Leaders at HSHS St. Mary’s Hospital and Decatur Ambulance Service (DAS) are asking city leaders to further investigate if licensing an additional ambulance service in Decatur is a good solution. Earlier this summer, Arrow Ambulance Service applied for a license to operate in Decatur. Reports indicate that they would like to operate five additional ambulances in Decatur, in addition to the six ambulances already in operation by DAS.
In June 2018, a subsidiary of Hospital Sisters Health System (HSHS) acquired DAS because both organizations are committed to a highly-collaborative environment of service and providing the best emergency care for patients and families in the Decatur area. “DAS is providing the same dedicated and loyal service that it was before the acquisition. But now that DAS is part of Hospital Sisters Health System, we have the financial resources and leadership of a major faith-based and mission-driven health system that help assure greater success for providing emergency care in these difficult economic times,” said EJ Kuiper, interim president and CEO at HSHS St. Mary’s Hospital.
Kuiper wants to stress that HSHS leaders are ready, eager and sincerely willing to work with city and county leaders to continuously meet the needs of emergency medical services in the area.
“Leaders and colleagues at HSHS St. Mary’s Hospital care very deeply about the families that live in Decatur and the surrounding communities,” said Kuiper. “That is why we have made a very serious investment over a substantial amount of time to this community. We hope this investment doesn’t get short-changed in this debate about licensing another ambulance service to operate with no limit in Decatur.” St. Mary’s has been serving Decatur for nearly 140 years; DAS has been in operation for nearly 60 years with an impressive record of success during emergency situations.
In the August 16 public hearing on issuing this additional ambulance license, HSHS was blindsided by the erroneous information presented by Arrow and Decatur Memorial Hospital (DMH) about their issues with the quality of DAS’ emergency response efforts. “This public hearing was the first time DMH has highlighted these types of issues to DAS in their nearly 60 years of operation,” said Dr. Ken Johnson, chief medical officer at HSHS and an emergency room doctor. “We are committed to working in good faith with all providers in the Decatur area to resolve any issues or concerns about the quality of our emergency response care.”
The testimony presented at this public hearing did not provide the full story of Decatur’s EMS needs, nor did the testimony provided by DMH employees accurately represent the current state of ambulance services in the Decatur market. Thus, it is necessary to provide additional information about the operations of HSHS and DAS so that the council can make a fully-informed decision.
After this public hearing, the hearing officer made a recommendation to council members to grant the license for Arrow to operate in Decatur. The council members were further advised not to discuss the recommendation. Therefore, our legal team filed a request on September 5, 2018, to seek council review so HSHS’ evidence can be fairly considered before a license is granted. You can see the full report here.
Here is a summary of the main points we’d like the council and the public to consider.
In the hearing, some misleading information was presented about the volume of emergency transports and alleged delays in transport. It was stated that DMH has seen a 12 percent increase in ambulance transports and transfers, and that 62 percent of patients experienced a delay due to ambulance coverage. Additionally, it was reported that critically injured patients should be transported and stabilized within 2 hours, but some are experiencing a 3-4 hour transport delay.
Although representatives from DMH testified to an increase in their emergency transport and transfer calls, there was no testimony offered as to whether the city’s overall call volume has increased. To the extent that DMH has seen an increase in volume, we suspect that it is related to DMH’s recent transition to a higher level of trauma care than they previously offered, resulting in an increase in emergency transports.
As the sole provider of ambulance transport in Decatur, DAS has only seen a 3 percent increase over the past year in emergency transport for the Decatur area.
Despite the implication that DAS is not adequately responding to DMH calls, over the year from July 2017- June 2018, DAS transported patients to DMH 7,420 times, and to St. Mary’s 4,738 times. Patients still have a choice in which hospital they are transported to when a DAS ambulance picks them up. In addition, the five stations operated by DAS in Decatur and Forsyth are an average distance of 3.6 miles and 7.8 minutes’ drive time from DMH, while St. Mary’s is an average distance of 4.7 miles and 9.8 minutes’ drive time away. It is only logical that DMH will continue to be adequately served by DAS, regardless of their parent company’s affiliation, based on these statistics alone.
The allegation that patients are experiencing 3-4 hour transport delays needs to be further examined by the council to determine the root cause of these delays. DAS has an average response time to urgent 911 calls of 5 minutes and 19 seconds. In addition, the vast majority of responses are under the standard 8 minute response time required by the ordinance. Thus, it appears that there are a reasonably adequate number of ambulances already in operation within the city.
The allegation that there are delays experienced by DMH patients during inter-facility transports (when a patient is transferred via ambulance from DMH to a higher level care facility) is also one that is entirely outside the scope of this ordinance. Additional ambulance services, including Arrow, are already providing inter-facility transports between DMH and other higher level care facilities, and therefore may be responsible for these delays.
Decatur Fire Chief Jeff Abbott recently stated in a July 3, 2018 article in the Decatur Herald & Review that Decatur Ambulance Service provided adequate response times and service to the community. This statement was made three weeks after HSHS acquired DAS, and one day after the date Arrow’s application was signed. These comments should be taken with the utmost veracity based on their author and timing.
The population of Decatur and Macon County has steadily declined since 1990, and DAS has simply not experienced the increase in call volume alleged by DMH. For reference, Decatur had a population of 84,000 in 1994, and DAS was operating sufficiently with only four ambulances. Today, the population is 72,000 and DAS is currently operating six ambulances on a 24/7 basis.
Adding additional ambulances to the community will not create increased call volume, but rather, it will dilute the quality of services and service providers in an already shrinking market. Further investigation should be conducted to determine what effect an additional service could have on the quality of ambulance services and services providers, including the job market for paramedics and ambulance service employees.
It’s important to consider the history of DAS and the investment they’ve made in the local community. DAS was founded in Decatur in March of 1959, and was acquired by HSHS in June 2018. DAS employs approximately 135 people, and operates six ambulances around the clock out of four stations in Decatur and one station in Forsyth. Most of their full-time employees live and work in Decatur and are invested in the community.
DAS is unique because each ambulance is predominantly manned and operated by two EMT-Ps (commonly known as paramedics) at all times. This is unlike most ambulance companies, including Arrow, as this procedure exceeds the national standard, which is to operate with a paramedic and an EMT-B, also known as a “basic.” Paramedics are trained to handle all levels of emergency calls, whereas a basic may not be qualified to handle certain injuries or situations. Thus, if an ambulance team is called to 10 emergencies during their shift where the basic is not qualified, then the paramedic will be responsible for the majority of the work on each of those calls. However, the DAS procedure allows paramedics to alternate who takes the lead on each call, which reduces their work load, stress level and burn out over time.
It is unclear how the local 911 dispatch center would effectively manage calls between two ambulance companies without a significant and costly upgrade to their current dispatch system. Here is the way it works now when a 911 call comes into dispatch and an ambulance is needed: Dispatchers contact DAS to send an ambulance to the site of the emergency. Since the dispatch center does not have GPS technology in place to see where the closest ambulance is in relation to the emergency, DAS purchased that advanced technology to make sure they can dispatch the nearest ambulance to the site of the emergency patient so that patient gets a more timely and efficient response.
After taking time to carefully research and deliberate this issue, HSHS is asking the city council to examine HSHS’ standpoint on this and vote against the city hearing officer’s one-sided recommendation. This would mean denying Arrow’s application for an ambulance license in Decatur. “HSHS is not trying to be anti-competitive here, but really logical,” said Kuiper. “It is important to respect and maintain the solid emergency response operation that DAS has created and enhanced in the Decatur community, especially when we are an organization that stands ready and willing to discuss whether additional emergency transport changes need to be made to meet the community’s needs. It seems illogical to double the number of ambulances in Decatur by granting a permit to another company. Surely it’s not the city council’s intention to put DAS out of business or cause local emergency responders to lose their jobs. Let’s all work together—the city, county, DMH and HSHS—to figure out how to best address the emergency response needs in the Decatur area. At the end of the day, we need to keep in mind that it’s all about being able to provide the best care possible for our local families who need our help in emergency situations.”
About HSHS St. Mary’s Hospital
Founded in 1878 by three Hospital Sisters of St. Francis, HSHS St. Mary’s Hospital is a 244-bed, all private room health care facility that combines modern technology with the caring spirit of the original founders. St. Mary’s is situated on an attractive 21-acre campus overlooking Lake Decatur and offers a broad spectrum of comprehensive health services, including the latest diagnostic equipment, interventional cardiology, surgical and medical intervention, emergency medical care, outpatient radiation therapy, pain management and a sleep center. St. Mary’s also offers a wide range of community education and wellness programs. The hospital also has both a unique intergenerational day services program and the community’s only provider of hospital-based behavioral health services for all ages. Learn more by visiting www.stmarysdecatur.com.
About Hospital Sisters Health System
Hospital Sisters Health System’s (HSHS) mission is to reveal and embody Christ’s healing love for all people through our high quality Franciscan health care ministry. HSHS provides state-of-the-art health care to our patients and is dedicated to serving all people, especially the most vulnerable, at each of our 15 local systems and physician practices in Illinois (Breese, Decatur, Effingham, Greenville, Highland, Litchfield, O’Fallon, Shelbyville and Springfield) and Wisconsin (Chippewa Falls, Eau Claire, Oconto Falls, Sheboygan and two in Green Bay). HSHS is sponsored by Hospital Sisters Ministries, and Hospital Sisters of St. Francis is the founding institute. For more information about HSHS, visit www.hshs.org. For more information about Hospital Sisters of St. Francis, visit www.hospitalsisters.org.