Wednesday, March 14, 2007

Conflict of Interest

Conflict of Interest in Peoria
Author: Dr. John A. Carroll

(I included some comments that followed this post. Tony, who I found out later comments from, made many interesting comments, especially knowing from where he posts at times.)

Conflict of interest is a phrase that is used frequently. Conflict of interest can exist in many circumstances and is only bad when the conflict is acted upon in a negative way.

Tony, who comments quite frequently on this web log, believes there IS a negative conflict of interest in Peoria at the level of Emergency Medical Services. Tony works for a local EMS agency and knows how the Peoria Area EMS System (PAEMSS) works. Please see Haitian Hearts Christmas Challenge comments and Tony’s answers to some direct questions I asked him about Peoria’s EMS.

However, Tony refuses to say who he is and not for the reasons he gave in his answer. He does not want people to know because he is afraid. He doesn’t answer some questions and spins others. Nonetheless, after one sorts through his chaff, his answers are interesting.

When I asked Tony if he thought that it was negative conflict of interest that Dr. George Hevesy receives a salary from Advanced Medical Transport (AMT) and OSF, he replied that he DOES think that it is negative conflict of interest. Dr. Hevesy was Project Medical Director (in charge of all ambulances in the Peoria area) for many years and is currently the OSF Emergency Department Director. There is virtually no one who understands the situation in EMS in Illinois, with whom I have spoken, who does not understand the negative conflict of interest involved. A former Project Medical Director in Peoria screamed “conflict of interest” when asked about Dr. Hevesy’s financial relationship with AMT.

I asked Tony if the Peoria Fire Department (PFD) paramedics should be able to secure an advanced airway for a patient and give advanced cardiac life support drugs without waiting for permission from the AMT paramedics. Tony replied that yes they should be able to do so as long as they meet IDPH requirements. Now, Tony didn’t mention that Dr. Hevesy is also director of Region 2 for IDPH and has had a relationship with the IDPH office in charge of EMS in the state of Illinois for many years.

It becomes more interesting to know that fire departments in Illinois can petition IDPH to perform services above what their department is designated. For example, I spoke with a firefighter/paramedic in another city in Illinois which has a fire department which functions at the Basic level. However, when he is working for the city fire department and a 911 call comes in, he functions as a paramedic. He showed me his laryngoscope and endotracheal tubes and advanced life support medication on the fire truck. Thus, this takes their fire department to a higher level of service and they can provide advanced quick service when he is working. He does not need to wait on the local private ambulance service to ask him for his assistance. The PFD paramedics have to wait for AMT to ask them for help. What if AMT is not present at the scene and the patient needs a breathing tube or advanced life support? (As far as I know, the PFD doesn’t even carry the breathing tube [endotracheal tube] on the truck, unless the policy has been changed.)

This isn’t exactly rocket science as you can see.

When I asked Tony if there were any obstacles placed in front of the PFD, he responded that the “internal barriers are higher than anything external”. Tony sites the Peoria City Council policy as a barrier. I would view the Council to be a big EXTERNAL barrier for the PFD since policy is determined at the Council level. The Council is allowing AMT to be the only ambulance transport company in Peoria. And don’t you think that the hospital administrators that attend the City Council meetings in the past couple of years, who support AMT, sway the Council members just a bit? Could the Project Medical Director who works for OSF have swayed the Council just a bit also?

Tony states that, “The PFD does not want to be in the ambulance business”. If that were true, why did the PFD buy an ambulance several years ago with the Foreign Fire Fighters fund and attempt to equip it? The Project Medical Director at OSF did not allow them to equip it, so they sold it. But doesn’t it make sense to let the PFD paramedic carry the equipment and medication and let him work on you if he is at the scene first and is the most qualified? Even if he can’t transport you, he should be allowed to stabilize you and possibly save your life.

Tony sums things up as a “non-issue”. That is also is inaccurate if you are the one that is denied advanced care and transport when you need it in an emergency and the PFD paramedics on scene are not allowed to give it. Then this issue could be the biggest in your life.

This could all easily be worked out in favor for Peorians if the fiduciary responsibilities of the health care providers and community leaders were taken seriously. And Tony and people like Tony need to come out of their anonymous worlds and identify conflict of interest when it has negative consequences.
John A. Carroll,

Mahkno on December 28th, 2006
Finally,… you post something that possibly matters to folks in Peoria and nary a word about Haiti (aside from the link but thats understandable).
Conflicts of interests can be a bad thing or they could benefit from the ’synergy’. There still are some holes in what you present. If Dr. Hevesy’s ‘conflicts of interest’ and AMT’s monopoly on transport are so bad then surely someone sooo much in the know like yourself can produce some statistics showing how Peorian’s are adversely affected. How many people have died because the PFD paramedics could not do their jobs? What is the percentage of that happening? Is it happening at all? As you said it “could be the biggest (issue) in your life” but that is speculation.
I don’t really have a side in this but I know AMT comes up periodically as an issue. When I had to call 911 for my wife once, PFD arrived first but then they are 3 blocks away. I am a bit fuzzy about how things transpired at the time but it all worked out fine. Then a couple weeks later I got the bill… heh. They never say how much it will cost up front.

Dr. John A. Carroll on December 28th, 2006
Dear Mahkno,
“Conflicts of interests can be a bad thing or they could benefit from the ’synergy’”.Mahkno, my friend, I think you missed the point just a tad.
However, I am glad you brought up the word “statistics”. Nationally, pre-hospital data looks at a number of parameters to see the quality of pre-hospital care given in a region. When I tried to obtain statistics from Peoria’s EMS office based at OSF, the nurse in charge told me that “no aggregate data are kept”. A secretary told me essentially the same. So I called the local Peoria IDPH office regarding how our EMS system is performing. Guess what? He was unable to provide me any data either. Incredible, don’t you think? To make matters worse, the City hired the consulting firm from California (Matrix), who allegedly had ties with AMT (surprise), and for a mere $79,000 dollars of Peoria’s taxpayers’ money, they told the City that the PFD responds approximately 2.5 minutes quicker than life threatening emergencies than does AMT. But they offered no statistics like you are requesting.

I know you must be frustrated with this bad news.

Mahkno, if you collapse and suffer a cardiac arrest, would you like the first responder who is best trained to try immediately to resuscitate you or would you want them to wait? I say that if the PFD responds before AMT, which the consulting firm said they do, and the PFD has a paramedic at the scene, he/she should be able to try and save you. Does that make sense, Mahkno?

And Mahkno, Tony’s identity is very relevant to HIS argument, and would reveal much regarding his views about Peoria’s EMS.


Mahkno on December 28th, 2006
Regarding the statistics… were they just not collected and recorded or do they have them and are refusing to reveal them? Unless you know for certain they have the statistics, you are just fishing for a conspiracy.

If I were to collapse into cardiac arrest and the first one on the scene is a police officer who happens to have paramedic training, are you saying he should be able to treat me? Is he obligated to? What if my neighbor who might not work for AMT or PFD, happens to have paramedic training, should he work on me too? It’s not their jobs. By not letting PFD do ambulance work, the city and others have essentially told them its not their job. But again you venture into speculation. What is the reality? How many people have suffered because PFD couldn’t treat people first? You are fishing because you don’t know, do you? You are casting about conspiracies and accusations based on assertions with no supporting information.

Tony’s identity means nothing regarding his views. A good debater can present a case from any point of view irregardless of what they feel is the correct position. Even if you knew who he was his position would be unknown. People can feel one thing and practice another. Example… a lawyer who defends someone whom he knows is guilty. Privately he would like to see the man put away but publicly he has defend the man and try for his release.

Tony on December 28th, 2006

I’ll answer your post later. But first, let this be known so that Dr. Carroll can give my identity a rest. I am not employed by AMT nor do I recieve pay in any way for any involvement in EMS or Fire/Rescue work. In short, I am a volunteer, so let the conspiracy theories rest.

Dear Anonymous Tony,
I think your word of the day is “conspiracy”. A conspiracy is a “combination of persons for a secret, unlawful, or evil purpose”.

I don’t think there is a “conspiracy theory” (your words) that stops you from giving your true identity. I think you are just afraid. The fact that you don’t work for who you say doesn’t explain anything. You have committed yourself and have said you believe that negative conflict of interest is occurring with the former Project Medical Director receiving a salary from Peoria’s only paramedic and transport agency. Can you imagine the potential fallout for you and your agency if you identified yourself?

What you and the other anonymous bloggers are attempting to do is put words in my mouth and divert attention with your comments from the real topics. It won’t work. I will do all I can to keep us focused.

Anonymous Tony, you stated the following, “Nobody has ever been denied transport or advanced care. They may have had to wait longer, but hey….” Do you realize what you are saying? The brain can only go without oxygen for several minutes. So when the patient waits longer for AMT to arrive and the PFD cannot provide advanced care, that can be a real bad thing for the patient.

Amazingly, you also said, “On the contrary if the PFD were at a higher level I would think that it would reflect on AMT in that they would be associated with a perceived “better care” of the patients”. So, Anonymous Tony, you believe that the ILS firefighters and Paramedic firefighters for the PFD would not perform as well as AMT even though they respond to 10,000 medical calls per year and arrive 2.5 minutes quicker to life threatening calls than AMT? That seems quite presumptuous on your part.

You also open a new can of worms when you infer that your small agency should NOT offer advanced skills. An argument could easily be made that rural EMS agencies SHOULD provide advanced care because of logistics. I think the key thing to do, Anonymous Tony, is to keep an open mind in this dynamic area of medicine.

Finally, please clarify your answer regarding the “external barriers” that you state have been placed in front of the PFD that may have hindered them from upgrading their skills for the people of Peoria. Also, could you supply us with memos/e-mails from the Project Medical Director and PAEMSS that encourage the PFD to make sure that their ILS firefighters and Paramedic firefighters, with the sanction of IDPH, retain their skills and licenses so they can provide care at the scene when AMT is not present?

We all know that after the man died at the restaurant in Peoria, Dr. Rick Miller the Project Medical Director at the time, changed the rule, and now will allow the PFD to intubate, only if asked to do so by AMT. This change in policy is quite weak, but it proves the point that upgrades can and should be made for the PFD….and can be done quite easily. (The PFD had advised Dr. Miller that the public would not like it if they knew that the PFD paramedics were being held back.) Too bad the policy changed AFTER the man died.

What do you think about this? Does this all sound like PAEMSS is working real great?


P.S. Anonymous commenters, I know this will make many of you quite angry, but do any of you think there is ANY chance that there is a connection between what I have written above and the fact that Haitian children are being denied heart surgery in Peoria? Just curious.

Dear Anonymous Tony,

So you DO believe that there would be LESS deaths if the PFD had upgraded their service years ago. Many people believe this of course, but you finally admitted this.
If you are right about this, then it would have behooved the Project Medical Director, PAEMSS and OSF, to have helped/led/encouraged/advocated at the level of the City for the PFD to upgrade many years ago. Right?

Fiduciary responsibilites should guide health care guidelines and mandates. Several years ago, when Dr. Hevesy was Project Medical Director, he told the City Council that if the PFD upgraded, it would just be a “duplication of services”. He did not appear to be supportive of the PFD functioning at a paramedic level, which, according to you, would save lives.

What was the City Council going to think when the “expert” was giving them advice? (Dr. Hevesy really needed to declare to the City and the people of Peoria that he was on AMT’s salary when he spoke to the Council about the PFD staying at the Basic level of training, don’t you think?)

Something smells funny here, Anonymous Tony.

And why do you think that the “rule” was changed by the Project Medical Director (Dr. Rick Miller) within the last couple of years, that paramedics for the PFD can now “jump” to their level of training when AMT arrives? Maybe to decrease morbidity and mortality (deaths) in Peoria? Why did it take all of these years to change this simple rule? Do you think that Dr. Miller may have been encouraged to change this rule by someone based on emergency medical mishaps in Peoria?

Anonymous Tony, a lot of unanswered questions. But we are getting there.

Happy New Year.


No comments: