No matter how bad 'ambulance billing' is, things could be worse ...
Original post made by Jay Thorwaldson on Feb 2, 2009
That's what city officials and the public learned this week with the release of a special City Auditor's report on billing irregularities that may have cost the city tens of thousands of dollars -- perhaps several hundred thousand -- in recent years.
This report caught my personal attention for several reasons. One was a general interest in city flaws that cost money that could be better spent on services and projects of real value rather than being wasted.
Another reason is from the past: The paramedics program was created as a result of a five-part series of investigative articles I wrote for the erstwhile Palo Alto Times many years ago, in 1971, in fact.
Those articles resulted in the creation of the paramedics program, after the late Joe Carleton took up the cause and lobbied the City Council and city officials. The articles outlined serious, sometimes life-threatening shortcomings of the private ambulance services locally and statewide.
These were not just billing problems -- they were problems with inadequate (if any) training, ambulance crews not knowing streets, how patients were handled in cases of serious illness or accidents, and cut-throat competition between firms.
So no matter how serious the current billing problems are -- and they seem quite serious, as outlined in Staff Writer Gennady Sheyner's coverage this week -- things could be worse. Thus far, no allegations or reports have surfaced about problems with patient care emanating from the life-saving service, which next year will be observing its 40th anniversary.
At the time of the series, one medical official estimated that proper training and operation of an emergency-response service could save at least eight lives a year in Palo Alto. Let's see, 8 x 40. …
The core problem at the time was that state law required ambulance crews to get First Aid training within a few months of getting a job with an ambulance firm, as I recall. But because most employees of ambulance firms -- who often had to put in 90-hour shifts -- were young and single, the pattern was that an attendant would quit one company just shy of the required time and get a job at another.
This created a life-and-death "musical chairs" pattern of virtually untrained crew members never getting trained, unless they were lucky enough to land on a crew with a more experienced member who knew something.
The result was that some patients were permanently paralyzed or more seriously injured by being handled ineptly, while others simply died in transit from heart attacks or other acute illnesses.
The high rotational turnover also left ambulance crews with no one who knew the local streets.
A colleague of mine at the Times was thrown from her horse along Alpine Road when it shied at some construction work for the new I-280 freeway. She suffered a broken hip. When the ambulance headed back toward Stanford Hospital, the driver turned right at Alpine and Junipero Serra Boulevard. My friend, in pain but looking out a side window, had to tell them they were going the wrong way and that they needed to jog left and right to get onto Sand Hill Road to get to the hospital. Oh. OK.
A fire official recounted how firemen were dropped off at corners of tricky subdivisions -- such as the Greenmeadow or Barron Park neighborhoods -- to wave the ambulance crew in the right direction. Just follow the string of firefighters.
Then there was the cut-throat competition.
I first heard about companies racing each other to pick up patients to get the lucrative transport fees, then confirmed with multiple sources.
In one instance in East Palo Alto, an officially dispatched ambulance crew from San Mateo County arrived at the address of a heart-attack victim to find him being wheeled out of the house on a gurney by a Palo Alto-based company. When the newcomers protested, a Palo Alto crew member responded by pointing out that the patient was on their gurney.
Well, yeah, the late arriver said, holding aloft a set of keys to the Palo Alto ambulance, which he then tossed into a bush and claimed the patient while the Palo Alto crew scrabbled to find their keys.
I confirmed this incident with a crew member of one of the ambulances as well as with other medical people.
I got a kick five years later when the film, "Mother, Jugs and Speed," came out and included a scene at a golf course where one crew tosses the other crew's keys into the rough and claims the patient. It was the one really funny part of a mostly crummy film that even its star-power stars Bill Cosby, Raquel Welch and Harvey Keitel couldn't resuscitate.
Critic Vincent Canby of the New York Times rightly described it thus: "'Mother, Jugs and Speed' is a rip-off of vulgarity, poor taste and shock, which, like guns, should be kept away from film makers who don't know how to use them. …"
But I've always wondered where they got the idea for the tossing of the ambulance keys into a bush.
on Feb 3, 2009 at 1:13 pm
If the city pays for the paramedics, why are citizens billed when their services are used? Should we be we billed if the fire department puts out a fire? Are we to be billed if we call the police to catch an intruder in our residence? Lastly, why do we hire an outside company to prepare the bills? They probably cost more than keeping the paramedics trained. Can't our large city staff handle this?
This whole area need an in-depthlook.
on Feb 3, 2009 at 5:26 pm
Two years ago my husband was taken from the Palo Alto Clinic Urgent Care to the Stanford ER - a distance of sixth-tenths of a mile. He did have oxygen and already had an IV in which the paramedic decided to re-do. Cost $800.00 for this trip which took less than five minutes. . Palo Alto transport 'accepts assignment' which means it can charge Medicare patients ONLY according to the Medicare payment schedule which was about $400 then. We had to pay 20%. I shudder to think what those not on Medicare have to pay. And of course, the homeless don't and can't pay anything. There is a suggestion at City Hall to increase these fees - which would especially hurt the elderly who comprise the majority of the transports.
on Feb 4, 2009 at 8:29 am
Good piece, but perhaps you can send Gennady to report whether non-City ambulances still have the problems you found in 1971. Have the standards and rules changed? Palo Alto is the only city in Santa Clara County to opt out of the county system. Do other cities and towns have problems with the county system?
The Merc reported a couple years ago that Santa Clara and San Jose's city ambulances have been a flop.