Public Utility Model

[Guest guest]

What one must understand is that the so-called Public Utility Model is the

product of one Jack Stout, an economist, and his wife, who have made a

ridiculously good living from manipulating EMS services for the last 20 or so

years.

The PUM is founded upon the idea of system status management, a flawed

doctrine that was never based upon anything other than economics. Patient care

and

public service were only incidental. The idea was to convince city councils,

county commissioners, and city managers that a system constructed of smoke and

mirrors would provide excellent patient care while expending the least amount

of money possible. Clever enticements such as " all our medics will be NREMT "

and other meaningless promises were used to mesmerize dumb city councilmen,

county commissioners, and city managers into believing that contracts with

private providers were the way to go. Artificial but high-sounding concepts

such

as responses within 8:59 90% of the time for urban responses and 12:59 90% of

the time in rural responses came into being. They were based upon nothing

other than Jack Stout's musings. None of the councilpersons, commissioners, or

city managers ever had or now have even a clue about patient care issues, nor

do they give a shit about those issues.

Stop and think about it! What good will an 8:59 response do for a patient in

cardiac arrest? Not much, even if good CPR has been done. But this figure

was sold over and over to politicians who hadn't a clue and who fell for a

great presentation, which Jack is perfectly capable of rendering.

Thus emerged the concept of unit hour utilization which strives to force the

maximum amount of work from each unit in the shortest amount of time,

providing a stated amount of coverage for a very little expenditure, but not

taking

into consideration the level of care provided. Nobody who controls the finances

actually gives a rats patoot about patient care. Care to challenge me on

that? Git it on! Prove it to me. You can't.

There are no considerations given by system status management to the personal

comfort or needs of the employee; in fact, as Jack Stout once said to me over

a lunch, the idea is to employ young people as medics, work the living shit

out of them, burn them out in about 3 years, and replace them with new

employees. That way you never have to give pay raises based on seniority and

experience. Mr. Stout and his disciples fervently believe and adhere to this

concept.

Most of the people now running the big national EMS companies are Stoutians.

The PUM combines the concept of SSM with a so-called " fail-safe " system where

a pseudo public utility is formed which will control the provision of EMS

through letting contracts to private contractors who will provide the services.

The PUM typically has the ability to confiscate the rolling stock and supplies

of a company that goes belly up and thus ensure continuity of service. That

appeals to county commissioners, who know nothing about medicine but want to

cover their butts if the contractee collapses. There ARE some PUMs that have

good executive management, but they are sparse.

The private contractors who bid on these contracts, big players like AMR,

R/M, and others, typically " low ball " the bid in order to get the contract and

then engage in a scheme to demand increased subsidies from the PUM in order to

continue service.

The examples of this scheme are legion.

Top level managers in these services are paid corporate salaries in the

multiple 6 figure ranges, and their allegiences are to their owners rather than

the

public. They are no different from the CEO of Halliburtin, or General

Electric. Their output and accomplishments are never designed to provide

excellent

care to those they serve; rather their entire set of goals are intended to

make money for the company and perpetuate their jobs.

Since street medics are traditionally anti-union and cannot be enticed to

band together for the common good, they are a corporate manager's dream. The

managers exploit the workers to the max, and they play the game to remain in

power by providing service as the very lowest cost to the PUM but still making a

profit for the corporation.

Into this mix goes Medicare/Medicaid abuse and fraud, abuse of employees by

enacting schemes to deprive them of overtime, and so forth.

At one time paramedics were a glut on the employment market. However, now,

there are fewer and there is a shortage. But corporate providers will never

respond to the market by paying better wages; rather, they will find ways to use

lower level certified medics such as EMT-I and EMT basic to do the bulk of

the work in their systems.

Since medics are reluctant to join trade organizations, and since there is a

real rift between medics who work for private contractors and FD based EMS

medics, there is no unified action by medics to improve their lot. Medics who

are outside the fire service typically make much less money, enjoy much less

benefits, and have no job security.Medics who work for Fire typically refuse to

become members of non-fire department organizatons. They don't see the need to

do it. And, practically speaking, they're right.

The private, hospital based, and 3rs service paramedic community encourages

this by refusing to join or even be interested in organizations that might

represent them.

So what does the PUM do for EMS? Little except huge salaries for its

managers. Somebody else please post a list of the PUMs. I'm not going to put

my

neck on the line any more than I have, but wouldn't it be interesting to know

who

the surviving PUMs are and who their managers are and where they came from.

You'll find out that they all came from services that Jack Stout was hired to

build and structure.

Would somebody please come forward and attempt to justify the PUM. You've

got the stage. Can you do it? Let's see.

GG.