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Ambulance Service on two-year probation |
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Written by Andrew Powell
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Friday, 13 June 2008 |
The Kentucky Board of Emergency Medical Services has placed the ambulance service on probation for two years until February 2010 after an administrative investigation into practices at the service. The issue began in November 2007 after an employee at Scott County Hospital filed a formal complaint against the service stating a patient transported to the hospital had received substandard care.
A 4-year-old in active seizures was treated and transported by the ambulance service. The hospital employee said a paramedic on board the ambulance failed to provide an IV, oxygen “or other interventions” in caring for the patient.
Records obtained from the Kentucky Board of Emergency Medical Services show that board members reviewed the allegations made in the complaint in January 2008. Minutes from the meeting when the complaint was reviewed state “it has been alleged that an ambulance service violated KRS 311A.050(2)(a) and (c) when it failed to administer Advanced Life Support Care to a 4-year-old patient experiencing seizures and administered inappropriate care to patients on a regular basis.”
After that review, the board initiated an administrative hearing with Amy Barnett, Ambulance Service Director, Deputy Judge-Executive Tony Jones and the service’s medical advisor Dr. James Foster in February to allow the local ambulance service an opportunity to respond to the allegations.
“After the hearing, it was determined that the paramedic did follow medical protocol,” Barnett said. “The complaint should not have been filed and I have been told other hospital personnel advised this person against filing the complaint, because the claims were unsubstantiated.”
An incident data report filed by the paramedic providing care during the ambulance transport, shows that oxygen was supplied to the patient and IV attempts were unsuccessful because of the status of the young patient.
“The paramedic did all they could do in the situation,” Barnett said. “Even Dr. Foster said nothing was out of order.”
Barnett says that while the complaint was unfounded and did not lead directly to the supervised probation, the inquiry into the complaint did reveal other conditions within the service that violated state medical protocol.
Barnett said that investigating board members reviewed nearly 800 advanced life support (ALS) incident reports, medical records required to be filed after each patient transport, and 14 incidents were uncovered where a paramedic, who should have been providing care during the ALS transport, was driving the vehicle.
Barnett said those occurrences are not typical, and have never resulted in inadequate or substandard patient care. Sometimes a transport can be classified as ALS, but the patient may not necessarily require the advanced care.
Barnett said one of the incidents flagged by investigators included a run where she, serving as paramedic on board, drove the vehicle. The patient’s history constituted an ALS transport, but the patient was not in emergency status at the time and required only a routine transport to a medical facility, she said. Even though the patient was receiving standard care and not endangered during the transport, it is denoted as a violation of protocol because the paramedic was not with the patient during the ALS transport.
The ambulance service was also cited for not regularly reviewing incident reports through a required “quality assurance” program. Ambulance service directors and their medical supervisors are routinely required to review transport incident reports to ensure all emergency crew members follow standard medical protocol.
“We were not doing that on a regular basis, but are following guidelines now. Everything has been taken care of and the board has told me we do not have major problems within this service and the probationary period could end sooner than initially stipulated,” Barnett said.
Barnett said since the probation was issued in February, medical board investigators have made investigative visits to the service on two occasions, in March and April. They have not made any subsequent visits.
“They could come at anytime and that is fine. We have nothing to hide and have always done the best we could to make sure this service is efficient and standard procedures followed,” Barnett added.
An order issued on behalf of the medical board following the inquiry and administrative hearing, states any acts requiring discipline from the medical board could result in the ambulance service losing its license to provide care. That order basically requires quality assurance updates on a regular basis and closer medical oversight with the service’s medical director, Dr. Foster.
That order was signed by Barnett and Charles O’Neal, Kentucky Board of Medical Services Executive Director, on March 18.
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