STRETCHING THE POINT

     From time to time, readers ask questions that are probably on the minds of other EMS managers and administrators as well. Here is one to give you something to think about.

     "I am a manager of an ambulance company. We currently hold the contract for all of the transportation needs for a large hospital. The current system is contracted for ambulance, wheelchair, ambulatory and stretcher van transport. My dilemma is regarding the stretcher van transports and the liability they create. The transports are scheduled by social workers with little or no medical training, and our drivers are the same. The hospital has made it clear that stretcher vans are a cost-saving measure. Do you happen to have or know of any information that would solidify my argument regarding the potential for liability? Any help would be greatly appreciated."

     I personally do not like stretcher vans as a transport option because it creates a gray area within a gray area, and, I agree, that leads to liability issues. "Medical necessity" is vague enough, and it is often difficult to decide whether wheelchair van service should be used versus transport by ambulance. When you add in another option for non-medical stretcher van, it makes the decision even more difficult. This is especially true if the person making the decision has no medical training and does not fully appreciate and understand the differences in the various types of transportation.

     My feeling has always been that if patients cannot safely sit in a wheelchair in a moving vehicle, they need to travel by stretcher. The problem is, if the person is sick or debilitated enough to need a stretcher, he probably needs someone in the back to assist or monitor him as well. If the patient needs to be monitored, he will need someone with medical experience and skills. And what good is someone with medical skills if he does not have medical tools and devices to use? Add all of that up: If you need a "stretcher van" with personnel on board who can assist the patient and medical devices to treat/monitor the patient, what do you have? An ambulance.

     The question of liability is even more difficult. If a patient is taken by "stretcher van" (or "ambulette" as some call it) and something happens to her, who is at fault? The transport company that took a patient it could not appropriately care for, or the hospital that requested the stretcher van to save a few dollars (assuming the transport was a DRG-covered trip that the hospital had to pay for)? In all likelihood, the hospital would be most at risk, but any good lawyer would sue everyone and let a jury sort it out. So in the end, everyone loses.

     But liability issues are not the only problem with stretcher vans. I am seeing carriers and Medicare auditors deny coverage based on their opinion that the "patient could go by ambulette," even in states where there are no regulations governing "ambulettes." Once again, creating the additional level of service leads to more subjective decisions. And when I say "creating," I really mean it. While the word "ambulance" is found in Webster's Collegiate Dictionary and Merriam Webster's Medical Dictionary, "ambulette" is not a recognized term according to either of those sources. I'm not saying ambulettes don't exist, but I am saying that just because someone made them up does not make them a legitimate means of transportation for most patients. More important, if you are providing stretcher van services, make sure the people deciding what type of vehicle to request are trained to make those decisions on behalf of your patients.

     That is just my two cents. I am sure there are those who will disagree with me, and I have no studies or reports to support my position. In fact, there are likely some instances where stretcher vans would be the most appropriate method of transportation, but my feeling is that situation is rare and does not justify creating a whole other level of transport.

     Thanks for your inquiry. If anyone has a question that deals with management, operations, billing, contracting or legal issues, please feel free to e-mail me at chris@emscltd.com, or the editor, Nancy Perry, at nancy.perry@cygnusb2b.com. I will answer all inquiries directly, and questions that deal with national issues may be reprinted here. I encourage you to share your thoughts and problems with us so we can all benefit from bringing these issues into public discussion.

     This article is not intended to be legal advice.

G. Christopher Kelly is an attorney practicing in Atlanta, GA. Chris focuses on federal laws and regulations as they relate to the healthcare industry and specifically to the ambulance industry. He also lectures and advises ambulance company clients across the U.S. Contact him at chris@emscltd.com.