Looking Back....PFD Becomes Paramedic in 2008

In 2008, as documented in this blog, the PFD became paramedic.

As the years pass in Peoria, EMS leadership will change. We can hope that new leadership will be transparent and strive for excellence in pre hospital care for Peoria.

Looking Back....Rescue Services Get Some Criticism (Revised)

My comments are at the bottom.

Even though this article downplayed the situation, EMS was going to change for the better in Peoria. The Journal Star wasn't going to make it look like it had been too bad either.

And anyone that had read my Forum articles and posts carefully knew that I wanted the Peoria Fire Department to be able to help the citizens of Peoria and not be held back. I knew many of the AMT paramedics and relied on them greatly when they brought a patient to me in the Emergency Department. The paramedics were not at fault. Peoria's EMS leadership was the problem.


Peoria Journal Star
July 7, 2005

JENNIFER DAVIS
DAYNA R. BROWN

Rescue services get some criticism - EMTs, firefighters work well together, officials say

PEORIA - Criticism of the city's private ambulance service by a former emergency room physician is being downplayed but could still lead to discussion on how to improve the system.

Dr. John Carroll, who worked for 21 years at OSF Saint Francis Medical Center before he was fired in 2001, told the City Council on Tuesday of a recent incident in which a man at a Peoria restaurant went into full cardiac arrest and later died while a Peoria firefighter/paramedic on the scene wasn't allowed to try to help save him.

"Just think if that was your family member," Carroll told the council. "Valuable minutes really shouldn't be wasted at the scene" waiting for the city's ambulance service to arrive.

Carroll has been critical of Advanced Medical Transport, the city's only ambulance provider, since at least 2002, but some question whether his accusations are personally motivated by his firing.

"Dr. Carroll has been critical of our operations for some time now. I don't recall ever having the chance to speak with him personally," said Andrew Rand, AMT's executive director. "It's regrettable that these sort of anecdotal references are made that are unsubstantiated."

Rand noted that the AMT was recently given its second perfect score from the Commission on Accreditation of Ambulance Services, making it the only private provider in Illinois thus recognized.

"We have an excellent system," said Dr. Rick Miller, Emergency Medical Services Medical director. An employee of St. Francis, Miller has the responsibility of certifying people as paramedics and EMTs and overseeing their education. If there are any problems and someone has to be reprimanded, he is also involved.

"To say (firefighters) are standing around is inflammatory and an insult to the fire department," Miller added.

Firefighters can perform CPR, control a patient's airway, ventilate a patient, give oxygen and administer several medications. They can also use a defibrillator, which could be the most important tool for a cardiac patient, Miller said.

Those firefighters who are also system-certified paramedics can also use their skills to assist AMT paramedics if they request help - a relatively new change allowed by Miller.

It's also an example of what appears to be a sea change in the relationship between the fire department and AMT. Just a couple years ago, the fire department wanted to get into the ambulance transport business over AMT's objections. But now both sides say they are working together like never before.

"The last thing we want to do is go backwards in terms of the relationship between the fire department and AMT," said Tony Ardis, president of the firefighters' union.
Rand agreed.

"One of the important results of the city's emergency services study was to show the community and the policymakers the benefits of an organized emergency response system. (The study) was the catalyst for us to begin talking about things we never talked about before," Rand said. "We are talking constantly. The dialogue is weekly at various levels."

Indeed, Rand said it's likely both sides will talk about allowing firefighters who are already paramedics to do more, "but it's not because someone is beating me over the head."

Mayor Jim Ardis said he would like all sides to discuss ways to improve the system "as long as we differentiate the conversation and make sure it's clear we're not talking about transport.

"I think it would be a productive discussion to have, and I don't think it's getting into AMT's business," the mayor said. "I'm going to see if there's a feeling on the council as well as long as everyone understands that I don't see this as an effort to start up that whole transport war again."
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My comments today--March 30, 2009. Here is what was really going on in the summer of 2005:

1. Dr Rick Miller was in charge of 80 EMS agencies (ambulance and rescues services) in the area. OSF appointed him to the job when Dr. Jim Hubler resigned from this position.

2. I was told in June, 2005 that Dr. Miller had reprimanded a Peoria Fire Department (PFD) firefighter and the firefighter was suspended from answering medical calls. The PFD firefighter had tried to secure an airway in an emergency by intubating the patient and that was apparently against the rules.

Apparently there were other airway issues with other patients in the weeks before I spoke to the Council. However, Dr. Miller was told that if the media found out about the suspension of the Peoria firefighter, after the firefighter had been trying to help the patient, that it would not be good for Dr. Miller and Peoria’s EMS.

3. As the Journal Star article above stated, I spoke to the City Council in early July and described the medical emergency that had happened in a Peoria restaruant.

4. I had spoken with the PFD paramedic who had taken care of this gentleman. The paramedic had told me that a man collapsed at a restaurant and 911 was called. The PFD arrived before AMT arrived and found the patient in full cardiac arrest. The PFD defibrillated the patient’s heart with successful return of a pulse. AMT arrived at the scene and attempted to intubate (place a breathing tube in the trachea) in the patient. When AMT was unsuccessful, they asked the PFD paramedic firefighter to intubate. Since he was not allowed to and his fire station captain was there to make sure that he did not intubate the patient, the PFD paramedic declined. Apparently, the AMT paramedics were able to intubate the patient successfully, but the patient died.

5. The Journal Star reported, “Those firefighters who are also system-certified paramedics can also use their skills to assist AMT paramedics if they request help - a relatively new change allowed by Miller.”

At some point after this terrible situation in the restaurant, Dr. Miller changed the rules. Dr. Miller was on the defense. Even though he was stating what an “excellent system” was in place, he was changing rules behind the scenes. The new rules stated that the PFD paramedics could intubate and give advanced life support drugs only if Advanced Medical Transport was on the scene AND asked for help from the PFD paramedics.

As a Basic unit, the PFD did not carry advanced medication, laryngoscopes, or tubes. So the new rules still had the patient waiting until AMT arrived to receive paramedic care.

6. In reality things had not been working great between the PFD, the Project Medical Director (Dr. Miller), and AMT as the Journal Star tried to convince the reader. There were a lot of politics involved behind the scenes. And there was a lot of money at stake if AMT lost their ability to be the sole transporter of pre hospital patients in Peoria.

7. After I spoke to the Council a committee was set up behind the scenes with the usual players involved in Peoria’s EMS placed on the committee. The Journal Star did not report this either.

8. Andrew Rand, Executive Director of Advanced Medical Transport, of course never denied that what I said occurred. And as I mentioned above, I always had respect for the AMT paramedics. It is the leadership in the Peoria Area EMS that is the problem.

9. The Journal Star reported, “Firefighters can perform CPR, control a patient's airway, ventilate a patient, give oxygen and administer several medications. They can also use a defibrillator, which could be the most important tool for a cardiac patient, Miller said.”

This is Basic-D care. Not advanced care. Controlling a patients airway and ventilating the patient is bagging them with a bag-valve-mask. The medications were medications that the patient could have had in their pockets. Dr. Miller made it sound like a lot, but it was not Intermediate or Paramedic care. The PFD paramedics were not allowed to function as independent paramedics for three more years in Dr. Miller’s “excellent system”.

Looking Back....OSF's Dr. Rick Miller (Revised)

Well, it was time for OSF's Rick Miller to jump in and defend OSF and Peoria's EMS. That is what he was paid to do.

See my comments below.

Peoria Journal Star
March 10, 2005


End false allegations about Peoria's ambulance service

Re. Feb. 23 Forum letter by Dr. John Carroll, "Let Peoria Fire Department operate its ambulance:"

Dr. Carroll's letter is filled with misleading statements.

First, the ambulance owned by the Peoria Fire Department never had a license or a staffing pattern to be placed into use. All pre-hospital services that provide ambulance transport are strictly governed by the Illinois Department of Public Health. The fire department does an excellent job as a basic life support, non-transporting agency.

Second, Emergency Medical Services (EMS) for Peoria have markedly advanced in the past 20 years through a commitment by the Peoria area hospitals to support a single quality agency. This agency pioneered throughout central Illinois the first critical care curriculum for paramedics and transport and has been accredited, receiving an outstanding score. Dr. Carroll's attempt to paint a picture of negligence and poor care is absolutely erroneous and inflammatory.

Third, emergency rooms at St. Francis, Methodist and Proctor receive traffic from up to 80 different ambulance agencies. The quality of care of each patient transported is of great importance.

Protocols have been developed for quality patient care to be delivered. In the last five years, the system has continued improvement by the addition of medications for all in the system. Physicians who monitor patient care and work to improve EMS protocols are provided a stipend for their services.

Dr. Carroll continues to create, by innuendo, a sense that the system he knows little about is not meeting the needs of Peoria. It is a shame that this continued dialogue may confuse some people regarding emergency care for the city.

Dr. Rick Miller
Medical Director
Peoria Area Emergency Medical System

Comments by me March 26, 2009:

1. If you scan down to the post below, where are the misleading statements that Dr. Miller attributes to me in the article from February 23, 2005? I was pleading for transparency in Peoria's EMS and was willing to buy the PFD ambulance that they were selling on e bay?

My point is that OSF and AMT, using Dr. Miller, did not want this to happen. AMT's money is made in patient transportation and they did not want to lose any of this to the PFD.

2. Actually Dr. Miller's Forum article is full of misleading statements.

3. The PFD ambulance could have been used by them if Dr. Miller and Dr. Hevesy at OSF had agreed. The Matrix consulting firm had noted in 2004 that the PFD had applied to Dr. Miller to outfit their engine with basic and advanced life support medication and equipment and their request was denied. And Dr. Hevesy worked for IDPH. So Dr. Miller did not need to cast all the responsibility on IDPH. This was diversionary and misleading on his part. The decision to let the PFD use their ambulance was a local decision that should have been made by Dr. Miller and supported by Dr. Hevesy. IDPH would have backed the local project medical director's decision.

4. Notice that Dr. Miller did not mention Advanced Medical Transport (AMT) by name any where in his Forum article. He referred to AMT as an "agency". He did not want the public to read a letter from him, respresenting OSF and Peoria Area EMS, with any connection to AMT at all. In reality, OSF and AMT are joined at the hip.

And his statement about 80 different ambulance agencies in the area was just meant to be confusing. Dr. Miller just wanted AMT to imperceptibly blend in with all of the rest. But AMT had been paying Dr. Hevesy for years to get what they wanted.

5. Dr. Miller wrote that my "attempt to paint a picture of negligence and poor care is absolutely erroneous and inflammatory." Please scroll down to my February 23 article and tell me where I wrote of "negligence and poor care". I didn't write of negligence and poor care. Dr. Miller was misleading the reader again.

6. Dr. Miller wrote that "physicians who monitor patient care and work to improve EMS protocols are provided a stipend for their services". What he didn't tell the public was who was providing the "stipend". What he didn't want people to know was that AMT had paying Dr. Hevesy for years. Was AMT paying Dr. Miller also?

7. As indicated on a previous post, I heard from an excellent source that a very high ranking EMS physician asked to be the Medical Director of the PFD for a salary. And if this occured the PFD was assured they would advance from Basic to a higher level of medical care--Intermediate or Paramedic. Peoples' lives in Peoria should not depend on whether the PFD paid off a physician.

8. Unfortunately for Dr. Miller, his Forum article was badly timed. He stated that the Peoria EMS, which he was Director, was meeting the needs of Peorians. The PFD warned Dr. Miller several months later that the needs of Peorians were not being met and that things needed to change before the media found out. Pre-hosptial patient management in Peoria was not optimum to say the least. The "negligence and poor care" that Dr. Miller was writing about was occurring under his watch.

Several months later, behind the scenes, Dr. Miller would give in and allow PFD paramedics to use their skills for the first time in Peoria EMS history.

More to come.

Looking Back....Let Peoria Fire Department Operate its Own Ambulance

Peoria Journal Star
February 23, 2005


Let Peoria Fire Department operate its own ambulance

On Feb. 1 the Peoria City Council voted to sell the only Peoria Fire Department ambulance, which has been sitting idle in a garage. It was never allowed to respond to 911 calls. Numerous firefighters who are certified paramedics are not allowed to use their skills. They have been wasted.

To help rectify this situation, I will purchase the PFD's ambulance at its present market value and donate it back to the PFD if these conditions are met:

1. This ambulance will be used for sick or injured Peorians and staffed by PFD firefighters/paramedics allowed to use their advanced life support skills in Peoria.

2. Doctors George Hevesey and Rick Miller have been directors of the Emergency Department at OSF for the past 15 years. They have controlled all ambulances in the area. Both physicians need to publicly declare any fees, stipends, salaries or other benefits they've received from their relationship with Advanced Medical Transport, the only company allowed to operate in Peoria.

3. OSF's Emergency Medical Services Department needs to provide health-care data for the past decade to the city manager and City Council revealing how Peoria's pre-hospital patients did when cared for and transported by AMT. This data was conspicuously absent in the 149-page consultant's report that evaluated fire and emergency medical services in Peoria last year.

The medical ambulance debacle in Peoria, plagued by conflicts of interest, confusion and corporate greed for many years, needs to end.

Dr. John Carroll
Peoria
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My comments today March 29, 2009:

1. I wasn't taken up on any of my offers. I thought it would be win-win for the city of Peoria. But other people influencing and making local EMS policy obviously did not agree.

2. I heard from an excellent source that a high ranking physician in the EMS circle approached the Peoria Fire Department (PFD) and tried to cut a deal with them. The PFD was allegedly told that if they paid this physician, the PFD would be able to advance their level of care for the people of Peoria. The PFD did not think this was the manner in which policy should be changed, and declined the offer.

3. Once again, the PFD remained at Basic level and non transport. As mentioned in the previous post, the PFD ambulance was sold.

Looking Back...Should the Peoria Fire Department Sell its Only Ambulance?

Peoria Journal Star
December 12, 2004


Should Peoria Fire Department sell its only ambulance?

What will the city do with the one Peoria Fire Department ambulance that sits alone and unused? Will it be sold for something more important than saving people's lives?

In September, the Matrix Consulting Group evaluated Peoria's emergency medical services. Matrix reported that the fire department's average response time to life-threatening emergencies was almost two minutes faster than Advanced Medical Transport's. Since the fire department can only provide basic life support, patients frequently wait until AMT arrives for paramedic intervention.

One plan formulated by the consulting firm to improve service was to target certain areas with four non-transport fire department engines. These vehicles would be staffed by firefighter/paramedics who would provide advanced life support. The fire department has paramedics who could provide their expertise for these engines.

The problem is the two physicians who have controlled ambulances in Peoria for the last two decades don't support the fire department's advancing from basic life support service to advanced life support. Unfortunately, Peoria firefighter/paramedics are not allowed to use their paramedic skills at emergencies.

Matrix noted the fire department has applied to the physician in charge of ambulances to outfit its only engine with various basic and advanced life support medications and equipment. That request was denied.

The boards of directors of our local "health-care industry," and the doctors who have been responsible for ambulances in Peoria, need to disclose their private interests and explain why selling the one and only fire department ambulance is beneficial to sick and injured pre-hospital patients in Peoria.

Dr. John Carroll
Peoria

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My Comments today March 25, 2009:

1. Peoria Area EMS did not take the suggestions of Matrix. Peoria Fire Department firefighters/paramedics were not allowed to use their advanced skills saving lives.

2. The Peoria Fire Department sold their one and only ambulance.

3. It took until the middle of 2005 for change to occur.

Looking Back....OSF and Willie Fortune

What was happening in 2004 at OSF was unimaginable.

OSF was going to let Willie die in Haiti from a worn out pacemaker. And Willie had been on the cover of the Children's Hospital of Illinois (CHOI) magazine a few years before. Now he seemed to mean nothing to CHOI.

At the same time, Jackson Jean-Baptiste was becoming more ill in Haiti and OSF would not allow him to return to OSF either. Jackson would be dead in early 2006.

Read how OSF's administrator seemed to find some humor in Willie's picketing the hosptial. Doesn't seem possible, but it happened.



Peoria Journal Star
June 16, 2004

ELAINE HOPKINS

Haitian Hearts doctor pickets Saint Francis

PEORIA - Dr. John Carroll and Willy Fortune, a 16-year-old heart patient, picketed OSF Saint Francis Medical Center on Tuesday because the hospital has refused to provide heart care to Fortune.

"I'm asking for a good pediatric cardiology exam," he said. Haitian Hearts is willing to fully pay for the care, Carroll added, but St. Francis has refused.

Fortune received a pacemaker at St. Francis in 2000. When St. Francis would not replace it this year, Carroll arranged for Fortune to have the surgery done May 21 at Vanderbilt Children's Hospital in Nashville, Tenn. More care is needed, he said.

"You just don't replace a pacemaker and forget about things," Carroll said.
Carroll said he should not have to take Fortune back to Nashville. "He's here. This hospital has a value system. He's a St. Francis patient."

On Tuesday, Carroll carried a sign with a photograph of Fortune on a poster the hospital used in 2000. It stated "Willy, a mended Haitian Heart at Children's Hospital."

Fortune said he was feeling "good, but was hungry after a long day of picketing."

St. Francis spokesman Chris Lofgren said the hospital would not comment on Carroll, an emergency room physician for 21 years who was fired in December 2001.

Last year, Haitian Hearts became an independent foundation that can accept tax-deductible gifts, and continues to raise money to bring Haitian patients to the U.S. for heart and other care. In 2003, it brought in 16 patients. So far this year, the organization has brought in three patients, Carroll said, and others are planned.

Haitian Hearts was once a part of Children's Hospital at St. Francis, but the hospital severed ties with the group in July after the two entities could not agree on several issues. Since then, the hospital has refused to participate in Haitian Hearts' program.

Carroll also said the Illinois Attorney General's office has been investigating whether St. Francis misused funds donated to its Children's Hospital that were earmarked for Haitian Hearts. People have told him about donations which never were credited to Haitian Hearts, Carroll said. He complained to the Attorney General's Charitable Trust division, he said, and provided the office with records.

"We responded in detail" to the attorney general, Lofgren said. "As far as I know, it's over."

A spokesman for the attorney general, Scott Mulford, said Tuesday that the office is still "looking into the situation."

Carroll said people should be alarmed about St. Francis' refusal to provide care for Fortune.

For the hospital to refuse care to a former patient "is unprecedented," he said. "Where are the Catholic ethicists at St. Francis?" he asked.
---------------------

My Comments from today March 25, 2009:

1. My wife Maria and I were working in Haiti in early 2004.

2. Willie’s mom brought him to me because he was short of breath. He could walk up a small incline, but walked slowly and was quite short of breath. My exam in Haiti revealed that his pacemaker was malfunctioning. Willie’s pacemaker was on a back up mode which was keeping him alive. He needed a new pacemaker.

3. Willie had been operated at OSF in Peoria in 2000. He had an extended stay in the hospital. Willie had a permanent pacemaker put in at that time. Many excellent people took care of Willie at OSF.

4. However, OSF would not accept Willie back in 2004 even with Haitian Hearts offering complete charges for the new pacemaker. The pacemaker would have been donated by the company for an international patient, and so would not have cost OSF anything. And pacemakers are frequently placed as outpatients.

5. His host family in the Peoria area was shocked and worried. We all thought this may be the end for Willie. We wondered how OSF could turn their back on this young man after he had survived two heart surgeries at OSF a few years before. This did not seem possible.

6. So for the next few months we looked for another medical center in the United States to accept Willie Fortune.

7. In a convoluted fashion Willie was accepted at Vanderbilt Children’s. Haitian Hearts donated $5,000 dollars to Vanderbilt Children’s for the procedure.

8. When Willie showed up at Vanderbilt Children’s, they kept him in the hospital and performed the procedure in a semi urgent fashion. The Vanderbilt Children’s Administrator questioned OSF’s medical ethics when OSF refused Willie.

9. Willie did great after receiving the new pacemaker and came to Peoria to live with Maria and me while he recovered. We walked along the Rock Island Trail and he was able to walk well.

10. For the first time in all of Haitian Hearts history, a physician at OSF who had taken care of Willie in 2000 refused to give Willie a complete cardiac exam in his office. The physician was very frightened to check Willie.

11. So, as the article states, Willie and I picketed OSF. While we were picketing OSF’s administrator Keith Steffen showed up at Sister Canisia’s big plate glass window that looked out over Glen Oak Ave. Mr. Steffen stood slightly behind Sister Canisia and threw back his head and acted like he was laughing at Willie and me on the sidewalk. Sister Canisia could not see Mr. Steffen’s antics. Willie witnessed all of this too but did not understand the inappropriate behavior of Mr. Steffen.

12. The article states that hospital spokesperson Chris Lofgren had no comment. What was Mr. Lofgren to say? Should he have said that everyone at OSF felt great rejecting Willie and that OSF would have left Willie in Haiti to die from a worn out pacemaker after OSF had been offered full charges by Haitian Hearts?

13. And I asked in 2004 where OSF's ethicists were. I am still asking the same question in 2009.

14. Pictured above is Willie's mom in Haiti a few months ago. What right does any medical center have to turn down her son? What right does any medical center have to turn down her son after full charges have been offered for his medical care?

Evidence Against "Stay and Play" Pre-Hospital Care

Emergency Physicians Monthly published an article in February, 2009.

The article concerned pre hospital patients suffering trauma (car accidents, etc.) The Ontario Pre-hospital Advanced Life Support Study (OPALS) was used as evidence. OPALS is the largest study examining the impact that Advanced Life Support (ALS) has on patient care.

In a before/after analysis OPALS analyzed the effect ALS (paramedic care) had on almost 3000 major trauma patients. The idea was to see how much ALS improved outcomes at the scene of a trauma.

Here is what they concluded:

"When on scene and transport times are considered, Basic Life Support is better than Advanced Life Support. The longer they stay, the worse the patients do.

"So is it time to get rid of Advanced Life Support? Probably not.

"We know that most, if not all, of the skills and procedures that EMT-I and EMT-P providers can perform are beneficial in the hospital setting or we wouldn't have extended such procedures and capabilities to them (pre hospital providers).

"The question is, "At what point in time in the field to we reach the point of diminishing returns on any additional time spent."

"This data tells a compelling story that time is, perhaps, the most critical factor in prehospital care delivery."

So what about Peoria?

In 2004 when my brother and I wrote these Forum articles, Advanced Life Support and rapid transport were considered the gold standard. However, the Peoria Fire Department was not allowed to perform Advanced Life Support or transport patients. The injured patient needed to wait for Advanced Medical Transport to arrive to give Advanced Life Support and transport the patient.

Would it not have made sense to allow the Peoria Fire Department to transport patients and give Advanced Life Support at the same time? The Peoria Fire Department had and has firefighters that are paramedics and work for AMT also. But these same firefighters were not allowed to give their paramedic Advanced Life Support while working for the Peoria Fire Department for trauma patients or any type of patient.

And the Peoria Fire Department still cannot transport trauma patients or ANY type of patient even today. This goes against the OPALS conclusions.

Looking Back...Peoria's Medical Mafia

Peoria Journal Star
July 27, 2004


Peoria's medical mafia limiting emergency care

Re. July 16 editorial, "Send corrupt health facilities planning board to morgue":
The Journal Star states that in Illinois, "Any board with this much authority over this much money becomes a trough of corruption." Truer words could not have been written.

For 30 years lobbyists, attorneys and politically connected people have influenced the decisions made by this nine-member board regarding construction of new hospitals and expansion of existing ones in Illinois.

Unfortunately, similar conflicts of interest and cronyism are currently occurring in Peoria. The stakes are very high here with lives and money on the line.

In Peoria we have one paramedic transport company, Advanced Medical Transport (AMT). Its medical director is Dr. George Hevesy, who happens to be the medical director of OSF-St. Francis' emergency department. Dr. Hevesy is salaried by both OSF-St. Francis and AMT. OSF is the main supporter of AMT and is also the base station for all emergency medical services in central Illinois.

The AMT board of directors, composed of prominent Peorians, has the support of the OSF-St. Francis board of directors. Dr. Hevesy's relationship with the Illinois Department of Public Health in Springfield, which regulates paramedics and ambulances in the state, is well known in emergency medicine circles throughout Illinois.

And finally, the Peoria City Council, which will decide if AMT remains in total control of paramedic care and transport in Peoria for the next decade, will consider the findings and recommendations of a California-based consulting firm.

Some members of the council suspect a pre-existing relationship between AMT and this California firm. One needs a scorecard to keep track of this local health care travesty.

In the meantime, the Peoria Fire Department continues to respond to medical emergencies, can only provide basic life support (not paramedic care) and cannot transport patients, even with its one ambulance.

The PFD obviously does not enjoy the support of the above-named individuals, boards and state agencies.

The real loss, of course, is for Peorians who suffer an out-of-hospital medical emergency. State-of-the-art, pre-hospital emergency care is not offered in Peoria, not because we can't, but because our medical mafia will not allow it.

Dr. John Carroll
Peoria

Looking Back....Let Fire Department Transport

See my comments that follow this Forum article.

Peoria Journal Star
February 28, 2004


Let fire department transport critically ill patients

The Peoria Fire Department purchased one or two ambulances recently. A Feb. 3 Journal Star editorial asked, ". . . what good is a fire department ambulance if it can't transport patients to the hospital?" Good question.

Perhaps a better question is, "Why can't the fire department transport patients in the first place?"

Fire department personnel, many of whom are trained paramedics, are the first responders to emergency medical calls every day. However, the fire department is not allowed to transport patients to a hospital and cannot provide advanced medical care at the scene.

Trauma patients must wait for paramedics from Advanced Medical Transport, a private ambulance company, to arrive. Since patient survival improves with faster response, the firefighters should be allowed to use their skills.

Control of ambulances and emergency medical services lies in the hands of the project medical director. The OSF-employed physician who held this post for nine of the last 12 years, Dr. George Hevesy, was paid a salary by AMT.

Freedom of Information documents from the state of Illinois reveal that OSF administrators knew and approved of this arrangement. There is an immense conflict of interest when a project medical director accepts money from a private ambulance company. Small wonder the fire department is not competing with AMT in the paramedic and transport business.

OSF should not allow an employee to accept money from an ambulance company he or she regulates. OSF also needs to explain why corporate profits have been given greater importance than fast emergency response times. City Manager Randy Oliver's commission on emergency services must address this conflict of interest.

The present project medical director, Dr. Rick Miller, needs to assure Peoria that the Peoria Fire Department will be adequately trained and allowed to transport patients in their new ambulances and that financial gain will not be allowed to override the public's right to the fastest and most efficient medical care possible.

Tom Carroll
Peoria

My comments today March 23, 2009:

1. My brother Tom wrote this article.

2. The PFD owned one ambulance at the time. However, they were never allowed to use it to transport patients in Peoria. They eventually sold the ambulance. The PFD still has no amublance today and cannot transport patients.

Last summer (2008) there was a bus accident in Peoria. Due to the number of patients involved, AMT was overwhelmed, and did not have the vehicles to transport all of the victims. The PFD could not transport these patients. So CityLink, the Peoria public transportation company, did transport these patients to local emergency departments. Doesn't something seem wrong here?

3. Tom thought that rapid transport for trauma patients may save their lives. The next post will provide information from a Canadian study that suggests rapid transport of trauma patients is the most important intervention.

4. The conflict of interest that my brother documented still continues today in Peoria. And there is no end in sight.

Looking Back...City Needs Independent Study of Amblulance Service

Please see my comments that follow the article.



Peoria Journal Star

January 10, 2004

EDITORIAL


City needs independent study of ambulance service

Peoria's new city manager, Randy Oliver, is organizing a commission to study emergency medical services (EMS) in Peoria. The editorial board of the Journal Star pleads for a fiscally responsible decision regarding these services. Local physicians need to insist that both fiscally and medically responsible choices are made for pre-hospital patients.

The EMS services in Peoria are provided by two agencies. Advanced Medical Transport (AMT) provides the only advanced life support service and transport of patients. This company is supported by Peoria's three hospitals and governing boards. AMT grosses over $7 million per year and desires a 10-year contract to remain the only paramedic and transport agency in Peoria.

The second agency is the Peoria Fire Department. Firefighters arrive quickly at the scene, but can provide only basic life support and are not permitted to transport patients.

The Peoria Medical Society needs to consider the following questions: Who will compile and interpret the statistics regarding local EMS care? What EMS issues will be analyzed? What is the response time for the Peoria Fire Department versus AMT to an emergency? How much time elapses from the 911 dispatch call until the electrical shock is administered to a patient in full cardiac arrest?

When AMT arrives at the scene and begins its advanced life support, have the patients waited longer than necessary? What percentage of Peorians survive and walk out of the hospital after suffering a cardiac arrest? Are Peoria's trauma patients transported quickly and efficiently with the "scoop and treat" philosophy? How does Peoria compare to other cities in the U.S. and Canada that have state-of-the-art EMS? Might it not be responsible and medically important to allow Peoria firefighters to advance their skills (such as improved airway control and IV medication administration) to improve patient outcome?

The most important question is: Can Peoria's EMS system be studied in an independent and unbiased fashion? The same doctors, administrators and boards of directors that made questionable decisions 10 years ago are still in absolute control today.

Thus, the Peoria Medical Society needs to do exactly what the first sentence of its mission statement professes: To promote the health and general welfare of the Peoria public.

Peoria's pre-hospital patients have never been in a more perilous situation.

Encourage Oliver's study to ask the correct questions and answer them using scientific rigor. Then and only then will fiscal and medically appropriate decisions be made regarding EMS in Peoria.

Dr. John Carroll
Peoria
-------------------

My comments today, March 22, 2009:

1. This Forum article was written 5 years ago. Since I submitted this article, the Peoria Fire Department paramedics have been allowed by OSF to give advanced life support drugs and can intubate the patient at the scene of an emergency. And two fire stations in Peoria have become paramedic. OSF EMS leaders were critical of my attempts to inform the public, but then the same doctors made the needed changes. More about this later.

2. The Matrix Consulting firm came to Peoria in September, 2004, six months after this Forum article, and documented that the Peoria Fire Department responded to life threatening emergencies almost two minutes faster than Advanced Medical Transport. (When I called the Peoria Area EMS office, I was told by the director that no statistics existed regarding how Peoria pre hospital patients were doing in Peoria's EMS.)

3. I did write the President of the Peoria Medical Society, Richard Anderson, M.D., during these years and he assured me that all was fine with Peoria's EMS. He also told me not to publish the contents of his letter.

4. In March, 2005, EMS Director Rick Miller, would write the Journal Star criticizing me. However, a couple of months later in 2005, a man would die in a Peoria restaurant, and Dr. Miller would change the policy. His policy change would allow the PFD paramedics to intubate the patient at the scene.

5. Even now in 2009, the Peoria Fire Department cannot transport patients. AMT still has this monopolized. I will report the summary of a study that states that quick transport in trauma patients can be life saving. Peoria is not there yet....

Good News for Katina

Please check this out.

The accepting medical center confirmed this today with her official medical record number.

This news was a great way to end the week.

Cardinal George's Letter to President Obama

Office of the President
3211 FOURTH STREET NE
WASHINGTON DC 20017-1194
202-541-3100 FAX 202-541-3166
Cardinal Francis George, OMI
Archbishop of Chicago



March 19, 2009


Honorable Barack Obama
President
United States of America
The White House
1600 Pennsylvania Avenue, N.W.
Washington, D.C. 20500

Dear Mr. President:

On behalf of the Catholic Bishops of the United States, I write to ask you to designate the country of Haiti for Temporary Protected Status (TPS) for a period of eighteen months. The United States Catholic Bishops Conference (USCCB) has a long history of serving the Haitian community, both in the United States and in Haiti, and has first-hand knowledge of the great humanitarian challenges facing the Haitian people.

As you know, a designation of TPS permits nationals of a designated nation living in the United States to reside here legally and qualify for work authorization. A designation of TPS is based upon a determination that armed conflict, political unrest, environmental disaster, or other extraordinary and temporary conditions exist in a nation and that the return of that country’s nationals would further destabilize the nation and potentially bring harm to those returned.

Haiti meets the standard for TPS because it has experienced political tumult, four natural disasters, and severe food shortages in the last year, not to mention the devastation of Hurricane Jeanne in 2004. In April 2008, starving citizens took to the streets to protest rising food prices, causing political instability.

In August and September 2008, Hurricanes Gustav and Ike and Tropical Storms Fay and Hanna passed through Haiti, causing severe damage and the death of close to 700 persons. Massive flooding from the storms has destroyed homes, crops, roads, and bridges, and largely rendered areas like Gonaives inaccessible to relief workers. Over 90 percent of Haiti has been impacted. Tens of thousands have been displaced, and the fate of thousands more is unknown. More than 300,000 children have been affected.

In addition, the conditions in Haiti are at least as bad, if not worse, than those in nations which recently received an extension of TPS. The Department of Homeland Security (DHS) announced late last year that it was extending TPS for El Salvador, Nicaragua, and Honduras because of “lingering effects” from the earthquakes in 2001 and from Hurricane Mitch in 2004. These effects included destroyed roads and bridges, high unemployment, and incomplete international development efforts.

We agree wholeheartedly with DHS’ decision to extend TPS to these countries. However, if “lingering effects” in these countries merit a grant of TPS, then so do the conditions in Haiti, where multiple disasters this year have left immediate and devastating effects.

Some observers argue that granting TPS to Haiti would cause a massive “boatlift” that would bring thousands of Haitians to the United States. In our view, this argument holds little merit, since TPS is only available to Haitian nationals already in the United States at the time of the designation. No such boatlift occurred in 1997, when President Clinton granted Deferred Enforced Departure (DED) to Haiti, or in subsequent years when Haiti experienced increased political violence and civil unrest. Additionally, few Haitian water craft currently exist, having been destroyed by the recent storms.

Another consideration is that designating TPS to Haiti would allow Haitian nationals already in the United States to work and send much-needed remittances back to their poverty-stricken homeland. The Inter-American Development Bank reports that Haitians abroad sent close to $1.83 billion home in 2007, which equals about 35% of the country’s gross domestic product. It is critical that this life-blood of the fragile Haitian economy be sustained.

Mr. President, by any measure, the conditions in Haiti meet the statutory requirements for TPS. There has been “substantial disruption” in living conditions and Haiti is “unable to handle adequately” the return of its citizens abroad. Extending this mantle of protection to struggling Haiti is a just, compassionate, and concrete step the United States can take toward alleviating the human suffering of the Haitian people.

Thank you for your consideration.

Sincerely yours,

Francis Cardinal George, OMI
Archbishop of Chicago

Interview with Heurese

March 15, 2009

The following is an interview I did with Heurese.

The interview was conducted in Creole and translated into English. The words in English are not direct translations of her words in Creole, but are very close. Her narrative’s meaning is the same in both languages.

I left out my interview questions and wrote this in the first person. It is in chronological order as Heurese's life has played out.
-----------------------


I was born in Bainet, Haiti in 1978. Like the rest of my brothers and sisters, I was born at home. I have four brothers and four sisters. My mom is living in Bainet now. My parents were never married.

Bainet is on Haiti’s southern peninsula and is a seacoast village. I don't know how many people live in Bainet. We lived up on a mountain side and we could see all that was happening in Bainet. We could also see the ocean to the south.

My father is dead. His name was Vicaisse. He died in February, 1991 at age 41 years. I was about 13 years old when he died.

My father was a fisherman and he use to drop lines into the ocean from a cliff perched above the water. He and a friend left home about 6 PM and sometimes they did not get back until morning.

One night my father and his friend made a fire and sat down on the cliff. His friend was sitting about twenty feet away from my father. At some point his friend hollered out to my father but my father did not answer. His friend walked over to the place where my father was fishing and my father had disappeared.

My father’s friend looked down and saw my father in the ocean below. My father yelled back up that he did not know how he ended up in the ocean. My father said that he did not jump.

My father’s friend threw some rope over the edge of the cliff, but my father could not get to it. So my father’s friend descended the cliff and by the time he got to the water, my father was gone.

My father’s friend came back up the road to our house sobbing.

They searched for my father’s body for two days without success.

My mother went “fou” (crazy) after my father’s death. She talked and screamed a lot. She had to be tied to a chair.

Before my father died, my life was pretty good. I went with him in the morning when he worked in the field. When I stayed at home with my mom she spanked me a lot. But my father disagreed with this and he did not spank me. My father knew that there was something wrong with me. Even when I was four years old my legs were swelling.

Since my father died, my life hasn’t been good. Mwen pa viv bien.

After my father died, my mom made us get up very early and herd the goats and pigs into the woods. My mother still works very hard. Her name is Dieuta. She is about 62 years old now. She doesn’t sit down much.

I love my mother because she carried me in her abdomen for 9 months. She spent a lot of money on me over the years when I was sick. But she didn’t speak nicely to us when we were growing up and spanked me a lot.

(I have spoken to her since surgery in December, 2008 and she is happy that I survived. It was a nice conversation. But she doesn’t really understand.)

My mother goes to a market on a donkey. The market is a long ways away. It is near Mirogoane. She buys beans, bananas, yam, peanuts, and several types of fruit. She sells them from our house which sits right along the road above Bainet.

My mother does not go to church.

My mother does vote. But she does not say who she is voting for. In Haiti that can be dangerous. My brothers go to a church that forbids them talking about politics.

I went to grade school in Bainet. But I was sick a lot. I went to the local Baptist church. I was in the choir and I went on “missions”. I was baptized when I was 12 years old. Now I don’t go to church but I still believe in God.

As the years went by, I moved into Port-au-Prince and went to school in Petionville. When I did not have my lessons done correctly, my teacher would beat the palms of my hands in class with a whip. I would cry and become quite short of breath. Finally, I got so sick that I needed to go back to Bainet.

The years passed in Bainet, and by the time I was 18 years old, I was very sick.

My mother and I went to the houngan's home in Bainet and we both lived with him for two months. My mother paid him a lot of money to care for me.

The houngan believed I had five zombies inside of me. He would beat me to try and drive the zombies out. Also, he made a potion of leaves mixed with water and spread it all over my body including my face. It smelled terrible. Also, this concoction got into my eyes and I could not see.

An elder in the village convinced my mother to take me to our local hospital in Bainet. The houngan asked my mom for $5000 Haitian in order for me to come back to him. After I left the hospital, I could see better and my mom never took me back to the houngan and did not pay him any more money.

I went back home all swollen and was at home in Bainet for about 6 months with no medication. I laid in bed in my mother’s house. I had no medication. Fluid was leaking out of my legs. Many people from Bainet came and visited me and I could hear many of them say that I was going to die.

My mother said I was going to die too. She went out and bought me a mahogany casket for $1,000 Haitian dollars. She put it up off the floor hanging from the boards above. I stared at the casket but I did not think that I would end up in it. My mother thought that someone in Port had sent a zombie to me. I tried to assure her that no one was upset with me in Port and I didn’t believe in zombies. I didn’t think I was going to die.

The doctors in Bainet eventually told my mom that I had tuberculosis and started treating me with injections for tuberculosis.

My mother took me to the General Hospital in Port but most of the hospital was on strike. I went to another hospital in the capital and they told me that I did not have tuberculosis. They told me that I had heart disease. The doctors also told me that I was going to die. However, the doctors at this hospital wrote a note to the doctors not on strike at the General Hospital.

I went back to the General Hospital Emergency Department and they admitted me to a part of the hospital that was still working. They started treating my heart disease and I felt better. I could breathe better. I was in the General Hospital for 15 days. My mothers and sister Vita took care of me there.

The doctors at the General Hospital told my mother that I needed to go to Milot for heart surgery. Milot is a northern city near Cap Haitian. A group of foreign doctors come in once a year and do heart surgery for a couple of weeks.

I was released from the General Hospital and lived in Port with a relative. I returned to the General Hospital every month where I received a shot of penicillin and got more heart medications.

During this period of time I started to feel better. My mother and Vita were working in Bainet and Port, saving their money, and making plans to send me to Milot for heart surgery.

During the days before I was to leave for Milot, I was staying in my aunt’s home in Port. The night before I was to leave Port for Milot, I had a dream. In the dream someone came to me and told me not to go to Milot. After the dream, I woke up early, got up, and snuck to a friend’s house. The driver that had come to take me to Milot could not find me.

I remained in my friend's house for three days.

When I returned to my aunt’s house, my mother and Vita were really mad. They said they were finished with me and refused to pay for any more medication for me or to take me back to the General Hospital.

So I went back to Bainet and stayed a few months in my mother’s home. I felt better but needed more medication. Eventually my mother gave in and paid for more medication. I had been without medication for three months.

In 2002 I decided to go back into the Port to make peace with my sister Vita. Vita was working at a home for disabled children. The home is called Notre Maison.

When I arrived Vita told me that her boss, the director of Notre Maison, had met Dr. John and told him about my medical problems.

I immediately went to see Dr. John. He examined me and told me that he would bring me to the U.S. for heart surgery. I went back to Bainet and told my mother this. She said that Dr. John would never take me.

Dr. John took me to the U.S. for heart surgery in 2002. I did very well and felt good after surgery.

I have no jealousy towards the people of the United States with all that they have. I believe the people in the U.S. deserve what they have because they work hard.

When I came back from Haiti after my surgery in October 2002, I traveled alone on a bus from Port to Bainet. I was dropped off in Bainet with my one suitcase and met my sister Jenny at her school in Bainet. Jenny was happy to see me.

Jenny and I walked up the mountain for 45 minutes and arrived at my mom’s house. Jenny helped me carry the suitcase.

When I got to my house in Bainet, the doors and windows were closed. I knocked on the door and no one answered. Eventually Jenny put her finger on her lips like to say “shhh”.

My mom finally came to the door and asked me why I came back from the States. She asked my why I didn’t stay there and work. She was very mad at me for returning to Haiti. A passerby on the street heard my mother shouting at me and intervened and tried to be a peacemaker. After some talking, my mother calmed down and let me in the house and things were better.

In July 2003, I moved back to Petionville and took a part time job with a missionary from Canada. I worked in her school in Delmas.

I also met a young man who I liked very much. He was from Bainet.

I became pregnant with his child. However, his family were devout Baptists that thought a man and a woman should be married when having children. However, they were very much against their son marrying me because they described me “pa youn moun anke”. What this means is that I was not a whole person, I was just a "piece of a person" because I had heart surgery in the United States.

One day in 2003 I was eating with my boyfriend at his place in Bainet and was given a plate of rice and beans. He was given the same meal on a different plate.

After the meal, my boyfriend went to Jacmel to collect his check from Teleco. He supplied me with money.

But in Jacmel he became quite ill. The next day he found someone with a motor scooter to give him a ride back to Bainet. My boyfriend was so weak that he had to be tied with a rope to the driver so he would not fall off the motor scooter.

When my boyfriend arrived in Bainet he was very sick and was vomiting blood. His last words to me were that his family had tried to poison me, but they got the plates of food mixed up, and in fact had accidentally poisoned him.

He died 10 days later after that meal of rice and beans. I did not go to his funeral. His family was mad at me and said that my mother was the person that poisoned their son.

Two months later I delivered our baby girl.

I went back to Carefour. Carefour is a zone in Port.

The years went by and I met another young man and had a baby boy with him in 2004. He stayed with me for two years but then left us for another woman.

In March, 2008 I became quite ill again. I was too sick to go to Mirogoane to the market to buy used clothes to sell in the market in Carefour. I sold fruit in the market in Carefour when I felt good enough. However, I had no constant source of food to give to my children and my health was deteriorating. None of us were eating regularly. I thought I was going to die.

I gave my children to my family members in Bainet and went back to Carefour to live in our one room shack with my 19 year old brother, Saint Louis.

In addition to all of this, Haiti’s food prices are very high and we had food riots last year. Four hurricanes hit Haiti last year and many people starved to death all over Haiti.

And the kidnappings continued in 2008.

However, one day my brother Saint Louis, was in a cyber cafe in Carefour. A young man entered the cyber cafe and asked my brother if he could type a quick e mail on my brother's computer because he had no money. My brother agreed.

My brother noted that this young man, who he did not know, was sending an e mail to Dr. John. Saint-Louis asked the young man how he knew Dr. John. The young man, whose name is Frandy, replied that he had a heart problem too and was taken to the United States also by Haitian Hearts. Saint Louis then told Frandy that I was very sick, and that I had heart surgery in the United States in 2002, and needed to see Dr. John as soon as possible.

A few weeks after that Frandy came to visit me and asked me questions about Dr. John and his family to see if I really knew him or not. I answered the questions correctly and Frandy believed me.

Frandy contacted Dr. John and told him that I was very sick and needed help. Frandy helped me a lot.

When I found out that OSF in Peoria would not accept me back for repeat heart surgery, I thought it was because I had done something to hurt my heart after they fixed it and that the hospital was mad at me. Dr. John assured me that that was not the case.

In December, 2008 I returned to the U.S. for heart surgery at a different hospital. I am gaining weight again and feel good. When I go back to Haiti, I hope to move to a cleaner and safer area of Port. I live near the gang members in Carefour. I hear in the mornings how they asked people for their money or cell phone as the people are heading to Carefour market. If people do not give them something, they will be killed by the gang. But the gang in Carefour is not as bad as the gangs in Soleil.

I think the UN provides good security for Haiti. However, Haitian girls sell themselves to UN soldiers all of the time for money. This is how Haitian girls can feed their families. This is Haiti’s biggest problem.

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Heurese Asks OSF for Help

March 16, 2009


Dear OSF Charity Assistance Program and Sister Judith Ann,


My name is Heurese Joseph and I am from Haiti. I am 30 years old. Dr. John Carroll is helping me write this letter to you since I don’t speak English.

I am humbly requesting an echocardiogram to be done pro bono by OSF through the Charity Assistance Program. I would have it done as an outpatient at HeartCare Midwest. The cardiologist that would read the echocardiogram told Dr. John that he would read it for no charge.

In 2002, Dr. John brought me to OSF for heart valve surgery and closure of a ventricular septal defect. I was very thankful for all the physicians and nurses who took care of me at OSF.

I returned to Haiti in 2002 and Dr. John and his wife Maria returned to Haiti many times during the next six years. Dr. Carroll examined me each year and Haitian Hearts brought me medicine and provided me with echocardiograms in Port-au-Prince.

However in 2008 I became quite ill again and had to give my two young children to my family to care for. I was in congestive heart failure and could not feed my children or myself. I felt like I was dying.

Dr. John examined me again and another echocardiogram showed that I needed repeat heart surgery.

During November, 2008 Haitian Hearts moved me to a guest house in Port-au-Prince for the entire month. I was able to eat three meals a day and did not worry about being kidnapped from my home in the slum.

Since OSF-SFMC would not accept me back last year, Dr. John fortunately found another medical center to do my surgery. In December, 2008 I was successfully operated and have a new aortic valve.

I am living with Dr. John and his family during the last month of my stay in the United States. I feel great for the first time in a long time.

I have no income in Haiti. My mother, who is also very poor, pays equivalent to 90 dollars U.S. every six months for my one room home in Port-au-Prince. The room is about 15 feet by 15 feet. I share it with my 19 year old brother.

I have no running water and cook on a charcoal grill outside my front door. I have electricity occasionally. My hope is to move to a safer and cleaner area of Port-au-Prince with my children when I return to Haiti.

Dr. John stopped my Coumadin today and started me on another type of blood thinner. My surgeon wants me to have an echocardiogram in one week. We have to be sure that my new aortic valve is working properly.

Please allow me to have my echocardiogram done free of charge. I have no funds to pay you.

Thank you for all you did for me in 2002.

Sincerely,


Heurese Joseph



P.S. Please forward a copy of this to Sister Judith Ann Duval at OSF Corporate. I know that she would not refuse me.

University of Chicago ED Halts New Policies

Chicago Hospital to Halt New Emergency Department Policies After Criticism

Kathleen Louden

Medscape Medical News 2009. © 2009 Medscape

March 16, 2009 (Chicago, Illinois) — After 2 national emergency physician groups took the unusual action of separately voicing concerns last month about emergency department (ED) policies at a large Chicago hospital — policies they believe could reduce patient access and quality of care — the hospital has said it will reconsider its policies.

At the center of the controversy is the University of Chicago Medical Center, which recently announced reorganization plans, including reducing the number of inpatient beds available to emergency patients by more than 30 and expanding efforts to redirect to other hospitals and clinics those ED patients who do not need emergency care. The tertiary care hospital, which has a high percentage of Medicaid patients, reported that about one third of the patients who come to its ED have nonurgent conditions. In a news release last month, the medical center said the changes, along with other cost-cutting measures, were needed to "meet today's financial challenges."

The University of Chicago Medical Center has decided to halt plans to redirect patients deemed nonurgent from its ED to other facilities, the Chicago Tribune reported on Saturday. The move came after external and internal protests of the plans.

Reorganization Opposed

Both the American College of Emergency Physicians (ACEP) and the American Academy of Emergency Medicine (AAEM) made public statements opposing the proposed reorganization. ACEP also questioned whether the south side medical center's treatment of a young dog-bite victim nearly violated the requirements of the Emergency Medical Treatment and Labor Act (EMTALA).

ACEP, the country's largest professional association of emergency physicians, commented on the individual case because its leadership believes the case represents a growing national problem, said the college's president-elect, Angela Gardner, MD. She spoke to Medscape Emergency Medicine in a phone interview.

"The concern of the American College of Emergency Physicians is that [more and more] hospitals across the country are taking measures that fulfill the letter of the law for EMTALA but decrease care for patients," said Dr. Gardner, an emergency physician at the University of Texas Medical Branch at Galveston.

The case involves 12-year-old Dontae Adams, who last August was attacked by a pit bull that allegedly tore off part of his upper lip. According to the February 13 Chicago Tribune, the boy's mother alleged that the University of Chicago ED physicians did not adequately treat her son because they did not want to accept his Medicaid insurance. The mother claimed that the ED staff gave the boy only painkillers, a tetanus shot, and an antibiotic prescription; refused to perform reconstructive surgery; and instructed them to follow up in a week with the county public hospital, John H. Stroger Jr. Hospital of Cook County, regarding possible reconstruction.

Instead, the mother immediately took her son by bus to Stroger Hospital on the city's west side, where Dontae underwent successful reconstructive surgery on his lip the same day.

The Tribune also cited the University of Chicago's plans to expand a "controversial program aimed at clearing its ER" of patients with nonurgent injuries and illnesses by redirecting them to community hospitals and clinics.

Emergency Physicians Speak Out

In a written public statement February 19, ACEP said "the University of Chicago Medical Center is failing in its obligation to treat emergency patients" and its policy toward emergency patients is "dangerously close to 'patient dumping.' "

Nick Jouriles, MD, president of the Dallas, Texas–headquartered ACEP and an Akron, Ohio, emergency physician, said in the statement, "This is a dangerous precedent that could have catastrophic effects in poor neighborhoods across the country."

University of Chicago officials said Dr. Jouriles did not attempt to verify the facts of Dontae's case. On its Web site, the medical center disputed ACEP's claims and reported that its pediatric ED physicians determined it was not medically appropriate to close the boy's wound at the time.

"He got the full treatment he needed here," said Robert Mulliken, MD, medical director of the adult ED and interim co-section chief of emergency medicine at the University of Chicago Medical Center, in a telephone interview with Medscape Emergency Medicine.

A hospital spokesperson said the boy's treatment included intravenous antibiotics, pain medicine, and cleaning and dressing the wound.

However, ACEP's Dr. Gardner said emergency physicians must consider not only legal obligations but also moral and ethical responsibilities to the patient.

"Every action we take as emergency physicians should pass the 'Aunt Betsy' test: 'Is it good enough for your Aunt Betsy?' " she said. "If not, I don't think it's something emergency physicians should be doing."

Days after ACEP's statement last month, the Milwaukee, Wisconsin–headquartered AAEM told the Chicago Tribune that the University of Chicago Medical Center should "re-evaluate its triage and screening examination policies."

AAEM President Larry Weiss, MD, JD, told Medscape Emergency Medicine in an email that the academy received information from University of Chicago physicians that the hospital had "drastically changed" the manner in which nurses and physicians perform triage and screening examinations in their ED. The doctors told them, "A physician is now directed by policy to discharge a patient at the time the physician determines that the patient is stable, rather than completing a diagnostic evaluation and providing admission or appropriate outpatient treatment," wrote Dr. Weiss, professor of emergency medicine at the University of Maryland School of Medicine, Baltimore.

"AAEM has a policy stating that an emergency department may triage a patient to another facility for treatment and follow-up care," he added. "However, this must be done in a safe manner. Hospitals should not merely tell patients to go to another hospital without proper referral."

"Triage Out": Pros and Cons

To do so is a form of "triage out" — sending low-acuity patients, after a medical screening examination, out of the ED to receive care at an urgent care center, clinic, or physician's office. One expert who spoke with Medscape Emergency Medicine called it the "push" system of triage out.

Arthur Kellermann, MD, MPH, chairman of the Institute of Medicine's planning committee for the National Emergency Care Enterprise workshops, described the "push" system: "We've looked you over. You're not that sick. Now go away."

The danger is that patients without private insurance often do not have access to care elsewhere.

"If we don't see them in the emergency room, they will not get the care they need, and some of them will come back much sicker," said Dr. Kellermann, professor and associate dean for health policy at Emory University School of Medicine in Atlanta, Georgia. "Most of my colleagues are unwilling to not treat [low-acuity] ED patients if they do not have reasonable assurance that the patients have someplace appropriate to go."

Still, advocates of triage out say it is more efficient and decreases misuse of the ED. The University of Colorado Health Sciences Center in Denver and its affiliate, Denver Health Medical Center, use a triage-out plan in their EDs. Christopher Colwell, MD, associate director of emergency medicine at Denver Health, told Medscape Emergency Medicine that the screening process works well there. Their program gives patients deemed as having nonemergent problems the option of going elsewhere and getting help making the appointment, or of receiving treatment in the ED but paying an insurance copayment or full payment up front.

The approach does, however, have limitations, he said. Any triage-out program must be blind to patients' insurance status before the medical screening examination, Dr. Colwell stressed. As a result, the ED will lose the revenue of any insured patients it screens out. Neither does the approach solve the problem of ED "boarding" due to lack of inpatient beds. Also, the triage staff could miss a true medical emergency.

Most emergency physicians who have not used triage out are uncomfortable with the concept, Dr. Colwell said, which he can understand. He said he sometimes thinks, "Selecting out patients we're not going to see goes against what our specialty is about."

A good way of screening out ED patients whose conditions are not emergent is a "pull" system, Dr. Kellermann said. Before discharge the hospital arranges accessible options for the patient, such as a medical home for primary care.

University of Chicago Tells Its Side

That is what the University of Chicago Medical Center is trying to do with its Urban Health Initiative and South Side Health Collaborative program, hospital officials said. The South Side Health Collaborative sends patient advocates into the ED — after treatment, if needed — to help patients with nonemergent conditions establish an ongoing relationship with a community health center or physician if they do not have a medical home.

By doing so, the medical center hoped to eventually reduce the long waiting times in its ED and to more quickly treat the severe injuries and illnesses that, as a level I trauma center, it is best equipped to handle, said Carolyn Wilson, RN, MBA, chief operating officer, University of Chicago Medical Center. At the same time, it would send business to partner hospitals and clinics that want to provide less complex urgent care and can do so at much lower cost than the academic hospital can.

"Our emergency department demand outstrips our capacity," she told Medscape Emergency Medicine in a phone interview. "Part of the controversy is that we're not trying to grow, like most hospitals. We're trying to be good stewards of limited resources across the south side [of Chicago]."

Most of the changes proposed for the ED have not yet occurred and are still being refined, Ms. Wilson said. The hospital did eliminate its urgent care center on February 8 and plans to add a resident physician to help the triage nurse. But the policy change announcement likely means that those plans are on hold.

The University of Chicago Medical Center, she said, is trying to create a national model for urban hospitals and to be a leader in finding solutions to the problems facing emergency care in the United States.

John Fildes, MD, chair of the American College of Surgeons Committee on Trauma and a University of Nevada trauma surgeon, agreed that the US emergency care system is broken. But he said, "The underpinning principle is that patients have to have access to care that is reliable, accountable, and affordable."

Some of the University of Chicago Medical Center's own physicians apparently consider patient safety threatened by the hospital's plans to decrease the number of inpatient beds available to emergency patients requiring admission. More than 190 fellows and residents from multiple specialties — including emergency medicine — protested the plan in a letter addressed to hospital trustees, The Wall Street Journal reported last week.

They wrote that "these changes directly violate our oath as physicians to do no harm."

None of the sources in this article reported any financial conflict of interest.
Discuss This Article in Physician Connect »

Haiti's Kidnapping Nightmare

Haiti has had many kidnappings during the last three years. More kidnappings have occurred in Haiti the last few years than in any other country in the Western Hemisphere. There were hundreds of people kidnapped in 2006, 2007, and 2008. Everyone is fair game to be taken. Both children and adults are kidnapped.

Twenty-five U.S. citizens were kidnapped in 2008. We have known a fair number of people who were kidnapped or had family members kidnapped and Haitian Hearts has been involved in negotiations for their release.

This video tells the story of a man named Phil. After he was kidnapped in Port-au-Prince several years ago, we were with his family. There was much anxiety as deliberations went on between the kidnappers and the FBI. Phil's family was not allowed to talk to him on the phone or to deliberate with the kidnappers.

The night he was released, he appeared amazingly good for all that he had endured. While he was held in the slum, he told us that he couldn't understand why family members would not answer when the kidnappers called them on his cell phone. Phil understood after he was released that the FBI did not want family members offering outrageous ransoms and getting in the way of deliberations. It was a very tricky business.

We examined him the night he was released and started him on antibiotics for the shotgun wound to his left shoulder.

Phil left Haiti 5 days later with a child that needed eye surgery in the States. Phil and his family continue to work in Haiti today.

All kidnappings in Haiti must stop. Prostitution and kidnappings are not the answer for poor people that need money. Real long term, fair paying jobs for Haiti is the answer.

Looking Back

The last post takes us to the end of 2003.

The next series of Looking Back posts will be about the ambulance monopoly in Peoria and how it changed in the last few years. Some of the posts will be about OSF's denial of care to Haitian kids that continues today.

Looking Back...Haitian Hearts Expands to National Program

Peoria Journal Star
September 21, 2003

ELAINE HOPKINS

Haitian Hearts expands to national program -- Group continuing mission as independent foundation

PEORIA - Cut off from OSF Saint Francis Medical Center, where it operated for years, Haitian Hearts is expanding into a national organization.

It now has 16 patients who have undergone heart surgery this year or who have been accepted for surgery at hospitals in New York, Virginia, Florida, Ohio and elsewhere in Illinois, founder Dr. John Carroll said.

"We're really happy," he said.

The group has become an independent foundation and can accept tax-deductible gifts. It will continue to raise money and bring Haitians to the United States for treatment, Carroll said.

Several of the surgical procedures this year are being funded by the Rotary Club's Gift of Life program, through contacts he made in New York, Carroll said. This program pays hospitals $5,000 per case.

Haitian Hearts arranges for the surgery, negotiates discounts with hospitals when payment is necessary, Carroll said, and pays for travel, visa and other expenses.
Physicians donate their services, and hospital social workers find temporary placements for the patients, mostly children, as they recover, he said.

The downside, he said, is that the patients no longer will be staying with families in the Peoria area. Many people have benefited from the experience of hosting these children and developing contacts with their families in Haiti, he said.
Carroll said the Haitian Hearts program arranged for 17 patients to have surgery last year, with 15 of those at St. Francis.

Since the program began, it has brought almost 100 Haitians to the United States for life-saving treatment. Most are children and most had heart surgery unavailable in Haiti.

"We gave Children's Hospital (at St. Francis) $1.1 million over six years. In cash," Carroll said.

But in July, OSF Healthcare System and the Catholic Diocese of Peoria announced they would no longer participate in the program after financial negotiations failed.

Carroll said St. Francis then was offered $25,000 cash to perform a surgical procedure, but the hospital refused to accept the patient, who was successfully treated elsewhere for $5,400.

St. Francis spokesman Chris Lofgren said the hospital would not comment.
Last December, St. Francis refused to approve any more visas for medical care for the Haitian 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.
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1. As the article mentioned, we were very happy to have patients operated on elsewhere. These kids stood no chance in Haiti without surgery.

2. Late in 2003, Haitian Hearts noticed that we had received no funds from OSF. Generous people in the community were still donating to Haitian Hearts but their donations were going to Children's Hospital of Illinois. And we became a 501 C 3 not for profit in 2002. We questioned OSF Foundation repeatedly and they said they would provide us with a donor list, but they never did. If we didn't get the funds we at least wanted to know who to thank. Finally, late in 2003, OSF turned over a check to Haitian Hearts signed by Keith Steffen and Sister Canisia for money that was donated to Haitian Hearts, not Children's Hosptial of Illinois. (I am quite sure that Sister Canisia had no idea that she was giving us our own money back.) Children's had taken the money, was going to keep it, except we kept after them for it, so they finally gave it up. And they never told us who donated the funds, so we had no one to thank as 2003 ended.

OSF was blocking the door to Haitian kids every way they could manage.

Looking Back...Haitian Hearts Will Continue Program

Peoria Journal Star
August 14, 2003

ELAINE HOPKINS

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 www.haitichildren.com.

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.

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My comments today, March 12, 2009:

1. Haitian Hearts has had Haitian kids operated in New York, Florida, Georgia, Tennessee, Indiana, Illinois, Iowa, Missouri, New Jersey, and Ohio. My wife Maria and I travelled to Guatamala and met Dr. Aldo Castaneda in Guatamala City. He was considered the best pediatric heart surgeon in the world during his years in Boston. Dr. Castaneda and his team accepted a Haitian toddler with a ventricular septal defect to be operated in Guatamala.

2. And as mentioned in a previous post, we have brought or played a role in bringing about 150 kids to the States for surgery, usually cardiac.

3. Douglass Marshall, OSF's attorney, sent me a letter several years ago stating that OSF would not accept any patients from me. So far they are sticking to this unfair and deadly embargo of their own Haitian patients that need to return to OSF for follow up surgery. The Children's Hospital Advisory Board and the Children's Hospital International Committee must be in agreement with this policy because I have written them pleading for their help with no answer. Finding other medical centers to take care of OSF's Haitian kids that have been abandonded by OSF is not easy. Other medical centers that have accepted OSF's Haitian Hearts patients are not happy with OSF.

Looking Back...Failed Mediation

Peoria Journal Star
July 19, 2003

ELAINE HOPKINS

Failed mediation may break Haitian Hearts -- Talks between OSF, diocese, doctor dissolve

PEORIA - After a failed bargaining session, the OSF Healthcare System and the Catholic Diocese of Peoria announced Friday that Haitian Hearts has stopped beating, at least in Peoria.

''OSF Healthcare System will no longer participate in the Haitian Hearts program,'' said a written statement from corporate director of marketing and communications James Farrell. ''They (Haitian Hearts supporters) did not accept the offer,'' Farrell said of the bargaining.

''The cardiologists, pediatric intensivists and cardiovascular surgeons'' at OSF Saint Francis Medical Center support this decision, according to the statement.

The diocese also issued a statement Friday saying it ''was unable to successfully facilitate an agreement'' between the hospital and the Haitian Hearts program.'' Spokeswoman Kate Kenny said no diocese officials would comment further.

Haitian Hearts is a program that brings children from Haiti to Peoria for medical treatment, mainly heart surgery, at St. Francis. Nearly 100 children have received surgery at the hospital through the program, but disputes between the two sides over debt and organization spurred the diocese to step in and help negotiate.

Haitian Hearts founder Dr. John Carroll, contacted Friday on his way to Haiti, said he attended Thursday's meeting, the second held since the diocese agreed to get involved six months ago.

After an hour, Monsignor Steven Rohlfs adjourned the meeting and left, Carroll said. The bishop did not attend.

Carroll said hospital officials told Haitian Hearts it must accept the $200,000-a-year grant St. Francis offered, plus a 55 percent discount on costs above that grant, then details of the program would be negotiated further.

''We can't bargain that way. The details could stop the program,'' he said. ''You wouldn't buy a house like this.''

There were many details that needed negotiating, Carroll said, including the hospital's insistence on a ''no cap'' clause, so that if one patient ran up a $1 million hospital bill, the group would be liable for it.

The hospital also wanted its committee to review visa extensions, he said. Visas are granted for only six months, but if a child needs follow-up care, they must be extended.

''I've been pushed to take kids back before they were ready,'' Carroll said.

Dr. William Albers, who served on the committee but left it recently, blamed Carroll for the failure. ''He was unwilling to negotiate. It's too bad. I think people tried, but it didn't work.''

Farrell said the hospital will continue to provide medical care to Haitian patients who came to Peoria in 2002.

Carroll said recently he has a waiting list of 31 patients, mostly children, who need lifesaving surgery. He would like to bring back the five worst cases, but since December, St. Francis has refused to approve any visas for medical care for Haitian Hearts patients.

''Children's lives depend on decisions to be made here,'' in Peoria, he said.

In January, Bishop Daniel Jenky announced the diocese would help Haitian Hearts, and hospital officials said they wanted the program to continue, but they needed to limit charity care to Haitians and wanted better planning for the patients brought in for care.

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

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My comments today, March 12, 2009:

1. Reading this article again is very painful. After two and one half years of fighting local Haitian Heart battles with OSF and the Catholic Diocese of Peoria, we had now reached the lowest of the low. Bishop Jenky had walked away from the Haitian kids too. (He wasn't at the meeting...Monsignor Rohlfs did all the dirty work.)

2. As this article explained, Haitian Hearts kids were going to die now.

3. A very reasonable thing for Bishop Jenky to have done if he had been serious about Haitian Hearts from the beginning, would have been this:

Bishop Jenky should have thanked OSF for all they had done for Haitian kids over the years. He then should have made an announcement that I would be leaving for Haiti to pick up three sick kids accepted by other medical centers that he had contacted. Bishop Jenky definitely had the say-so and knowledge of how medical centers work to get the kids accepted. Three medical centers could have accepted one child apiece. This would have been collaborating for health care which is a Directive of the U.S. Catholic Bishops for Catholic Health Care. The Diocese would not have had to go to Haiti or even spend any money. Haitian Hearts would have done all of the "grunt work" for the Diocese. However, as mentioned before, The Catholic Diocese of Peoria did not want OSF to look bad in any way. So after the Diocese threatened to go to the media AGAINST Haitian Hearts several months before, now they were walking away in a very public way. Instead of becoming more docile, the Diocese should have become proactive for the Haitian kids. The Diocese saw first hand what I was dealing with at OSF. In the Catholic Post, after the Diocese left, the Diocese said there had been good faith by both parties, i.e. OSF and Haitian Hearts. This was untrue. There was not good faith exhibited by OSF or the Diocese of Peoria.

4. One of the Haitian Hearts supporters was so depressed that night after Monsignor Rohlfs closed the meeting, she got into a minor car accident on the way home. At the meeting Monsignor referred to one of may Haitian kids pictures at the meeting as "an advertisement."

5. The Diocese and OSF had been setting a trap for months and now wanted us to accept details without knowing what they were.

6. Joe Piccione, OSF Corporate Ethicist was at the meeting, and was openly aggresive against Haitian Hearts. Jerry McShane, Director of Ethics at OSF, was at the meeting too. He had his golf shoes on and was ready to be done with all of this.

7. Interestingly, OSF Sister Diane was there, and appeared quite upset. She said that Haitian Hearts would be responsible for any bills that went over $200,000 per year. She and Dr. McShane had an open disagreement at the meeting, so it told us that OSF did not have their act together. And the Diocese already said that they would contribute no financial assistance to Haitian Hearts. And if Paul Kramer, et al were keeping the books, and the Haitian kids visas, the kids were doomed.

8. Jim Farrell, OSF's Corporate Director of Marketing and Communications, quote in the paper was a very low blow. He said that the CHOI doctors were in agreement. This statement hurt so much because the CHOI doctors had been and still were so supportive of my Haitian kids. I called Dr. Dale Geiss, the pediatric heart surgeon, the day this article was published, and he denied that he was aware of what was going on...so how could he be supportive of the tragic decision against Haitian kids? I called another doctor who was highly involved in the kids care, and he knew nothing either. I didn't believe Jim Farrell's comments at the time and don't believe them today. It was a public relations move on Jim's part to try and convince the community that even CHOI doctors were in agreement with OSF Administration that it was time for Haitian Hearts to go.

9. Dr. William Albers was NEVER on a Haitian Hearts committee of any type. But OSF attempted to show that Dr. Albers was in agreement with the decision. Dr. Albers said that I failed to negotiate. Nobody negotiated more than I did for the lives of these kids in Haiti and Peoria. I have negotiated for the lives of 150 kids that have made it to the U.S., and I negotiated for months and months before this meeting. Again, this was an attack by OSF using Dr. Albers this time. I was use to it at this point, but it was still hard to accept. Dr. Albers had been my mentor for two decades and he was doing incredible damage. My brother called Dr. Albers after this article appeared and Dr. Albers hung up and would not answer my brother's questions.

10. The day after this terrible meeting I flew from Peoria to Miami and was on my way to Haiti to start another clinic. The Diocese spokesperson Kate Kenny called me in Miami just as I was boarding the plane. She told me it was over...i.e., support for Haitian Hearts from the Diocese of Peoria. This was a terrible feeling and then getting on the plane to fly to Haiti was pretty miserable.

11. At the meeting the night before, my brother asked Monsignor Rohlfs for another meeting. My brother knew that OSF (Sister Diane and Jerry McShane) did not have their facts right, and more time was needed for discussion. Haitian kids lives were at stake. Monsignor Rohlfs said the meeting was going to last only 60 minutes. My brother asked "why only 60 minutes", and Monsignor Rohlfs responded "because I said so." So who was not negotiating---Haitian Hearts or the Catholic Diocese of Peoria?

12. So Haitian Hearts had fought the "good fight". We did negotiate for the lives of kids. And we still are. This was an incredible learning experience for all of us at Haitian Hearts. We saw the ugly side of our Catholic hospital and our Catholic Diocese. The warnings of my friends about the "help" of the Diocese still haunts me today.