I pit myself, my employer and a local hospital system (weak and lame)

The BBQ Pit
1

So I’ve been burning over this for a few months, and recent events made me over boil…

I work for an ambulance company in Las Vegas. One of our contracts is with a local hospital system that has a large number of quick cares. These are akin to urgent care offices. Our contract is to transport patients from those quick cares to the emergency room for further care if necessary. This contract is worth a significant amount of money (I’m not privy to how much, but it’s a whole lot)

Now, a little background on our company. It was founded five years ago by a few people who were tired of big business (AMR) running the ambulance in Las Vegas. It was felt that a local ambulance service could better serve the community. The back of our ambulances even say “We Care”.

So, when someone goes to one of these quick cares with chest pain, we provide transport for that patient to the hospital. Now, here is where is where the irritation begins to set in.

Now, according to federal law, any time you call 911 for me to come to your house, I am to ask you what hospital you want to go to. Only if you say that you don’t care what hospital you want to go to, or if you’re unable to do so, am I to pick one for you. This law applies to any time a patient is moved from one place to another. The quick cares seem to have forgotten about this. The quick cares simply arrange for transport to their own ER. Never is the patient given the choice on what ER they’d like to go to. I cannot count the number of times I’ve walked into one of these clinics and asked the pt, “I understand you’d like to go to (snip) Emergency Room.” and they say “um, no, do I have to?”

These clinics also frequently just funnel patients to the ER. Simple complaints such as dehydration are sent to the ER. God forbid they’d rehydrate the patient and see if they’re better. Nope, ship them out, so they can be charged twice (once for the office visit, once for the ER)

Here is where my distain for my company comes in. I once thought that my job as a paramedic was not only to care for patients, but to be patient advocates as well. I have twice said something while at the quick care, stating that the patient does not have to go to your ER, and has the right to go to any ER they wish. This has resulted in corrective action from my company. The company stance on this situation is that I am to do absolutely nothing. They feel that we are there, by contract, to simply provide transport. To the quick cares I am nothing more than a qualified taxi service, which is to be seen, but not heard. The company does not wish to anger the quick cares and loose the contract. The fact that the quick cares are violating the law does not bother my employer as much as it bothers me. Just this week a patient told me, while still at the quick care, that she did not want to go to (snip) ED, and that she wanted to go else where. I told the staff at the quick care that the patient wished to speak to one of them. The patient asked if she had to go to (snip) ED, that she would rather go somewhere else. The response was that the transport had already been arranged, and that she did not have a choice! I was fuming! During the transport I called my supervisor, and was basically told to keep quiet. I told the patient that she should complain to the administrators at the hospital she was being transported to, and that I couldn’t do anything about it.

Apparently morality does have a price. My employer doesn’t care, and I cannot afford to. Unemployment makes it difficult to make a house payment. This is the first time I can think of that I’ve had to sell out my own beliefs to keep a job and I really don’t like it.

2

Well, you have my sympathies, but pause a moment and consider whether maybe you’re just plain in the wrong health-care job? Obviously you crave a job where you are allowed to “care” about people and make a difference. Why not move into a more hands-on health-care career, like nursing, or nursing assistant, or visiting nurse?

CNAs can make a big difference in people’s lives.

3

Thanks for the thoughts. These transports only account for about 5% of the calls I run. The other 95% I get to act like a normal paramedic, running 911 calls. IMHO paramedics actually have more freedom to do what we believe is best for the patient, more so than nurses (RNs), LPNs, or CNAs. We act relatively independently from all other health care providers, making our own decisions on the spot.

On a side note, I am getting my RN ticket, but only so I can continue on to nurse practitioner.

4

I feel for ya. I’m a medic for a company that was founded to provide better medicine and customer service than AMR. If I’m thinking of the same clinics (same name as an insurance company?), we’ve been picking up a lot of overflow from them because their ambulance contract is up. I’ve got the same complaints. Although, a lot of the time, it’s almost like running a 911 call since they haven’t done anything yet- no IV, no analgesia, no nothing.

St. Urho
Paramedic

5

Oh, and to DDG, I think you’d be hard pressed to find a health care career that’s more “hands on” than EMS.

6

Are there any regulatory agencies you can anonymously complain to?

7

Uhhh, and nothing personal here, but are you suggesting that an experienced, good, and passionate paramedic should just say screw in and become a CNA with a straight face?

I’m not kinoons, but I have a feeling that if he were a less polite than he actually is, he might seem rather insulted.

Anyway, back to the OP. kinoon, you have my sympathy, but I don’t know what to tell you. The situation is absolutely shitty, and if nothing else I’m confident that you could find work as a paramedic somewhere as equally nice as Las Vegas, maybe with a FD or agency nearby so you wouldn’t have to move, if you were to be fired from your agency. At any rate, without emperiling your job, I suggest that you take your complaint (annonymously) to a local media outlet or regulatory agency if your discussions/pressure on the people you’re contracting for or your company haven’t gone anywhere.

Good luck, and thank you for being a brave advocate for your patients interest.

8

Oh yeah, and so how much longer until you go onto RN school or graduate if you’re working through RN school?

Good luck!

9

Most fire departments are no place for people who like being paramedics.

10

Just a second…you were disciplined for refusing to do something that’s explicitly against the law? Do you not have a union advocate or some kind of state employee protection board?

11

My volunteer background includes three years riding around a lot with Littleton Fire Rescue as well as some time up here in Boulder with Pridemark (ambulance only), and I have to say that I don’t see anything wrong with working in a FD. In fact, a lot of parts of it were better. But that’s only two agencies and obviously it varies by agency, but what do you have against fire departments?

LFR was sure as hell a step up from AMR, but then again, so is strapping patients to the backs of donkeys, giving the ass a kick in the ass, and screaming, “Denver Health Ho!” and hoping that the patient shows up within the next 12 hours.

12

Well, the pay and benefits are almost universally better. However, it’s an unfortunate fact that in many fire agencies, EMS takes a distant backseat to fighting fires in terms of both status and funding.

13

Yeah, isn’t there a whistle-blower’s protection law in place?

14

Thanks, Guiinastasia. I completely forgot the name of that kind of program.

15

Ex-EMT and current (non medical) business owner checking in.

The ambulance company I worked for did alot of non urgent transfer work as well. AFAIK you’re kinda stuck with it because you have been hired by the facility ot perform a transfer. If the patient refuses to be transferred to facility X they need to take it up with the person writing the transport orders, not the ambulance crew. It basically is taxi work, even if the patient is not entirely stable.

I’m going to take a WAG that if the clinics are part of the same company as the hospital, part of the consent paperwork involves transport to other facilities they own, meaning they have already consented to the transport on paper at least.

Something like this is not IMHO not going to set off too many flares with local county EMS agencies unless the patients choose to file those complaints. If an EMT wanted to serve as a patient advocate as well as keep their job they could advise the patient to contact the county government EMS adminstration people and question the policy. IF they are willing to go to bat for those patients rights issues they will have the muscle to make it stick and can pull permission to operate ambulances for violating that rule. For something like this, I wouldn’t bet my job on my county’s point of view on things. If it really matters to the patient that much, let them make a stink. Ultimately our job as EMT’s is to assure that the patient recieves the care that they need in a timely manner. If they will recieve that care at the hospital you are contracted to take them to then you have done your job. As I’m sure you understand, alot of this biz is about what the patient needs, not what they want. Would you comply with a patients wishes to be transported elsewhere if it was a transfer between two lockdown psych facilities? As I understand it, the transport orders carry just as much weight either way.

If you don’t like it, the little enteurpreneur in me says “you could always start your own ambulance company :D.”

Drach, ex-EMT who got his ass chewed many times over for not picking my fights very well.

16

Right, but did you read the OP? He’s not being allowed to be “hands-on” in the way he’s interpreting the term “hands-on”.

I meant "hands-on where your bosses aren’t going to tell you to stop being so hands-on.

“Hands-on” where “hands-on” is not only permitted but desireable.

Yep.

Did you read the OP? He’s not being allowed to do his paramedic’s job the way his job ethic and his conscience tells him it ought to be done, and so yeah, I suggested he find another job, one that’s similar in terms of hands-on caring, but without the static from the HigherUps telling him to quit being so goldarned caring and hands-on.

17

I too have a very bad case of this. :smack: It is well known where I work that I am very good at running off at the mouth when I do not agree with a company policy/decision/etc…

thanks for all the suggestions everyone. I remembered that the last system I worked for had an ethics hotline you could call. I’m betting that the hospital system that is doing this to their patients also has one I could call.

DDG I appreciate the suggestion. If I was not clear in the OP, this situation only occurs once a week or so, and the rest of the time I get to do what I want without crazy oversight. Also, to become a CNA would be a huge step backwards for a paramedic. Without going too far into it, and not knowing how familiar you are with the medical system in the US, CNA’s are little more than gophers in nursing homes and hospitals. They carry around supplies, wipe patients butts, and other busy work like that. I am ten times more qualified and educated than any CNA out there. In many respects I have more freedom than even RN’s to directly infulence patient care. Prior to arriving at the hosiptal patient care is up to me, and me alone. Once at the hospital, many of the MD’s will listen very carefully to what I have to say and treat the patient based on my findings.

18

Well, I’m glad to hear that this is a small minority of your load, but I do think that patients have a right to participate in their healthcare decisions and I think drachillix is a bit dismissive on this point.

And, uh, yeah, that’s what I was trying to say about being a CNA but I didn’t want to put words in your mouth or come off as too much of a pompous ass. Good luck on the RN practicioner bit.

19

Non-urgent transfers are not our judgement call to make. If the patient wants to refuse transport, fine. I’m not saying tht a patient shouldn’t have any say in their care decisions, just take it up with the right person. The transport crew is not that person.

20

The transport crew is just what, following orders?

Let’s say hypothetically that a doctor in an ER flips through a patient’s chart, talks with them for thirty seconds, and decides to prescribe an injection of penicillin. Later the nurse comes in, says, “here’s your penicillin!” and patient, being allergic to penicillin, naturally freaks out and refuses. Should the nurse say:

A. “Well, you should have brought that up with the doctor. Penicillin is what you were prescribed and it’s what you’re going to get, now hold still!”
B. Take this apparent lack of consent and hold off on giving any medication and bring it up with the doctor to find an agreeable alternative.

That federal law is there for a reason, and if for whatever reason an individual doesn’t want to be transported to a given ER, then that should a part of the decision as to where that patient goes. If this affects their payment because it’s, “out of network” or something, then they should know that too and know how it will affect their costs as a patient. The financial interests of the company running both clinics are secondary.