbursement rate. They lasted a couple years and promptly left the area.

[RockDoc]

Not sure where you are, but in this area, NOBODY sleeps in EMS. The majority of the rigs do 6-7K calls/month. Do the math- that does not leave a whole lot of down time. As for privates taking over- they work in some areas, and fail miserably in others. Years ago AMR thought they could steal 911 response from the FD. They flooded the market with tons of rigs and pushed a bunch of privates out of business. They set their sites on taking over, but soon realized it is NOT a money maker with a 30-40% reimbursement rate. They lasted a couple years and promptly left the area.

The same thing happened in Montgomery County, Texas. For 3 years running, I think 1984 thru 1987,Montgomery County EMS was listed as National Paramedic System of the year. Resident taxes paid for the EMS as well as the county hospital, Level 1. Along came Rural Metro and convinced the county fathers to sell the EMS to them, Columbia bought the hospital. RM revamped the EMS system to put it on a for-profit basis and literally destroyed the entire system, along with its quality care. 911 units were pulled off the streets to work football games, conventions, drag races, motocrosses, IFT's ,anything that would make a dollar. Response times went to hell in a handbasket, with many times mutual aid being called from surrounding communities when ambulances were not available for emergency calls because of prior commitments. Pay rates were cut for medics, quality medics left to work for other systems and within 2 years our EMS system was shot to hell.

RM notified the authorities that they were leaving Monkey Çounty in 30 days, and they did, taking ambulances and equipment with them. It took almost 5 years to rebuild our EMS system. I will say that today it is back to being one of the finest.

One rule has always been true about TRUE 911 EMS services. It is not a profit making venture. Never has been, never will be.

[Kiwiology]

DISTRICT 1

9.53PM SUSPICIOUS / SICK PERSON

*Kiwi rolls up in a two tone 1988 Dodge Diplomat equipped with massive red-blue rotator light bar sporting hip pouch full of suxamethonium, .357 Magnum N frame and peers over his aviator sunglasses, removes big ass wooden nightstick from belt and throws patient up against car; what you doing up in here boy, you know you don't belong in these parts, you coming to buy drugs? Oh lookey here, where'd this cash come from, never mind that, I'll just keep this, now get out ass out of here, don't let me see you in these parts again boy, *taps nightstick on car, you hear me? Go on out of here. get off my street! ... Control one baker, patient refused transport, we clear twenty-six omega

Corrupt? What you talkin' bout man

I'll stop now before I loose any more points ....

Edited October 26, 2011 by kiwimedic

[azemt2007]

From what I see, anytime you have someone willing to do anything it takes to make money, they'll find a way. Our current society seems to produce laziness and the hunt for a fast buck. Yes the taxpayers are being burdened beyond belief with the corruption but what about the poor patients that are being shuffled around to places that are unnecessary for reasons they can't comprehend? I got into this whacky business to help people and in the houston area, it seems they have lost sight of that. I realize it's a grossly huge example of corruption in EMS but in same ways I think it's very indictive of the business model most private/for-profit ambulance services operate on...the bottom line. As I stated in another thread, most private EMS services will run their people ragged and push the burn out envelope to squeeze out a bit more money, then only update systems/equipment when almost forced by the government regulators. I don't think we need more regulations in the Houston situation, but we need more medicare enforcement. Clearly from the article, 2 enforcement/investigators for the Houston area is not enough when you have over 300 services operating.

[HERBIE1]

One rule has always been true about TRUE 911 EMS services. It is not a profit making venture. Never has been, never will be.

EXACTLY. Yes, we charge a fee for our services but it certainly does not generate a profit. It's one of those essential services people do not mind paying for. That's why in many places, the FD charges for false automatic alarms, for clean up costs associated with accidents, and for fire inspections. It's not much, but it's SOMETHING.

[Richard B the EMT]

Not sure where you are, but in this area, NOBODY sleeps in EMS. The majority of the rigs do 6-7K calls/month.

Along the same lines, the NYC 9-1-1 system responds both FDNY EMS and "voluntary hospital" anbulances to 2.3 million calls a year. I forgot where Herbie1 is at, but it is also a very active 9-1-1 system.

[Kaisu]

Do you work for superior ambulance based in elmhurst il?

No, I work for the largest private in the country, and am based in Arizona. We have the best wages in the state (better even than fire), 401K with company match, health and dental benefits, uniform allowances, free education etc. I run 911 and CCT. We transport for 8 or 9 different agencies, including urban fire, and are first and sometimes only response on about 50 % of calls. We run more calls than any of the fire agencies. We are subject to rigorous internal QA/QI, and overseen not only by our medical director, but the EMS directors in the 5 hospitals we transport 911 patients to. We are also watched by the fire agencies and as the largest private, the state makes regular inspections of our operations.

I responded to this thread to counteract the perceived bias against privates. Just as there is a great variation in quality of patient care in fire and vollies, so also privates. Do not tar all providers with the same brush.