Carroll Fiscal Court tables EMS request to stop doing some non-emergent transfers

Carroll Fiscal Court has tabled a proposal by Carroll County’s Emergency Management Services Director David Crutcher to reduce the number of non-emergent transfers the ambulance service makes — especially in the overnight hours — until a later date.

District Three Magistrate Scott Nab, presiding over the meeting in the absence of Judge-Executive David Wilhoite, said Crutcher and his EMTs recently submit a proposal to no longer make non-emergent transfers from 9 p.m. to 9 a.m. in an effort to provide better work conditions for ambulance crews who are spread thin when they have to respond to both emergency and non-emergency transports 24 hours a day.

Under the changes proposed by Crutcher, non-emergency transfers — the transport of patients to and from Carroll County Memorial Hospital and other healthcare facilities and hospitals — would have to be scheduled with private ambulance services effective April 29 unless there was an emergent need for the county’s ambulance service to respond.

The proposal is not popular with the local hospital and two administrators at Carroll County Memorial attended Tuesday’s meeting to express their shock and opposition to the plan and ask the fiscal court to intervene on the behalf of patient care.

“A little bit of aftershock from this decision,” said Jennifer Liter, voicing her reaction and concern as director of nursing at the hospital while attending the meeting with Kim Haverly, the hospital’s chief executive officer. Liter said the decision will impact patient care in not only the emergency department but the hospital as a whole since the ability to transfer patients promptly impacts not only that patient but other patients the facility is trying to care for

“The literature specifically addressing delays in non-emergent transfers from the emergency department is lunatic, studies on ED overcrowding and patient flow management have shed light on potential dangers associated with such delays,” Liter said.

• Liter said delayed transfers can contribute to prolonged emergency department length of stay “which has been linked to adverse outcomes such as increased rates of patients leaving without being seen, higher mortality rates, and decrease patient satisfaction.” She said studies have shown that prolonged stays in the emergency room due to delayed transfers can also “compromise the quality of care provided to our patients” due to overcrowding and its adverse impact on limited resources, and reduced attention from healthcare providers.

She said delayed transfers could also increase the cost of personnel, equipment and supplies while increasing healthcare costs and straining financial resources.

Based on data Liter provided by CCMH, there were 309 non-emergent transfers made at the hospital between the hours of 9 p.m. and 9 a.m., specifically. She also said what might be assessed as a non-emergent transfer could later be upgraded to an emergency.

“While not all transfers are clearly delineated as emergent or non-emergent, I’d ask the court to recognize that medical reasonableness of medical necessity always trumps subjective opinion,” Liter said.

She also the challenges of having a private ambulance service — or the ambulance service of the receiving hospital or facility come to Carrollton for that patient — can present other challenges from external factors such as weather and equipment issues. Weather can take a turn for the worse, roads can be blocked by wrecks and ambulances and helicopters can have mechanical issues.

Crutcher argued that Liter’s concerns were hospital problems and not county and Carroll County’s Emergency Management Services problems. “When they talk about issues in the emergency department, those belong to the hospital,” he said.

County Attorney Nick Marsh disagreed and cited that the “tight” relationship between the county, CCMH and CCEMS impacts the healthcare of the citizens of Carroll County. “If the effects of anything that this court does or that hospital does ... affects the citizens of this county and the care that they receive, it is the business of the court and the prerogative of the court,” Marsh noted.

Liter asked the court for more time to consider the schedule changes to “evaluate the true impact … on the patients we serve.” She said the changes should be delayed “until all potential risk has been identified and mitigated to the best of our abilities.”

Magistrate Clay Cable suggested the court meet with EMS and the hospital board to discuss the issue “for the benefit of everybody.” He also proposed that the matter be tabled until all parties can come up with a better solution.

Other members of fiscal court agreed in order to come up with a solution that will benefit EMS and the hospital.

“It doesn’t mean we’re done with this conversation, but we are just going to postpone this thing until we’ve had a better chance to review it,” said Nab.

The next fiscal court meeting will be at 9 a.m. on Tuesday, April 23.