County, hospital, squad tackle ambulance issue

Morgan County residents frustrated by the limits of medical care at War Memorial Hospital and the long wait to get transferred to bigger hospitals are keeping their pressure on county and emergency officials, who met about the issue on Thursday, May 5.

County Commissioners Stacy Dugan and Brad Close leaned on representatives from War Memorial Hospital, Valley Health Transports, the Morgan County Rescue Service and West Virginia Medical Command (MedCom) for answers to residents’ questions.

The commissioners insisted that local patients deserve quicker transport services and more choice about where county ambulances take them in the first place.

“The concern is that we have people sitting in the hospital in extreme conditions waiting for transport,” said Close.

War Memorial, then wait
“Where does Valley Health Transport stand? I’ve been confronted with instances where patients have had to wait four or five hours for transport,” Close said.

Chris Rucker, head of Valley Health Transports, said the response time for his company’s 20 ambulances must take into account the needs of patients in 14 counties across three states.

“We triage those calls based on acuity
of the patient. Someone actively having a heart attack is a higher priority than a leg broken that’s been splinted and the patient is under pain management,” he said.

“Making the arrangements for a higher level of care can take two to six hours,” said Rucker.

Commissioner Dugan asked if Valley Health Transport is the only company used by War Memorial to move patients.

“No, but we start with them because they have the greatest resources,” said Neil McLaughlin, president of War Memorial Hospital.

He said they use Ryneal and other private companies, including helicopters, depending on the need.

McLaughlin said a patient must be screened and stabilized before a decision is made to move them. Then, hospital staff must find a facility and physician to accept the patient.

“That means the delay isn’t always the transport company, but the process,” McLaughlin said.

Who decides where?
Close and Dugan pressed Morgan County Rescue members and MedCom for details about how ambulance crews decide where to take emergency patients.

“What we’re trying to establish is what the procedure is,” Close said.

“The main issue is people being picked up and feeling like they’re being forced to go to War Memorial Hospital when they want to go somewhere else.
They’re angry about that,” said Dugan.

Kevin Duckwall of Morgan County Rescue said the decision is made with patient input and the expertise of the care provider, along with MedCom.

Larry Contruso, medical director of MedCom, addressed the question by phone from his office in Morgantown.

“They can do one of two things. They
can tell us they have a patient and are
en route to some hospital or they may need
a physician to give medical direction,” Contruso said.

He said if a patient is in extremis, or on the verge of death, he or she will automatically go to the local hospital.

“If somebody doesn’t want to go to a particular hospital, MedCom would not override that decision,” Contruso said.

Duckwall responded by quoting West Virginia law that places the ultimate decision for a patient’s destination at the feet of MedCom.

“I’m not disputing that,” Contruso said. “MedCom doesn’t make a practice of dictating where a patient goes.”

“Now you’re putting us in the middle,” said Duckwall, referring to local ambulance crews.

“The ultimate decision, 99.9% of the time, is made by the medic,” said Contruso.

Is local better?
Todd Songer of Morgan County Rescue agreed that local paramedics on the scene have the most information about what is best for a patient.

Close brought up an example of a patient with a broken hip being taken to War Memorial, then needing to be transported later.

“If the patient does have a broken hip, going to Winchester can be a bumpy ride. Do they want to go 40 miles up the road like that, or go to War Memorial and get stabilized first?” Songer asked.

“These guys are in the back of a rig and have 12 to 13 minutes to make an assessment about stabilizing their patient. In a lot of cases, going to a local facility is beneficial. The patient gets a full assessment, not by one person in a six-to-eight-foot space,” said Neil McLaughlin.

“They have to make a choice to stabilize and transport, versus going that extra distance without the full information about their condition,” McLaughlin said.

“If I’ve got heart trouble, why take me some place where they can’t fix it? Take me some place where they can and make it part of my emergency call,” said resident Dale McConnell.

Dugan asked if there is a waiver that allows patients to choose which hospital the rescue squad takes them to.

Duckwall said the waiver states that the patient will pay the cost of the ambulance ride to another facility, since most insurance only covers services to the nearest facility.

“But patients will sign anything at that point,” he said.
“That should be my choice. It’s pointless to bring me to a hospital where I won’t be cared for the way I want to be cared for. I’m the one paying the bill,” Dugan replied.

Close disagreed, saying local emergency responders should make decisions about where to take patients based on their training and experience.

“We try to accommodate the patient as much as we can,” said Duckwall.

Citizens urge change
Gary Miller praised the meeting, saying it was “a long time coming.” Miller described his own experience of having been taken to War Memorial Hospital three times.

Each time he was unconscious. Local hospital staff stabilized him, but he required transport to another hospital all three times.

The delay in transport — several hours in each case — caused his doctors and his wife great distress and impacted his medical condition, Miller said.

His wife was particularly upset to see local ambulance crews sitting outside their squad building while her husband waited for a transport company to come get him.

Duckwall said the county’s ambulance units are available for 911 calls, which is what the ambulance fee is meant to fund.

“I have yet to hear anyone not happy with 911. The problem is just waiting up at War Memorial for four hours for a transport,” said Bill Albanese.

“If the doctor at the hospital says ‘I’ve got to get this guy to another hospital or he’ll die,’ that should change back to a 911 call, not a transport,” said Dale McConnell.

Resident Marion Park thought part of the problem is a lack of information about the rescue squad in the community.

Another local resident agreed, suggesting the county should include a specific information sheet about 911 emergency medical service in county tax bills or other mass mailing.

Commission president Dugan said she favored that idea.

Resident and rescue squad board member Betty Mason said her own experience waiting for transports from War Memorial Hospital had been terrible for her and her family.

“You lay up there for four
hours wondering if you’re going to be a vegetable when this is over,” said Mason.

“It’s hurting the reputation of Morgan County and Morgan County Rescue,” she said.

“Nobody should have to lay up there, with your family looking at you, wondering what you’re going to be like. Nobody should have to live through that. There has to be an answer,” Mason said.

Transport service costly
Miller asked Valley Health Transport if they would be willing to consider keeping a transport ambulance in Morgan County while the county works on the issue.

Chris Rucker said his company could look at that option, but it would add about $500,000 to their expenses.

Asked if one of the county’s four ambulance units could be used for transports, Duckwall said two of the units are older backup ambulances that the county got for free.

He felt they wouldn’t be suitable for the equipment required to do inter-facility transports, even if the squad became licensed and staffed to offer that service again.

Duckwall repeated his estimate that it would cost taxpayers
over $700,000 per year to have the squad start routine transports again.

The county commissioners will meet again with hospital, squad and transport representatives on Thursday, June 9 at 9:30 a.m. to continue the discussion about transport services and patient care.

County officials will also hold a budget meeting with the Morgan County Rescue Service at noon on Wednesday, June 1.