Pa. County Offers Cautionary Tale on Ambulance Service

Jan. 05--Imagine a loved one shuffling through the house, maybe rummaging through the refrigerator, when suddenly he feels a slight clench in his chest.

The squeeze tightens. Eventually it feels as if his heart is being crushed by a fist.

Luckily someone else is there, quickly dialing 911 and praying an ambulance will arrive shortly.

But a capable and closer unit is bypassed for an ambulance located farther away. The victim lies on the floor suffering while precious minutes slip away.

It's a preventable scenario that has already happened in Luzerne County, and could happen again.

Patient care or politics?

Exeter Township, for example, does not always call the closest possible ambulance for serious medical emergencies. When its first choice from nearby Pittston is tied up on a call elsewhere, the township summons an ambulance from the for-profit company Trans-Med Inc. based in the borough of Luzerne, approximately five miles and eight minutes farther than a second Pittston option -- the city's advanced life support ambulance.

The problem isn't unique to Exeter Township. Last January, a 3-year-old girl in Newport Township waited nearly 40 minutes for an ambulance after suffering a seizure. In March, a 75-year-old Lehman Township man collapsed in his home and lay on his kitchen floor for 20 minutes before a paramedic arrived. In both cases, a closer ambulance option sat free and ready to go. But because the townships had previously instructed the county 911 center to send a more distant ambulance, the dispatcher's hands were effectively tied.

Luckily, both victims made full recoveries.

Yet those extra seconds and minutes spent waiting for medical care can lead to long-term complications, such as weakened heart function, or even death, said Dr. David Schoenwetter an emergency room physician in the Geisinger Health System.

"From the time the patient suffers the injury, there is a clock ticking," he said.

When asked in a very brief phone interview last month why Exeter Township uses the farther option, potentially putting lives at risk, Gary Eble, the head of the Harding-Mt. Zion Community Ambulance Association, which covers Exeter Township, "respectfully decline(d) to comment" and refused to answer further questions.

Due to reasons Schoenwetter says are "politically charged," which industry insiders blame on clashing egos, favoritism and turf disputes, several municipalities across Luzerne County do not call the closest possible ambulance when emergency strikes.

The immediate problem is an easily correctable one. While most municipalities have their own ambulances for basic calls, more advanced units for more serious emergencies, sparsely spread throughout the county and carrying a paramedic, must often be summoned from out-of-town. Many municipal governments rightly leave those choices in the hands of the experts in their local ambulance or fire company. But for those who don't put patient care first, elected borough and township officials have the legal right to step in and make the corrections themselves.

A 2008 change to Pennsylvania township and borough codes puts the responsibility for providing emergency services on the municipality, a fact many local officials did not know when queried by The Citizens' Voice.

Ambulance wars

Before 1994, Lackawanna County was the site of an ongoing and dangerous battle -- the Ambulance Wars.

Emergency medical crews would fib their positions to 911 dispatchers in order to appear closer to an accident, and race other ambulances in order to arrive first and thus have the right to bill the patient, said Jerry Gaughan, the former head of the Lackawanna County 911 Center. He admitted the jockeying may have cost lives.

Prompted by Gaughan, the Lackawanna County district attorney convened a grand jury in front of which Gaughan testified and played recordings of the long-nosed ambulance crews.

Armed with that testimony, the district attorney then threatened the ambulance companies with criminal charges if they continued their drag racing and two-facing. Gaughan said he used that momentum to persuade county commissioners to budget money for a proximity-based system using GPS devices -- which is still in place today -- that allows the 911 center to know where each ambulance is at all times. He also gave ambulance companies a choice: purchase compatible GPS units for their trucks, or don't get dispatched, and subsequently, paid.

"I got to be enough of a pain in the ass (that) they really started towing the line," said Gaughan, who retired from Lackawanna County in 2004.

The ambulance crews of the for-profit company Trans-Med Inc., based in the borough of Luzerne, have faced similar accusations of misrepresenting their position from others in the industry, a charge the company's Operations Director Phillip Hamilton called "ridiculous."

"If any of my employees did that, they wouldn't be working here anymore," he said, adding that volunteer companies feel threatened by a for-profit one.

But one of his very employees, speaking on the condition of anonymity for fear of reprisals, admitted the practice to The Citizens' Voice, and said that Trans-Med exaggerates the number of ambulances it has available for 911 calls.

At least one of Trans-Med's neighbors also said they have witnessed the deception.

Sue Stevenson, captain of Larksville Ambulance, in turn called the response times of the for-profit company "ridiculous." Their ambulances, she said, sometimes needed 12 minutes to drive to her town from their declared departure point of Luzerne, despite a distance between the two of less than three miles and an estimated drive time of seven to eight minutes.

Her organization, which also covers Courtdale -- a direct neighbor of Luzerne -- previously called Trans-Med ambulances to its territory, but Stevenson said disputes over the cost of service and trust led to the disintegration of the partnership.

"They are stationed there," Stevenson said of ambulances in Trans-Med's Luzerne headquarters, which float around the valley and transport patients between health care facilities. "But they're not coming from there."

Instead, Larksville, Courtdale and the neighboring community of Edwardsville, which also has its own ambulances for basic calls, summon a truck for their more extreme emergencies from across the river in Plains Township -- 2.5 miles and a few minutes farther away than Luzerne. Those ambulances must drive directly past the Trans-Med headquarters in order to reach the communities on the west bank of the Susquehanna.

Officials from the Edwardsville Ambulance Association did not return calls seeking comment. Trans-Med and the association are currently locked in a court battle over payment disputes.

To save lives, change needed

Gaughan argues the medicine that cured Lackawanna County's ambulance ailment is exactly what's needed in Luzerne County.

"You can't guarantee that you're sending the nearest available ambulance without a (GPS) system, in my opinion," he said.

Any new system would no doubt have a financial cost, which could make it a hard proposition for a county over $380 million in debt. But Luzerne County 911 officials have said state grants could soften the blow.

Even if the county could find the money, the difficulty then is persuading all the municipalities and ambulance companies to buy into the system, a daunting task in a county notorious for resisting regionalization of its police and fire departments.

To spark the change, the county would likely need a champion like Gaughan in Lackawanna County. Luzerne County Manager Robert Lawton asked his 911 center this summer to create a policy paper for municipalities that would suggest how to provide emergency services, but he has been quick to point out that the county cannot legally mandate anything on the issue. The center has not yet completed the policy paper, 911 officials have said, because turnover has been heavy in the past several months, with three different bosses juggling multiple jobs.

Jack Robshaw, the executive director of Luzerne County 911 who is currently working double-duty leading the county's Operational Services Division until a permanent replacement is found, did not return messages seeking comment.

And just as in Lackwanna County, Luzerne County District Attorney Stephanie Salavantis said she would need a complaint brought to her to take action.

All the while, the weaknesses in the system remain, and industry insiders say lives are at stake until improvements are made to the system and municipal leaders take a greater role in shaping it.

pcameron@citizensvoice.com

570-821-2110, @cvpetercameron

Copyright 2014 - The Citizens' Voice, Wilkes-Barre, Pa.