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[Guest guest]

Wes,

I went to HS with the guy named in this article and his wife.

Wayne

ExLngHrn@... wrote:

Something worth thinking about -- both for " 911 " medics and transfer

providers...

-Wes Ogilvie

Austin, Texas

Some Hospitals Call 911 to Save Their Patients

By REED ABELSON

The New York Times

(April 2) - Should a hospital be able to handle a medical emergency? The

answer may seem self-evident. But patients at some hospitals may find the staff

resorting to what someone might do at home in a crisis: call 911 for an

ambulance.

That happened recently in Texas, where a 44-year-old man named Steve Spivey

developed breathing problems after spine surgery. No physician was working

there when the staff first recognized he was in trouble. They phoned 911, and

he was taken to a nearby full-service hospital, where he was pronounced dead a

short time later.

The episode occurred at a small hospital that is owned and run by doctors —

one of roughly 140 such hospitals around the country, with nearly two dozen

more under development, that are set up to specialize in certain types of

procedures like heart surgery, back operations and hip replacements.

These hospitals have been assailed for cherry-picking the most profitable

procedures from the nation’s 4,500 or so full-service hospitals.

Critics have argued that the doctors have a financial incentive in sending

patients to their own facilities, even when those patients might be better off

having their surgery in regular hospitals.

But the Texas case, and others like it, have invited new scrutiny from

regulators and members of Congress about these hospitals’ ability to care for

patients who suffer complications after their operations.

While some of these hospitals are large sophisticated operations, like those

hospitals specializing in cardiac care, others are much more modest. For

example, small surgical hospitals may not have separate emergency facilities or,

as in the Texas case, a doctor on site at all times during a patient’s

recovery.

A similar case involved an 88-year-old woman two years ago at a small

doctor-owned hospital in Portland, Ore., where the nurses called 911 after she

was

given too much pain medicine following spine surgery. She, too, later died.

As the number of doctor-owned surgical hospitals grows, federal and state

officials now acknowledge that the government rules may be too vague about the

emergency abilities a hospital must have in place. Regulators are

particularly concerned about the very small hospitals that focus on only a few

kinds of

surgery but perform operations that frequently require an overnight stay.

While Medicare’s rules currently say a hospital must ''meet the emergency

needs

of patients in accordance with acceptable standards of practice,'' the

details are left largely to the hospital's discretion. Federal and state

officials

say they are now reviewing the guidelines to toughen the rules and make them

more specific.

''We’re concerned about good quality of care in any or all settings,'' said

E. Hamilton, who oversees hospital certification for the federal

Centers for Medicare and Medicaid Services.

Medicare recently terminated its agreement with the facility involved in the

Texas case, West Texas Hospital, a 14-bed hospital in Abilene that performed

procedures ranging from plastic surgery to complex spine operations.

That is where Mr. Spivey had spine surgery.

Sometime during the night following his surgery, the staff grew alarmed by

his breathing difficulties and called the surgeon back to the hospital.

Ill-equipped to handle a medical emergency, the West Texas staff phoned 911,

said

Darrell , the lawyer who is representing Mr. Spivey's family and is still

investigating what happened.

When the paramedics arrived, they inserted a breathing tube before taking

him to a nearby full-service hospital where he was pronounced dead a short time

later.

''It is horrific that Steve Spivey had to sacrifice his life in order to

expose the problems associated with physician-owned hospitals,'' Mr. said.

West Texas, citing patient privacy, said it could not comment, although it

defended the quality of its care.

After a review of the hospital following Mr. Spivey's death, federal

officials decided last month that the hospital could no longer continue treating

patients covered under the government's Medicare program. Although the chief

executive of West Texas Hospital defended its practices, he said it would not

appeal the government's decision. The hospital has since closed.

The doctors who set up the specialized hospitals defend them by saying that

by running the centers themselves and concentrating only on certain

procedures, they can provide the best results for patients.

''This is really about the physicians getting back in control,'' said Greg

Weiss, chairman of USMD Hospital, a small physician-owned hospital in

Arlington, Tex. USMD, which has 18 beds, has an emergency department and a

doctor

present around the clock, and is also building an intensive-care unit, Mr. Weiss

said.

Proponents of the specialty hospitals say the Abilene and Portland cases are

aberrations that critics are exploiting to defend the turf of full-service

hospitals. They say they are able to handle their patients’ medical

emergencies, whether or not they have emergency departments.

But some members of Congress are now pushing Medicare to take a closer look

at how such hospitals are regulated.

''The problem with physician-owned specialty hospitals is that

decision-making is more likely to be driven by financial interest rather than

patient

interest,'' said Senator E. Grassley, Republican of Iowa, who is a

longtime critic of such hospitals.

''You see it in the cherry-picking of patients, and with policies that

instruct hospital staff to call 911 for the local community hospital if

emergency

care is needed,'' said Mr. Grassley, a ranking member of the Senate Committee

on Finance, which oversees Medicare.

Supporting his effort is the committee’s chairman, Senator Max Baucus,

Democrat of Montana, and Representative Pete Stark, Democrat of California, who

leads the subcommittee on health for the House Committee on Ways and Means.

Congress in 2003 temporarily banned new construction of specialty hospitals

over concern that they were draining profit away from the full-service

hospitals. The moratorium ended in 2005. Congress has asked for various reports

on

the issue, including a comprehensive analysis last year by the federal

Department of Health and Human Services. The number of these hospitals, around

100

at the time of the moratorium, have steadily climbed to nearly 140 today,

with more than two dozen under construction.

Mr. Hamilton, the Medicare official, says the agency is now reviewing

whether its rules need to spell out exactly what emergency procedures a hospital

is

required to have in place, and whether hospitals must disclose any

limitations to patients. Some types of hospitals may merit greater attention and

oversight than others, depending on the nature of the operations they perform,

he

said, and ''size may be a factor.''

Because some of the hospitals are so small, they may not have the systems in

place to handle an emergency.

''It almost assumes no one is going to get sick,'' said Dr. Mark V.

, a professor of medicine at Emory University. Without a doctor on

premises,

a nurse must call a physician for help if there is an emergency, he said, but

there is evidence that nurses are often reluctant to do that.

According to Medicare's review of state records, West Texas Hospital had

called 911 for an ambulance 15 times to transfer patients during medical

emergencies since it opened in May 2005.

The hospital says that some of those calls may have involved routine

transfers of patients to other hospitals.

Some proponents of doctor-owned hospitals defend calling 911. It is “by no

means an uncommon practice,†said Molly Gutierrez, executive director of

Physician Hospitals of America, which represents many doctor-owned hospitals.

Although stabilizing a patient is essential for any hospital, she said,

hospitals of all kinds and sizes frequently rely on emergency services to

transport patients to other medical centers.

But among full-service hospitals, such routine transfers are carefully

coordinated, according to Carmela Coyle, senior vice president for policy with

the

American Hospital Association, which represents full-service medical

centers.

" The difference is, a community hospital plans for the unpredictable,'' she

said. Medicare does require all hospitals to meet certain general standards,

relying on the states or an independent national accrediting body called the

Joint Commission to make sure hospitals meet the requirements.

Beyond any changes Medicare might make, some states are also contemplating

new rules. Texas, for example, is considering requiring any hospital in a

county with 100,000 or more residents to have a doctor on the premises around

the

clock and to have certain emergency medical equipment on hand. Indiana and

Kansas are also contemplating similar changes.

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[Guest guest]

In a message dated 4/2/2007 7:32:09 P.M. Central Daylight Time,

ExLngHrn@... writes:

Something worth thinking about -- both for " 911 " medics and transfer

providers...

To me the " bigger " something to think about is if you or your loved one are

going to have a MAJOR surgical procedure do you do it at a 14 bed rural

" clinic " (my word).

As an urban dweller my whole life I got an eye opening experience riding on

a box where our closest transport hospitals were " Basic Trauma Care "

facilities. I learned that 1) those facilities do indeed save lives and 2) they

can't

do it all like the facilities that I am use to transporting too but, like

all things in life they need to know their limitations (the ones I saw in

action did for sure).

The bottom line for me is when your life and health are on the line and you

have any ability to " elect " the times and places where things happen then you

had better use some sound judgement. If the patient in this story had been

transferred BEFORE the surgery and had the same complication one must ask what

the outcome might have been?

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

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

LNMolino@...

(Cell Phone)

(IFW/TFW/FSS Office)

(IFW/TFW/FSS Fax)

" A Texan with a Jersey Attitude "

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

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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.

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[Guest guest]

This actually brings up a question I've been pondering for a while. I've

worked in a Medical Office, where we've had patients come in (some sick,

some even just for a check-up), and take a turn for the worst in our

office. We have BLS Equipment including oxygen in the office, as well as

some drugs such as Epinephrine, in the event of anaphylaxis post-injection.

This situation came up recently, with a child who started de-satting and

changing color, and was put on Oxygen. She obviously needed to be in the

hospital. The physician decided that this patient had to be transported

via EMS. The office staff ended up calling 911, and advised them of the

situation. She explained that they just needed a transport, as the

patient could not be taken off of Oxygen and whatnot. Of course, in San

...there is no priority system setup, and therefore...we got the

full lights-and-sirens response, including a BLS Fire Engine. I felt

really bad that we were taking both a BLS Engine and ALS Unit out of

service from higher priority 911 Calls. How is the best way to handle

these situations? Just like this? Is it possible to set up an agreement

with a third-party EMS Provider, and have them transport if necessary?

Just curious about your thoughts.

BJO

[Guest guest]

Yes you can set up with a third party EMS Provider. Just contact a

local non-emergency EMS Provider and ask them what do they need in

order to transport patients from your hospital to the destination.

I work for both a 911 EMS Service and a private non-emergency/911

serivce, so for some patients there is no need to call 911. It bring

emergency units out of service for a non-emergency transport.

So just call the private service and ask them what do they need to

transport from your facility. Here in Houston are, private services

can't always pick up patients where ever we want. We need contracts

and permits.

Hope this helps.

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