Patient transports pose tough costly problem
For decades, the Morgan County Rescue Service transported local residents from War Memorial Hospital and local nursing homes to other medical facilities when they needed additional care.
Many residents came to expect that if they couldn’t get the medical treatment they needed at the local hospital, the rescue squad would take them to a hospital where they could receive appropriate care.
But the Morgan County Rescue Service does not do that anymore. In 2007, the organization made the decision to put 911 calls inside the county at the top of their priority list.
Instead of having crews traveling routinely out of the county, the new policy was intended to ensure that residents and visitors always have 911 medical services, said squad director Kevin Duckwall.
In 2009, new state rules took effect requiring ambulance companies and their personnel to have special licenses and added training to do transports.
Morgan County Rescue Service didn’t seek those licenses or training. So, the county’s rescue service can’t legally do transports between facilities, even though many residents wish they could.
Wait time can impact health
Instead, the staff at War Memorial uses transport companies to carry patients to other hospitals, either by private ambulance or via helicopter. Valley Health runs its own transport company among its various area hospitals.
None of the transport companies are based in Morgan County, so their response time or availability can mean local patients suffer an extended wait time before being moved.
During cardiac or stroke events, or severe traumas, the wait for a transport company can have serious consequences for a patient’s health. It can mean losing “The Golden Hour” that’s crucial to a full recovery.
“When you need them, you need them fast,” said War Memorial President Neil McLaughlin.
“You never like to see patients degrade in front of you when you know they can get the next level of care at another facility,” McLaughlin said.
Who goes where?
McLaughlin said many small hospitals face the same challenges regarding transports and care.
Because critical access hospitals lack many specialty medical providers, patients often have to go on to other hospitals for full care.
When a patient comes to War Memorial’s emergency room via the rescue squad, the ambulance crew has been directed to take them there by West Virginia Medical Command (MedComm), a centralized 911 advisory service at West Virginia University.
A doctor directs local responders to provide certain care and take patients to certain facilities based on the patient’s symptoms, the circumstances of the event and the capability of hospitals to receive the patient.
When it is clear that a patient needs specialized care, MedComm will direct the Morgan County Rescue Service to take them straight to a larger hospital, said Duckwall.
He said patients often express their desire to go to a certain facility, but ultimately it’s up to MedComm to direct the crew and coordinate with a hospital to take the patient, based on their needs.
While War Memorial might be the first stop for someone needing emergency care, they might have to go elsewhere for full care.
McLaughlin said each patient has different needs, and it takes the ER staff time to evaluate which patients will stay in Berkeley Springs and which will be transported.
“I’d like to be able to do more locally and not have to transport people,” McLaughlin said.
Advancing medical technology might allow that in the new hospital, but War Memorial will always be “a sender” of patients, he said.
Residents question policy
Recent questions from the public have focused on the personal impact of Morgan County’s squad transport policy.
Some have asked why their family members had to wait at War Memorial for a private ambulance while the local rescue squad was available.
Some county taxpayers have wondered what they’re getting in exchange for their annual $75 ambulance fee if the rescue squad isn’t providing all the services the public wants.
At an informational session on April 6, Duckwall said it would be costly for the Morgan County Rescue Service to be licensed for routine transports.
The squad can’t afford to finance the licensing, staff and equipment needed to meet state laws for transports, he said.
“We can perform the transports, we just don’t have the finances to do that,” Duckwall said.
The total bill for adding that capability would be an estimated $1.1 million per year, according to Duckwall and Renea Stansburry, the squad’s financial officer.
Their estimates include a projected income of $376,000 from transports. That figure is based on data from War Memorial Hospital, which required 462 transports of patients to other facilities last year.
The $737,000 revenue shortfall between revenue and expenses would fall on someone’s shoulders.
Why so much?
Ambulance crew members are trained to perform certain functions -- from basic life support to the administration of some drugs. Certifications range from EMT to Paramedic, with varying course and test requirements.
Ambulance companies that perform all levels of transports must have crew members with more specialized skills, as well as the credentials to administer a wider range of drugs than typical Paramedics. Ambulances used for transports have to carry additional equipment.
Essentially, a transport ambulance is supposed to maintain the same level of medical care as the hospital, so patients’ conditions don’t deteriorate en route.
Higher ambulance fee?
If the Morgan County Commissioners turned to the county’s Ambulance Fee as a way to finance the return of transport services, the current $75 fee would have to rise to $167, according to Duckwall.
As with the current ambulance fee, residents wouldn’t receive free ambulance services in exchange for their taxes. Instead, they would be paying to ensure the service is available when they need it.
Duckwall is concerned that asking the rescue squad to take on another function would short-change its primary job -- to respond to 911 emergencies.
“We can’t adequately cover the county for 911 calls as it is,” he said.
Last year, the squad responded to 1,318 calls with a staff of seven full-time responders and help from 36 part-time crew members.
One ambulance is staffed 24 hours a day, seven days a week, for the county’s 200 square miles of primary coverage area.
An additional crew staffs a second ambulance at peak call times. More than two 911 calls at the same time usually means the county will have to call other locales for help.
“I think our concern needs to be 911 and make sure that’s been done properly,” Duckwall said.