Doctors describe need for patient transfers

"In a true emergency, the ability of a patient to pay is not the

number one priority. We are not transferring healthy patients."

- Dr. Kenneth Williams

Dr. Gregory Stallworth, director of Alliance Hospital’s emergency service, and Dr. Brian Wall, met with the Marshall County Board of Supervisors Jan. 5 to urge LifeGuard Ambulance Service to provide transfers of patients to larger hospitals when needed.

Stallworth described a patient, who had a feeding tube, was brought to Alliance’s Rural Emergency Hospital at 3:15 p.m. The patient was stablilzed and needed to be transported back to her nursing home facility but waited until 9 a.m. The next day before LifeGuard arrived to transport the patient, he said.

There was a baseball player who was struck in the groin and had a surgical emergency, but LifeGuard would not pick the patient up. He had to be taken by friends to a higher level facility, Stallworth said.

The examples are too many to enumerate here.

District 1 supervisor Charles Terry asked if the ambulance stays at the hospital while a patient is being stabilized before transfer to a higher level facility.

Stallworth said if the condition of the patient is urgent, the ambulance providers are “good at sticking around to help.”

“Once the patient goes to the hospital, where does the billing go?” Terry asked. “We need a hospital here in the county.”

He said there are healthcare concerns in the county and the issues of transferring patients need to be clarified by the board of supervisors and by the ambulance provider under contract (subsidized by) with the county.

Stallworth explained to supervisors the definitions of emergency versus urgency.

Emergent means the patient has 12 hours to receive support or will not live. Urgent means the patient must receive care within 24 hours or will not live.

Dr. Vetra Gipson said her dad, Quintell, became ill with a small bowel obstruction and doctors tried to get a tube in to decompress. He waited eight hours to be transferred. She said if her dad had not been strong he would not have survived.

“The whole point is my dad became sicker while waiting for transportation,” she said. “He was there for many hours when he could have gotten care (at a higher level facility). The hospital must transfer to the next higher level of care.

“My dad went in walking. Now he is bedridden.” District 4 supervisor George Zinn III said most of the members of the board understood what the county was trying to do when it contracted with LifeGuard to keep five ambulances in service in the county. If a patient is deemed to be in an emergency, Alliance is there to receive the patient.

Zinn said if the ambulance is going to take the patient somewhere else, supervisors do not want them to be taken somewhere else (if they can receive service at Alliance).

Stallworth said a patient may have a broken hip, a heart attack or not be breathing. The patient will be transferred once stabilized.

District 3 supervisor Keith Taylor asked Stallworth how many patients come to Alliance who need to be transferred to a higher level hospital.

Stallworth said over 20 patients in the last few months have been transferred.

He said the ambulance service usually bills the patient it transfers.

Ricky Barnett, director for LifeGuard in Marshall County, said the hospital has to agree to pay the bill of the patient.

Zinn said the contract with the county is to have LifeGuard available to answer 911 calls, but the patient is still responsible for the cost of transportation, no matter what. He said the hospital typically agrees if the patient does not pay, that Medicaid will be billed.

“We are paying for the availability, not for patient service,” Taylor said. “We need a hospital here.” Stallworth said the decision to transfer a patient should be made by the physician.

“We could go on with this unto next week,” Taylor said, trying to move on to another topic. “We are not paying for the ambulance for the patient.”

Wall said there are only a small number of transfers involved at Alliance.

“They are sitting there dying in front of us,” he said, “and we are told `we ain’t coming.’ You will lose your bed if you don’t have an immediate transfer (to a higher level facility. It’s frustrating to have to call a helicopter (when an ambulance is what is needed).”

Taylor suggested that the board take the matter up with the attorney and LifeGuard first.

“The county contract is just with the ambulance,” said board attorney Amanda Whaley Smith. “We pay them a lot of money to be available.”

“We want to get that contract amended,” Stallworth said. “We should be a part of the conversation regarding transporting a patient to a higher level of care.”

Barnett said LifeGuard has five trucks.

“And they are running all day,” he said. “Ultimately, the responsibility is to the county.” Taylor asked if LifeGuard would be willing to alter the contract with the county.

Barnett said redrawing the contract would be the last resort, “because we are losing money already.” In a separate interview with Dr. Kenneth Williams, owner of Alliance Hospital, he said the majority of patients seen have the ability to pay with less than 10 percent of patients coming in without insurance to the Emergency room.

“In a true emergency, the ability of a patient to pay is not the number one priority,” he said. “We are not transferring healthy patients. The hospital gets 10 percent of what the ambulance service gets (in subsidies).”

He said Alliance is supposed to get $200,000 a year, but after tax is subtracted, the hospital clears only about $75,000 a year from its subsidy.

“We are only getting about $10,000 a month from the county for indigent care,” he said. “Providers have to deal with patients who don’t have money sometimes.”

“The ambulance service is putting a gun to the county’s head, a gun to the hospital’s head, and ultimately is shooting the patient by not transporting,” Williams said. “That’s not supporting the indigent community. All they (the ambulance service) is interested in is getting paid.”