Thursday, February 26, 2009

OSF's Ethics Director Does not Answer Consult

On February 12 I posted a letter I had written to the new Ethics Director at OSF-SFMC.

I did not receive an answer.

Is it ethical not to answer an inquiry regarding an ethics question?

My guess is that Ms. Skujdak Mackiewicz was told not to answer by the "higher ups" at OSF.

Welcome to OSF and Peoria.

Wednesday, February 25, 2009

Looking Back....The Peoria Ambulance Monopoly

On November 17, 2002, the Journal Star published an article I had written as an Op-Ed.

The article expressed my concerns over the ambulance/paramedic monopoly in Peoria.

(I have been unable to find this Op-Ed in the Journal Star Archives and so I was not able to post it here.)

Over the next few months after the Op-Ed was published readers wrote to the Journal Forum. Some were in agreement and others wrote that Peoria's EMS situation was just fine.

However, in 2008, the Peoria Fire Deparment became Paramedic for the first time. So things probably weren't fine in Peoria during the previous 15 years.

The following article was exceptionally good and appeared in the Journal Star.

My comments follow.

December 8, 2002


City explores giving fire department more power -- However, proposal taken off Peoria City Council's agenda

PEORIA - The city of Peoria wants to upgrade its fire department from offering basic life support services as it does now to becoming an intermediate service that can also administer medication in emergency situations.

''The fire department has been given the power by the city to explore the possibility of going into ILS (intermediate life support),'' said Fire Chief Roy Modglin. ''Intermediate life support is one step higher than what we are allowed to do at this time.''

At the intermediate level, firefighters would be able to administer drugs and other medication in addition to instituting a defibrillation program that will increase the chance of survival for those who suffer a heart attack. A proposal to make this happen was on the Peoria City Council's agenda for this week, but it recently was retracted.

For 15 months, representatives of Advanced Medical Transport, the fire department and the city have been meeting to discuss the issue and possibly develop a collaboration program with AMT. The latter group would provide the necessary training.

One caveat of the proposal was that it didn't let the fire department enter the ambulance business for a certain number of years, said at-large Councilman Jim Ardis, who is involved in the negotiations. Most ambulance services are certified to provide advanced life support services - which is yet another step higher.

For years, AMT has balked at the fire department entering this arena. AMT is an independent not-for-profit organization initiated by the three Peoria hospitals. It has been providing ambulance and wheelchair van transportation services to 22 communities in the Peoria area for more than 10 years.

The majority of municipal fire departments provide ambulance services says Pete Stehman, information service manager of Associated Firefighters of Illinois in Springfield. According to the association's figures, in Illinois there are 16 union fire departments with 100 or more firefighters. Of this number, at least 13 of them or 81 percent transport patients. There are eight fire departments that serve populations of 90,000. Of this, six departments or 75 percent handle transportation.

AMT is willing to help the fire department advance to the intermediate level, but it does not want the department to transport patients, said Andrew Rand, AMT executive director.

''They can provide more comprehensive care than they do now,'' Rand said. ''It's a powerful system, and in fact we agreed to provide that training free.''

Rand said Ardis had also proposed a franchise agreement where both parties would collaborate on improving services.

''We were going to receive hazmat training and decontamination procedures from them because we are on the frontlines of bioterrorism and decontamination,'' Rand said.

The point of contention however, Ardis said, is AMT's insistence that the city keep out of the ambulance business for an extended period of time.

''That's one of the issues that has fluctuated a lot,'' Ardis said. ''It has been anywhere from four years to 10 years. My impression is that we aren't going to commit to anything longer than four to five years.''

Proponents of letting the fire department transport patients argue that the fire department should be in the ambulance business because it is usually first on the scene of an emergency situation and provides basic life support. They argue that two or three minutes can make a difference in saving a life. In addition to transporting patients, proponents want the firefighters to be able to administer the necessary drugs and bill the patient for the service.

The proponents have written several letters to the editor recently publicizing their stance.

Rand disputes that the fire department is usually the first responder.

''That is absolutely false,'' Rand said. ''They keep propagating it but their response time doesn't jive with their records.''

Rand said he's obtained fire department records through the Freedom of Information Act which shows otherwise.

In addition, Rand said that while the fire department responds to all calls with lights and sirens, the AMT uses lights and sirens only half the time. ''We prefer not to risk life and limb of citizens when there is no immediate emergency,'' he said, adding that if a person had a minor injury, an additional two or three minutes would not make a difference in that situation.

Rand also said the fire department has stated it is not interested in providing ambulance service.

''All of the discussions have been that the fire department wants to do intermediate life support, and it does not want to transport patients. That has always been the position. That was what the agreement was written to address; to balance the collaboration of both parties,'' Rand said.

But, city officials have not ruled it out.

''If we want to have a highly trained fire and medical department in the city, there is nothing that AMT can do to prevent us from doing so,'' Ardis said. ''That is a policy decision. I don't think that anybody can make the argument that anybody would not want the best trained people to be there for them all the time in case of an emergency. Why would you not want that?''

Rand said he requested that the proposal not be presented to the Council at this time because City Manager Michael McKnight had advised the council not to adopt it. McKnight did not return Journal Star phone calls.

''I don't think it is appropriate for that agreement to come up, and what we have asked the city to do is sit down and see what it takes to solve 15 months of negotiation,'' Rand said.

While Rand is confident that all the differences will be resolved, Mayor Dave Ransburg said he did not know when the subject is likely to come before the council.

''Will it come back on? I don't know,'' Ransburg said. ''It may never come up again.''

Another part of the proposal is for AMT to pay the city a fee of $60,000 a year for using the city's dispatch system. Currently, they pay nothing.

''All that the city provides to AMT is an address to an emergency situation,'' Rand said. He said the service is not comparable to what other departments, such as the Peoria Sheriff's Department, receive.

''The city's dispatch center actually follows a deputy to that whole call,'' he said. ''With AMT it is not even dispatching; it's simply messaging from their computer to ours.''

My comments from today, February 25, 2009:

1. Not much had changed since 1992. AMT wanted to keep the transport monopoly of sick EMS patients in Peoria. And Andrew Rand was proven wrong when Matrix came to Peoria and studied response times in and reported to the City Council that the PFD responded about 1.5 minutes quicker than AMT to life threatening events. Peoria Fire Fighter Terry Carter had hit it all on the head 10 years earlier.

2. Where were Drs. George Hevesy and Rick Miller? Why weren't they supporting that the PFD upgrading to Intermediate level? Did OSF have anything to do with their silence?

Dr. Hevesy was being paid by AMT.

3. The next month, January 2003, AMT lost a City Council vote for the contract to be the only paramedic/transport agency in Peoria for the next ten years. And Andrew Rand and AMT did not teach the PFD to become Intermediate providers.

4. I will provide Forum letters that appeared over the next several years in coming posts. Dr. Rick Miller at OSF continued to defend Peoria EMS and the PFD stayed at Basic-D with Basic drugs. When a man died in the restaurant a few years later, and I spoke to the City Council about this, things started to change.

Looking Back....Samuel Valbrun

Peoria Journal Star, The (IL)
August 27, 2002


A chance to survive -- Haitian Hearts program provides child's surgery

PEORIA - With his aunt and cousin at his bedside, a 7-month-old Haitian baby struggled for breath Monday as he recovered from heart surgery at The Children's Hospital at OSF Saint Francis Medical Center.

''He's a survivor,'' said Janet Knepp, a Haitian Hearts supporter who has cared for the baby, Dan-Samuel Valbrun.

Samuel's cousin, 32-year-old nursing student Myrtho Dupresil of Jersey City, N.J., said hospitals in New Jersey turned her down when she asked them to provide the lifesaving surgery that the baby needed.

A friend of a friend in Haiti knew of Dr. John Carroll, the Peoria physician who founded the Haitian Hearts program, she said.

''He saw the baby and said surgery was needed or he would die. They brought him here,'' Dupresil said.

Samuel is one of 90 Haitian children whom Carroll has brought to the U.S. for surgery and post-operative care unavailable in Haiti. The charity program has been supported by donations and fund-raisers.

Doctors donate their surgical skills, and the hospital, usually St. Francis in Peoria, has supported the effort in various ways, lately by offering discounts to Haitian Hearts patients.

Asked about the ethics of spending scarce medical resources on a few very sick children, Carroll questioned whether medical spending should be a matter of selecting priorities.

''The money is there in our society,'' he said. ''The technology is there. The will is there, among the nurses, the physicians, the providers, and we should be doing this. There's no reason every hospital in the U.S. could not help out'' by providing this type of care.

Dr. Gary Raff performed heart surgery on Samuel that repaired a congenital defect complicated by the reversal of his abdominal organs. He had suffered oxygen deprivation since birth, Carroll said, and his body still is adjusting to the repairs.

His prognosis is guarded, Carroll said. ''He doesn't have a normal heart and may need further corrective surgery but the (procedure) helped him and raised (his) oxygen levels. Every day is a big day for Samuel. He fights a bunch of little battles every day.''

Dupresil and the baby's aunt, Anchise Valbrun of Haiti, arrived last week. They're leaving today but Dupresil is adopting Samuel to keep him in the U.S. for additional medical care.

Samuel arrived in Peoria on June 29, and was cared for by a registered nurse in the Haitian Hearts program until a family emergency sent him to live with the Knepps.

The surgery and its difficult recovery were only the latest travail for Samuel.

Tears filled Knepp's eyes as she described how Samuel awoke early Aug. 3, was fed, then suddenly stopped breathing. Knepp said she called for her husband, dialed 9-1-1 then watched in amazement as the couple's 17-year-old daughter, Sarah Knepp, who had been asleep, awoke and administered CPR, saving Samuel's life.

Sarah had been a lifeguard, Knepp said, but had never saved a life at the pool.

Knepp had gone to Haiti with Carroll, had taken Samuel from his mother, Rosemond Valbrun, and held him on the flight back to Peoria. ''I was the one who carried him home. I took him from his mother. Nothing could happen to him,'' she said.

Samuel is the Knepp family's fifth Haitian child in the program. ''You can tell your (own) kids about helping others but until they experience it,'' she said, they won't understand.

Samuel's birth in Haiti was also difficult. He is the only child of Rosemond Valbrun, a 40-year-old single mother, Dupresil said. Just before her due date, the mother collapsed and had to be resuscitated, Dupresil said.

Samuel immediately had breathing problems because of his heart difficulties, and spent most of the spring in Haitian hospitals on oxygen.

Despite his medical problems, Samuel is bright and friendly, Knepp said. He says ''da-da'' and smiles, and plays with toys. He weights only 11 pounds, but has gained weight since arriving in central Illinois.

''They're big challenges,'' Carroll said of the Haitian children. ''It takes courage to take care of them.''

CAPTION: Dan-Samuel Valbrun

CAPTION: Myrtho Dupresil, left, of New Jersey and Anchise Valbrun, of Haiti smile at 7-month-old Dan-Samuel Valbrun as he lies beneath an oxygen hood at OSF Saint Francis Medical Center's pediatric's intensive care unit Monday morning. Dupresil found the Haitian Hearts Program while desperately trying to find a way to get her tiny second-cousin life-saving medical treatment unavailable in Haiti. Samuel was born with a defective heart and other serious health problems. Dupresil and Valbrun, Samuel's aunt, came to Peoria last Friday before his heart operation.

My comments:

1. At the clinic in Haiti in June, Samuel was brought to me. He had congenital heart disease. I examined him and reviewed his echocardiogram. I called Dr. Dale Geiss, our excellent pediatric heart surgeon in Peoria. He told me that if I did not bring Samuel, the baby would die.

2. We returned to Peoria with Samuel and with other kids that needed heart surgery on June 29, 2002.

3. Samuel had his appointment with the pediatric cardiologist soon after we arrived in Peoria. His cardiologist recommended surgery within the week.

4. Samuel’s host mom was pediatric cardiac intensive care nurse at OSF. She was pleading that Samuel be operated quickly.

5. However, weeks went by, and Samuel was not operated.

6. At about 6 AM on August 3, 2002, I received a phone call. On the other end of the line was Janet Knepp who was hysterical and screaming that Samuel had just quit breathing and her daughter was doing CPR. They lived 25 miles from Peoria and called the local volunteer ambulance service. I told Janet to continue all support and that I would meet them in the OSF-ER.

7. As I quickly drove down Main Street in Peoria, I was planning Samuel’s funeral. How terrible and sad, I thought. I felt physically ill.

8. Waiting in the OSF ER for the arrival of the ambulance was torture for many reasons. Finally, the squad arrived and we descended on the big white stretcher with Samuel’s little brown body in the middle. However, as I looked at him, I heard him make a whimper.

9. Samuel was alive and trying to breathe. His eyes opened and, even though his gaze was divergent, he was looking around.

10. In the ER we supported him with oxygen and an IV and admitted him to pediatric cardiac intensive care.

11. As the days went by, Janet Knepp and I told Paul Kramer, Executive Director of Children’s Hospital, how upset we were with the delay in Samuel’s surgery and his subsequent arrest.

12. Samuel was stabilized and operated at OSF Children’s Hospital of Illinois.

13. I met with Monsignor Steven Rohlfs of the Catholic Diocese of Peoria to report Samuel’s neglectful care at OSF. Monsignor Rohlfs responded, “If it ever happens again, let me know.” That was it.

Looking Back...OSF Cuts all Financial Support for Haitian Hearts

Peoria Journal Star
July 14, 2002


Haitian Hearts loses funding -- St. Francis slashes support

PEORIA - OSF Saint Francis Medical Center has cut most of its financial support for the Haitian Hearts program.

The hospital has been providing $257,000 yearly in nursing and other support for the sick children from Haiti, Dr. John Carroll, who founded the program seven years ago, said Saturday.

But at a meeting Friday night, the Haitian Hearts committee learned that support will be cut and the hospital now will offer only a 55 percent discount off its regular charges to care for the children, Carroll said.
''This will mean the deaths of Haitian children,'' Carroll said. ''I walked out the door'' at the meeting, where some others in attendance were in tears, he said.

St. Francis spokesman Chris Lofgren said Saturday the discount offered to the Haitian Hearts program softens the blow. ''It probably is a deeper discount than other contracts'' at the hospital, he said.

''We're contacted by a wide variety of groups for international kids. We have to get a handle on services provided to all international patients, including Haitian Hearts patients,'' Lofgren said.

With fund-raising from the Haitian Hearts group, about 15 patients will be served annually, Lofgren said. ''We are not turning our back on the Haitian Hearts program.''

Carroll said the hospital's support of $257,000 was in addition to a 45 percent discount for the children's care, a discount that he believes was above the hospital's actual costs.

Carroll worked at St. Francis for 21 years but was fired in December after a dispute with hospital officials over care standards in the emergency department. He still retains hospital privileges, however.

At the time, hospital officials said support for Haitian Hearts would continue, though Carroll expressed concern that it would diminish or end.

If the hospital cannot afford the program, top executives should take pay cuts and channel that money into the program, Carroll said Saturday.

Surgeons have donated their services to the Haitian children, he said. Carroll also has financially supported the program himself.

Support for the program is ''the right thing to do,'' follows the mission of the Sisters of St. Francis and also provides valuable learning experiences for the hospital's residents and medical students, he said. ''These kids are from the developing world.''

Since the year began, the Haitian Hearts committee has raised more than $400,000, which Carroll said has been paid to Children's Hospital at St. Francis. It's raised more than $1 million in the past 41/2 years. That level of fund-raising will be difficult to sustain, he said.

Carroll said he was not sure when the hospital's support was ending, but he felt the fund-raising had been sufficient to treat the seven Haitians he brought here at the end of June.

Lofgren said he also was unsure when the cutback goes into effect, but the hospital's fiscal year begins Oct. 1.

My comments:

1. As Haitian Hearts predicted, OSF cut all financial support for Haitian Hearts. Behind the scenes Keith Steffen had indicated all along that he was going to cut support. (Behind the scenes Mr. Steffen also said that Haitian kids make him want to vomit...) And Chris Lofgren told the public that OSF was not turning their back on the Haitian Hearts they were cutting all financial support for the program.

2. Now OSF was going to charge Haitian Hearts 55% of total charges per case. This was a lot of money. We raised money with spaghetti dinners and selling cookies. And this would mean the death of Haitian children.

3. No OSF Sisters were present at the meeting. Sister Judith Ann had told me multiple times that they would never turn down a child. But at the same time the Sisters were allowing their administrators to cut all funding for these kids. The Sisters had lost control of the hospital. And it was going to get worse in the coming years.

Friday, February 20, 2009

Looking Back at the Haitian House after Paul Kramer told us not to build it...

This will be an interesting post...

What will this be about?

It will be about Children's Hospital of Illinois discouraging us from building the house. And then when we built it, Paul Kramer pleaded for the money.

Mr. Kramer told Jim Holmes there was no such thing as Haitian Hearts and asked Community Foundation Director James Sullivan to release the money. Neither individual would release the money to Mr. Kramer.

After Haitian Hearts donated the money (approximately $187,000) to Children's Hospital at the end of 2002, Mr. Kramer "thanked us" by calling the American Consulate in Haiti to stop me from bringing any more Haitian children for heart surgery to OSF.

Peoria Journal Star
March 20, 2002


Haitian Hearts breaking new ground -- Proceeds from sale of $200,000 home will go to Carroll program

EAST PEORIA - Katina Antoine clutched her arms around her jacket and looked out of her element. Temperatures never dip near freezing in Haiti.

But the muddy ground on the wooded lot along Illini Drive has thawed by now and Katina, 7, took the gold-painted shovel handed to her and joined local dignitaries and friends, including Dr. John Carroll, in turning a ceremonial first spade of earth.

Soon, the holes they started will reach deep enough to hold the full basement of a house that Carroll and other members of the grass-roots Haitian Hearts Program hope will sell for $200,000 or more.

None of that money will pay the home's builders, Jim Holmes & Sons of Groveland, or even the building materials' costs, said Holmes and Jeff Kolbus, who represented the Homebuilders Association of Greater Peoria at the groundbreaking ceremony.

Every dollar from the home's purchase, they said, will go directly to the charity, which Carroll helped found to bring young people from the poverty-stricken Caribbean country to Peoria for live-saving heart surgeries.

''When I see this project (begin), I'm seeing five Haitian kids waiting to come for heart surgery,'' Carroll told the group, which included Mayor Charles Dobbelaire and city commissioners Harold Fogelmark and Betty Dodson.

Carroll and Kolbus credited Holmes, who with his wife is adopting a Haitian child too ill to return home with much hope for survival, for organizing the plan to build the home entirely with donated materials and labor for the charity's benefit.

Carroll and other charity officials personalized the point of their program by bringing Katina and five other Haitians, whom Carroll has most recently selected for surgery, to the one-third-acre site in the 700 block of Illini. All but Yvel Gresseau, 28, are children, ages 2 to 16.

''They all need surgery,'' said Carroll, who in December was released from OSF Saint Francis Medical Center after 21 years as an emergency room physician but still maintains ties between the hospital and the charity he co-founded.

Holmes said he expects to begin construction of the home by next week and complete it in time for sale offering in late June.

Thursday, February 19, 2009

Looking Back....the Journal had to Silence Pam Adams in 1992

Why did Pam Adams publish nothing during the next 16 years about Dr. Hevesy being on Advanced Medical Transport's (AMT) salary? Or about AMT's Medicare fraud conviction?

Why did Pam Adams publish nothing on Haitian Hearts kids being allowed to die due to OSF's negligence?

I don't think her Journal Editors would allow her to write about these stories.

Her articles would be too bad for Peoria and for the Journal.

Here is an article that Pam wrote in 1992 regarding the newly formed Advanced Medical Transport.

Below the article are my comments.

Journal Star (Peoria, IL)
November 8, 1992



Rona Ramage thought she was taken for more than an ambulance ride when the $440 bill arrived.

"I thought it was a mistake," she says. "They didn't do anything but get me out of bed and take me across town."

The $400 was the base rate, the $40 was a $5-a-mile-charge.

Ramage's injuries were no more than a muscle spasm, but her husband didn't know that when he dialed 911 for an ambulance last June. She had gone to bed with a stiff neck, only to awaken unable to move without excruciating pain.

Though the pain was gone in a few days, it came back a few weeks later when her insurer asked for an itemized bill because the ambulance charge was so high.
Angry at the cost, Ramage started asking questions. And she got a stiff-necked lesson in what it means for a city to have almost state-of-the-art ambulance service -- Advanced Medical Transport of Central Illinois.

AMT, the only ambulance service in the city of Peoria and parts of the rest of the county, is a not-for-profit corporation owned by Saint Francis and Methodist medical centers and Proctor Hospital. (Although officials say their eventual goal is to convert it to a for-profit private company.)

The good news is, until AMT was started in 1991, Peoria had never had such a high level of ambulance service. "The city has not been this well covered, ever. It's one of those things nobody knows," says Dr. Jim Thomas, emergency services director at Methodist and associate medical director for the Peoria Area Emergency Medical Service System.

AMT has 14 paramedic ambulances to cover Peoria, Bartonville, Dunlap and Limestone Township. Each ambulance is staffed with a paramedic and an emergency medical technician.

In years past, there were only two paramedic ambulances to cover the area.

The bad news is, citizens pay high-level prices for care that involves highly trained paramedics operating out of ambulances that are basically mobile emergency rooms, or Advanced Life Support systems.

The base rate increased from $300 to $400, which does not include mileage or charges for any medical services provided by paramedics. The other bad news is that AMT's aggressive tactics created tensions with some other Emergency Medical Service providers -- fire department rescue squads, volunteer fire departments, ambulance companies -- most of whom operate with Basic Life Support systems, staffed with emergency medical technicians. Those emergency technicians only provide the basics until a paramedic arrives or the patients gets to the hospital.

"There's the general feeling that when something is more expensive, it's a bad thing. The other issue gets to be, in some ways the ambulances appear to encroach on what may have been viewed as the work of government units, like a fire department," says Peoria County State's Attorney Kevin Lyons, himself a member of the volunteer fire department in Hanna City.

"I hate to say it's competing for victims, but it is."

Dr. George Hevesy of St. Francis is project medical director of the Peoria Area Emergency Medical Services System, a state-mandated entity made up of public and private agencies responsible for pre-hospital care in a 16- county region.

Because St. Francis is the resource hospital for the system, Hevesy acts as sort of an emergency czar, with ultimate responsibility and supervision of the medical aspects of ambulance companies, fire departments, rescue squads and their paramedics or emergency medical technicians.

"I do not -- nor will I -- allow competition for victims," Hevesy says. "The patient loses because the focus is not patient care, but politics."

Hevesy, along with associate medical directors of the area's emergency services system who are based at Methodist and Proctor, were strong proponents of an Advanced Life Support system with fast response and flexible deployment. Good or cheap Ramage questioned the care she got, but what she really wanted to know was how AMT could get away with charging so much.

Hevesy's answer is that area residents either can have a good, fast system or a cheap system.

Basically, Ramage paid Advanced Life Support prices when all she needed was basic care. But people don't always know that when they dial 911 -- which automatically means that they will receive advanced care.

Ramage got a clue to the complexities when she called the American Ambulance Association and the Illinois Department of Health, which regulates emergency medical service systems.

She also called other area ambulance companies to compare prices. That's when she learned, "There's a great deal of animosity out there about AMT." Using the information she gathered, Ramage railed at AMT until it reduced her bill to $175, Blue Cross/Blue Shield's usual and customary fee.

Andrew Rand, director of AMT, says the care Ramage received did not deviate from accepted standards and that the reduced bill was a last resort to resolve a problem with a persistent, irate customer.

"The American public will always expect ambulance service at taxicab rates. Those aren't taxicabs," he says, gesturing toward the fleet of ambulances beyond his office walls.

Quick response sought Rand, 31, is a paramedic with a degree in finance. The three hospitals hired him to shepherd a fragmented, slow- responding, money-losing system into an efficient, life-saving, financially black fleet with at least one paramedic on each ambulance. They also wanted a system capable of responding to 90 percent of the life-threatening emergency calls within 10 minutes -- 12 in outlying areas.

AMT was created in September 1991 by merging each hospital's paramedics unit with their Mobile Medics Ambulance, itself the result of the hospitals' earlier attempts to improve ambulance services.

Along with adding paramedic rigs, the way of keeping them at hospitals changed. System Status Management strategically placed ambulances throughout the coverage area to match supply with demand. Locations are determined by use.

In reorganizing, Rand also increased the ratio of scheduled calls, for instance non- emergency transportation between hospitals and nursing homes, to 40 percent. It had previously been about 15 percent, he says.

The base rate for scheduled, non-emergency transportation, is $200. Though most scheduled transportation is paid by Medicare or Public Aid, emergency transportation for Public Aid recipients drains AMT's revenues, Rand says.

Another reason costs were lower in the past is that the hospitals were absorbing the ambulance company's losses, Dr. Thomas says.

Reimbursements from Medicare and Public Aid are $84 and $70, respectively. About 50 percent of AMT's payment sources are from Medicare and Medicaid; 32 percent from individuals; and 16 percent from private insurers.

"As we expand, we can cut costs," he says. "That's just based on economy of scale. " Broad changes AMT bought out B&B Ambulance, a privately owned company in Limestone Township, in September. In a little more than a year, AMT has been the catalyst for broad changes in emergency services. Even its critics agree that ambulance service is better.

But change is difficult, Rand says.

AMT's employees, including paramedics and EMTs, had to accept a new role "as care givers, not just lights-and- sirens response," he says. "That was very, very difficult."

Other emergency service providers, seeing AMT's growth and prestige, may have felt like they were targets, he says. "That was not our aim."

And AMT needs to improve its marketing, when it comes to explaining fees to the public, he says.

Eventually, says Thomas of Methodist, the goal is for AMT to phase out its dependence on the hospitals until it is a private company.

My comments today, February 19, 2009:

1. Wow.

2. I don't know where to begin.

3. Pam Adams described Dr. Hevesy in his role as Project Medical Director for the Peoria area as an "emergency czar". I think many EMS agencies in the area would agree with that description.

Dr. Hevesy's comments above were very definitive regarding the fact that under his watch he was not going to allow competition between EMS agencies for "victims". (The fact that he was paid by AMT may have helped him implement his policy regarding no competition.) The Peoria Fire Department (PFD) has said multiple times that Dr. Hevesy created obstructions when the PFD wanted to upgrade their services for the people of Peoria.

4. OSF and the Peoria Area EMS (PAEMSS) should have never allowed Dr. Hevesy to receive a salary from AMT. As Director of all ambulance agencies in the area, none of which paid him except AMT, he should have never accepted a salary because of the appearance of negative conflict of interest.

5. One of AMT's employees would turn in AMT to the Feds several years after this article was written. AMT was upcoding and charging the patient and taxpayer too much.

6. Why did the three hospitals in Peoria allow Andrew Rand to resume his job at AMT after AMT was found guilty of Medicare fraud?

7. Dr. Hevesy stated above that Peoria can have a "good, fast system or a cheap system" was not true. The Matrix study performed 10 years later in Peoria revealed that the PFD was responding faster to life threatening 911 calls than was AMT.

8. Too bad Pam Adams was silenced regarding EMS after this article in 1992.

Looking Back...Life Support Call Unacceptable

I found two mind blowing articles today in the Journal Star Archives which I have printed below and in the next post.

In 2001, while OSF, Dr. Hevesy, and Keith Steffen were preparing to fire me, I learned from multiple different people at OSF and EMS agencies in the Peoria area that Dr. Hevesy, OSF-Emergency Department Director, was also on the payroll at Advanced Medical Transport. Everyone, including an OSF-ER physician were screaming "conflict of interest" regarding Dr. Hevesy.

EMS providers everywhere seemed to be upset but did not know what to do since Dr. Hevesy held their EMT licenses in his hand. Dr. Hevesy also works for the IDPH and has some power and friends at the State level (which might not be a position of prestige right now...)

One day, after being warned by others, I waited for Andrew Rand, Executive Director of AMT, to leave Dr. Hevesy's office at OSF. I was having yet another meeting with Dr. Hevesy regarding my limited future at OSF. And remember, AMT was paying Dr. Hevesy, the Peoria Fire Department was not.

I was being educated by many people in the area regarding how EMS in Peoria worked.

A good friend of mine told me in detail how she lost her husband to a heart attack at OSF while waiting for Advanced Medical Transport to arrive at her home and transport her husband. Dr. Hevesy spent a fair amount of time in her home with her to try and stop a lawsuit against OSF and AMT. And over the next few years, I became aware of other people in the area that waited excessive times for AMT's arrival with subsequent bad consequences for their loved ones.

In 2002, I wrote an OP-ED which the Journal Star printed in November, 2002. The article was about my concerns that OSF and AMT were dangerously monopolizing ambulance paramedic and transport care in Peoria. (I had to submit it twice over two months since the Journal told me they never received it.) Today, I looked for my article on the Journal Star Archives and cannot find it. Maybe it is there, but I sure can't find it.

Anyway, today after my search in the Journal Archives the article below showed me that I was NOT the first to complain or document Peoria's dangerous EMS. In fact, I was ten years late.

What is not mentioned in these articles is the fact that Dr. Hevesy was being paid by AMT and, because it hadn't happened yet, AMT with Mr. Rand at the helm, was found guilty of Medicare fraud and fined over $2,000,000 dollars by the Federal government. (Peoria's three hospitals paid the fine.)

Here is the article and Pam Adams article is in the next post.

And if I can find my missing OP-ED, I will post it. Many forum articles followed it in the years to come...some supportive of AMT and some not supportive of the AMT ambulance paramedic monopoly.

Interestingly, OSF leaders defended their EMS policy to the max.... until they changed the policy in 2008. The new policy allowed the Peoria Fire Department to advance to paramedic providers for the first time in their history. More on that later.

And kudos to Peoria firefighter Terry Carter for being the first to document Peoria's dangerous EMS. I wonder how many lives in Peoria have been lost in the intervening 16 years?


Life Support Call—Response Time Unacceptable
April 1, 1992

Journal Star (Peoria, IL)
April 1, 1992


The citizens of Peoria need to be informed of the fact that Firefighters Local 544's warning to the City Council has come true.

A basic life support call was received by Engine 12 at the Lutheran Home on Galena Road (across from the now vacant Fire Station 17) between the hours of 9 a.m. and 10 a.m. on March 19. Engine 12 just happened to be at the Fire Academy on Galena attending a CPR refresher course and responded to the nursing home, providing initial care in less than three minutes.

It took the ambulance, the one specially assigned at the foot of War Drive to cover the area lost by the 17's, 10 minutes and six seconds to arrive on the scene. This proves that response times to this area are unacceptable even under ideal conditions. Had it not been for fire units training across Galena Road, the ambulance would have been first on the scene.

A heart attack or stroke victim doesn't have 10 minutes and six seconds to spare. The public needs that initial Emergency Medical Services crew on Engine 17 that has been snatched away from them by their elected officials.

In addition, City Manager Peter Korn stated on local television that the ambulance used at War Memorial Drive and Galena Road to cover the loss of Engine 17 is a rescue team. It is not. They carry no extrication tools of any type. This crew can't even aid the fire department in extrication of accident victims for they carry no personal protective equipment such as leather gloves, helmets or eye protection.

Finally, I would like to bring attention to two people for their work.

First is Andrew Rand, manager of Advanced Medical Transportation, for aiding our city officials in not only reducing EMS personnel, but also lengthening response times through ambulance relocation. He exaggerated AMT's ability to quickly respond to Engine 17's area, rather than aiding in the fight to keep Engine 17 in service.

Second is Mayor James Maloof, who begged and pleaded to join the United Auto Workers at their recent rally in order to appear to be on the union's side. Does the mayor need to be reminded that the United Auto Workers and the International Association of Firefighters are both AFL-CIO unions?

Terry S. Carter
Peoria Firefighters
Local 544 Peoria

Wednesday, February 18, 2009

Looking Back...Maxime is Dead and Katina Still Fighting for her Life in 2009

My comments from today follow the article.

Haitian Hearts Still Beats Strong

February 6, 2002


Haitian Hearts still beats strong -- Despite losing his job, Dr. Carroll still helps sick children get treatment

PEORIA - After four weeks in Haiti, Dr. John Carroll arrived back in Peoria on Tuesday night accompanied by six children and an adult, all needing medical care.

''All will be big-time challenges to Peoria's medical community,'' Carroll said. ''They are all surgical cases. These kids will get the care they need; I know they will.''

About 50 friends and supporters met Carroll and the Haitians at Greater Peoria Regional Airport. The Haitians will stay with host families while undergoing medical treatment.

Carroll, 48, of Peoria, is a founder of Haitian Hearts, a charity that brings children with life-threatening illnesses to Peoria and elsewhere in the United States for treatment they otherwise could not receive. He has won awards and visibility for his work with the Haitians.

A week before Christmas, however, Carroll was fired from his job of 21 years as a physician in the emergency department of OSF Saint Francis Medical Center. He said the dispute began over his push for more beds in the department.

St. Francis officials will not comment on the firing but have said the hospital's support for the Haitian Hearts program will continue.

Despite his firing, Carroll retains medical privileges at St. Francis, and he said Tuesday he will focus, for now, on overseeing care for the Haitians.

''My goal is to keep the kids healthy, improve them, get them back to Haiti,'' he said.

Carroll's mother, Mary, was among the group at the airport. She said several potential employers have attempted to contact her son recently.

Carroll said Tuesday he is still working on treatment plans for the Haitians. ''I would like to give Children's Hospital (of Illinois at St. Francis) the privilege of taking care of Haitian children.''

All the Haitians he brought back have either rheumatic heart disease or congenital heart problems.

He first met the 28-year-old, Yvel, three years ago. Yvel had rheumatic fever as a child and likely will need two heart valves replaced, Carroll said. ''He was hard to turn down after three years.''

Dr. Stephen Bash and his wife, Patty, were among the group meeting Carroll. Bash, a pediatric cardiologist, said he is scheduled to see three of the patients immediately.

''I'll find out tomorrow (what is wrong with them) and see if we can fix them,'' he said.

The newly arrived Haitians spoke no English and were weary and hungry after 12 hours of travel. Carroll said a nurse he knew from St. Francis happened to be on the same flight from Miami, and she helped with the children. They are Katina, 7, Cathia, 11, Stanley, 5, Jean, 5, Maxime, 16, and Jocelyn, 11.

Debbie Fischer of Benson brought the four children in her household, ages 4 to 16, to meet the Haitian child she will host. She has hosted others in the past and as a nurse can handle children with special needs.

Helen Martin of Eureka and her daughter, Sally Achterberg, a board member of Children's Hospital, brought homemade comforters and bags filled with small items for the newly arriving Haitians.

Martin said her church, Roanoke Apostolic Christian Church, funded the bags and made the comforters through its World Relief program.

Achterberg said she is serving on the Haitian Hearts Auction committee, an event scheduled for April 12. She hopes the auction this year will raise $100,000 for the program. It raised $60,000 last year.

''People are very generous,'' she said.

CAPTION: Clinging to Dr. John Carroll, Katina, a 7-year-old Haitian girl, appears timid after arriving Tuesday night at Greater Peoria Regional Airport. Katina is among seven Haitians--six childre--who were flown to the United States through the Haitian Hearts program to undergo heart surgery.


My comments from today, February 19, 2009:

1. Maxime Petion, who was part of this group I brought to Peoria, was operated in Peoria in 2002. I took Maxime back to Haiti after he recovered from his surgery.

In 2006 while I was in Haiti, Maxime became sick again. He needed heart surgery. OSF refused him care along with all Haitian Hearts patients. He died at another medical center in the States in 2007 and is buried overlooking the Illinois River.

2. Katina, who is also referred to in this article, was operated at OSF also in Peoria. As documented on this blog in multiple posts, Katina is fighting for her life in Haiti now. She needs heart surgery again and, so far, I can't find a medical center for her. OSF is refusing her care too.

(Photograph of Maxime at the American Consulate in Port-au-Prince, Haiti. This picture was taken one month before he died in 2007.)

Looking Back...You can Disagree to a Point...but then be Careful

My comments today follow the article.

Journal Star
January 9, 2002


Fired doctor: Dispute began over suggested ER upgrades -- OSF official declines comment on issue

PEORIA - Dr. John Carroll was fired from OSF Saint Francis Medical Center in a dispute that began over more patient beds for the emergency department where he worked, he said Tuesday.

Carroll, an award-winning physician and founder of the Haitian Hearts program that brings sick children from Haiti to St. Francis for treatment, said he has no regrets about pushing for improved service for emergency patients.

''Would I do it again? Yes,'' he said.

Carroll said his job problems began with a letter he wrote about bed capacity in the emergency room, a letter which caused the hospital to discipline him in a ''punitive'' manner.

''The letter precipitated the incident and the discipline I disagreed with,'' he said.

The discipline involved placing him on ''probation'' for six months, Carroll said. The letter of dismissal that St. Francis sent to him mentioned ''disobedience,'' he said.

The 48-year-old Peoria native worked at the hospital for 21 years. St. Francis has been his only employer.

Hospital spokesman Chris Lofgren would not discuss the matter. ''It's an employee issue. We won't talk about it,'' he said.

Lofgren then added that Carroll ''was not fired because of ER issues. That's the only thing I will say at this point.''

Carroll said he was not offered another position at the hospital as the situation between him and his employer deteriorated. Both sides ''dug in their heels,'' he said.

Carroll acknowledged that the letter he sent to his colleagues and hospital officials circumvented the usual chain of command at the hospital. He knew he was taking a risk when he sent that letter, he said, adding, ''I wrote the letter with some trepidation.''

Carroll's firing, a week before Christmas, stunned his friends and supporters.
''He was by far the most compassionate doctor we had there,'' said a co-worker who didn't want to be identified. ''John has high standards of care and expects that care to be delivered to patients.''

The person said ''we are afraid to talk,'' for fear of being fired. ''We are in complete, absolute fear.''

''All he wanted to do is improve the ER procedures,'' a colleague said. ''He was frustrated. Others are also.''

People who have worked with Carroll confirmed Carroll's concerns about the emergency department. It was built to serve 35,000 patients a year but now is serving more than 60,000 annually. Some wait for hours, co-workers said.

Lofgren confirmed the usage figures, and said the hospital is planning to spend more than $2 million to alleviate the crowded conditions. The plans have been in the works ''for some time,'' he said.

Carroll has talked about his personal situation reluctantly, but said the truth should be told. He still believes in the hospital's mission, he said, and also does not want to jeopardize the hospital's support for the Haitian Hearts program.

He is leaving for Haiti soon and plans to stay there for a month. He said he has no idea what he will do about his career when he returns. He still retains physician privileges at the hospital, and his medical work was not an issue in his dismissal, he said.

Carroll has consulted an attorney about his dismissal, he said, but is reluctant to sue the hospital, because he doesn't want to enrich himself at the hospital's expense.

''It's not about money,'' he said of his dispute with St. Francis.

My comments on this article today, February 18, 2009:

1. While I was writing the letter to Mr. Steffen and my colleagues in September, 2001, another OSF employee in the Emergency Department strongly warned me that I may be fired if I sent the letter.

I viewed the ER overcrowding as a "hospital problem" that needed to be solved with everyone involved. Plus, I did not believe that Drs. Hevesy and Miller were strong enough or politically inclined to try and solve the overcrowding issue on their own.

2. During my first meeting with Mr. Steffen in early October, 2001 he told me in his office that "whenever there is bleeding the bleeding must be stopped before it turns into a hemorrhage" and that a "cancer needs to be cut out before it metastasizes". (Not exact quotes but very close.) He was referring to me.

3. During that same meeting with him, I told Mr. Steffen that I was worried about "institutional neglect" regarding the overcrowded Emergency Room. He asked me what "institutional neglect" was.

4. Mr. Lofgren may not have wanted to comment in the Journal about my termination, but he was sure talking inappropriately with other OSF employees. And I WAS fired regarding ER issues. Mr. Lofgren was not being truthful to reporter Elaine Hopkins.

5. The patient and employee satisfaction in the OSF ER was the lowest in the medical center. Dr. Hevesy looked at me once and said look what I have inherited. He meant that the ER was very dysfunctional under Rick Miller's direction.

6. And as Elaine Hopkins documented, we were seeing tens of thousands of patients more each year than the ER was designed to see. Elective (insured) patients were filling inpatient beds, so ER patients like mine had to wait a long time to be admitted. And studies performed since 2001 have documented increased morbidity and mortality for ER patients that are boarded in the ER.

7. I invited Mr. Steffen to come to the ER and work with us. I really thought it would be a win-win situation if he would come and join us for an evening. I thought that ER personnel attitudes would improve if they saw him working on the overcrowding issue, and I also thought that patients and their families would take solace in talking with the OSF administrator regarding their long wait in the ER.

Mr. Steffen declined my offer.

Looking Back

Peoria Journal Star
January 5, 2002


John Carroll is the kind of a doctor all patients need

Knowing the dedication that Dr. John Carroll has shown the patients of St. Francis and the children of Haiti, his quiet dismissal was as loud as a bomb to many of his friends, volunteers and admirers.

Statements by hospital spokesman Chris Lofgren in the Journal Star were very confusing and left me wondering if this dismissal had really been done thoughtfully. How can Dr. Carroll ''still have hospital privileges to practice medicine at St. Francis'' and at the same time be told to ''leave the premises''?

I find it hard to believe that Haitian Hearts would be ''unaffected by John's departure.'' Dr. Carroll, the hospital administration and employees did not reveal the reason for dismissal. However, from statements in the Journal Star and knowing Dr. Carroll's dedication to his patients, I have to believe that the problem was due to differences with the administration over patient care and policy.

When a doctor employed by a hospital for 21 years hopes he doesn't get ''in trouble'' for carrying an infant to intensive care, there's something wrong. Also, Dr. Carroll being described as ''a perfectionist and a fighter for his patients'' may sound good to the public, but this attitude must have caused problems for the administration of St. Francis and proved to be detrimental to his career.

Dr. Carroll's friends, peers and co-workers have witnessed the dedication, self-sacrifice and care he has given his patients. The administration of St. Francis should have thought a lot longer before ever considering dismissal. He is a superb physician who will disagree vehemently with anyone or any organization that he believes does not give proper treatment to a patient. He is a doctor that all patients need in their corner when they enter an emergency room.

Terminating his employment at St. Francis will definitely not improve emergency room care and may make citizens of Peoria wonder why such an excellent doctor found it so difficult to fit into the mold dictated by his employer.

Dottie Canellas
Former St. Francis employee
Tucson, Ariz.

Tuesday, February 17, 2009

Looking Back...Haitian Hearts Skips a Beat

Peoria Journal Star
January 3, 2002

Phil Luciano

Haitian Hearts skips beat

Haitian Hearts still beats, but time will tell how long or how strong.

Its founder, Dr. John Carroll, was fired by OSF Saint Francis Medical Center last month. Since then, this newspaper has been deluged by calls and letters, most of them confused about the future of Haitian Hearts.

The official line from St. Francis: The hospital will keep donating its services.

But Dr. Carroll says he has been told St. Francis will stop assisting Haitian Hearts as early as this year - a move that would greatly reduce the number of children the group saves.

''The last thing we'd like to see is the demise of Haitian Hearts,'' says Carroll, 48.

Before we get to the nittygritty, let me make a disclosure: I've known Carroll for years and have worked with him at medical missions in Haiti. I'd consider him a friend, though I see him at most maybe three times a year.

I don't aim to vindicate John Carroll. I honestly have no idea why he was canned from St. Francis after 21 years in the emergency room. Maybe he doesn't brush his teeth enough, or he wears bunny slippers. But he did nothing nefarious: His termination had something to do with professional differences between Carroll and hospital poo-bahs.

The hospital refuses to discuss personnel matters, and Carroll won't talk about his firing. He doesn't want to burn any bridges that remain between St. Francis and Haitian Hearts, which he started in 1995.

Years before, Carroll had begun making medical missions to Haiti, the poorest county in the Western Hemisphere, where medical care is almost nonexistent for 95 percent of the population. During his visits, Carroll would examine children with severe ailments, many of them heart-related, that are treatable in the United States but fatal in Haiti.

Carroll began to bring back one or two kids a year, beg his cardiac colleagues for help and lean on St. Francis for assistance. Carroll began spending six months a year at Haitian medical clinics, and he'd find more and more kids with bum tickers.

St. Francis donates bed space, nurses and other services; it won't reveal the worth of its donations, but Carroll estimates the figure at about $257,000 a year. Cardiac surgeons and other specialists donate their time. Carroll himself covers many extraneous costs, such as air fare.

But those donations don't cover everything. Haitian Hearts treats about 10 children a year, at an average of $25,000 per hospital stay. However, complications can prompt overruns; one lad needed some $750,00 worth of care before returning to Haiti.

So Carroll created Haitian Hearts to help raise money. It's part of St. Francis's Children's Hospital of Illinois. Over the past three years, Haitian Hearts has raised nearly $600,000, with about $275,000 pledged for this year.

So what's the problem?

Lately, this newspaper's letters-to-the-editor have railed against Carroll's dismissal. Some question whether Haitian Hearts can survive.

Chris Lofgren, spokesman for St. Francis, wants people to understand that the hospital hired Carroll as an ER doctor, not as administrator of Haitian Hearts. The group is independent of the hospital, he says.

Carroll's termination had nothing to do with Haitian Hearts, Lofgren says. Further, he says, the hospital will continue to support the program as it has in the past, regardless of Carroll's firing.

''John's leaving (St. Francis) really doesn't change Haitian Hearts at all,'' Lofgren.

Not so, says Carroll. Though he won't talk about the explicit reason behind his termination, he says St. Francis CEO Keith Steffen wanted him to somehow change his ways.

''Haitian Hearts was held over my head by Keith Steffen,'' Carroll says. ''The implication was, Haitian Hearts would survive if I survived (at St. Franics).''

Hospital spokesman Lofgren says Steffen never tied Carroll's job to the future of Haitian Hearts. Yet Carroll says that after he was fired, St. Francis sources told him Haitian Hearts funding would be discontinued - part of a hospitalwide cost-cutting measure to offset expected decreases in Medicaid and Medicare reimbursements.

If that were to happen, Haitian Hearts could continue, but at half-power or less. But that only takes into account dollars and cents.

Without his half-time job at St. Francis, Carroll cannot afford to spend half a year in Haiti. That means not only will he encounter fewer children, but he will have less time to wade through the quagmire of Haitian bureaucracy. Visas can take upwards of a year to procure, and that's only with a Haiti-savvy guy like Carroll greasing the wheels.

Plus, without a job, Carroll could have a harder time prompting donations. Potential contributors might be skittish about writing a check to Haitian Hearts when its lead physician isn't employed.

Carroll, along with the Haitian Hearts board of directors, plan to push forward - business as usual. Upwards of 10 Haitian kids are scheduled to come to St. Francis in the next couple of months, and Carroll says everything is in place for their treatment.

After that, who knows? But Carroll (who leaves this week for another monthlong clinic in Haiti) remains optimistic.

''If we can do only one children a year instead of 10, one is better than none,'' he says.

* Write Phil Luciano at 1 News Plaza, Peoria, IL 61643, or call 686-3155 or (800) 225-5757, Ext. 3155. E-mail him at

My comments today, February 18, 2009:

1. As Phil accurately wrote, the future of Haitian Hearts was up in the air in early January, 2002. I don't think he believed Chris Lofgren or Keith Steffen either. And Mr. Steffen did indicate to me that Haitian Hearts at OSF depended on me being employed at OSF. And even if Mr. Steffen didn't fire me in December, 2001, he was telling others that Haitian Hearts days were numbered.

2. I sure did not want to be fired from OSF. I loved the place. Taking care of patients and teaching UICOMP medical students and resident physicians was fun. Also, some residents from UICOMP and other students and medical students from other medical centers in the U.S. travelled with me to Haiti and worked in the Haitian clinics and hospitals. It was a great experience for them and for me.

Also, working with Haitian Hearts host families in the Peoria area was a superb experience. We went through many tough times together when Haitian children had setbacks with surgery...but we went through it together, and usually everything worked out fine. At times, the local host family would travel back to Haiti with the child after recovery from surgery and present them to their Haitian mother. There are no words to express this situation.

However, the more I talked with Mr. Steffen and Dr. Hevesy, I could see that OSF was headed down the wrong path regarding the Emergency Department, intimidation of OSF employees, conflict of interest, general "administrative malaise" (described by a Monsignor in the Diocese), and lack of respect for the Ethical and Religious Directives that guide Catholic health care. Dr. David Gorenz, who is President of District 150 School Board, and Sue Wozniak, CFO at OSF-SFMC, even entered a meeting I was having with Sister Canisia through a side door from Mr. Steffen's office. I had not invited them. Their main goal was to sabotage my only meeting with 87 year old Sister Cansisia.

All in all, I thought it was time to let OSF fire me if that is what they wanted. Phil Luciano of course did not know what was happening in Mr. Steffen's office. He had no idea of what Mr. Steffen was saying to me or how bizarre he was acting.

A Look Back....Letters of Support

These letters of support were printed in the Forum section of the Peoria Journal Star.

My comments follow.

Peoria Journal Star
December 29, 2001


Carroll's firing raises questions for St. Francis

It is very puzzling that the administrators at OSF St. Francis Medical Center would quietly fire the finest and most caring doctor in the emergency department. Was this done to intimidate other employees of the department so they would kowtow to administrators?

To me, the fact that Dr. John Carroll's dismissal was done quietly indicates guilt. I am not surprised that the administration did not want publicity for their action, given Dr. Carroll's sterling reputation in our community.

Dr. John Carroll wanted improvements made in the ER, but his suggestions were apparently rebuffed - probably because his ideas were superior to those of the administration. Dr. Carroll's dissatisfaction with the ER is certainly understandable given its recent rating of 25 out of a possible 100. Is this the kind of health care you want for you and your family?

The last time I was in the ER at St. Francis, I had to wait more than an hour before seeing medical personnel. During that time, I was left in a hall, and I felt like a spectacle for all to see. The two doctors I finally saw were not able to give a diagnosis. However, several days later, Dr. Carroll diagnosed my problem and proper medication was given.

By the way, who owns St. Francis? Why do the sisters allow situations such as this to occur? Do they ever observe procedures in the ER? Do the sisters attend meetings when important decisions are made? Do they know how the unfortunate situation created by uncaring administrators is affecting the reputation of their hospital? Why are they allowing the administrators to make important decisions that should not be made without the approval of the sisters? Did they approve the firing of Dr. Carroll?

Geraldine DuMars

Peoria Journal Star
January 1, 2002


St. Francis must keep supporting Haitian Hearts

OSF Saint Francis Medical Center has been very generous to Haitian Hearts. The sisters' mission needs to be preserved; Haitian Hearts is an excellent example of their love, compassion and devotion. They have supported Dr. John Carroll in his work for over six years. We want to thank the Sisters of St. Francis for their incredible generosity.

Dr. Carroll will not comment on his firing and he will not brag about his accomplishments. His patients from the emergency room and the host families of the Haitian patients are quick to tell everyone they know how he has selflessly devoted himself to their care. He has often met extended family members and others in emergency situations and made sure that we were taken care of. We are all stunned that he has been fired, because we have received such good personal care from Dr. Carroll and the other doctors in the emergency room.

The week before he was fired, he went to New Orleans and spoke to help raise money for Haitian Hearts and Children's Hospital. He knew he was going to be fired, but he went anyway. Nothing will stop him from helping those who need him. Those of us involved in Haitian Hearts hope and pray that his firing will not affect the future care of these very needy children.

There will be some financial difficulties, but we know that the sisters have been good to us in the past, and they will continue to be charitable and live up to their mission statement.

Dr. Carroll and his Haitian Hearts supporters have raised hundreds of thousands of dollars in the last three years for Children's Hospital, and we will continue to raise funds for this cause that we so deeply believe in.

Mary Kay Hersemann

Peoria Journal Star
January 3, 2002


Haitians Hearts can't continue without Carroll

The high integrity and the moral character of Dr. John Carroll has been an inspiration to all of us who have been associated with him in his work with Haitian Hearts and the emergency room at OSF hospital.

For over 20 years, he has always lived up to his oath as a humanitarian. The dismissal of Dr. Carroll from OSF, in such a degrading manner, is not due to any professional incompetence, but rather with the administration.

As lifelong supporters of OSF, we are bitterly disappointed in the reaction of the sisters by allowing the administration to dismiss Dr. Carroll. Just last month, Dr. Carroll was the recipient of the Catholic Diocese's Bishop's Award for Service. He also received the Governor's Award last year for his Haitian Hearts program. Through all his honors and work, Dr. Carroll has always put OSF and the Children's Hospital in the forefront.

Be not deceived; there is not a Haitian Hearts program without Dr. John Carroll. He is the founder, torchbearer and the keeper of this wonderful and compassionate program.

Rebecca, Fred and Jo Ann Schotthofer


My thoughts today, February 17, 2009:

I was very grateful for the written support of these people.

However, Haitian Hearts had a bad feeling that OSF was going to withdraw their support of the program now that they had me out of the way. OSF was trying to reassure the public in the Journal and they even wrote a letter to Children's Hospital supporters saying that Haitian Hearts would continue at OSF.

Sister Judith Ann, President of OSF, had told me numerous times that the Sisters would "never turn down a child".

However, Keith Steffen, Paul Kramer, and OSF ended all financial support for Haitian Hearts in July, 2002.

Our worst fears were realized.

Monday, February 16, 2009

A Look Back and Lessons Learned

The "take home" lessons are listed below the article.

Peoria Journal Star
December 21, 2001


St. Francis quietly fires doctor -- Renowned Haitian Hearts founder will keep healing children

PEORIA - A prominent OSF Saint Francis Medical Center physician who founded the Haitian Hearts program has lost his job at the hospital.

Dr. John Carroll, whose program brings sick children from Haiti to Peoria for treatment, said he was fired from St. Francis on Tuesday. ''I was told to leave the premises,'' he said Thursday, adding the ''situation had evolved over a number of weeks.''

St. Francis spokesman Chris Lofgren said the hospital cannot comment on why Carroll lost his job as an emergency room physician.

''This was not done lightly,'' Lofgren said. ''it was done thoughtfully over a long period of time.''

Carroll said he was not sure of his long-term plans, but he is planning to leave for Haiti on Jan. 9 for a monthlong stay. He wants to bring back more children, he said. Without advanced medical care, these children will die, he said.

''The main thing to me is the future of Haitian Hearts,'' Carroll said. He would not discuss the reasons for his job loss, but said he regretted leaving.

Carroll, 48, worked in the hospital's emergency department and has been at the hospital for 21 years. A Peoria native, he did his residency there and never has worked anywhere else.

Carroll has won numerous awards and brought national publicity to St. Francis and its Children's Hospital for the Haitian Hearts program, and also raised money for the program.

He said he has raised $819,000 in donations and pledges for the Children's Hospital of Illinois at OSF St. Francis Medical Center in the past three years.
''We're the single-highest private donor to OSF Children's Hospital,'' he said.
Carroll still has hospital privileges to practice medicine at St. Francis, Lofgren said.

Asked about the Haitian Hearts program, Lofgren responded, ''as it stands right now, it's unaffected by John's departure.''

Carroll will have to discuss future treatment of the Haitian children with the staff and physicians who treat them, Lofgren added.

Heart surgeon Dr. Dale Geiss, who has worked with Carroll and donated his services for the Haitian children, termed Carroll ''an outstanding individual and superb physician.'' He said he was not familiar with the issues leading to Carroll's job loss.

Saying he hopes Carroll stays in Peoria, Geiss added, ''I've been assured that Haitian Hearts will continue to be supported by St. Francis if that is what Dr. Carroll wants.''

Other physicians also support the program, he said.

Dr. Greg Tudor, who worked with Carroll, said hospital employees were told not to comment on Carroll's departure. Carroll is ''a community icon and nothing short of that. I can't believe it,'' he said.

Karol Holmes of Tremont is caring for a 1-year-old Haitian baby who has been treated at St. Francis since May.

''Everybody in Haitian Hearts is devastated,'' she said. ''I can't begin to understand it.''

Carroll has given ''his whole life for this. The emergency room and Haitian Hearts is his whole life. His compassion is incredible. I've never known a man like him,'' she said.

She told of Carroll fighting to save the baby's life, and at one point, personally carrying the infant to the pediatric intensive care unit without prior approval, saying ''I hope I don't get in trouble for this.''

She and others described Carroll as a perfectionist and a fighter for his patients.
''He's pretty strong willed. That's not a bad thing. If I'm sick and dying, I want him on my side,'' Holmes said.

Holmes is planning to accompany Carroll to Haiti in January, where they will seek the mother's approval for the Holmes family to adopt the baby, who will need medical care for years.

In the months before that adoption can take place, she said, the family will be dependent on Haitian Hearts and St. Francis for medical care for the boy. Carroll's situation has her worried, she said. ''What am I going to do without Carroll?''

Geiss said that Carroll's use of expensive medical resources for the Haitian children is not an issue for St. Francis, whose officials have often expressed support for Haitian Hearts.

About 75 children from Haiti have been treated since 1995, Carroll said.

''A lot of families are involved,'' he said. ''I don't think it's done anywhere else in the U.S., and I don't think the generosity of hospitals anywhere in the U.S.'' can match the generosity at St. Francis.
My comments today, February 16, 2009:

1. This article was written a few days after I was fired from OSF in 2001. As documented in Peoria’s Medical Mafia, I was placed on probation at OSF on September 28, 2001. The day before I had written OSF administrator Keith Steffen warning him of the overcrowded and dangerous Emergency Department at OSF.

I was also aware of OSF Emergency Department Director Dr. George Hevesy’s financial conflict of interest with Advanced Medical Transport. I did not feel that Dr. Hevesy or Dr. Rick Miller, previous OSF-ER Director, would be able to do much of anything about overcrowding in the ER due to the fact that they both had excellent jobs in the ER and Mr. Steffen had too much on them for either of them to contest him on anything.

2. I was attempting to save Haitian Hearts at this point. I had been told by an insider that Mr. Steffen was going to withdraw all financial support from Haitian Hearts…I just didn’t know when he was going to do this. (OSF withdrew all financial support for Haitian Hearts in July, 2002...six months after I was fired.) Dr. Geiss was given the wrong information when he was quoted above saying that OSF would continue their support of Haitian Hearts. Paul Kramer, Executive Director of Children's Hospital of Illinois (CHOI), told me in his office before I was fired, that Haitian Hearts was becoming "too much competition" for Children's (due to our very successful volunteer fundraising). Caterpillar Inc. was donating significant money to Haitian Hearts that went directly to CHOI. I think this really unnerved OSF because they wanted donated money to go to the Milestone Project, not to children from Haiti who needed heart surgery. (Also, $9,500 dollars from Caterpillar to Haitian Hearts in 2001, months before I was fired, turned up missing at Children's Hospital of Illinois...I wonder where it went...)

Even though I was fired, we were able to keep Haitian Hearts alive at many other medical centers in the United States.

3. In the months before he fired me, in his office, Mr. Steffen would smile and tell me, “When this comes out about you, John, it won’t be good.” When I asked him what he was talking about, he would just shake his head and smile. He spoke to other employees about me and to people outside of the hospital. They told me what he said.

Mr. Lofgren, hospital spokesman, also spoke inappropriately about my termination... he admitted to me that he did. (Much of what Mr. Steffen and Mr. Lofgren were saying came back to me and my family.)

How was I supposed to explain this bizarre behavior by OSF to Elaine Hopkins, the Journal Star reporter and, at the same time, try to protect Haitian Hearts from OSF's Administration?

I know that Mr. Steffen and some of his administrative staff are very dangerous people. They sure shouldn’t be in charge of OSF-SFMC. But OSF-Corporate and the OSF Sisters and the Catholic Diocese of Peoria know much of Mr. Steffen’s history and must just using him. And from a very good source, they will terminate him when the time is right.

4. As reported above, the Emergency Room staff of doctors and nurses were told by OSF ER directors not to comment on my firing. Everyone was being muzzled. Mr. Lofgren even sent out an e mail to the entire hospital saying that no one should comment. (I guess it was ok if he did.) The Executive Committee of physicians at OSF weren’t even consulted with my termination.

5. As stated in the article, I was grateful to OSF for their support of the Haitian kids. All physicians and the perfusionists on the open heart team donated all of their services. During 2002, the year after I was fired, and the year that OSF terminated Haitian Hearts, we donated $445,000 more dollars to OSF-Children's Hospital of Illinois.

6. So what have I learned from this experience with the OSF-Administrative team? I have learned alot. I have seen a few people cover for their colleagues when things get tough. I have also seen how people react when they are scared. People are afraid to take on OSF for so many reasons.

And most importantly I have seen how a small group of people at the top of OSF-SFMC destroyed the lives of many Haitian kids who deserved a chance. I have had the privilege of working with so many good people that took care of Haitian kids in their homes. I have seen their pain too as Haitian Hearts at OSF was destroyed.

Sunday, February 15, 2009

A Look Back

Below is an article in the Journal Star. Following the article are my comments today giving historical perspective.

Peoria Journal Star

August 14, 2003

Haitian Hearts will continue its program -- Patients will be treated in the U.S. and elsewhere

PEORIA - Haitian Hearts will continue to bring heart patients from Haiti for treatment at hospitals in the U.S. and perhaps elsewhere, its founder, Dr. John Carroll said Wednesday.

Carroll returned last week from Haiti where he arranged for two adult patients to be treated in the U.S. One is scheduled to receive a pacemaker at St. John's Hospital in Springfield, he said, and the other is to have heart valve surgery at a Jacksonville, Fla., hospital.

In July, OSF Healthcare System and the Catholic Diocese of Peoria announced they would no longer participate in the Haitian Hearts program.

Haitian Hearts has brought nearly 100 Haitians, mainly children, from Haiti to Peoria for medical treatment, mostly heart surgery at OSF Saint Francis Medical Center.

On Tuesday, the last Haitian child in Peoria, a 10-year-old girl who has been in the U.S. since last year, received heart surgery at St. Francis, a follow-up to earlier surgery. Carroll said the surgery went well.

Doctors, nurses and others who have cared for this child and other Haitians have expressed regret that the program is ending in Peoria, Carroll said. Some have donated their time and materials, and even offered to care for Haitian children in their homes while they recovered, he said.

Carroll said he now is working with others interested in Haiti, including the Mercy and Sharing Foundation, founded by philanthropist Susan Scott Krabacher. The organization operates an orphanage and medical center in Haiti. Its Web site is

Carroll said he hopes that up to 20 children soon will be placed in hospitals in the U.S., Canada and Europe for surgery. He has identified 38 who need surgery. A 19-year-old died while on the waiting list, he said.

Since December, St. Francis has refused to approve any visas for medical care for Haitian Hearts patients.

St. Francis fired Carroll in December 2001 from his job of 21 years as an emergency room physician after a dispute with hospital managers.

Looking back from today, February 15, 2009:

1. Many Haitian Hearts patients in Haiti have died since this article was published. Two young men that were operated at OSF, but were denied care at OSF when they needed heart surgery again, have died too. Haitian Hearts has been able to get a few OSF Haitian Hearts patients operated in different medical centers, and all have done well, but they wouldn't have if it were up to OSF. All Haitian Hearts patients are still being refused at OSF.

2. Bishop Daniel Jenky and the The Catholic Diocese of Peoria had one 45 minute meeting with Haitian Hearts in February, 2003. There were no other Haitian Hearts meetings with Bishop Jenky. Ever. When my brother asked Bishop Jenky at this single meeting if I could go to Haiti and bring back five sick Haitian kids to OSF for heart surgery, he replied no.

Yet, two weeks later in his office with Patricia Gibson (Diocesan Chancellor and Canon Law Lawyer) present, Bishop Jenky told me that I needed to go to Confession to him in one year if I petitioned for a Catholic Tribunal Court against OSF. He was holding me responsible for any Haitian deaths that occurred in this time period. My education how the Diocese acted behind closed doors was "up close and personal". I left the Chancery in disbelief.

3. Since this article, Haitian Hearts has personally brought or consulted in approximately 150 Haitians who have come to the United States for surgery. Most have been children. Most have had heart surgery.

4. And my "dispute with hospital managers" noted above, included overcrowding in the OSF Emergency Department. No one who worked there at the time would have disputed this.

Since this article was written, OSF has admitted in the Journal Star that the OSF-ER was dramatically overburdened. Work on a new ER has started as part of the one-half billion dollar OSF Milestone Project and an Observation Unit for ER patients was started several years ago.

Friday, February 13, 2009

Eric Whitaker and the University of Chicago Emergency Department

See this article in the Chicago Tribune today.

Here are some points regarding this article:

1. It seems like the poor and underinsured are the people who will be moved around. These people on the South side of Chicago are not trusting that the system is geared to help them.

2. To have a system of community hospitals and clinics linked together to help non urgent cases and keep them out of the emergency room makes sense on paper. Will it work in real life?

3. Would Dr. Eric Whitaker, Director of Urban Health Initiative at U. of C., agree to take his child to John Stroger Hospital (Cook County Hospital) with the same injury that the child in this article had? Dr. Whitaker stated that the hospital does not take into account the insurance status of patients deciding who will be diverted to other hospitals. In this article, the child's mother stated the opposite. Who are we to believe?

4. The Tribune found that the U. of C. Medical Center was near the bottom among Cook County non-profit hospitals in the rate of free care it provides to indigent patients even as it reaps tens of millions in tax benefits based in part on its promise to treat the uninsured.

Thursday, February 12, 2009

Letter to OSF's New Ethics Director

Dear Ms. Skujdak Mackiewicz,

I would like to present the following as a formal ethics consult to you as Ethics Director at OSF.

Katina Antoine is a 13 year old Haitian girl who suffers from valvular heart disease. I brought her to OSF in Peoria in 2002 as part of the Haitian Hearts program.

She underwent mitral valve surgery at OSF and recovered at my brother’s home in Peoria. She attended St. Thomas Church with my brother's family and St. Thomas School sends a yearly monetary gift to Katina which pays for her school in Haiti.

I have been following her in Haiti since I took her back in 2002.

I examined her in November, 2008 and obtained an echocardiogram. Her physical exam and echocardiogram revealed that Katina needs a new mitral valve. The repair done on her mitral valve at OSF in Peoria gave her a couple of years, but she now needs a prosthetic valve placed in the mitral position.

As you may know, complex technical heart surgery such as this is not done in Haiti.

Several years ago a letter from Douglass Marshall, OSF attorney, informed me that OSF would not operate on any patient referred by me to OSF. This included Haitian Hearts patients.

Two of OSF’s young Haitian Hearts patients, Jean-Baptiste and Maxime, have died very painful deaths in the last couple of years after being denied care at OSF.

I have tried to get Katina accepted into numerous other medical centers in the United States without success. Other medical centers seem quite concerned that OSF is not following up with their Haitian patients.

I am afraid that Katina is running short on time.

The Catholic Post recently quoted you regarding your belief and reliance on the Ethical and Religious Directives regarding Catholic health care in the United States. I would hope that you and the Ethics Committee would review these Directives with Attorney Marshall and OSF’s Administration so their policy denying OSF’s Haitian Hearts patients care would be changed immediately.

OSF's leaders in Corporate and at the Medical Center need to come together to give Katina the concern and the care she deserves in Peoria.

Since 1995, Haitian Hearts has donated over 1.1 million dollars to Children’s Hospital of Illinois. We are able to pay up to $10,000 dollars for Katina’s care at OSF.

I have sent you this letter via “snail mail” since my OSF e mails have been blocked in the past. I did not think that you would receive my request any other way. (I did leave a voice mail on your phone the other day, but did not hear back from you.)

Also, I have published this letter on my web logs, and Also, these two sites will provide you with an adequate historical background regarding OSF’s negligent and unethical behavior regarding Haitian Hearts patients.

I will publish your response regarding this consult in a future post. As Katina’s physician and guardian in the United States, I will also share this post and your response with Katina’s parents in Port-au-Prince, Haiti.

Physicians are supposed to be “attorneys for the poor”. My hope is that you will be an “ethicist for the poor”. Katina and her family are indeed poor.

Haitian Hearts fervently wishes that you and the Ethics Department at OSF will have the courage to convince others at OSF that accepting Katina is the only good ethical decision that can be made.


John A. Carroll, M.D.
Peoria, Illinois

Tuesday, February 10, 2009

With the Greatest Care and Love

The Chicago Tribune had an article several days ago regarding a bad nursing home in Berwyn, Illinois. This nursing home was rated a one star out of a possible five stars. The article states that the lobby smells of urine.

One star means bad and five stars means good.

OSF Saint Clare Nursing Home on Galena Road in Peoria gets a one star too. That isn't good.

Lutheran Nursing Home on Galena Road is five stars.

Apostolic Christian Nursing Home on Galena Road is five stars.

OSF has its priorities. And the elderly at Saint Clare's and their hallways that smell like urine don't seem to be among them.

OSF has New "Ethics Director"

The Peoria Catholic Post February 8, 2009 announced that OSF has a new ethics director.

She is Birgitta Skujdak Mackiewicz.

The Post reports:

"Sujdak Mackiewicz said that when she receives requests for ethics consultations, for example, she tries to eduate all involved so they feel they have the necessary resources to address problems now and in the future.

"They're alway welcome to call, of course, but at least this gives them tools to work through some of these issues, to recognize ethical issues where they may not have seen them before," she told the Post.

"In terms of policy development, Sujdak Mackiewicz said OSF-SFMC, like all Catholic hospitals, relies to a great extent on the Ethical and Religious Directives for Catholic Health Care Services. This document was developed by the U.S. Conference of Catholic Bishops' Committee on Doctrine.

"Our consultation service here at the hospital is available 24 hours a day, seven days a week. It has been in existence for some time," according to Sujdak Mackiewicz, who said anyone can request an ethics consultation."

The article reports that she handles ethics calls the majority of the time and works closely with Dr. Gerald McShane, who chairs the OSF Saint Francis Ethics Committee and is president of the OSF Medical Group.

Sujdak Mackiewicz states that "above all, ethics consultations should improve patient care."

My comments on the article:

1. Why does OSF need an "ethics director"? They already have Drs. Gerry McShane and OSF Corporate Ethics Director, Joe Piccione.

2. I feel bad that this new ethics director is working with Gerry and Joe. I have submitted multiple ethics consults to both Gerry and Joe over the past eight years. Never once have I been granted an ethics consultation from either of them that I know of. If the Ethics Department and committee talked about my concerns at OSF (the abandonment of Haitian Hearts patients, the Advanced Medical Transport monopoly on ambulance services, and the management style of OSF Administrator Keith Steffen and his use of fear with employees), I am unaware of any of their conclusions. One one occasion I spoke with Dr. McShane in his office about Mr. Steffen's management style and asked him to present it to the Ethics Committee. He said that he would not because Mr. Steffen sat on the Ethics Committee. Dr. McShane referred me to Howard Wiles at OSF, the Compliance Officer.

3. Both Dr. McShane and Joe Piccione, along with Monsignor Steven Rohlfs, were very instrumental in ending the Haitian Hearts program at OSF. This does not seem to be consistent with Sujdak Mackiewicz's statements above about OSF following the Ethical and Religious Directives. In fact, Dr. McShane, Mr. Piccione, and Monsignor Rohlfs did the opposite.

4. I called Sujdak Mackiewicz's office yesterday, and left a voice mail. I want to make yet another formal consult to the ethics department at OSF for their abandonment of their Haitian patient, 13 year old Katina Antoine. I did not get a return phone call. (My e mails to OSF have been cut off for several years. Dr. McShane played a role in that via an e mail I received several years ago.)

5. So, according to Sujdak Mackiewicz, it looks like anyone can make ethics consults 24 hours per day to OSF unless it is about medical negligence of Haitian children, the OSF-AMT ambulance monopoly and conflict of interest, or fear used against employees by OSF's administrator.

6. I guess I need to give her time. She is new on the job and probably doesn't understand all of the people that will be working against her at OSF.

Monday, February 9, 2009

Katina is Sick

Frandy is a 19 year old Haitian Hearts patient that helps us in Haiti.

He received a call from Katina's father yesterday.

Below is an internet chat with Frandy from yesterday February 9, 2009:

6:18 PM Dejean: are you there Maria?
i just have a quick news about Katina
6:19 PM please tell dr Carroll that she's not doing well, her father called me this morning to inform me about that
me: ok frandy. how is she not doing well?
6:20 PM we are looking hard for a hospital
Dejean: she's surffering because of her belly
6:21 PM me: her stomach hurts? is it big?
Dejean: the ball around her neck does not hurt her
6:22 PM yes her stomach, i don't know if it s big
me: frandy this is dr john is she short of breath...eske li soufle anle
6:23 PM Dejean: no
me: please tell the father we are searchig for a hospital
6:24 PM Dejean: her stomach and the place where she was operated on are hurting her
ok i will
me: ok, thanks frandy
Dejean: and i will email you more about that
me: dont let them give up hope
6:25 PM Dejean: no

Saturday, February 7, 2009

Pressing Forward with Katina

Another medical center will review Katina's case this coming week. They will decide to accept her or not accept her for heart surgery.

With all the money in Peoria, and all the medical expertise, and with all of the people in the area that want Katina to be able to return to OSF, it is so amazing that she is not allowed to come back to OSF.

A few people in key positions are blocking her from returning to Peoria and it may cost Katina her life. This position cost Jean-Baptiste and Maxime their lives.

It does not surprise me that only a few people are obstructing her care. What is bothersome is the silence of people that know better.

Friday, February 6, 2009

Financial Crisis in the U.S. and Overcrowded ER's

In September, 2001 I wrote a letter to OSF-SFMC administrator Keith Steffen.

I thought that OSF-SFMC had too many elective inpatients which dangerously slowed moving sick Emergency Room (ER) patients to inpatient beds. I also thought that OSF was stacking insured patients in inpatient beds to the detriment of the ER patients. Sick patients at OSF were waiting a long time to be admitted.

I was put on probation the day after I sent the letter, and during my first meeting with Mr. Steffen he likened me to a cancer that needs to be cut out "before it metastasizes".

I was fired from OSF-SFMC three months later.

Below are bullet points from an article in the Annals of Emergency Medicine, February 2009:

1. There were 119 million visits to U.S. Emergency Rooms in 2006.

2. Emergency Departments are part of the nation's early warning system of the severity of our socioeconomic problems. The nation's Emergency Departments are uniquely responsive to the symptoms of a diseased economy.

3. Employer-insured people are one layoff away from having no health insurance.

4. Mortgage foreclosures could produce social dislocation in both forms and degrees that threaten the quality of medical care for large parts of the population.

5. Crowding in the entire hospital produces crowding and boarding in the Emergency Room.

6. It is possible that hospitals allow themselves to be over capacity with elective insured patients because that maximizes profits. In my opinion this is one of the main reasons OSF-SFMC in Peoria's Emergency Room was/is so dysfunctional.

7. Rising numbers of uninsured people heighten the pressure in Emergency Departments. There is also increased use by middle-class patients whose usual source of care is the private physician's office.

Annals of Emergency Medicine
February, 2009

If emergency departments (EDs) are part of the nation's early warning system for underlying socioeconomic problems, the crowding that emergency physicians have seen in recent years may have presaged the deep-seated, population-wide strains that are now recognized as a severe recession. The failure of major financial institutions, the decline of the stock market last October, and the proposals for the federal government to bail out the Big Three automakers and other sectors of the economy have made it impossible for economists and officials to ignore something that American emergency physicians have seen for years: that large numbers of their fellow citizens live on the financial precipice.

The employer-insured are one layoff away from a drop through a porous safety net; many of the uninsured are already falling through. And over the coming months, say physicians and economists, the health care system is likely to see a drastic shift from the former group to the latter.

“A serious downturn in the next few months, unless there's emergency help, is going to lead to a real influx of people who formerly had insurance and have no other place to go,” says Robert J. Blendon, ScD, professor of health policy and political analysis at the department of Health Policy and Management, Harvard School of Public Health. The newly unemployed and the firms that once paid their medical premiums are not the only ones whose wellbeing is at risk during the economic contraction. States will be hard-pressed to cover the rising costs of Medicaid and the State Children's Health Insurance Program (SCHIP), Blendon believes, and some hospitals may even face threats to their viability. The crash of 2008, he says, “appears to be the largest-scale recession we've had since the Great Depression.”

Moreover, say some policy analysts, the nature of this recession is poorly understood, and the difficulty of recovering from it is hard to predict. The dramatic headlines to date have involved collapsing investment firms leading to a plunging Dow Jones industrial index, but the effects are not limited to the shareholding classes. The triggering events, says Glenn Melnick, PhD, senior economist at the RAND Corporation and Blue Cross of California Chair of Health Care Finance at the University of Southern California, affected the most important assets most Americans hold: their homes.

Mortgage foreclosures in some areas could produce social dislocation in both forms and degrees that threaten the quality of medical care for surprisingly large parts of the population. “This is a much more complicated economic crisis than we've faced in many years, and I'm not sure that it's been figured out yet,” Dr. Melnick comments. “I think the whole mortgage/foreclosure crisis could depress economic growth for many, many years if they don't figure it out…. There could be waves of foreclosures, a couple million every year, for the next 3 or 4 years.”

Just as the nation's EDs are uniquely responsive to the symptoms of a diseased economy, the nation's economy is headed for the policy equivalent of intensive care. The incoming administration of President-elect Barack Obama has its work cut out, as commentators have pointed out in numerous contexts. Obama's team may also encounter opportunities for much-discussed, long-delayed systemic reforms in the health care sector; as in the 1930s, a state of crisis can shake loose obstacles and foster constructive change. The chances of rebuilding the foundations of the medical economy in the long run, experts speculate, depend to a large degree on how policymakers and institutions manage the current uncertainties in the short run.

Already Peaking Before the Wave Hits

That America's EDs are already operating at or near capacity will come as no surprise to physicians working in them. Expanding capacity has not kept up with demand, which rose from 67 million visits in 1996 to 119 million in 2006, as reported by the Centers for Disease Control and Prevention (CDC).[1] As ACEP president-elect Angela F. Gardner, MD, told the New York Times, “We have no capacity now.”[2] The new National Report Card on the State of Emergency Medicine[3] establishes formal recognition of a situation that has multiple causes, including but not limited to the cause repeatedly identified in the lay press: the sharply rising numbers of uninsured patients. Conditions in EDs were approaching a critical point well before the current recession began.

Jesse M. Pines, MD, MBA, MSCE, assistant professor of emergency medicine at the Hospital of the University of Pennsylvania and senior fellow at the Leonard Davis Institute of Health Economics, points to problems well beyond the ED itself, including institutional economic incentives and internal politics as well as demographic changes. Crowding in the entire hospital produces boarding in the ED, as do procedural bottlenecks in admitting patients from the ED to inpatient beds. “It's a patient throughput issue,” Dr. Pines notes, but “it's also that hospitals allow themselves to be over capacity because that's the profit-maximizing strategy.”

Although EDs, contrary to some myths, are a profit center for many hospitals rather than a loss leader, direct admissions for non-emergent conditions make marginally greater contributions to the institutional bottom line than admissions through the ED. “A guy coming in for his elective heart procedure, a guy from the suburbs with good insurance” will offer more predictability in terms of both ability to pay and advance recognition of the time of admission, Dr. Pines says, than a random ED patient who may be uninsured or covered by Medicaid, with its lower payments. Filling beds with patients in the former category increases the likelihood of 12- to 18-hour waits for those in the latter.

Logistics, too, creates logjams that exacerbate ED crowding. Decreased effective ED capacity, Dr. Pines has observed, “tends to happen most on Mondays, Tuesdays, and Wednesdays, because those are the same days when there are a lot of elective surgeries going on… and hospitals tend to prioritize the beds for elective procedures over the patients in the ED. The hospital will be full to capacity, and you'll have patients waiting in the ED for beds on the busiest day for the ED.

“In our place, and in a lot of hospitals, Monday is the perfect storm… half the beds in the ED are dedicated to admitted patients, the other half are active beds, and essentially the effective capacity on your busiest day is one half of what it should be.” (Dr. Pines recommends “surgical schedule smoothing,” a simple policy of distributing procedures more evenly among the days of the week, as an effective strategy for breaking these bottlenecks. In practice, however, implementing such a schedule often evokes opposition from surgeons who cherish their time off; some threaten to take their profitable procedures to a different hospital if administrators raise the possibility of working larger numbers of days, even if total working hours remain constant.[5])

Rising numbers of uninsured people intuitively heighten the already-intense volume pressure on EDs, but they have not been its chief cause to date, say scholars who have studied the phenomenon. The rise in adult ED use from 1996 to 2004, according to one recent study of national Community Tracking Study Household Survey data, reflected increasing use by insured middle-class patients whose usual source of care is a physician's office.[4] Percentages of uninsured visitors remained stable, even declining by a nonsignificant amount.

Bluntly stated, it hasn't been the mythical uninsured person who follows the advice of outgoing president G.W. Bush and others[6] simply to “go to the emergency room” and thus burdens the whole system -- the popular scapegoat of a “healthy, cavalier, uninsured ER abuser,” as Dr. Pines and Zachary Meisel, MD, recently described and debunked in Slate.[7] It's been the insured patient who is unable to see his or her primary care doctor promptly.