Friday, November 23, 2007
I believe Peoria has a problem.
I have attempted to document what I think some of the problems are regarding pre hospital care on Peoria's Medical Mafia and on this web log.
In summary, the Peoria area has many Emergency Medicine Services (EMS) agencies ("ambulance services"). The doctor in charge of the all of these agencies is called the Project Medical Director (PMD).
The doctor who served as PMD for many years was Dr. George Hevesy. Dr. Hevesy was also the Assistant Director of the OSF-SFMC Emergency Department and, even though he was the PMD which covered all of Advanced Medical Transport's (AMT) pre-hospital protocols, he was named the Corporate Medical Director of Advanced Medical Transport(AMT). Dr. Hevesy receives a salary from both OSF-SFMC and AMT. Dr. Hevesy is also Director of EMS for Region II for the State of Illinois.
When Dr. Hevesy was appointed Director of the OSF-Emergency Department in 2001, he resigned his position as PMD but kept his position as Corporate Medical Director of AMT and as Director of EMS for Region II. (Sue Wozniak, Chief Operating Officer at OSF-SFMC and a member of the board of Directors at AMT, told me that it was good that Dr. Hevesy resigned as PMD with his compensated affiliation with AMT.)
The current OSF physician who is PMD for all of central Illinois is Matt Jackson, M.D. Dr. Jackson works for OSF-SFMC in the Emergency Department. Dr. Hevesy is Dr. Jackson’s supervisor in the OSF-SFMC Emergency Department. Dr. Jackson most likely needs to clear his pre hospital EMS protocols with Dr. Hevesy.
The Peoria Area EMS System (PAEMSS) office is on the OSF campus. PAEMSS is composed of a conglomeration of people who rubber stamp what is good for OSF, AMT, and Dr. Hevesy. Douglas Marshall of Hinshaw-Culbertson supports PAEMSS, OSF, Dr. Hevesy, and I believe he was AMT’s lawyer in the past.
AMT is the only Paramedic/Transport agency in the city of Peoria. They have a board composed of business people. Again, Dr. Hevesy receives a salary from Advanced Medical Transport as their Corporate Medical Director.
The Peoria Fire Department is a Basic level pre hospital provider. They cannot transport patients. They do not own an ambulance. They have no “corporate medical director” to help them upgrade their services and educate them regarding state of the art pre hospital medical care. They have to answer to the local PMD.
Several years ago an important policy was changed. For the first time, the PFD paramedics were allowed to give paramedic care at the scene under the supervision of AMT’s paramedics. (The PFD carries no advanced life support drugs or breathing tubes for the patient, so the PFD has to rely on AMT’s equipment.) I believe this policy change happened after the unfortunate death of a Peorian in a restaurant.
This policy change, which allowed the PFD paramedics to function as paramedics, was decided locally by the PMD. It did not make the local news for obvious reasons.
Why was the policy changed and why did it exist in the first place? Did it take this patient's death to change the policy? How many lives would have been saved during the last 15 years if the PFD paramedics could always have functioned as paramedics with the proper equipment? How many more lives would be saved if the PFD paramedics did not need to wait for AMT to arrive before they give advanced life support?
Was the PFD ever discouraged or intimidated from attempting to upgrade their services for the citizens of Peoria? And if so, by who?
Dr. Hevesy's position and power are feared by many people. Hundreds of people that work for municipal and rural EMS agencies as paid and unpaid employees know that Dr. Hevesy and his cronies largely control what these agencies can and cannot do as pre hospital care providers. Dr. Hevesy has the support of the puppet board of directors of AMT and PAEMSS. The legal team which supports OSF, AMT, and PAEMSS would obviously support Dr. Hevesy as well. Also, his influence at the State of Illinois in Region II is well known around the state.
Dr. Hevesy obviously wears many hats locally and at the state level. In addition to the above he is Chairman of the Disciplinary Review Board for the State of Illinois.
Should his control and influence regarding EMS in central Illinois for the past 15 years be scrutinized and evaluated? Should his own Disciplinary Review Board review Dr. Hevesy?
Tuesday, November 20, 2007
See this article regarding emergency care in the United States.
My letter to Keith Steffen and George Hevesy, M.D. six years ago described the dangerous situation from "ground zero" in the Emergency Room at OSF-SFMC.
See Keith's Letter.
Wednesday, November 14, 2007
As indicated in a previous post, congestive heart failure (CHF) is a huge problem in the United States. Approximately 5,000,000 Americans are living with CHF. Many of these patients can live many years with medications.
CHF is a common cause for breathing problems in Peoria. When the Peoria Fire Department (PFD) answers a 911 call for “shortness of breath” the PFD Firefighter EMT’s can provide the patient with an oxygen mask but are not permitted (usually) to intubate the patient.
The CPAP (Continuous Positive Airway Pressure) machine has been used for decades in hospitals to help patients breathe and avoid a ventilator. CPAP is now being used in many locations in the United States in the prehospital setting by firefighter EMT’s. In Wisconsin, fire departments that have Basic EMT skills have been taught how to use CPAP machines and are allowed and able to save people’s lives.
I spoke with an individual yesterday in Houston who was involved in obtaining a grant for CPAP machines for the Houston Fire Department. Sixty-one CPAP machines were donated to the Houston Fire Department which is the main EMS structure for Houston and has paramedic firefighters. The Houston firefighters were taught to use the machines in 45 minutes. (There is one button to turn on the machine.)
The Houston individual stated that in the last several months, only 35 of 175 patients treated with CPAP at the scene needed to be intubated and put on a ventilator. This is an incredibly good figure. Patients NOT put on ventilators live longer and leave the hospital earlier. Plus their medical care is much less expensive.
Peoria had a bad snow in December, 2006. People with special needs were shut in. 911 calls had to go slower in the streets. The PFD usually arrives before Advanced Medical Transport on a good day in Peoria. Just think how helpful CPAP administered by the PFD would be for people unable to get out of their homes?
For this to play in Peoria, multiple people and entities have to agree.
If a grant could be obtained, as Houston did, the taxpayer would pay nothing for the CPAP units.
The Peoria City Council would need to study the issue and agree that CPAP should be part of what the PFD does with its Basic Life Support skills.
The PFD needs to want to learn CPAP. Firemen work and are paid to help others. Why wouldn’t they want to learn this invaluable technique? I know of no Peoria firefighter that wouldn’t be open to learning this.
OSF, the resource hospital for Peoria’s EMS, would need to agree to support this. The Project Medical Director (PMD) who is employed by OSF would need to agree. This should happen also, but will it? (Hint: An OSF physician wrote an article regarding CPAP's important role for congestive heart failure in the pre-hospital setting. He did include in the article that CPAP pre-hospital use would be for PARAMEDICS, which would naturally rule out the PFD and keep CPAP in the hands of Advanced Medical Transport. The OSF physician left out of his article that CPAP is being used by Basic Life Support fire departments in other cities.)
If history repeats itself in Peoria, most likely the PFD will NOT acquire CPAP units or be taught how to employ CPAP for Peorians with life threatening problems related to congestive heart failure.
Thursday, November 1, 2007
A few years ago, a document was submitted to the Illinois Department of Public Health by the Peoria Area EMS. The document stated that even though the Project Medical Director, Dr. George Hevesy, received a "stipend" from Advanced Medical Transport, this did not constitute conflict of interest or even the POSSIBILITY of conflict of interest.
Many people in the Peoria EMS community disagree.
This week's New England Journal of Medicine (November 1, 2007) has an article regarding physicans, industry, and "influential relationships".
"But physician–industry relationships can also have serious negative effects. For example, doctors with ties to industry may be more inclined than their colleagues to prescribe a brand-name drug despite the availability of a cheaper generic version. The provision of free samples may reinforce this behavior and perhaps stimulate off-label use of medications, which can pose risks for some patients.
"Industry relationships may stimulate the premature adoption of novel treatments, which could lead to serious health problems for patients. Industry inducements may reduce physician adherence to evidence-based practice guidelines in favor of company medications or interventions that are not recommended in independently developed guidelines.
"Finally, the financial rewards from industry relationships may reinforce a culture of ENTITLEMENT among physicians, which could limit their ability to honestly acknowledge and manage the potential negative effects of these relationships.
"In general, physicians vehemently DENY that their industry relationships have any of these negative effects — but they are less convinced that the same is true of their physician colleagues."