Cost estimate of ambulance transports requested
While County Commission President Stacy Dugan continued to press for answers about non-emergency medical transports for Morgan County residents, local rescue squad and hospital officials laid blame elsewhere for extended patient waits at War Memorial Hospital.
Some residents recently complained that they waited at the local hospital for more than four hours before being transported to another facility for care.
A follow-up meeting about interfacility transports, held on Thursday, June 9, didn’t yield the “solutions” that Commissioner Dugan wanted.
Dugan has asked Morgan County Rescue Service to prepare a realistic estimate of what it would cost the squad to do non-emergency transports on a selective basis.
How long do patients wait?
Extensive discussion led Dugan and others to focus on cases where patients would have a long wait at War Memorial for a private company to transport them.
According to the hospital, an average of one patient per day is sent to another hospital for advanced care.
The majority of those are taken to Winchester Medical Center, which is part of Valley Health Systems, as is War Memorial.
“The perception is, if I have to go here to War Memorial, there’s a four to five hour wait to get somewhere else,” said Dugan.
War Memorial Hospital president Neil McLaughlin again asserted that the delay in moving a patient to a higher level of care is not about securing an ambulance to move the patient.
Physicians and nurses at the hospital, once they decide a local patient needs advanced care elsewhere, still must find a facility and a physician willing to take the patient, McLaughlin said.
“It’s illegal to let a patient leave War Memorial without knowing they have someone to take them,” McLaughlin said.
In some cases, a receiving doctor might ask War Memorial to do more screening or testing first.
Dugan asked McLaughlin if he knew what the average wait time was for patients destined for other hospitals.
He didn’t know, but said a new system in the hospital might be able to track that.
“It’s not to our advantage to have patients sitting around for four or five hours,” McLaughlin said.
“It sounds like you’re more interested in the process than the patient,” said resident Phil Spriggs.
Spriggs wondered how he could ensure that, in an emergency, he would be taken to a hospital near his cardiologist.
“I’m not going to sit there for three or four hours waiting for care,” he said.
Can 911 patients choose?
Dugan also spent a lot of time asking about rescue squad protocols for 911 calls, and how ambulance crews determined where to take a patient.
Representatives of Morgan County Rescue and West Virginia Medical Command (MedComm) discussed how their services interact during a 911 call, leading to the transport of an emergency patient either to War Memorial or another facility.
That decision seems to rest largely on the shoulders of the 911 crew in the back of the ambulance, based on their assessment of a patient’s condition, knowledge of their medical history and the crew’s ability to stabilize a patient.
Rescue Service Administrator Kevin Duckwall continued to draw attention to state law, arguing that MedCom has the ultimate say in where a 911 patient is taken.
MedCom Medical Director Larry Pantruso and MedCom Manager Stellman Teter, who traveled from Morgantown for the meeting, said their medical staff rarely makes that decision — and usually only if a hospital can’t take patients because they are full.
Teter said even if a hospital is “on diversion,” or asking for no more patients, individual patients can still request services there.
He said there is a waiver form that patients can sign, saying they have asked to bypass the closest hospital and go elsewhere.
The form releases the ambulance crew from liability if the patient’s condition suffers due to the longer trip.
Commissioner Dugan asked Duckwall if the waiver is routinely available to 911 patients.
“It’s always on the form,” Duckwall said.
Dugan pressed for a clearer answer. “How many times is that used?” she asked.
“Frequently,” said Todd Songer of the Rescue Service.
“I think the people in the back of the ambulance should know their rights,” said Dugan.
“If I’m alert and oriented, I should be able to make that decision,” she said.
Songer said he hoped patients respect the judgment and training of the medics trying to treat them.
“When it matters what facility you go to, time is of the essence. The hard ones are when you thought it was okay to make the extra drive, and it wasn’t,” said McLaughlin.
Most other hospitals in the region are at least 30 miles away.
“Unfortunately, since items have come out in the paper, more people have been saying ‘Take me to Winchester’ or ‘Take me to City Hospital’ when they could have been taken care of by War Memorial,” said Songer.
Can squad step in?
Duckwall has repeatedly said Morgan County’s rescue squad isn’t licensed to do non-emergency transports like it used to.
But MedCom Manager Stellman Teter said the squad’s license to operate does indeed include transports.
The crew, however, would require special training and certification to do Class 3 transports - which would cover the majority of transports done from War Memorial.
Teter said the training, if done in a classroom, would take a couple of days. The classes may soon be available online.
Ambulances that perform transports also have to carry additional medical equipment.
“Do we know how much it would cost for that additional training and equipment?” asked Commissioner Brenda Hutchinson.
Dugan asked Duckwall to prepare some estimates.
“It boils down to additional service equals additional costs,” said Hutchinson.
“I’d pay more to get better service,” said resident Kevin Sites. “You’re telling me right now you couldn’t move me from War Memorial and that’s unacceptable.”
“This is the county rescue squad and they’re supposed to be here for the residents,” Sites said.
He asked if there is a way for the squad to be called if private transport companies aren’t available and a patient needs to get care elsewhere.
Commissioner Dugan put the question on the agenda for another meeting in August, when county and squad officials may look again at the cost of offering transport services.