Councilman Proposes Payment Up Front Before Ambulance Ride

>

**************

Get trade secrets for amazing burgers. Watch " Cooking with

Tyler Florence " on AOL Food.

> > http://video.http://video.<whttp://videh <http://video.http://video.<

?NCID=aolfod00030000000002)

May 21, 2008

Well, you can talk to your City Attorney's office and find out the claims

history, and everybody knows about the case involving Nurse Myrick where she

refused to send on a heart attack call and the patient died (might have been

dead

already but we'll never know) and the city was blasted all over the media for

months. Also, you might talk to Jack Ayers. He can tell you all about

Dallas's history of claims.

Gene

>

> Its a single councilmember suggesting it. Not Dallas EMS. And show me where

> I can read about all those lawsuits you mention and or that bad reputation..

> Its a single councilmember suggesting it. Not Dallas EMS.

>

> Re: Councilman Proposes Payment Up Front Before

> Ambulance Ride

>

> Why don't they just hire Nurse e Myrick to triage their calls again,

> and

> they can cut out all those " unnecessary transports. " Can paramedics (or, if

> rumor is correct, EMTs in the future) in Dallas reliably determine who needs

> to go and who does not? Dallas has a very bad reputation for refusing

> transports that has lasted for the last 30 years. They have been sued

> repeatedly

> for making service-initiated refusals. Patients have died because of it.

> This Councilman needs to review the history of Dallas EMS before making such

> a

> proposal.

>

> GG

> In a message dated 5/21/08 12:32:38 PM, bbledsoe@... <

> mailto:bbledsoe%mailto:bbledmai> writes:

>

> >

> > DALLAS, TX-- A Dallas City Council member said he wants people to pay

> > upfront before getting a ride to the hospital, NBC 5 reported.

> > Council member Rasansky said if the call is not life threatening,

> > first responders should ask the caller how they are going to pay for the

> > ambulance ride to the hospital.

> > He said there would be no questions asked in a true emergency but said

> > taxpayers have to pay millions every year for ambulance rides. He said his

> > proposal is not so much about the bottom line, but about financial

> > responsibility.

> > " Even when we send in those insurance claims, we still get charged a

> > commission, why should we pay a commission. This is a way to save taxpayer

> > money, " Rasansky said.

> > At this point, the idea is only a proposal and Rasansky said he hopes his

> > fellow council members will seriously consider it in the name of saving

> > taxpayer dollars.

> > Dr. Pepe, the director of Dallas EMS, responded by saying, " When it

> > comes down to it, if there is an emergency or if there is a question, our

> > job is to response and we will be there no matter what. "

> >

> > nbc5i.com

> >

> whttp://videh>

> >

>

> ************ **

> Get trade secrets for amazing burgers. Watch " Cooking with

> Tyler Florence " on AOL Food.

> (http://food.http://food.<whttp://fohttp:// & amp; <http://food.http://food.<

> whttp://fohttp:// & amp;>

> ?NCID=aolfod0003000 ?NCID=ao

>

May 21, 2008

Further comment. The Dallas City Council and the City Manager bear 100% of

the responsibility for the past troubles of DFD since they allowed the

policies that caused the problems. Things are undoubtedly better now, but what

this

councilperson wants to do would take it back to the bad old days when medics

would hand the patient a list of private ambulances and say " call one of

these. "

I also have personal experience that I can tell you about, because I used to

ride out regularly with DFD back in the early days.

Gene

>

> Its a single councilmember suggesting it. Not Dallas EMS. And show me where

> I can read about all those lawsuits you mention and or that bad reputation..

> Its a single councilmember suggesting it. Not Dallas EMS.

>

> Re: Councilman Proposes Payment Up Front Before

> Ambulance Ride

>

> Why don't they just hire Nurse e Myrick to triage their calls again,

> and

> they can cut out all those " unnecessary transports. " Can paramedics (or, if

> rumor is correct, EMTs in the future) in Dallas reliably determine who needs

> to go and who does not? Dallas has a very bad reputation for refusing

> transports that has lasted for the last 30 years. They have been sued

> repeatedly

> for making service-initiated refusals. Patients have died because of it.

> This Councilman needs to review the history of Dallas EMS before making such

> a

> proposal.

>

> GG

> In a message dated 5/21/08 12:32:38 PM, bbledsoe@... <

> mailto:bbledsoe%mailto:bbledmai> writes:

>

> >

> > DALLAS, TX-- A Dallas City Council member said he wants people to pay

> > upfront before getting a ride to the hospital, NBC 5 reported.

> > Council member Rasansky said if the call is not life threatening,

> > first responders should ask the caller how they are going to pay for the

> > ambulance ride to the hospital.

> > He said there would be no questions asked in a true emergency but said

> > taxpayers have to pay millions every year for ambulance rides. He said his

> > proposal is not so much about the bottom line, but about financial

> > responsibility.

> > " Even when we send in those insurance claims, we still get charged a

> > commission, why should we pay a commission. This is a way to save taxpayer

> > money, " Rasansky said.

> > At this point, the idea is only a proposal and Rasansky said he hopes his

> > fellow council members will seriously consider it in the name of saving

> > taxpayer dollars.

> > Dr. Pepe, the director of Dallas EMS, responded by saying, " When it

> > comes down to it, if there is an emergency or if there is a question, our

> > job is to response and we will be there no matter what. "

> >

> > nbc5i.com

> >

> > http://video.http://video.<whttp://videh <http://video.http://video.<

> whttp://videh>

> >

>

> ************ **

> Get trade secrets for amazing burgers. Watch " Cooking with

> Tyler Florence " on AOL Food.

> (http://food.http://food.<whttp://fohttp:// & amp; <http://food.http://food.<

> whttp://fohttp:// & amp;>

> ?NCID=aolfod0003000 ?NCID=ao

>

May 21, 2008

DALLAS, TX-- A Dallas City Council member said he wants people to pay

upfront before getting a ride to the hospital, NBC 5 reported.

Council member Rasansky said if the call is not life threatening,

first responders should ask the caller how they are going to pay for the

ambulance ride to the hospital.

He said there would be no questions asked in a true emergency but said

taxpayers have to pay millions every year for ambulance rides. He said his

proposal is not so much about the bottom line, but about financial

responsibility.

" Even when we send in those insurance claims, we still get charged a

commission, why should we pay a commission. This is a way to save taxpayer

money, " Rasansky said.

At this point, the idea is only a proposal and Rasansky said he hopes his

fellow council members will seriously consider it in the name of saving

taxpayer dollars.

Dr. Pepe, the director of Dallas EMS, responded by saying, " When it

comes down to it, if there is an emergency or if there is a question, our

job is to response and we will be there no matter what. "

nbc5i.com

http://video.nbc5i.com/player/?id=253781

May 21, 2008

Its a single councilmember suggesting it. Not Dallas EMS. And show me where I

can read about all those lawsuits you mention and or that bad reputation....I

haven't seen or heard it. And who died because of it?

Re: Councilman Proposes Payment Up Front Before Ambulance

Ride

Why don't they just hire Nurse e Myrick to triage their calls again, and

they can cut out all those " unnecessary transports. " Can paramedics (or, if

rumor is correct, EMTs in the future) in Dallas reliably determine who needs

to go and who does not? Dallas has a very bad reputation for refusing

transports that has lasted for the last 30 years. They have been sued repeatedly

for making service-initiated refusals. Patients have died because of it.

This Councilman needs to review the history of Dallas EMS before making such a

proposal.

GG

In a message dated 5/21/08 12:32:38 PM, bbledsoe@...

<mailto:bbledsoe%40earthlink.net> writes:

>

> DALLAS, TX-- A Dallas City Council member said he wants people to pay

> upfront before getting a ride to the hospital, NBC 5 reported.

> Council member Rasansky said if the call is not life threatening,

> first responders should ask the caller how they are going to pay for the

> ambulance ride to the hospital.

> He said there would be no questions asked in a true emergency but said

> taxpayers have to pay millions every year for ambulance rides. He said his

> proposal is not so much about the bottom line, but about financial

> responsibility.

> " Even when we send in those insurance claims, we still get charged a

> commission, why should we pay a commission. This is a way to save taxpayer

> money, " Rasansky said.

> At this point, the idea is only a proposal and Rasansky said he hopes his

> fellow council members will seriously consider it in the name of saving

> taxpayer dollars.

> Dr. Pepe, the director of Dallas EMS, responded by saying, " When it

> comes down to it, if there is an emergency or if there is a question, our

> job is to response and we will be there no matter what. "

>

> nbc5i.com

>

<http://video.http://vidhttp://videhttp:/>

>

**************

Get trade secrets for amazing burgers. Watch " Cooking with

Tyler Florence " on AOL Food.

<http://food.aol.com/tyler-florence?video=4 & amp;>

?NCID=aolfod00030000000002)

May 21, 2008

One must also consider this.

What got the hospital community in a HEAP of hot waster in terms of federal

regulations being created?

Answer,

asking about ability to pay before treatment, hence the creation of EMTALA.

If you spend any time on any hospital EM list you learn fast that EMTALA is

the din of every ED administrator and ED doctor in the US. Some loathe it,

many fear it, seemingly all damn it over and over publicly and God knows what

they say privately!

If this type of pay before we treat/transport, screening whatever your

emergency 9-1-1 call came to pass over a larger scale than one Texas City how

long

before someone with enough brains to get elected to the US House or Senate

comes along and creates something like EMTALA that would affect EMS?

Would we want that?

Note I'm not an advocate of " if you call we haul " policies and I actually

have helped to institute some EMS initiated refusal policies in a statewide

system far more arcane than Texas I don't think everyone gets a free ride I

think tying anything to ability to pay in 9-1-1 EMS is a HUGE mistake.

As Doc B pointed out the whole system abuse issues are wider deeper and much

much bigger then we here in EMS can really affect, they are social, and

political and racial and all sorts of other ugly words that will only serve to

harm EMS in the long run if we allow ourselves to be drug into such issues. We

are a SERVICE, granted you MUST fund a service for it to work but doing it in

the manner as proposed is just not a viable solution in my view.

LNM

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@...

(Cell Phone)

(Home Phone)

(IFW/TFW/FSS Office)

(IFW/TFW/FSS Fax)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

**************Get trade secrets for amazing burgers. Watch " Cooking with

Tyler Florence " on AOL Food.

(http://food.aol.com/tyler-florence?video=4 & ?NCID=aolfod00030000000002)

May 21, 2008

From the New York Times, published March 7, 1984.

AMBULANCE CALL DELAY FOR DYING WOMAN BRINGS 300,000 CLAIM

*

Top of Form

UPI

Published: March 7, 1984

A Fire Department official said Monday that a nurse-dispatcher who argued for

several minutes with a man who was demanding an ambulance for his dying

stepmother was given counseling and returned to duty after a two-day suspension

with pay.

Mike , a Fire Department section chief, said Billie Myrick, a nurse with 17

years' experience, was placed on paid administrative leave one month after the

incident but was returned to duty two days later.

''We put her back on because we figured all she needed was a refresher on

policy,'' Mr. said.

Larry Boff, whose 60-year-old stepmother died Jan. 5, filed a $300,000 damage

claim against the city in the incident. Officials said a full investigation

should be completed this week. Abuse of System Reported

Mr. said his department used nurses to determine emergencies from the

hundreds of calls received each week.

'We've had a lot of system abuse,'' he said. Studies have shown that more than

half of the people requesting ambulance service do not require emergency

transportation, he said.

Mr. Boff said he called the Fire Department shortly before 11 P.M. on Jan. 5

because his stepmother, Lillian Boff, was having trouble breathing.

A Dallas television station, KDFW, obtained Fire Department tapes of the

conversation in which Miss Myrick was told that Mrs. Boff was ill. Miss Myrick

asked to speak to the woman.

The tape contained this exchange:

Mr. Boff: ''No, you can't. She seems like she's incoherent.''

Miss Myrick: ''Why is she incoherent?''

Mr. Boff: ''How the hell do I know?''

Miss Myrick: ''Sir, don't curse me.''

Mr. Boff: ''Well, I don't care. These stupid questions you're asking me. Give me

someone who knows what they are doing. Why don't you just send an ambulance out

here?''

Miss Myrick: ''Sir, we only come out on life-threatening emergencies.''

Mr. Boff: ''Well, this is a life-threatening emergency.''

Miss Myrick: ''Hold on, sir. I'll let you speak with an officer.'' Supervisor

Comes on Line

On the tape, Don Greene, a supervisor, also asked to speak to the woman. Mr.

Boff's response contained the word ''hell'' and Mr. Greene threatened to hang

up.

Miss Myrick came back on the line and insisted on talking to Mrs. Boff. When Mr.

Boff told Miss Myrick again that Mrs. Boff could not talk, Miss Myrick told him

to give the woman the telephone anyway.

Mr. Boff said he would call a hospital. A few minutes later, Mr. Boff's

roommate, Dennis Fleming, called back, and again Miss Myrick insisted on talking

to Mrs. Boff.

''She cannot talk,'' said Mr. Fleming. ''She is just out of it.''

At 11:01 P.M., about eight minutes after the first call, the Fire Department

sent an ambulance to Mr. Boff's home. Mrs. Boff was pronounced dead at 11:30

P.M. of heart disease.

From: texasems-l [mailto:texasems-l ] On Behalf

Of Shaw, Kenny

Sent: Wednesday, May 21, 2008 3:07 PM

Subject: Re: Councilman Proposes Payment Up Front Before Ambulance

Ride

Its a single councilmember suggesting it. Not Dallas EMS. And show me where I

can read about all those lawsuits you mention and or that bad reputation....I

haven't seen or heard it. And who died because of it?

Re: Councilman Proposes Payment Up Front Before Ambulance

Ride

Why don't they just hire Nurse e Myrick to triage their calls again, and

they can cut out all those " unnecessary transports. " Can paramedics (or, if

rumor is correct, EMTs in the future) in Dallas reliably determine who needs

to go and who does not? Dallas has a very bad reputation for refusing

transports that has lasted for the last 30 years. They have been sued repeatedly

for making service-initiated refusals. Patients have died because of it.

This Councilman needs to review the history of Dallas EMS before making such a

proposal.

GG

In a message dated 5/21/08 12:32:38 PM, bbledsoe@...

<mailto:bbledsoe%40earthlink.net> <mailto:bbledsoe%40earthlink.net> writes:

>

> DALLAS, TX-- A Dallas City Council member said he wants people to pay

> upfront before getting a ride to the hospital, NBC 5 reported.

> Council member Rasansky said if the call is not life threatening,

> first responders should ask the caller how they are going to pay for the

> ambulance ride to the hospital.

> He said there would be no questions asked in a true emergency but said

> taxpayers have to pay millions every year for ambulance rides. He said his

> proposal is not so much about the bottom line, but about financial

> responsibility.

> " Even when we send in those insurance claims, we still get charged a

> commission, why should we pay a commission. This is a way to save taxpayer

> money, " Rasansky said.

> At this point, the idea is only a proposal and Rasansky said he hopes his

> fellow council members will seriously consider it in the name of saving

> taxpayer dollars.

> Dr. Pepe, the director of Dallas EMS, responded by saying, " When it

> comes down to it, if there is an emergency or if there is a question, our

> job is to response and we will be there no matter what. "

>

> nbc5i.com

>

>

**************

Get trade secrets for amazing burgers. Watch " Cooking with

Tyler Florence " on AOL Food.

<http://food.aol.com/tyler-florence?video=4 & amp;> & amp;

<http://food.aol.com/tyler-florence?video=4 & amp;> & amp;>

?NCID=aolfod00030000000002)

May 21, 2008

Hello?? 24 years ago? A single dispatcher??

Re: Councilman Proposes Payment Up Front Before Ambulance

Ride

Why don't they just hire Nurse e Myrick to triage their calls again, and

they can cut out all those " unnecessary transports. " Can paramedics (or, if

rumor is correct, EMTs in the future) in Dallas reliably determine who needs

to go and who does not? Dallas has a very bad reputation for refusing

transports that has lasted for the last 30 years. They have been sued repeatedly

for making service-initiated refusals. Patients have died because of it.

This Councilman needs to review the history of Dallas EMS before making such a

proposal.

GG

In a message dated 5/21/08 12:32:38 PM, bbledsoe@...

<mailto:bbledsoe%40earthlink.net> <mailto:bbledsoe%40earthlink.net>

<mailto:bbledsoe%40earthlink.net> writes:

>

> DALLAS, TX-- A Dallas City Council member said he wants people to pay

> upfront before getting a ride to the hospital, NBC 5 reported.

> Council member Rasansky said if the call is not life threatening,

> first responders should ask the caller how they are going to pay for the

> ambulance ride to the hospital.

> He said there would be no questions asked in a true emergency but said

> taxpayers have to pay millions every year for ambulance rides. He said his

> proposal is not so much about the bottom line, but about financial

> responsibility.

> " Even when we send in those insurance claims, we still get charged a

> commission, why should we pay a commission. This is a way to save taxpayer

> money, " Rasansky said.

> At this point, the idea is only a proposal and Rasansky said he hopes his

> fellow council members will seriously consider it in the name of saving

> taxpayer dollars.

> Dr. Pepe, the director of Dallas EMS, responded by saying, " When it

> comes down to it, if there is an emergency or if there is a question, our

> job is to response and we will be there no matter what. "

>

> nbc5i.com

>

<http://video.http://vidhttp://videhttp:/>

<http://video.http:/vidhttp:/videhttp:/ <http://video.http:/vidhttp:/videhttp:/>

> <http://video.http://vidhttp://videhttp:/

<http://video.http://vidhttp://videhttp:/>

<http://video.http:/vidhttp:/videhttp:/ <http://video.http:/vidhttp:/videhttp:/>

> >

>

**************

Get trade secrets for amazing burgers. Watch " Cooking with

Tyler Florence " on AOL Food.

<http://food.aol.com/tyler-florence?video=4 & amp;

<http://food.aol.com/tyler-florence?video=4 & amp;> > & amp;

<http://food.aol.com/tyler-florence?video=4 & amp;

<http://food.aol.com/tyler-florence?video=4 & amp;> > & amp;>

?NCID=aolfod00030000000002)

May 21, 2008

I was an expert for Dallas on several cases in the later 80s and early 90s

before they abandoned their â€œFire Department Refusedâ€ whereby FD could

no-ride what were thought to be non-emergencies. The cases always went bad it

seemed and so did the litigation. It was sheer bedlam.

BEB

From: texasems-l [mailto:texasems-l ] On Behalf

Of Shaw, Kenny

Sent: Wednesday, May 21, 2008 3:54 PM

Subject: Re: Councilman Proposes Payment Up Front Before Ambulance

Ride

Hello?? 24 years ago? A single dispatcher??

Re: Councilman Proposes Payment Up Front Before Ambulance

Ride

Why don't they just hire Nurse e Myrick to triage their calls again, and

they can cut out all those " unnecessary transports. " Can paramedics (or, if

rumor is correct, EMTs in the future) in Dallas reliably determine who needs

to go and who does not? Dallas has a very bad reputation for refusing

transports that has lasted for the last 30 years. They have been sued repeatedly

for making service-initiated refusals. Patients have died because of it.

This Councilman needs to review the history of Dallas EMS before making such a

proposal.

GG

In a message dated 5/21/08 12:32:38 PM, bbledsoe@...

<mailto:bbledsoe%40earthlink.net> <mailto:bbledsoe%40earthlink.net>

<mailto:bbledsoe%40earthlink.net> <mailto:bbledsoe%40earthlink.net> writes:

>

> DALLAS, TX-- A Dallas City Council member said he wants people to pay

> upfront before getting a ride to the hospital, NBC 5 reported.

> Council member Rasansky said if the call is not life threatening,

> first responders should ask the caller how they are going to pay for the

> ambulance ride to the hospital.

> He said there would be no questions asked in a true emergency but said

> taxpayers have to pay millions every year for ambulance rides. He said his

> proposal is not so much about the bottom line, but about financial

> responsibility.

> " Even when we send in those insurance claims, we still get charged a

> commission, why should we pay a commission. This is a way to save taxpayer

> money, " Rasansky said.

> At this point, the idea is only a proposal and Rasansky said he hopes his

> fellow council members will seriously consider it in the name of saving

> taxpayer dollars.

> Dr. Pepe, the director of Dallas EMS, responded by saying, " When it

> comes down to it, if there is an emergency or if there is a question, our

> job is to response and we will be there no matter what. "

>

> nbc5i.com

>

<http://video.http:/vidhttp:/videhttp:/ <http://video.http:/vidhttp:/videhttp:/>

> <http://video.http://vidhttp://videhttp:/

<http://video.http:/vidhttp:/videhttp:/ <http://video.http:/vidhttp:/videhttp:/>

> >

>

**************

Get trade secrets for amazing burgers. Watch " Cooking with

Tyler Florence " on AOL Food.

<http://food.aol.com/tyler-florence?video=4 & amp;> & amp;

<http://food.aol.com/tyler-florence?video=4 & amp;> & amp;> > & amp;

<http://food.aol.com/tyler-florence?video=4 & amp;> & amp;

<http://food.aol.com/tyler-florence?video=4 & amp;> & amp;> > & amp;>

?NCID=aolfod00030000000002)

May 21, 2008

They were using nurses to screen calls for emergency versus non-emergency. This

hit about the time a paramedic going through a divorce accidently killed the

director of the Dallas Theatre Center with 2 grams of lidocaine he confused for

D50W (not DFD, but one of the Park Cities). The history is actually more sordid

than Gene is letting onto.

BEB

From: texasems-l [mailto:texasems-l ] On Behalf

Of Shaw, Kenny

Sent: Wednesday, May 21, 2008 3:54 PM

Subject: Re: Councilman Proposes Payment Up Front Before Ambulance

Ride

Hello?? 24 years ago? A single dispatcher??

Re: Councilman Proposes Payment Up Front Before Ambulance

Ride

Why don't they just hire Nurse e Myrick to triage their calls again, and

they can cut out all those " unnecessary transports. " Can paramedics (or, if

rumor is correct, EMTs in the future) in Dallas reliably determine who needs

to go and who does not? Dallas has a very bad reputation for refusing

transports that has lasted for the last 30 years. They have been sued repeatedly

for making service-initiated refusals. Patients have died because of it.

This Councilman needs to review the history of Dallas EMS before making such a

proposal.

GG

In a message dated 5/21/08 12:32:38 PM, bbledsoe@...

<mailto:bbledsoe%40earthlink.net> <mailto:bbledsoe%40earthlink.net>

<mailto:bbledsoe%40earthlink.net> <mailto:bbledsoe%40earthlink.net> writes:

>

> DALLAS, TX-- A Dallas City Council member said he wants people to pay

> upfront before getting a ride to the hospital, NBC 5 reported.

> Council member Rasansky said if the call is not life threatening,

> first responders should ask the caller how they are going to pay for the

> ambulance ride to the hospital.

> He said there would be no questions asked in a true emergency but said

> taxpayers have to pay millions every year for ambulance rides. He said his

> proposal is not so much about the bottom line, but about financial

> responsibility.

> " Even when we send in those insurance claims, we still get charged a

> commission, why should we pay a commission. This is a way to save taxpayer

> money, " Rasansky said.

> At this point, the idea is only a proposal and Rasansky said he hopes his

> fellow council members will seriously consider it in the name of saving

> taxpayer dollars.

> Dr. Pepe, the director of Dallas EMS, responded by saying, " When it

> comes down to it, if there is an emergency or if there is a question, our

> job is to response and we will be there no matter what. "

>

> nbc5i.com

>

<http://video.http:/vidhttp:/videhttp:/ <http://video.http:/vidhttp:/videhttp:/>

> <http://video.http://vidhttp://videhttp:/

<http://video.http:/vidhttp:/videhttp:/ <http://video.http:/vidhttp:/videhttp:/>

> >

>

**************

Get trade secrets for amazing burgers. Watch " Cooking with

Tyler Florence " on AOL Food.

<http://food.aol.com/tyler-florence?video=4 & amp;> & amp;

<http://food.aol.com/tyler-florence?video=4 & amp;> & amp;> > & amp;

<http://food.aol.com/tyler-florence?video=4 & amp;> & amp;

<http://food.aol.com/tyler-florence?video=4 & amp;> & amp;> > & amp;>

?NCID=aolfod00030000000002)

May 21, 2008

â€œI haven't seen or heard it. And who died because of it?â€

Kenny,

Hello!!! I provided the answer to your question.

Jack Pitcock

From: texasems-l [mailto:texasems-l ] On Behalf

Of Shaw, Kenny

Sent: Wednesday, May 21, 2008 3:54 PM

http://thirdpartyoffers.juno.com/TGL2111/fc/JKFkuJNzr0AcZsUyzxZMCqm6hKCWZU8lXC1V\

Subject: Re: Councilman Proposes Payment Up Front Before Ambulance

Ride

Hello?? 24 years ago? A single dispatcher??

May 21, 2008

I think it's an excellent idea.

_____________________________________________________________

Get Help Now to Quit Smoking

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May 21, 2008

The point is this, nobody has found a solution to the ambulance abuse issue

that is suitable to all parties.

1. DFD did refuse transport for years and were sued numerous times.

Sure there was abuse. But there were paramedics who followed the rules and

still got into trouble because their education did not allow them the skills

to determine who is really sick and who is not. It was not the fault of DFD

or the paramedics It was the City. Slowly, " automatic carry " policies were

put in place to assure that high-risk patients were transported. The

lawsuits continued.

2. The City of Dallas used to turn the water off if people didn't pay

their bill. One story in the Dallas Times Herald about a poor pensioner

whose water was shut off brought that to an end.

3. The use of nurses as call screeners was a disaster. The case Gene

mentioned was an effeminate sounding man who was begging to come and get his

mother (who was in the final throes of death). The tape would piss anybody

off. People are not to be treated that way.

4. In Fort Worth, we had to collect money for ambulance calls. The EMT

with the highest collections got a dinner. It was expected. More than that,

it was required if you liked your job. We also got bonuses for getting

funerals. We even had to ask for payment on death calls (although the bill

was $40.00) it hurt to see some widower write out a check minutes after his

wife of 50 years passed away.

5. London Ambulance has tried to refer calls to non-emergency centers

only to find the MPDS is a horrible screening tool for sick, non-sick. The

program stopped.

6. The Red River Project withered on the vine.

7. An eastern seaboard city allowed paramedics to give free cab

vouchers to nonemergency patients only to have the ACLU complain that

minorities were made to ride in cabs while whites were transported by

ambulance. When they ran the numbers, the ACLU was on to something and the

program went quietly away.

Every one of us has done something to dissuade a person from taking an

ambulance (who we thought didn't need it). Heck, I even helped jumpstart an

Oldsmobile that had not run in 3 months (and had no inspection sticker or

registration) so we could get back to a dinner that was just served before a

call because of an ingrown toenail. It is like being a mercenary-it works

for a while but eventually you screw up. As I matured, I learned, by the

time you talk the patient out of going, you could have had them at the

hospital. Then, you did not have to worry about the repercussions.

Don't think it is just EMS. Many times I have sat on a stool at 3:00 AM

looking at a patient in total disbelief as she described intermittent pelvic

pain that had been present off or on for 20 years has seen every doctor in

Texas, and expected me to figure it out, in the middle of a thunderstorm,

while I have 45 people coughing and hacking in the waiting room. I waste a

few grand on labs and ultrasound that left me no closer to solving her

problem than I was when she walked in. But, the ultrasound films we shot got

to join the 56 prior ultrasound films that are stored in Part 4 of 4 of her

x-ray folder. If I did not make an effort to treat her I would be hearing

from the administrator the next day.

Ambulance abuse is a complex problem (social, educational, racial,

religious, medical, financial). As it has been said, there are no simple

solutions to complex problems. My point in the original post is that the

Honorable City Councilman, like so many before him, is simply pissin' in the

wind.

May 21, 2008

Gene:

Here is how I see the problem. What first off constitutes an emergency? We need

to take the citizens point of view,who called us in the first place requesting

our services. Obviously, what or something ran through the citizens mental

computer and said I need you here to take care of what I think the emergency is.

Next, if we have a screener on the other end,he is receivng caller data,and

deciding if the citizen has an emergency or not through his mental computers.

Bottom line, is the citizen one way or another is funding this ambulance when

government collects tax revenue and spreads it about. Our next problem is abuse.

Again,this is a relative term. What constitutes abuse to the EMS crew may not be

to the citizen who called in the first place. What we have as a problem here is

the almighty $ and collection rate. This is a problem where many citizens cannot

pay a bill up front or after.Insurance,special fees,or subscriptions may

generate cash flow,and taxes are going to have to do the rest. All citizens

irrespective of income, pay taxes and property taxes(including an 8.25% sales

tax). As Clara Peller would say " Where's the beef? " .EMS is and never was meant to

be run as a business in the traditional sense,with a profit motive as private

companies are who can refuse to transport a patient and I have seen it done. We

in municipal EMS have a covenant or contract with them.When you call 911,we haul

with minor modificating from Major Ed " Too Tall " Freeman. Our objective is to

take care of the emergency,figure out a way to get our money later.Our

councilman,like many of the current crop of politicians beleives in minimal

government,minimal taxes,and minimal spending. This idea is now or should be out

the window. Our citizens expect us to respond , take care of their needs in what

they perceive the emergency to be. Anywhere,you go there will always be " free

loaders " . This is to be expected. We need to get out of the mentality that all

free loaders need an ambulance for what is an insignificant problem.One day,IT

WILL BE the real deal and bit you in the rear. We are a municipal service just

like Police,and Fire. We need to go handle the call,and take care of

business,and communicate our findings to a doctor. We must let him decide,and do

whatever it is he does.We do not need politicians deciding how to get EMS money

when they can't spend or manage it wisely in the first place. EMS is not one of

the biggest sources of government waste.Public health and welfare is a top

priority and constitutional mandate by both Federal and state constitiutions. We

are the frontline soldiers in protecting Public health.We need to do that .City

councils need to cutback on their expensive lunches and perks.One day in the

future,god forbid,that councilman will need an ambulance and may not be able to

pay the bill. EMS must be able to funded in a number of ways where all citizens,

whose incomes large or small makes a contribution to money pot. Ambulance and

EMS service is something we all need irrespective of our income or ability to

pay. I am now off my soap box addressing all of you RabbiEMS.

Re: Councilman Proposes Payment Up Front Before

> Ambulance Ride

>

> Why don't they just hire Nurse e Myrick to triage their calls again,

> and

> they can cut out all those " unnecessary transports. " Can paramedics (or, if

> rumor is correct, EMTs in the future) in Dallas reliably determine who needs

> to go and who does not? Dallas has a very bad reputation for refusing

> transports that has lasted for the last 30 years. They have been sued

> repeatedly

> for making service-initiated refusals. Patients have died because of it.

> This Councilman needs to review the history of Dallas EMS before making such

> a

> proposal.

>

> GG

> In a message dated 5/21/08 12:32:38 PM, bbledsoe@... <

> mailto:bbledsoe%mailto:bbledmai> writes:

>

> >

> > DALLAS, TX-- A Dallas City Council member said he wants people to pay

> > upfront before getting a ride to the hospital, NBC 5 reported.

> > Council member Rasansky said if the call is not life threatening,

> > first responders should ask the caller how they are going to pay for the

> > ambulance ride to the hospital.

> > He said there would be no questions asked in a true emergency but said

> > taxpayers have to pay millions every year for ambulance rides. He said his

> > proposal is not so much about the bottom line, but about financial

> > responsibility.

> > " Even when we send in those insurance claims, we still get charged a

> > commission, why should we pay a commission. This is a way to save taxpayer

> > money, " Rasansky said.

> > At this point, the idea is only a proposal and Rasansky said he hopes his

> > fellow council members will seriously consider it in the name of saving

> > taxpayer dollars.

> > Dr. Pepe, the director of Dallas EMS, responded by saying, " When it

> > comes down to it, if there is an emergency or if there is a question, our

> > job is to response and we will be there no matter what. "

> >

> > nbc5i.com

> >

> > http://video.http://video.<whttp://videh <http://video.http://video.<

> whttp://videh>

> >

>

> ************ **

> Get trade secrets for amazing burgers. Watch " Cooking with

> Tyler Florence " on AOL Food.

> (http://food.http://food.<whttp://fohttp:// & amp; <http://food.http://food.<

> whttp://fohttp:// & amp;>

> ?NCID=aolfod0003000 ?NCID=ao

>

May 21, 2008

I think Dr. Bledsoe's numbered points here hit it on the head. Those are valid

points all.

This problem, use of emergency response for non-emergency situations, is not

unique nor does it have any simple resolution. Unfortunately, it will continue

to be " the nature of the beast. " Public education of the community regarding

the definition of an emergency and " when to call 911 " sometimes helps, but it

never entirely solves the problem. An emergency is what the person who calls

911 PERCEIVES is an emergency, and you can't change perception in many people no

matter what you do. And passing an edict that would " educate " the public that

they will have a wallet biopsy if the responders decide the situation is not an

emergency will only do two things:

1. It will breed discontent in the community and could increase violence

towards emergency responders who are forced to tell the caller that their

situation is NOT an emergency and they will have to pay the bill in advance or

guarantee payment. For whatever reason many people call 911, in most

situtations SOMEONE is upset before the responders ever even get there. If

violence doesn't occur, complaints to the powers that be up above will most

likely increase because again, the caller perceives the situation as an

emergency regardless of what the responders tell them.

2. It could lead to some folks NOT calling for REAL emergencies when they

should for fear of being dunned for money at the time of service. Why call for

help when you can throw them in the car and drive them for the cost of gas???

It won't matter that the baby is not breathing. Again, it is based in

perception only now the perception is that if they don't have the money, you

won't treat them and transport them anyway.

The only thing I have to say about the article iteself is that the Dallas

councilman who is proposing this has a valid point regarding the financial

impact on taxpayers of non-emergency non-paid ambulance transports. But HE is

not educated to the real issues obviously or the potential ramifications of his

plan. Someone needs to educate him a little better, in my opinion, so that

maybe he can think of a better way to help the Dallas system and taxpayers.

Heck, maybe he can think of something better that ALL agencies could benefit

from.

Jane Dinsmore

To: texasems-l@...: bbledsoe@...: Wed, 21 May 2008

17:44:48 -0500Subject: RE: Councilman Proposes Payment Up Front

Before Ambulance Ride

The point is this, nobody has found a solution to the ambulance abuse issuethat

is suitable to all parties.1. DFD did refuse transport for years and were sued

numerous times.Sure there was abuse. But there were paramedics who followed the

rules andstill got into trouble because their education did not allow them the

skillsto determine who is really sick and who is not. It was not the fault of

DFDor the paramedics It was the City. Slowly, " automatic carry " policies wereput

in place to assure that high-risk patients were transported. Thelawsuits

continued.2. The City of Dallas used to turn the water off if people didn't

paytheir bill. One story in the Dallas Times Herald about a poor pensionerwhose

water was shut off brought that to an end.3. The use of nurses as call screeners

was a disaster. The case Genementioned was an effeminate sounding man who was

begging to come and get hismother (who was in the final throes of death). The

tape would piss anybodyoff. People are not to be treated that way.4. In Fort

Worth, we had to collect money for ambulance calls. The EMTwith the highest

collections got a dinner. It was expected. More than that,it was required if you

liked your job. We also got bonuses for gettingfunerals. We even had to ask for

payment on death calls (although the billwas $40.00) it hurt to see some widower

write out a check minutes after hiswife of 50 years passed away.5. London

Ambulance has tried to refer calls to non-emergency centersonly to find the MPDS

is a horrible screening tool for sick, non-sick. Theprogram stopped.6. The Red

River Project withered on the vine.7. An eastern seaboard city allowed

paramedics to give free cabvouchers to nonemergency patients only to have the

ACLU complain thatminorities were made to ride in cabs while whites were

transported byambulance. When they ran the numbers, the ACLU was on to something

and theprogram went quietly away.Every one of us has done something to dissuade

a person from taking anambulance (who we thought didn't need it). Heck, I even

helped jumpstart anOldsmobile that had not run in 3 months (and had no

inspection sticker orregistration) so we could get back to a dinner that was

just served before acall because of an ingrown toenail. It is like being a

mercenary-it worksfor a while but eventually you screw up. As I matured, I

learned, by thetime you talk the patient out of going, you could have had them

at thehospital. Then, you did not have to worry about the repercussions.Don't

think it is just EMS. Many times I have sat on a stool at 3:00 AMlooking at a

patient in total disbelief as she described intermittent pelvicpain that had

been present off or on for 20 years has seen every doctor inTexas, and expected

me to figure it out, in the middle of a thunderstorm,while I have 45 people

coughing and hacking in the waiting room. I waste afew grand on labs and

ultrasound that left me no closer to solving herproblem than I was when she

walked in. But, the ultrasound films we shot gotto join the 56 prior ultrasound

films that are stored in Part 4 of 4 of herx-ray folder. If I did not make an

effort to treat her I would be hearingfrom the administrator the next

day.Ambulance abuse is a complex problem (social, educational, racial,religious,

medical, financial). As it has been said, there are no simplesolutions to

complex problems. My point in the original post is that theHonorable City

Councilman, like so many before him, is simply pissin' in thewind. [Non-text

portions of this message have been removed]

_________________________________________________________________

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May 21, 2008

Kenny,

I posted this at 1316 this on Wednesday, May 21:

" Further comment. The Dallas City Council and the City Manager bear 100% of

the responsibility for the past troubles of DFD since they allowed the

policies that caused the problems. Things are undoubtedly better now, but

what this

councilperson wants to do would take it back to the bad old days when medics

would hand the patient a list of private ambulances and say " call one of

these. "

As to current status and what the future holds in terms of staffing levels,

read the report you yourself sent me several months ago.

Gene Gandy

>

> Interesting. That post has not hit my email yet, so I'm seeing it here

> first. And I don't think I can do a dissertation on the difference

> between facts and opinions so I'll let it go for now, I'm at the

> Hurricane Conference in Galveston and have things to do!

>

> ____________ ________ ________ _

>

> From: texasems-l@yahoogrotexasem [mailto:texasems-l@yahoogrotexasem] On

> Behalf Of , Rick

> Sent: Wednesday, May 21, 2008 4:56 PM

> To: texasems-l@yahoogrotexasem

> Subject: RE: Councilman Proposes Payment Up Front Before

> Ambulance Ride

>

> Taken directly from Mr. Gandy's post sent 5/21/08 at 3:16 pm in response

> to your request to be lead to this information.

>

> " Further comment. The Dallas City Council and the City Manager bear 100%

> of

> the responsibility for the past troubles of DFD since they allowed the

> policies that caused the problems. Things are undoubtedly better now,

> but what this

> councilperson wants to do would take it back to the bad old days when

> medics

> would hand the patient a list of private ambulances and say " call one of

>

> these. "

>

> I also have personal experience that I can tell you about, because I

> used to

> ride out regularly with DFD back in the early days.

>

> Gene "

>

> Further, everything Mr. Gandy indicated is verified by Dr. Bledsoe and

> Mr. Pitcock. Incidents have occurred in the 80's and 90's which is what

> he said. At the very least Ms. Boff died bearing out the claim that

> people have died based on this policy. You even indicate that Dr.

> Bledsoe's comments are ok because they are facts. Since Gene's

> statements have been verified by more than one source why are his

> comments not ok as facts?

> Rick

>

> ____________ ________ ________ _

>

> From: texasems-l@yahoogrotexasem <mailto:texasems-mailto:texasems-mai>

> [mailto:texasems-l@yahoogrotexasem <mailto:texasems-mailto:texasems-mai>

> ] On

> Behalf Of Shaw, Kenny

> Sent: Wednesday, May 21, 2008 4:42 PM

> To: texasems-l@yahoogrotexasem <mailto:texasems-mailto:texasems-mai>

> Subject: RE: Councilman Proposes Payment Up Front Before

> Ambulance Ride

>

> I just reread Mr. Gandy's comments and don't see where he said things

> have improved in Dallas...where is that? Everything he says is

> negative, including the innuendo that Dallas is going from Paramedic to

> EMT level service. And I do read with an open mind....but I know

> inappropriate insinuations when I see them....and those are

> inappropriate insinuations. And if he's clarifying the

> policy....comment on that and leave all the other ancient history out.

> Or maybe we should look at all of the complaints filed against every EMS

> service and lambaste them all. I don't think that is the intent of this

> forum - and I don't think we should tolerate it. Facts (as Dr. Bledsoe

> presented) are okay, but negative opinions, comments, and innuendo about

> our profession or one of our fellow agencies should not be.

>

> .

>

**************

Get trade secrets for amazing burgers. Watch " Cooking with

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May 21, 2008

Rabbi:

You can't compare the border with general US EMS. Most people living on or

near the border are Hispanic with significant ties to Mexico. In Mexico

(like all Spanish-class conscious societies), health care is there if you

can pay. If you have never worked in Mexico, you can't even go to a Social

Security Hospital. Most ambulances are cash before you go. Hell, when my

wife's father drowned in Ojinaga, her grandfather had to pay the divers to

recover the body and then pay off the local mortician and customs agent to

get the body back. People do not expect health care or they are not

surprised when EMS is denied because that is the way they were brought up.

But, on the tree-lined streets of Frisco and Plano, they play by a totally

different set of rules-rules set by personal injury attorneys and

politicians.

Damn, I'm getting a headache..

Shalom

From: texasems-l [mailto:texasems-l ] On

Behalf Of richard borenstein

Sent: Wednesday, May 21, 2008 8:21 PM

Subject: Re: Councilman Proposes Payment Up Front Before

Ambulance Ride

Hey Lou:

We really need to look at what we do. Here in Presidio not everybody gets

hauled as we have up to 100-200 miles to get to a hospital and one ambulance

to do it with. However,We are talking money here and wallectomy.As an urban

911 or rural EMS we need to check our patients out as see if indeed a real

emergency does exist,after a thorough evaluation.We still need to give our

patient the option to go the hospital if requests it be so.I would like to

know what the refusal policy was you referred to and how the decision of no

transport was arrived at.I spend time on scene when I can,and have the no

transport if certain parameters are met and the crew feels the right choice

was made. Our issue here, is money.Ambulance s cost money to

operate,maintain,and perform their mission as the pubic expects us. If we

call,you haul is Q.Publics mode of think,regardless of

race,politics,etc.We have laws which obligate us to treat any patient.We

have constitutional mandates state and

federal which mandate this.Ultimately,when municipal 911 was established an

unspoaken covenant or contracts exists,which states if we call 911,You

better be ready to haul us. After all,in one way or another the public

underwrites our checks and services.They are the customer,It is not for

overpaid,overperked politicians to decide who rides based on a field

walletectomy. Much less,our prerogative to decide who rides unless we can

thouroughly examine our patient,convince him he may not need to ride. But,he

has the option to decide to ride.It is the patient's thinking process that

decides he has an emergency.We must act on his wishes,offer our

expertise,and see if it convinces him otherwise.We must do a thorough field

evaluation and contact medical control.If all sides decide a ride is not

needed,than it should be so. Otherwise,you called we haul if that is what

you want.Like it or not we are public servants here. If they refuse and call

911 later,when an emergency does truly

exist,then we must haul.We must also treat,and do so in a dignified and

professional manner. As medics,we should have this discussion.Some

freeloaders,will ride no matter what we do. I do not want to go to court and

lose what I have because I decided someone should not ride.Lastly,not ride

because he can't pay the bill during or after.I want a policy that carefully

weighs the right of the patient to ride or not. Rabbiems,again on my soapbox

lnmolino@... <mailto:lnmolino%40aol.com> wrote:

One must also consider this.

What got the hospital community in a HEAP of hot waster in terms of federal

regulations being created?

Answer,

asking about ability to pay before treatment, hence the creation of EMTALA.

If you spend any time on any hospital EM list you learn fast that EMTALA is

the din of every ED administrator and ED doctor in the US. Some loathe it,

many fear it, seemingly all damn it over and over publicly and God knows

what

they say privately!

If this type of pay before we treat/transport, screening whatever your

emergency 9-1-1 call came to pass over a larger scale than one Texas City

how long

before someone with enough brains to get elected to the US House or Senate

comes along and creates something like EMTALA that would affect EMS?

Would we want that?

Note I'm not an advocate of " if you call we haul " policies and I actually

have helped to institute some EMS initiated refusal policies in a statewide

system far more arcane than Texas I don't think everyone gets a free ride I

think tying anything to ability to pay in 9-1-1 EMS is a HUGE mistake.

As Doc B pointed out the whole system abuse issues are wider deeper and much

much bigger then we here in EMS can really affect, they are social, and

political and racial and all sorts of other ugly words that will only serve

to

harm EMS in the long run if we allow ourselves to be drug into such issues.

We

are a SERVICE, granted you MUST fund a service for it to work but doing it

in

the manner as proposed is just not a viable solution in my view.

LNM

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@... <mailto:LNMolino%40aol.com>

(Cell Phone)

(Home Phone)

(IFW/TFW/FSS Office)

(IFW/TFW/FSS Fax)

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May 21, 2008

I hope you can stand it, because this is a good debate.

I apologize if I am repeating something that's already been posted on this

list--I belong to too many lists---but there is a very interesting EMTALA case

just decided in April that may be of peripheral interest to those in this

discussion.

The US Court of the Appeals for the 1st Circuit decided in a case from Puerto

Rico that a patient IN AN AMBULANCE ENROUTE TO A HOSPITAL has " come to the

hospital " for EMTALA purposes unless the hospital is on system divert, if the

hospital has notice that she's enroute.

Now, the court did not consider the EMS implications of this case, but let's

say that a hospital OWNS the ambulance service.

I'll let y'all ponder the implications of this case before I comment further.

Here are the facts of the case. Patient was in labor and was being

transported to hospital X. Ambulance calls Hospital X and speaks to ER

physician who

relates that he's busy and says to call back in a few minutes. Ambulance

calls back, and what ends up happening is that the doctor's comments are taken

by the ambulance crew to be a refusal to accept the patient, whereupon they

take her to hospital Y where she is treated. During the conversation the

doctor

asks whether or not the patient was insured, and he was informed that she was

not. Patient sues hospital X. District court dismisses based upon the

theory that the patient had not " come to the hospital " for EMTALA purposes.

Court of Appeals reversed and sent back to district court for further

proceedings.

Can you imagine the outcry if it became known that a major city owned EMS

system was demanding payment or proof of insurance before transport and refusing

those who had no insurance or could not pay? Segue right into EMTALA for

EMS.

GG

>

> Yes sir, it finally hit my mailbox. You might want to add " at that time " to

> the City Council and City Manager comment since it was all totally different

> people than now hold those offices. As for the Council Member's comment.....

> Yes sir, it finally hit my mailbox. You might want to add " at that time " to

> the City Council and City Manager comment since it was all totally different

> people than now hold those offices. As for the Council Member's comment.....<

> wbr>I was there when he made it....it was not a formal proposal but simply his

> opinion as a way

>

> And I read the report....it is a work in progress as it says throughout.

>

> G'night. I'm headed to bed so I'll have the strength and stamina to knock

> heads with you guys again tomorrow.... G'night. I'm headed to

>

> RE: Councilman Proposes Payment Up Front Before

> > Ambulance Ride

> >

> > I just reread Mr. Gandy's comments and don't see where he said things

> > have improved in Dallas...where is that? Everything he says is

> > negative, including the innuendo that Dallas is going from Paramedic to

> > EMT level service. And I do read with an open mind....but I know

> > inappropriate insinuations when I see them....and those are

> > inappropriate insinuations. And if he's clarifying the

> > policy....comment on that and leave all the other ancient history out.

> > Or maybe we should look at all of the complaints filed against every EMS

> > service and lambaste them all. I don't think that is the intent of this

> > forum - and I don't think we should tolerate it. Facts (as Dr. Bledsoe

> > presented) are okay, but negative opinions, comments, and innuendo about

> > our profession or one of our fellow agencies should not be.

> >

> > .

> >

>

> ************ **

> Get trade secrets for amazing burgers. Watch " Cooking with

> Tyler Florence " on AOL Food.

> (http://food.http://food.<whttp://fohttp:// & amp; <http://food.http://food.<

> whttp://fohttp:// & amp;>

> ?NCID=aolfod0003000 ?NCID=ao

>

May 21, 2008

Yes sir, it finally hit my mailbox. You might want to add " at that time " to the

City Council and City Manager comment since it was all totally different people

than now hold those offices. As for the Council Member's comment.....I was

there when he made it....it was not a formal proposal but simply his opinion as

a way to cover expenses that " might " otherwise not be covered. Several other

Council Members spoke against it, for all the reasons mentioned by our brother

and sister medics tonight, but the media writes what they want to write....

right?

And I read the report....it is a work in progress as it says throughout.

G'night. I'm headed to bed so I'll have the strength and stamina to knock heads

with you guys again tomorrow.....if I can stand it! : )

RE: Councilman Proposes Payment Up Front Before

> Ambulance Ride

>

> I just reread Mr. Gandy's comments and don't see where he said things

> have improved in Dallas...where is that? Everything he says is

> negative, including the innuendo that Dallas is going from Paramedic to

> EMT level service. And I do read with an open mind....but I know

> inappropriate insinuations when I see them....and those are

> inappropriate insinuations. And if he's clarifying the

> policy....comment on that and leave all the other ancient history out.

> Or maybe we should look at all of the complaints filed against every EMS

> service and lambaste them all. I don't think that is the intent of this

> forum - and I don't think we should tolerate it. Facts (as Dr. Bledsoe

> presented) are okay, but negative opinions, comments, and innuendo about

> our profession or one of our fellow agencies should not be.

>

> .

>

**************

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May 22, 2008

Gene;

I have engaged everybody thats possible in this debate tonight. This is very

healthy for us and we need it. We are medics who think critically and

analytically at least. I was a youngster when EMS started in1966. My

father,Dr.Borenstein in addition to practicing Pediatric medicine,also spent a

great deal of ER time,with his own and other patients. I got into EMS in 79 with

a first aid card,and I provided the same to my soldiers 6 years prior while on

Active Duty and the National Guard. My dad,pioneered the sliding scale

fees,along with others before him.He took care of his patients without bothering

to look at their wallets. We got our family dogs,as fees for services rendered

on two occasions. Bottom line was no patient went without care. This ethic

exists in very few doctors today. As far as ambulance services,we as 911

municipal services have a covenant with the citizens and a great majority of the

time require a ride to the hospital(99%). I feel that a

persons wallet content should not influence this decision. The good ol'days need

to go.I served as a military medic,nobody,military or civilian went without

care,who was in need and it applied to both sides in battle. If asked to risk my

life for a casualty,it will be done again. Medical care in our society is a

right we should have at least access to whether it is a clinic or hospital and

it needs be in reach for everybodys needs.In this country,we do not take care of

a lot of people,older folks in nursing homes,the homeless,and a lot of others. I

don't beleive rugged individualism is the total answer. Our medical system is

broken and in desperate need of repair and demolition.We have too many doing

without medical care.We are an affluent country,and the citizens deserve better.

What we are talking about here is money,and the lack of will to provide adequate

health care. Each within their means should contribute something toward this. I

want a better system than what exists now. What we have is inexcusable.

Regards,

rabbiems,SSG.Rick

Borenstein " Doc " (Retired).

RE: Councilman Proposes Payment Up Front Before

> > Ambulance Ride

> >

> > I just reread Mr. Gandy's comments and don't see where he said things

> > have improved in Dallas...where is that? Everything he says is

> > negative, including the innuendo that Dallas is going from Paramedic to

> > EMT level service. And I do read with an open mind....but I know

> > inappropriate insinuations when I see them....and those are

> > inappropriate insinuations. And if he's clarifying the

> > policy....comment on that and leave all the other ancient history out.

> > Or maybe we should look at all of the complaints filed against every EMS

> > service and lambaste them all. I don't think that is the intent of this

> > forum - and I don't think we should tolerate it. Facts (as Dr. Bledsoe

> > presented) are okay, but negative opinions, comments, and innuendo about

> > our profession or one of our fellow agencies should not be.

> >

> > .

> >

>

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May 22, 2008

Dallas has the 'eastern city plague'. Landlocked, surrounding urban sprawl,

political chaos, decaying infrastructure, urban flight one year followed by

urban saturation the next. EMS is one problem of hundreds. 25-30 years ago

City of Dallas made choices that continue to plague.

-MH

________________________________

From: texasems-l [mailto:texasems-l ] On Behalf

Of Bledsoe, DO

Sent: Wednesday, May 21, 2008 5:45 PM