Guest guest Posted January 31, 2006 Report Share Posted January 31, 2006 Wes, I may have missed some posts or maybe misunderstood some replies, but I hope that no one is publicly asking that we lower the standards of care. I hope instead that we are allowing the hospitals and nursing facilities to choose who *they* want to use, based on quality of care and that they have met the city and state's requirements. If someone is privately sending you emails supporting a completely unregulated service, then please herd them over to my neck of the woods for a flogging, because I for one sure don't want this field to lower itself to " Mother, Jugs, and Speed " standards. In fact, my hopes are that we can RAISE the current level of care by giving the set-in-stone-and-politically-protected non-emergency providers a reason to offer more than the mediocre level of service they have become used to providing. My points have been and still are: 1. Emergency EMS (9-1-1) is off-limits in this topic; I have never suggested that 9-1-1 should be " deregulated " . Competition for emergency calls is a frightening proposition, and I certainly would not support that in any sense with the current state of EMS. 2. L:imited resources: I agree that there is a limited number of patients to serve in the non-emergency setting. It *is* unfortunate though that a service who operates mostly at a large city is granted apparently exclusive rights to operate in a smaller one, yet chooses not to maintain a 24/7 presence there unless they feel like it. It only offers a crew in the smaller city when business is slow in the larger one. That does not benefit the city's 9-1-1 system in case of a need for backup EMS services or to allow the emergency responders to focus primarily on that: emergency response. Instead, the city EMS has to wear two hats instead... one as a 9-1-1 response, and the other to take Mrs. Elderly home from the hospital when the only other non-emergency provider is away for the day. Not a good allocation of resources in a smaller city. 3. Higher levels of standards and care: Ambulance services must be FULLY licensed, insured, staffed, and so on to either meet or exceed TSDHS requirements. In fact, before a city even allows an ambulance service to operate within city limits, why not raise the bar and expect more beyond the state minimum? But let the " permit " be something that any *qualifying* service may obtain with approval by a commission, and by meeting or exceeding these standards. If the service should not otherwise be allowed, DON'T GRANT THE PERMIT! But please don't just restrict the permit to one service and one service only simply because that franchised service will cry " foul " when another fully-licensed and permitted service offers the hospital a better level of care, and takes away their " business " --- even when only 5% of their business actually comes from the smaller city. 4. A " permit " should not guarantee the non-emergency service a certain number of patients. It should allow the service to care for its citizens knowing full well that it has met or exceeded the city and state's requirements, with all of the pertinant information about staffing, equipment, insurance, etc. fully addressed in the application process and reviewed by medical peers. At least with this option, a hospital may call a local outside service that holds a current " permit " for a scheduled, non-emergency transport without fears of ordiance violation. This is by far a better solution than having to play " pirate ambulance " when the hospital has no one else to choose, and the city won't grant another service a franchise based on politics and a desire to protect its current business interests. I'm sorry you feel that you need to take the sideline on this issue. I've learned quite a bit from you and others on this topic. I am intrigued on this idea of a Texas EMS Commission, which was a thread started separately from this one but offers an interesting opportunity on many levels to help better this state's EMS system. I've learned more about the legislative process and history of EMS through you, Gene, Dr. Krin, Mr. Wood, and Tater about this issue and through past threads; I am not an attorney, but at least there is a possible path to enact change that is more clear to me now than the attorney I hired had to offer. But most importantly, I've learned that even though a few posts in this thread left me wishing I stayed silent and hadn't typed at all, at least I see others' perspectives on the topic. I can respect that, and hope to try and make things better. Personally, I couldn't work with a system that blatently placed dollars ahead of the patient's welfare anymore, and had to do something about it. This thread hits on that very same problem, and maybe I should have remained quiet. In the end, I lost the battle with " the system " . Maybe I should have just stayed quiet, gone on to complete my paramedic, and spent the next 20 years working for a big-city EMS, closing my eyes to the current situation in front of me. I hope you continue to offer your wisdom and opinions Wes. In my opinion, it would be a great loss to not have heard them at all. A modest proposal > To the usual offenders: > > Well, it appears that I have ruffled everyone's feathers by explaining the > current state of affairs as the law allows. I attempted to explain how the > law allows the government to make certain intrusions upon the free market > in an attempt to protect the public and better distribute scarce resources > (I.E. a limited number of non-emergent transfer patients). In return, > from several of you, I have received little but pissing, moaning, and > whining. Most of you say how it should be, not understanding the how and > why of where we're at now, which may well be because of the previous > abuses brought on by an unregulated ambulance marketplace. The puerile > behavior strikes me as a temper tantrum from the illegitimate love-child > of Ayn Rand and Rush Limbaugh, moaning about " freedom of choice " and " free > enterprise, " with little, if any understanding of basic economics, much > less the law. > > Therefore, I issue you my modest proposal. Let's go back to a completely > unregulated EMS system. A basic first aid card is all you need to drive a > very fast Cadillac or Buick ambulance. We can't put any medical equipment > in the ambulance, because you want to get to every scene before your > competitor. Remember, you'll be competing with funeral homes for business, > and dead patients are more profitable. No need for a 911 system because > you can just jump calls from listening to the police scanner. I'd > recommend the name F & B Ambulance for your new venture. Remember, any > standards for EMS are communist plots from Hillary Clinton to deprive you > of your God-given right to make a fast buck. > > In a few months, the usual complainers will post on here asking why EMS > isn't taken seriously. Two quotes come to mind. One comes from a gentleman > who may have lived just after 1 A.D. " Physician, heal thyself. " The other > comes from a cartoon character, " We have met the enemy and he is us. " > > This will be my last post on EMS ordinances, and probably on many topics. > I'm going to join Gene, Dr. , and many others in sitting on the > sidelines, watching the children bicker. You kids have fun! I'll be around > watching and laughing, but contributing to other EMS internet forums where > actual topics related to patient care are discussed. > > See y'all around. I'm going back to EMS Utopia... > > Cheers! > -Wes Ogilvie, MPA, JD, EMT-B > Attorney at Law/Emergency Medical Technician > Austin, Texas > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 31, 2006 Report Share Posted January 31, 2006 Wes, I may have missed some posts or maybe misunderstood some replies, but I hope that no one is publicly asking that we lower the standards of care. I hope instead that we are allowing the hospitals and nursing facilities to choose who *they* want to use, based on quality of care and that they have met the city and state's requirements. If someone is privately sending you emails supporting a completely unregulated service, then please herd them over to my neck of the woods for a flogging, because I for one sure don't want this field to lower itself to " Mother, Jugs, and Speed " standards. In fact, my hopes are that we can RAISE the current level of care by giving the set-in-stone-and-politically-protected non-emergency providers a reason to offer more than the mediocre level of service they have become used to providing. My points have been and still are: 1. Emergency EMS (9-1-1) is off-limits in this topic; I have never suggested that 9-1-1 should be " deregulated " . Competition for emergency calls is a frightening proposition, and I certainly would not support that in any sense with the current state of EMS. 2. L:imited resources: I agree that there is a limited number of patients to serve in the non-emergency setting. It *is* unfortunate though that a service who operates mostly at a large city is granted apparently exclusive rights to operate in a smaller one, yet chooses not to maintain a 24/7 presence there unless they feel like it. It only offers a crew in the smaller city when business is slow in the larger one. That does not benefit the city's 9-1-1 system in case of a need for backup EMS services or to allow the emergency responders to focus primarily on that: emergency response. Instead, the city EMS has to wear two hats instead... one as a 9-1-1 response, and the other to take Mrs. Elderly home from the hospital when the only other non-emergency provider is away for the day. Not a good allocation of resources in a smaller city. 3. Higher levels of standards and care: Ambulance services must be FULLY licensed, insured, staffed, and so on to either meet or exceed TSDHS requirements. In fact, before a city even allows an ambulance service to operate within city limits, why not raise the bar and expect more beyond the state minimum? But let the " permit " be something that any *qualifying* service may obtain with approval by a commission, and by meeting or exceeding these standards. If the service should not otherwise be allowed, DON'T GRANT THE PERMIT! But please don't just restrict the permit to one service and one service only simply because that franchised service will cry " foul " when another fully-licensed and permitted service offers the hospital a better level of care, and takes away their " business " --- even when only 5% of their business actually comes from the smaller city. 4. A " permit " should not guarantee the non-emergency service a certain number of patients. It should allow the service to care for its citizens knowing full well that it has met or exceeded the city and state's requirements, with all of the pertinant information about staffing, equipment, insurance, etc. fully addressed in the application process and reviewed by medical peers. At least with this option, a hospital may call a local outside service that holds a current " permit " for a scheduled, non-emergency transport without fears of ordiance violation. This is by far a better solution than having to play " pirate ambulance " when the hospital has no one else to choose, and the city won't grant another service a franchise based on politics and a desire to protect its current business interests. I'm sorry you feel that you need to take the sideline on this issue. I've learned quite a bit from you and others on this topic. I am intrigued on this idea of a Texas EMS Commission, which was a thread started separately from this one but offers an interesting opportunity on many levels to help better this state's EMS system. I've learned more about the legislative process and history of EMS through you, Gene, Dr. Krin, Mr. Wood, and Tater about this issue and through past threads; I am not an attorney, but at least there is a possible path to enact change that is more clear to me now than the attorney I hired had to offer. But most importantly, I've learned that even though a few posts in this thread left me wishing I stayed silent and hadn't typed at all, at least I see others' perspectives on the topic. I can respect that, and hope to try and make things better. Personally, I couldn't work with a system that blatently placed dollars ahead of the patient's welfare anymore, and had to do something about it. This thread hits on that very same problem, and maybe I should have remained quiet. In the end, I lost the battle with " the system " . Maybe I should have just stayed quiet, gone on to complete my paramedic, and spent the next 20 years working for a big-city EMS, closing my eyes to the current situation in front of me. I hope you continue to offer your wisdom and opinions Wes. In my opinion, it would be a great loss to not have heard them at all. A modest proposal > To the usual offenders: > > Well, it appears that I have ruffled everyone's feathers by explaining the > current state of affairs as the law allows. I attempted to explain how the > law allows the government to make certain intrusions upon the free market > in an attempt to protect the public and better distribute scarce resources > (I.E. a limited number of non-emergent transfer patients). In return, > from several of you, I have received little but pissing, moaning, and > whining. Most of you say how it should be, not understanding the how and > why of where we're at now, which may well be because of the previous > abuses brought on by an unregulated ambulance marketplace. The puerile > behavior strikes me as a temper tantrum from the illegitimate love-child > of Ayn Rand and Rush Limbaugh, moaning about " freedom of choice " and " free > enterprise, " with little, if any understanding of basic economics, much > less the law. > > Therefore, I issue you my modest proposal. Let's go back to a completely > unregulated EMS system. A basic first aid card is all you need to drive a > very fast Cadillac or Buick ambulance. We can't put any medical equipment > in the ambulance, because you want to get to every scene before your > competitor. Remember, you'll be competing with funeral homes for business, > and dead patients are more profitable. No need for a 911 system because > you can just jump calls from listening to the police scanner. I'd > recommend the name F & B Ambulance for your new venture. Remember, any > standards for EMS are communist plots from Hillary Clinton to deprive you > of your God-given right to make a fast buck. > > In a few months, the usual complainers will post on here asking why EMS > isn't taken seriously. Two quotes come to mind. One comes from a gentleman > who may have lived just after 1 A.D. " Physician, heal thyself. " The other > comes from a cartoon character, " We have met the enemy and he is us. " > > This will be my last post on EMS ordinances, and probably on many topics. > I'm going to join Gene, Dr. , and many others in sitting on the > sidelines, watching the children bicker. You kids have fun! I'll be around > watching and laughing, but contributing to other EMS internet forums where > actual topics related to patient care are discussed. > > See y'all around. I'm going back to EMS Utopia... > > Cheers! > -Wes Ogilvie, MPA, JD, EMT-B > Attorney at Law/Emergency Medical Technician > Austin, Texas > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 31, 2006 Report Share Posted January 31, 2006 Wes, I may have missed some posts or maybe misunderstood some replies, but I hope that no one is publicly asking that we lower the standards of care. I hope instead that we are allowing the hospitals and nursing facilities to choose who *they* want to use, based on quality of care and that they have met the city and state's requirements. If someone is privately sending you emails supporting a completely unregulated service, then please herd them over to my neck of the woods for a flogging, because I for one sure don't want this field to lower itself to " Mother, Jugs, and Speed " standards. In fact, my hopes are that we can RAISE the current level of care by giving the set-in-stone-and-politically-protected non-emergency providers a reason to offer more than the mediocre level of service they have become used to providing. My points have been and still are: 1. Emergency EMS (9-1-1) is off-limits in this topic; I have never suggested that 9-1-1 should be " deregulated " . Competition for emergency calls is a frightening proposition, and I certainly would not support that in any sense with the current state of EMS. 2. L:imited resources: I agree that there is a limited number of patients to serve in the non-emergency setting. It *is* unfortunate though that a service who operates mostly at a large city is granted apparently exclusive rights to operate in a smaller one, yet chooses not to maintain a 24/7 presence there unless they feel like it. It only offers a crew in the smaller city when business is slow in the larger one. That does not benefit the city's 9-1-1 system in case of a need for backup EMS services or to allow the emergency responders to focus primarily on that: emergency response. Instead, the city EMS has to wear two hats instead... one as a 9-1-1 response, and the other to take Mrs. Elderly home from the hospital when the only other non-emergency provider is away for the day. Not a good allocation of resources in a smaller city. 3. Higher levels of standards and care: Ambulance services must be FULLY licensed, insured, staffed, and so on to either meet or exceed TSDHS requirements. In fact, before a city even allows an ambulance service to operate within city limits, why not raise the bar and expect more beyond the state minimum? But let the " permit " be something that any *qualifying* service may obtain with approval by a commission, and by meeting or exceeding these standards. If the service should not otherwise be allowed, DON'T GRANT THE PERMIT! But please don't just restrict the permit to one service and one service only simply because that franchised service will cry " foul " when another fully-licensed and permitted service offers the hospital a better level of care, and takes away their " business " --- even when only 5% of their business actually comes from the smaller city. 4. A " permit " should not guarantee the non-emergency service a certain number of patients. It should allow the service to care for its citizens knowing full well that it has met or exceeded the city and state's requirements, with all of the pertinant information about staffing, equipment, insurance, etc. fully addressed in the application process and reviewed by medical peers. At least with this option, a hospital may call a local outside service that holds a current " permit " for a scheduled, non-emergency transport without fears of ordiance violation. This is by far a better solution than having to play " pirate ambulance " when the hospital has no one else to choose, and the city won't grant another service a franchise based on politics and a desire to protect its current business interests. I'm sorry you feel that you need to take the sideline on this issue. I've learned quite a bit from you and others on this topic. I am intrigued on this idea of a Texas EMS Commission, which was a thread started separately from this one but offers an interesting opportunity on many levels to help better this state's EMS system. I've learned more about the legislative process and history of EMS through you, Gene, Dr. Krin, Mr. Wood, and Tater about this issue and through past threads; I am not an attorney, but at least there is a possible path to enact change that is more clear to me now than the attorney I hired had to offer. But most importantly, I've learned that even though a few posts in this thread left me wishing I stayed silent and hadn't typed at all, at least I see others' perspectives on the topic. I can respect that, and hope to try and make things better. Personally, I couldn't work with a system that blatently placed dollars ahead of the patient's welfare anymore, and had to do something about it. This thread hits on that very same problem, and maybe I should have remained quiet. In the end, I lost the battle with " the system " . Maybe I should have just stayed quiet, gone on to complete my paramedic, and spent the next 20 years working for a big-city EMS, closing my eyes to the current situation in front of me. I hope you continue to offer your wisdom and opinions Wes. In my opinion, it would be a great loss to not have heard them at all. A modest proposal > To the usual offenders: > > Well, it appears that I have ruffled everyone's feathers by explaining the > current state of affairs as the law allows. I attempted to explain how the > law allows the government to make certain intrusions upon the free market > in an attempt to protect the public and better distribute scarce resources > (I.E. a limited number of non-emergent transfer patients). In return, > from several of you, I have received little but pissing, moaning, and > whining. Most of you say how it should be, not understanding the how and > why of where we're at now, which may well be because of the previous > abuses brought on by an unregulated ambulance marketplace. The puerile > behavior strikes me as a temper tantrum from the illegitimate love-child > of Ayn Rand and Rush Limbaugh, moaning about " freedom of choice " and " free > enterprise, " with little, if any understanding of basic economics, much > less the law. > > Therefore, I issue you my modest proposal. Let's go back to a completely > unregulated EMS system. A basic first aid card is all you need to drive a > very fast Cadillac or Buick ambulance. We can't put any medical equipment > in the ambulance, because you want to get to every scene before your > competitor. Remember, you'll be competing with funeral homes for business, > and dead patients are more profitable. No need for a 911 system because > you can just jump calls from listening to the police scanner. I'd > recommend the name F & B Ambulance for your new venture. Remember, any > standards for EMS are communist plots from Hillary Clinton to deprive you > of your God-given right to make a fast buck. > > In a few months, the usual complainers will post on here asking why EMS > isn't taken seriously. Two quotes come to mind. One comes from a gentleman > who may have lived just after 1 A.D. " Physician, heal thyself. " The other > comes from a cartoon character, " We have met the enemy and he is us. " > > This will be my last post on EMS ordinances, and probably on many topics. > I'm going to join Gene, Dr. , and many others in sitting on the > sidelines, watching the children bicker. You kids have fun! I'll be around > watching and laughing, but contributing to other EMS internet forums where > actual topics related to patient care are discussed. > > See y'all around. I'm going back to EMS Utopia... > > Cheers! > -Wes Ogilvie, MPA, JD, EMT-B > Attorney at Law/Emergency Medical Technician > Austin, Texas > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 31, 2006 Report Share Posted January 31, 2006 Kim, This post really brings this issue to a head. Hospitals and Nursing Homes shoudl be able to call the provider of their choice based upon the quality of care...what a joke! What has happened in larger cities (who don't have ordinances that restrict who can and cannot operate ambulances in their cities) is that nursing home residences have become second class citizens. Have difficulty breathing in the house next to the nursing home get a 911 response in 4 to 8 minutes...have difficulty breathing IN the nursing home, get the " lowest price " ambulance from across town...because if it is DRG related then more of the money stays with the nursing home and (another dirtly little secret)...the 911 agency has enough to do without responding to that nursing home.... Like it or not, this is exactly what these ordinances and the whole certificate of need process is in place to solve. It does not rule out privates in favor of municipal services, it just establishes a benchmark and only allows those that are needed and can achieve that benchmark to do the job... Why do the " $59 dollars a transport " one van ambulances immediately become the most qualified ambulances to take the NH patient to the ER? Dudley Re: A modest proposal Wes, I may have missed some posts or maybe misunderstood some replies, but I hope that no one is publicly asking that we lower the standards of care. I hope instead that we are allowing the hospitals and nursing facilities to choose who *they* want to use, based on quality of care and that they have met the city and state's requirements. If someone is privately sending you emails supporting a completely unregulated service, then please herd them over to my neck of the woods for a flogging, because I for one sure don't want this field to lower itself to " Mother, Jugs, and Speed " standards. In fact, my hopes are that we can RAISE the current level of care by giving the set-in-stone-and-politically-protected non-emergency providers a reason to offer more than the mediocre level of service they have become used to providing. My points have been and still are: 1. Emergency EMS (9-1-1) is off-limits in this topic; I have never suggested that 9-1-1 should be " deregulated " . Competition for emergency calls is a frightening proposition, and I certainly would not support that in any sense with the current state of EMS. 2. L:imited resources: I agree that there is a limited number of patients to serve in the non-emergency setting. It *is* unfortunate though that a service who operates mostly at a large city is granted apparently exclusive rights to operate in a smaller one, yet chooses not to maintain a 24/7 presence there unless they feel like it. It only offers a crew in the smaller city when business is slow in the larger one. That does not benefit the city's 9-1-1 system in case of a need for backup EMS services or to allow the emergency responders to focus primarily on that: emergency response. Instead, the city EMS has to wear two hats instead... one as a 9-1-1 response, and the other to take Mrs. Elderly home from the hospital when the only other non-emergency provider is away for the day. Not a good allocation of resources in a smaller city. 3. Higher levels of standards and care: Ambulance services must be FULLY licensed, insured, staffed, and so on to either meet or exceed TSDHS requirements. In fact, before a city even allows an ambulance service to operate within city limits, why not raise the bar and expect more beyond the state minimum? But let the " permit " be something that any *qualifying* service may obtain with approval by a commission, and by meeting or exceeding these standards. If the service should not otherwise be allowed, DON'T GRANT THE PERMIT! But please don't just restrict the permit to one service and one service only simply because that franchised service will cry " foul " when another fully-licensed and permitted service offers the hospital a better level of care, and takes away their " business " --- even when only 5% of their business actually comes from the smaller city. 4. A " permit " should not guarantee the non-emergency service a certain number of patients. It should allow the service to care for its citizens knowing full well that it has met or exceeded the city and state's requirements, with all of the pertinant information about staffing, equipment, insurance, etc. fully addressed in the application process and reviewed by medical peers. At least with this option, a hospital may call a local outside service that holds a current " permit " for a scheduled, non-emergency transport without fears of ordiance violation. This is by far a better solution than having to play " pirate ambulance " when the hospital has no one else to choose, and the city won't grant another service a franchise based on politics and a desire to protect its current business interests. I'm sorry you feel that you need to take the sideline on this issue. I've learned quite a bit from you and others on this topic. I am intrigued on this idea of a Texas EMS Commission, which was a thread started separately from this one but offers an interesting opportunity on many levels to help better this state's EMS system. I've learned more about the legislative process and history of EMS through you, Gene, Dr. Krin, Mr. Wood, and Tater about this issue and through past threads; I am not an attorney, but at least there is a possible path to enact change that is more clear to me now than the attorney I hired had to offer. But most importantly, I've learned that even though a few posts in this thread left me wishing I stayed silent and hadn't typed at all, at least I see others' perspectives on the topic. I can respect that, and hope to try and make things better. Personally, I couldn't work with a system that blatently placed dollars ahead of the patient's welfare anymore, and had to do something about it. This thread hits on that very same problem, and maybe I should have remained quiet. In the end, I lost the battle with " the system " . Maybe I should have just stayed quiet, gone on to complete my paramedic, and spent the next 20 years working for a big-city EMS, closing my eyes to the current situation in front of me. I hope you continue to offer your wisdom and opinions Wes. In my opinion, it would be a great loss to not have heard them at all. A modest proposal > To the usual offenders: > > Well, it appears that I have ruffled everyone's feathers by explaining the > current state of affairs as the law allows. I attempted to explain how the > law allows the government to make certain intrusions upon the free market > in an attempt to protect the public and better distribute scarce resources > (I.E. a limited number of non-emergent transfer patients). In return, > from several of you, I have received little but pissing, moaning, and > whining. Most of you say how it should be, not understanding the how and > why of where we're at now, which may well be because of the previous > abuses brought on by an unregulated ambulance marketplace. The puerile > behavior strikes me as a temper tantrum from the illegitimate love-child > of Ayn Rand and Rush Limbaugh, moaning about " freedom of choice " and " free > enterprise, " with little, if any understanding of basic economics, much > less the law. > > Therefore, I issue you my modest proposal. Let's go back to a completely > unregulated EMS system. A basic first aid card is all you need to drive a > very fast Cadillac or Buick ambulance. We can't put any medical equipment > in the ambulance, because you want to get to every scene before your > competitor. Remember, you'll be competing with funeral homes for business, > and dead patients are more profitable. No need for a 911 system because > you can just jump calls from listening to the police scanner. I'd > recommend the name F & B Ambulance for your new venture. Remember, any > standards for EMS are communist plots from Hillary Clinton to deprive you > of your God-given right to make a fast buck. > > In a few months, the usual complainers will post on here asking why EMS > isn't taken seriously. Two quotes come to mind. One comes from a gentleman > who may have lived just after 1 A.D. " Physician, heal thyself. " The other > comes from a cartoon character, " We have met the enemy and he is us. " > > This will be my last post on EMS ordinances, and probably on many topics. > I'm going to join Gene, Dr. , and many others in sitting on the > sidelines, watching the children bicker. You kids have fun! I'll be around > watching and laughing, but contributing to other EMS internet forums where > actual topics related to patient care are discussed. > > See y'all around. I'm going back to EMS Utopia... > > Cheers! > -Wes Ogilvie, MPA, JD, EMT-B > Attorney at Law/Emergency Medical Technician > Austin, Texas > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 31, 2006 Report Share Posted January 31, 2006 Kim, This post really brings this issue to a head. Hospitals and Nursing Homes shoudl be able to call the provider of their choice based upon the quality of care...what a joke! What has happened in larger cities (who don't have ordinances that restrict who can and cannot operate ambulances in their cities) is that nursing home residences have become second class citizens. Have difficulty breathing in the house next to the nursing home get a 911 response in 4 to 8 minutes...have difficulty breathing IN the nursing home, get the " lowest price " ambulance from across town...because if it is DRG related then more of the money stays with the nursing home and (another dirtly little secret)...the 911 agency has enough to do without responding to that nursing home.... Like it or not, this is exactly what these ordinances and the whole certificate of need process is in place to solve. It does not rule out privates in favor of municipal services, it just establishes a benchmark and only allows those that are needed and can achieve that benchmark to do the job... Why do the " $59 dollars a transport " one van ambulances immediately become the most qualified ambulances to take the NH patient to the ER? Dudley Re: A modest proposal Wes, I may have missed some posts or maybe misunderstood some replies, but I hope that no one is publicly asking that we lower the standards of care. I hope instead that we are allowing the hospitals and nursing facilities to choose who *they* want to use, based on quality of care and that they have met the city and state's requirements. If someone is privately sending you emails supporting a completely unregulated service, then please herd them over to my neck of the woods for a flogging, because I for one sure don't want this field to lower itself to " Mother, Jugs, and Speed " standards. In fact, my hopes are that we can RAISE the current level of care by giving the set-in-stone-and-politically-protected non-emergency providers a reason to offer more than the mediocre level of service they have become used to providing. My points have been and still are: 1. Emergency EMS (9-1-1) is off-limits in this topic; I have never suggested that 9-1-1 should be " deregulated " . Competition for emergency calls is a frightening proposition, and I certainly would not support that in any sense with the current state of EMS. 2. L:imited resources: I agree that there is a limited number of patients to serve in the non-emergency setting. It *is* unfortunate though that a service who operates mostly at a large city is granted apparently exclusive rights to operate in a smaller one, yet chooses not to maintain a 24/7 presence there unless they feel like it. It only offers a crew in the smaller city when business is slow in the larger one. That does not benefit the city's 9-1-1 system in case of a need for backup EMS services or to allow the emergency responders to focus primarily on that: emergency response. Instead, the city EMS has to wear two hats instead... one as a 9-1-1 response, and the other to take Mrs. Elderly home from the hospital when the only other non-emergency provider is away for the day. Not a good allocation of resources in a smaller city. 3. Higher levels of standards and care: Ambulance services must be FULLY licensed, insured, staffed, and so on to either meet or exceed TSDHS requirements. In fact, before a city even allows an ambulance service to operate within city limits, why not raise the bar and expect more beyond the state minimum? But let the " permit " be something that any *qualifying* service may obtain with approval by a commission, and by meeting or exceeding these standards. If the service should not otherwise be allowed, DON'T GRANT THE PERMIT! But please don't just restrict the permit to one service and one service only simply because that franchised service will cry " foul " when another fully-licensed and permitted service offers the hospital a better level of care, and takes away their " business " --- even when only 5% of their business actually comes from the smaller city. 4. A " permit " should not guarantee the non-emergency service a certain number of patients. It should allow the service to care for its citizens knowing full well that it has met or exceeded the city and state's requirements, with all of the pertinant information about staffing, equipment, insurance, etc. fully addressed in the application process and reviewed by medical peers. At least with this option, a hospital may call a local outside service that holds a current " permit " for a scheduled, non-emergency transport without fears of ordiance violation. This is by far a better solution than having to play " pirate ambulance " when the hospital has no one else to choose, and the city won't grant another service a franchise based on politics and a desire to protect its current business interests. I'm sorry you feel that you need to take the sideline on this issue. I've learned quite a bit from you and others on this topic. I am intrigued on this idea of a Texas EMS Commission, which was a thread started separately from this one but offers an interesting opportunity on many levels to help better this state's EMS system. I've learned more about the legislative process and history of EMS through you, Gene, Dr. Krin, Mr. Wood, and Tater about this issue and through past threads; I am not an attorney, but at least there is a possible path to enact change that is more clear to me now than the attorney I hired had to offer. But most importantly, I've learned that even though a few posts in this thread left me wishing I stayed silent and hadn't typed at all, at least I see others' perspectives on the topic. I can respect that, and hope to try and make things better. Personally, I couldn't work with a system that blatently placed dollars ahead of the patient's welfare anymore, and had to do something about it. This thread hits on that very same problem, and maybe I should have remained quiet. In the end, I lost the battle with " the system " . Maybe I should have just stayed quiet, gone on to complete my paramedic, and spent the next 20 years working for a big-city EMS, closing my eyes to the current situation in front of me. I hope you continue to offer your wisdom and opinions Wes. In my opinion, it would be a great loss to not have heard them at all. A modest proposal > To the usual offenders: > > Well, it appears that I have ruffled everyone's feathers by explaining the > current state of affairs as the law allows. I attempted to explain how the > law allows the government to make certain intrusions upon the free market > in an attempt to protect the public and better distribute scarce resources > (I.E. a limited number of non-emergent transfer patients). In return, > from several of you, I have received little but pissing, moaning, and > whining. Most of you say how it should be, not understanding the how and > why of where we're at now, which may well be because of the previous > abuses brought on by an unregulated ambulance marketplace. The puerile > behavior strikes me as a temper tantrum from the illegitimate love-child > of Ayn Rand and Rush Limbaugh, moaning about " freedom of choice " and " free > enterprise, " with little, if any understanding of basic economics, much > less the law. > > Therefore, I issue you my modest proposal. Let's go back to a completely > unregulated EMS system. A basic first aid card is all you need to drive a > very fast Cadillac or Buick ambulance. We can't put any medical equipment > in the ambulance, because you want to get to every scene before your > competitor. Remember, you'll be competing with funeral homes for business, > and dead patients are more profitable. No need for a 911 system because > you can just jump calls from listening to the police scanner. I'd > recommend the name F & B Ambulance for your new venture. Remember, any > standards for EMS are communist plots from Hillary Clinton to deprive you > of your God-given right to make a fast buck. > > In a few months, the usual complainers will post on here asking why EMS > isn't taken seriously. Two quotes come to mind. One comes from a gentleman > who may have lived just after 1 A.D. " Physician, heal thyself. " The other > comes from a cartoon character, " We have met the enemy and he is us. " > > This will be my last post on EMS ordinances, and probably on many topics. > I'm going to join Gene, Dr. , and many others in sitting on the > sidelines, watching the children bicker. You kids have fun! I'll be around > watching and laughing, but contributing to other EMS internet forums where > actual topics related to patient care are discussed. > > See y'all around. I'm going back to EMS Utopia... > > Cheers! > -Wes Ogilvie, MPA, JD, EMT-B > Attorney at Law/Emergency Medical Technician > Austin, Texas > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 31, 2006 Report Share Posted January 31, 2006 Kim, This post really brings this issue to a head. Hospitals and Nursing Homes shoudl be able to call the provider of their choice based upon the quality of care...what a joke! What has happened in larger cities (who don't have ordinances that restrict who can and cannot operate ambulances in their cities) is that nursing home residences have become second class citizens. Have difficulty breathing in the house next to the nursing home get a 911 response in 4 to 8 minutes...have difficulty breathing IN the nursing home, get the " lowest price " ambulance from across town...because if it is DRG related then more of the money stays with the nursing home and (another dirtly little secret)...the 911 agency has enough to do without responding to that nursing home.... Like it or not, this is exactly what these ordinances and the whole certificate of need process is in place to solve. It does not rule out privates in favor of municipal services, it just establishes a benchmark and only allows those that are needed and can achieve that benchmark to do the job... Why do the " $59 dollars a transport " one van ambulances immediately become the most qualified ambulances to take the NH patient to the ER? Dudley Re: A modest proposal Wes, I may have missed some posts or maybe misunderstood some replies, but I hope that no one is publicly asking that we lower the standards of care. I hope instead that we are allowing the hospitals and nursing facilities to choose who *they* want to use, based on quality of care and that they have met the city and state's requirements. If someone is privately sending you emails supporting a completely unregulated service, then please herd them over to my neck of the woods for a flogging, because I for one sure don't want this field to lower itself to " Mother, Jugs, and Speed " standards. In fact, my hopes are that we can RAISE the current level of care by giving the set-in-stone-and-politically-protected non-emergency providers a reason to offer more than the mediocre level of service they have become used to providing. My points have been and still are: 1. Emergency EMS (9-1-1) is off-limits in this topic; I have never suggested that 9-1-1 should be " deregulated " . Competition for emergency calls is a frightening proposition, and I certainly would not support that in any sense with the current state of EMS. 2. L:imited resources: I agree that there is a limited number of patients to serve in the non-emergency setting. It *is* unfortunate though that a service who operates mostly at a large city is granted apparently exclusive rights to operate in a smaller one, yet chooses not to maintain a 24/7 presence there unless they feel like it. It only offers a crew in the smaller city when business is slow in the larger one. That does not benefit the city's 9-1-1 system in case of a need for backup EMS services or to allow the emergency responders to focus primarily on that: emergency response. Instead, the city EMS has to wear two hats instead... one as a 9-1-1 response, and the other to take Mrs. Elderly home from the hospital when the only other non-emergency provider is away for the day. Not a good allocation of resources in a smaller city. 3. Higher levels of standards and care: Ambulance services must be FULLY licensed, insured, staffed, and so on to either meet or exceed TSDHS requirements. In fact, before a city even allows an ambulance service to operate within city limits, why not raise the bar and expect more beyond the state minimum? But let the " permit " be something that any *qualifying* service may obtain with approval by a commission, and by meeting or exceeding these standards. If the service should not otherwise be allowed, DON'T GRANT THE PERMIT! But please don't just restrict the permit to one service and one service only simply because that franchised service will cry " foul " when another fully-licensed and permitted service offers the hospital a better level of care, and takes away their " business " --- even when only 5% of their business actually comes from the smaller city. 4. A " permit " should not guarantee the non-emergency service a certain number of patients. It should allow the service to care for its citizens knowing full well that it has met or exceeded the city and state's requirements, with all of the pertinant information about staffing, equipment, insurance, etc. fully addressed in the application process and reviewed by medical peers. At least with this option, a hospital may call a local outside service that holds a current " permit " for a scheduled, non-emergency transport without fears of ordiance violation. This is by far a better solution than having to play " pirate ambulance " when the hospital has no one else to choose, and the city won't grant another service a franchise based on politics and a desire to protect its current business interests. I'm sorry you feel that you need to take the sideline on this issue. I've learned quite a bit from you and others on this topic. I am intrigued on this idea of a Texas EMS Commission, which was a thread started separately from this one but offers an interesting opportunity on many levels to help better this state's EMS system. I've learned more about the legislative process and history of EMS through you, Gene, Dr. Krin, Mr. Wood, and Tater about this issue and through past threads; I am not an attorney, but at least there is a possible path to enact change that is more clear to me now than the attorney I hired had to offer. But most importantly, I've learned that even though a few posts in this thread left me wishing I stayed silent and hadn't typed at all, at least I see others' perspectives on the topic. I can respect that, and hope to try and make things better. Personally, I couldn't work with a system that blatently placed dollars ahead of the patient's welfare anymore, and had to do something about it. This thread hits on that very same problem, and maybe I should have remained quiet. In the end, I lost the battle with " the system " . Maybe I should have just stayed quiet, gone on to complete my paramedic, and spent the next 20 years working for a big-city EMS, closing my eyes to the current situation in front of me. I hope you continue to offer your wisdom and opinions Wes. In my opinion, it would be a great loss to not have heard them at all. A modest proposal > To the usual offenders: > > Well, it appears that I have ruffled everyone's feathers by explaining the > current state of affairs as the law allows. I attempted to explain how the > law allows the government to make certain intrusions upon the free market > in an attempt to protect the public and better distribute scarce resources > (I.E. a limited number of non-emergent transfer patients). In return, > from several of you, I have received little but pissing, moaning, and > whining. Most of you say how it should be, not understanding the how and > why of where we're at now, which may well be because of the previous > abuses brought on by an unregulated ambulance marketplace. The puerile > behavior strikes me as a temper tantrum from the illegitimate love-child > of Ayn Rand and Rush Limbaugh, moaning about " freedom of choice " and " free > enterprise, " with little, if any understanding of basic economics, much > less the law. > > Therefore, I issue you my modest proposal. Let's go back to a completely > unregulated EMS system. A basic first aid card is all you need to drive a > very fast Cadillac or Buick ambulance. We can't put any medical equipment > in the ambulance, because you want to get to every scene before your > competitor. Remember, you'll be competing with funeral homes for business, > and dead patients are more profitable. No need for a 911 system because > you can just jump calls from listening to the police scanner. I'd > recommend the name F & B Ambulance for your new venture. Remember, any > standards for EMS are communist plots from Hillary Clinton to deprive you > of your God-given right to make a fast buck. > > In a few months, the usual complainers will post on here asking why EMS > isn't taken seriously. Two quotes come to mind. One comes from a gentleman > who may have lived just after 1 A.D. " Physician, heal thyself. " The other > comes from a cartoon character, " We have met the enemy and he is us. " > > This will be my last post on EMS ordinances, and probably on many topics. > I'm going to join Gene, Dr. , and many others in sitting on the > sidelines, watching the children bicker. You kids have fun! I'll be around > watching and laughing, but contributing to other EMS internet forums where > actual topics related to patient care are discussed. > > See y'all around. I'm going back to EMS Utopia... > > Cheers! > -Wes Ogilvie, MPA, JD, EMT-B > Attorney at Law/Emergency Medical Technician > Austin, Texas > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 31, 2006 Report Share Posted January 31, 2006 Well Wes it appears that you are going to pick up your toys and go home. Is that right? If that is what Gene and others are doing, then I must have the wrong impression of Gene and others. This list is about everyone being able to voice their opinions. They have theirs, you have yours and I have mine. I will beat you until mine becomes yours. HAHa. I guess my point is that I really don't think you give up that easy. I know Gene doesn't. The problem here is that we see EMS from too many perspectives. Old timers see it as a struggle that must be continued. The younger folks can only see how it affects them at a precise moment in time. Others in between are confused in what they think. Don't give up. Keep posting and let us know what you think. Fish on!! Henry ExLngHrn@... wrote: > To the usual offenders: > > Well, it appears that I have ruffled everyone's feathers by explaining > the current state of affairs as the law allows. I attempted to explain > how the law allows the government to make certain intrusions upon the > free market in an attempt to protect the public and better distribute > scarce resources (I.E. a limited number of non-emergent transfer > patients). In return, from several of you, I have received little but > pissing, moaning, and whining. Most of you say how it should be, not > understanding the how and why of where we're at now, which may well be > because of the previous abuses brought on by an unregulated ambulance > marketplace. The puerile behavior strikes me as a temper tantrum from > the illegitimate love-child of Ayn Rand and Rush Limbaugh, moaning > about " freedom of choice " and " free enterprise, " with little, if any > understanding of basic economics, much less the law. > > Therefore, I issue you my modest proposal. Let's go back to a > completely unregulated EMS system. A basic first aid card is all you > need to drive a very fast Cadillac or Buick ambulance. We can't put > any medical equipment in the ambulance, because you want to get to > every scene before your competitor. Remember, you'll be competing with > funeral homes for business, and dead patients are more profitable. No > need for a 911 system because you can just jump calls from listening > to the police scanner. I'd recommend the name F & B Ambulance for your > new venture. Remember, any standards for EMS are communist plots from > Hillary Clinton to deprive you of your God-given right to make a fast > buck. > > In a few months, the usual complainers will post on here asking why > EMS isn't taken seriously. Two quotes come to mind. One comes from a > gentleman who may have lived just after 1 A.D. " Physician, heal > thyself. " The other comes from a cartoon character, " We have met the > enemy and he is us. " > > This will be my last post on EMS ordinances, and probably on many > topics. I'm going to join Gene, Dr. , and many others in sitting > on the sidelines, watching the children bicker. You kids have fun! > I'll be around watching and laughing, but contributing to other EMS > internet forums where actual topics related to patient care are > discussed. > > See y'all around. I'm going back to EMS Utopia... > > Cheers! > -Wes Ogilvie, MPA, JD, EMT-B > Attorney at Law/Emergency Medical Technician > Austin, Texas > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 31, 2006 Report Share Posted January 31, 2006 Well Wes it appears that you are going to pick up your toys and go home. Is that right? If that is what Gene and others are doing, then I must have the wrong impression of Gene and others. This list is about everyone being able to voice their opinions. They have theirs, you have yours and I have mine. I will beat you until mine becomes yours. HAHa. I guess my point is that I really don't think you give up that easy. I know Gene doesn't. The problem here is that we see EMS from too many perspectives. Old timers see it as a struggle that must be continued. The younger folks can only see how it affects them at a precise moment in time. Others in between are confused in what they think. Don't give up. Keep posting and let us know what you think. Fish on!! Henry ExLngHrn@... wrote: > To the usual offenders: > > Well, it appears that I have ruffled everyone's feathers by explaining > the current state of affairs as the law allows. I attempted to explain > how the law allows the government to make certain intrusions upon the > free market in an attempt to protect the public and better distribute > scarce resources (I.E. a limited number of non-emergent transfer > patients). In return, from several of you, I have received little but > pissing, moaning, and whining. Most of you say how it should be, not > understanding the how and why of where we're at now, which may well be > because of the previous abuses brought on by an unregulated ambulance > marketplace. The puerile behavior strikes me as a temper tantrum from > the illegitimate love-child of Ayn Rand and Rush Limbaugh, moaning > about " freedom of choice " and " free enterprise, " with little, if any > understanding of basic economics, much less the law. > > Therefore, I issue you my modest proposal. Let's go back to a > completely unregulated EMS system. A basic first aid card is all you > need to drive a very fast Cadillac or Buick ambulance. We can't put > any medical equipment in the ambulance, because you want to get to > every scene before your competitor. Remember, you'll be competing with > funeral homes for business, and dead patients are more profitable. No > need for a 911 system because you can just jump calls from listening > to the police scanner. I'd recommend the name F & B Ambulance for your > new venture. Remember, any standards for EMS are communist plots from > Hillary Clinton to deprive you of your God-given right to make a fast > buck. > > In a few months, the usual complainers will post on here asking why > EMS isn't taken seriously. Two quotes come to mind. One comes from a > gentleman who may have lived just after 1 A.D. " Physician, heal > thyself. " The other comes from a cartoon character, " We have met the > enemy and he is us. " > > This will be my last post on EMS ordinances, and probably on many > topics. I'm going to join Gene, Dr. , and many others in sitting > on the sidelines, watching the children bicker. You kids have fun! > I'll be around watching and laughing, but contributing to other EMS > internet forums where actual topics related to patient care are > discussed. > > See y'all around. I'm going back to EMS Utopia... > > Cheers! > -Wes Ogilvie, MPA, JD, EMT-B > Attorney at Law/Emergency Medical Technician > Austin, Texas > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 31, 2006 Report Share Posted January 31, 2006 Wes, Keep posting because ruffled feathers may very well be what we need to improve the state of affairs of EMS in Texas. The time has come for us to stand up and be accountable for actions or inactions that we have allowed over the years. stephen stephens In , ExLngHrn@a... wrote: > > To the usual offenders: > > Well, it appears that I have ruffled everyone's feathers by explaining the current state of affairs as the law allows. I attempted to explain how the law allows the government to make certain intrusions upon the free market in an attempt to protect the public and better distribute scarce resources (I.E. a limited number of non-emergent transfer patients). In return, from several of you, I have received little but pissing, moaning, and whining. Most of you say how it should be, not understanding the how and why of where we're at now, which may well be because of the previous abuses brought on by an unregulated ambulance marketplace. The puerile behavior strikes me as a temper tantrum from the illegitimate love- child of Ayn Rand and Rush Limbaugh, moaning about " freedom of choice " and " free enterprise, " with little, if any understanding of basic economics, much less the law. > > Therefore, I issue you my modest proposal. Let's go back to a completely unregulated EMS system. A basic first aid card is all you need to drive a very fast Cadillac or Buick ambulance. We can't put any medical equipment in the ambulance, because you want to get to every scene before your competitor. Remember, you'll be competing with funeral homes for business, and dead patients are more profitable. No need for a 911 system because you can just jump calls from listening to the police scanner. I'd recommend the name F & B Ambulance for your new venture. Remember, any standards for EMS are communist plots from Hillary Clinton to deprive you of your God- given right to make a fast buck. > > In a few months, the usual complainers will post on here asking why EMS isn't taken seriously. Two quotes come to mind. One comes from a gentleman who may have lived just after 1 A.D. " Physician, heal thyself. " The other comes from a cartoon character, " We have met the enemy and he is us. " > > This will be my last post on EMS ordinances, and probably on many topics. I'm going to join Gene, Dr. , and many others in sitting on the sidelines, watching the children bicker. You kids have fun! I'll be around watching and laughing, but contributing to other EMS internet forums where actual topics related to patient care are discussed. > > See y'all around. I'm going back to EMS Utopia... > > Cheers! > -Wes Ogilvie, MPA, JD, EMT-B > Attorney at Law/Emergency Medical Technician > Austin, Texas > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 31, 2006 Report Share Posted January 31, 2006 Wes, Keep posting because ruffled feathers may very well be what we need to improve the state of affairs of EMS in Texas. The time has come for us to stand up and be accountable for actions or inactions that we have allowed over the years. stephen stephens In , ExLngHrn@a... wrote: > > To the usual offenders: > > Well, it appears that I have ruffled everyone's feathers by explaining the current state of affairs as the law allows. I attempted to explain how the law allows the government to make certain intrusions upon the free market in an attempt to protect the public and better distribute scarce resources (I.E. a limited number of non-emergent transfer patients). In return, from several of you, I have received little but pissing, moaning, and whining. Most of you say how it should be, not understanding the how and why of where we're at now, which may well be because of the previous abuses brought on by an unregulated ambulance marketplace. The puerile behavior strikes me as a temper tantrum from the illegitimate love- child of Ayn Rand and Rush Limbaugh, moaning about " freedom of choice " and " free enterprise, " with little, if any understanding of basic economics, much less the law. > > Therefore, I issue you my modest proposal. Let's go back to a completely unregulated EMS system. A basic first aid card is all you need to drive a very fast Cadillac or Buick ambulance. We can't put any medical equipment in the ambulance, because you want to get to every scene before your competitor. Remember, you'll be competing with funeral homes for business, and dead patients are more profitable. No need for a 911 system because you can just jump calls from listening to the police scanner. I'd recommend the name F & B Ambulance for your new venture. Remember, any standards for EMS are communist plots from Hillary Clinton to deprive you of your God- given right to make a fast buck. > > In a few months, the usual complainers will post on here asking why EMS isn't taken seriously. Two quotes come to mind. One comes from a gentleman who may have lived just after 1 A.D. " Physician, heal thyself. " The other comes from a cartoon character, " We have met the enemy and he is us. " > > This will be my last post on EMS ordinances, and probably on many topics. I'm going to join Gene, Dr. , and many others in sitting on the sidelines, watching the children bicker. You kids have fun! I'll be around watching and laughing, but contributing to other EMS internet forums where actual topics related to patient care are discussed. > > See y'all around. I'm going back to EMS Utopia... > > Cheers! > -Wes Ogilvie, MPA, JD, EMT-B > Attorney at Law/Emergency Medical Technician > Austin, Texas > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 31, 2006 Report Share Posted January 31, 2006 Wes, Keep posting because ruffled feathers may very well be what we need to improve the state of affairs of EMS in Texas. The time has come for us to stand up and be accountable for actions or inactions that we have allowed over the years. stephen stephens In , ExLngHrn@a... wrote: > > To the usual offenders: > > Well, it appears that I have ruffled everyone's feathers by explaining the current state of affairs as the law allows. I attempted to explain how the law allows the government to make certain intrusions upon the free market in an attempt to protect the public and better distribute scarce resources (I.E. a limited number of non-emergent transfer patients). In return, from several of you, I have received little but pissing, moaning, and whining. Most of you say how it should be, not understanding the how and why of where we're at now, which may well be because of the previous abuses brought on by an unregulated ambulance marketplace. The puerile behavior strikes me as a temper tantrum from the illegitimate love- child of Ayn Rand and Rush Limbaugh, moaning about " freedom of choice " and " free enterprise, " with little, if any understanding of basic economics, much less the law. > > Therefore, I issue you my modest proposal. Let's go back to a completely unregulated EMS system. A basic first aid card is all you need to drive a very fast Cadillac or Buick ambulance. We can't put any medical equipment in the ambulance, because you want to get to every scene before your competitor. Remember, you'll be competing with funeral homes for business, and dead patients are more profitable. No need for a 911 system because you can just jump calls from listening to the police scanner. I'd recommend the name F & B Ambulance for your new venture. Remember, any standards for EMS are communist plots from Hillary Clinton to deprive you of your God- given right to make a fast buck. > > In a few months, the usual complainers will post on here asking why EMS isn't taken seriously. Two quotes come to mind. One comes from a gentleman who may have lived just after 1 A.D. " Physician, heal thyself. " The other comes from a cartoon character, " We have met the enemy and he is us. " > > This will be my last post on EMS ordinances, and probably on many topics. I'm going to join Gene, Dr. , and many others in sitting on the sidelines, watching the children bicker. You kids have fun! I'll be around watching and laughing, but contributing to other EMS internet forums where actual topics related to patient care are discussed. > > See y'all around. I'm going back to EMS Utopia... > > Cheers! > -Wes Ogilvie, MPA, JD, EMT-B > Attorney at Law/Emergency Medical Technician > Austin, Texas > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 2, 2006 Report Share Posted February 2, 2006 I take offense to some of your comments. Just because someone works for a private service does that automaticly make them stupid? I dont think so. I have work both sides and I dont work 911 becasue i dont want me or my family to go hungry. Let me see the last time i checked we all went to the same schools and had to pass the same state test. I didnt know there was a seperate Paramedic test for transfer services because we are dumber and cant pass your test. THEDUDMAN@... wrote: Kim, This post really brings this issue to a head. Hospitals and Nursing Homes shoudl be able to call the provider of their choice based upon the quality of care...what a joke! What has happened in larger cities (who don't have ordinances that restrict who can and cannot operate ambulances in their cities) is that nursing home residences have become second class citizens. Have difficulty breathing in the house next to the nursing home get a 911 response in 4 to 8 minutes...have difficulty breathing IN the nursing home, get the " lowest price " ambulance from across town...because if it is DRG related then more of the money stays with the nursing home and (another dirtly little secret)...the 911 agency has enough to do without responding to that nursing home.... Like it or not, this is exactly what these ordinances and the whole certificate of need process is in place to solve. It does not rule out privates in favor of municipal services, it just establishes a benchmark and only allows those that are needed and can achieve that benchmark to do the job... Why do the " $59 dollars a transport " one van ambulances immediately become the most qualified ambulances to take the NH patient to the ER? Dudley Re: A modest proposal Wes, I may have missed some posts or maybe misunderstood some replies, but I hope that no one is publicly asking that we lower the standards of care. I hope instead that we are allowing the hospitals and nursing facilities to choose who *they* want to use, based on quality of care and that they have met the city and state's requirements. If someone is privately sending you emails supporting a completely unregulated service, then please herd them over to my neck of the woods for a flogging, because I for one sure don't want this field to lower itself to " Mother, Jugs, and Speed " standards. In fact, my hopes are that we can RAISE the current level of care by giving the set-in-stone-and-politically-protected non-emergency providers a reason to offer more than the mediocre level of service they have become used to providing. My points have been and still are: 1. Emergency EMS (9-1-1) is off-limits in this topic; I have never suggested that 9-1-1 should be " deregulated " . Competition for emergency calls is a frightening proposition, and I certainly would not support that in any sense with the current state of EMS. 2. L:imited resources: I agree that there is a limited number of patients to serve in the non-emergency setting. It *is* unfortunate though that a service who operates mostly at a large city is granted apparently exclusive rights to operate in a smaller one, yet chooses not to maintain a 24/7 presence there unless they feel like it. It only offers a crew in the smaller city when business is slow in the larger one. That does not benefit the city's 9-1-1 system in case of a need for backup EMS services or to allow the emergency responders to focus primarily on that: emergency response. Instead, the city EMS has to wear two hats instead... one as a 9-1-1 response, and the other to take Mrs. Elderly home from the hospital when the only other non-emergency provider is away for the day. Not a good allocation of resources in a smaller city. 3. Higher levels of standards and care: Ambulance services must be FULLY licensed, insured, staffed, and so on to either meet or exceed TSDHS requirements. In fact, before a city even allows an ambulance service to operate within city limits, why not raise the bar and expect more beyond the state minimum? But let the " permit " be something that any *qualifying* service may obtain with approval by a commission, and by meeting or exceeding these standards. If the service should not otherwise be allowed, DON'T GRANT THE PERMIT! But please don't just restrict the permit to one service and one service only simply because that franchised service will cry " foul " when another fully-licensed and permitted service offers the hospital a better level of care, and takes away their " business " --- even when only 5% of their business actually comes from the smaller city. 4. A " permit " should not guarantee the non-emergency service a certain number of patients. It should allow the service to care for its citizens knowing full well that it has met or exceeded the city and state's requirements, with all of the pertinant information about staffing, equipment, insurance, etc. fully addressed in the application process and reviewed by medical peers. At least with this option, a hospital may call a local outside service that holds a current " permit " for a scheduled, non-emergency transport without fears of ordiance violation. This is by far a better solution than having to play " pirate ambulance " when the hospital has no one else to choose, and the city won't grant another service a franchise based on politics and a desire to protect its current business interests. I'm sorry you feel that you need to take the sideline on this issue. I've learned quite a bit from you and others on this topic. I am intrigued on this idea of a Texas EMS Commission, which was a thread started separately from this one but offers an interesting opportunity on many levels to help better this state's EMS system. I've learned more about the legislative process and history of EMS through you, Gene, Dr. Krin, Mr. Wood, and Tater about this issue and through past threads; I am not an attorney, but at least there is a possible path to enact change that is more clear to me now than the attorney I hired had to offer. But most importantly, I've learned that even though a few posts in this thread left me wishing I stayed silent and hadn't typed at all, at least I see others' perspectives on the topic. I can respect that, and hope to try and make things better. Personally, I couldn't work with a system that blatently placed dollars ahead of the patient's welfare anymore, and had to do something about it. This thread hits on that very same problem, and maybe I should have remained quiet. In the end, I lost the battle with " the system " . Maybe I should have just stayed quiet, gone on to complete my paramedic, and spent the next 20 years working for a big-city EMS, closing my eyes to the current situation in front of me. I hope you continue to offer your wisdom and opinions Wes. In my opinion, it would be a great loss to not have heard them at all. A modest proposal > To the usual offenders: > > Well, it appears that I have ruffled everyone's feathers by explaining the > current state of affairs as the law allows. I attempted to explain how the > law allows the government to make certain intrusions upon the free market > in an attempt to protect the public and better distribute scarce resources > (I.E. a limited number of non-emergent transfer patients). In return, > from several of you, I have received little but pissing, moaning, and > whining. Most of you say how it should be, not understanding the how and > why of where we're at now, which may well be because of the previous > abuses brought on by an unregulated ambulance marketplace. The puerile > behavior strikes me as a temper tantrum from the illegitimate love-child > of Ayn Rand and Rush Limbaugh, moaning about " freedom of choice " and " free > enterprise, " with little, if any understanding of basic economics, much > less the law. > > Therefore, I issue you my modest proposal. Let's go back to a completely > unregulated EMS system. A basic first aid card is all you need to drive a > very fast Cadillac or Buick ambulance. We can't put any medical equipment > in the ambulance, because you want to get to every scene before your > competitor. Remember, you'll be competing with funeral homes for business, > and dead patients are more profitable. No need for a 911 system because > you can just jump calls from listening to the police scanner. I'd > recommend the name F & B Ambulance for your new venture. Remember, any > standards for EMS are communist plots from Hillary Clinton to deprive you > of your God-given right to make a fast buck. > > In a few months, the usual complainers will post on here asking why EMS > isn't taken seriously. Two quotes come to mind. One comes from a gentleman > who may have lived just after 1 A.D. " Physician, heal thyself. " The other > comes from a cartoon character, " We have met the enemy and he is us. " > > This will be my last post on EMS ordinances, and probably on many topics. > I'm going to join Gene, Dr. , and many others in sitting on the > sidelines, watching the children bicker. You kids have fun! I'll be around > watching and laughing, but contributing to other EMS internet forums where > actual topics related to patient care are discussed. > > See y'all around. I'm going back to EMS Utopia... > > Cheers! > -Wes Ogilvie, MPA, JD, EMT-B > Attorney at Law/Emergency Medical Technician > Austin, Texas > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 2, 2006 Report Share Posted February 2, 2006 If you are taking offense, you are reading it wrong. Nowhere does he say that those who work for privates are any less educated or less capable. Read the entire email in context. I agree with what he says, there are reasons that ordinances need to be in place, that's the point that he is making, nothing more nothing less. Mike Hatfield FF/EMT-P > I take offense to some of your comments. Just because someone works > for a private service does that automaticly make them stupid? I dont > think so. I have work both sides and I dont work 911 becasue i dont > want me or my family to go hungry. Let me see the last time i > checked we all went to the same schools and had to pass the same state > test. I didnt know there was a seperate Paramedic test for transfer > services because we are dumber and cant pass your test. > > THEDUDMAN@... wrote: Kim, > > This post really brings this issue to a head. Hospitals and Nursing > Homes shoudl be able to call the provider of their choice based upon the > quality of care...what a joke! > > What has happened in larger cities (who don't have ordinances that > restrict who can and cannot operate ambulances in their cities) is that > nursing home residences have become second class citizens. Have > difficulty breathing in the house next to the nursing home get a 911 > response in 4 to 8 minutes...have difficulty breathing IN the nursing > home, get the & quot;lowest price & quot; ambulance from across > town...because if it is DRG related then more of the money stays with the > nursing home and (another dirtly little secret)...the 911 agency has > enough to do without responding to that nursing home.... > > Like it or not, this is exactly what these ordinances and the whole > certificate of need process is in place to solve. It does not rule out > privates in favor of municipal services, it just establishes a benchmark > and only allows those that are needed and can achieve that benchmark to > do the job... > > Why do the & quot;$59 dollars a transport & quot; one van ambulances > immediately become the most qualified ambulances to take the NH patient > to the ER? > > Dudley > > Re: A modest proposal > > > Wes, > > I may have missed some posts or maybe misunderstood some replies, but I > hope > that no one is publicly asking that we lower the standards of care. I > hope > instead that we are allowing the hospitals and nursing facilities to > choose > who *they* want to use, based on quality of care and that they have met > the > city and state's requirements. If someone is privately sending you > emails > supporting a completely unregulated service, then please herd them over > to > my neck of the woods for a flogging, because I for one sure don't want > this > field to lower itself to & quot;Mother, Jugs, and Speed & quot; standards. > In fact, my > hopes are that we can RAISE the current level of care by giving the > set-in-stone-and-politically-protected non-emergency providers a reason > to > offer more than the mediocre level of service they have become used to > providing. > > My points have been and still are: > > 1. Emergency EMS (9-1-1) is off-limits in this topic; I have never > suggested that 9-1-1 should be & quot;deregulated & quot;. Competition for > emergency > calls is a frightening proposition, and I certainly would not support > that > in any sense with the current state of EMS. > > 2. L:imited resources: I agree that there is a limited number of > patients > to serve in the non-emergency setting. It *is* unfortunate though that a > service who operates mostly at a large city is granted apparently > exclusive > rights to operate in a smaller one, yet chooses not to maintain a 24/7 > presence there unless they feel like it. It only offers a crew in the > smaller city when business is slow in the larger one. That does not > benefit > the city's 9-1-1 system in case of a need for backup EMS services or to > allow the emergency responders to focus primarily on that: emergency > response. Instead, the city EMS has to wear two hats instead... one as a > 9-1-1 response, and the other to take Mrs. Elderly home from the > hospital when the only other non-emergency provider is away for the day. > Not a good allocation of resources in a smaller city. > > 3. Higher levels of standards and care: Ambulance services must be > FULLY > licensed, insured, staffed, and so on to either meet or exceed TSDHS > requirements. In fact, before a city even allows an ambulance service to > operate within city limits, why not raise the bar and expect more beyond > the > state minimum? But let the & quot;permit & quot; be something that any > *qualifying* > service may obtain with approval by a commission, and by meeting or > exceeding these standards. If the service should not otherwise be > allowed, > DON'T GRANT THE PERMIT! But please don't just restrict the permit to one > service and one service only simply because that franchised service will > cry > & quot;foul & quot; when another fully-licensed and permitted service offers > the hospital > a better level of care, and takes away their & quot;business & quot; --- > even when only > 5% of their business actually comes from the smaller city. > > 4. A & quot;permit & quot; should not guarantee the non-emergency service a > certain > number of patients. It should allow the service to care for its citizens > knowing full well that it has met or exceeded the city and state's > requirements, with all of the pertinant information about staffing, > equipment, insurance, etc. fully addressed in the application process and > reviewed by medical peers. At least with this option, a hospital may > call a > local outside service that holds a current & quot;permit & quot; for a > scheduled, > non-emergency transport without fears of ordiance violation. This is by > far > a better solution than having to play & quot;pirate ambulance & quot; when > the hospital > has no one else to choose, and the city won't grant another service a > franchise based on politics and a desire to protect its current business > interests. > > > I'm sorry you feel that you need to take the sideline on this issue. > I've > learned quite a bit from you and others on this topic. I am intrigued on > this idea of a Texas EMS Commission, which was a thread started > separately > from this one but offers an interesting opportunity on many levels to > help > better this state's EMS system. I've learned more about the legislative > process and history of EMS through you, Gene, Dr. Krin, Mr. Wood, and > Tater > about this issue and through past threads; I am not an attorney, but at > least there is a possible path to enact change that is more clear to me > now > than the attorney I hired had to offer. But most importantly, I've > learned > that even though a few posts in this thread left me wishing I stayed > silent > and hadn't typed at all, at least I see others' perspectives on the > topic. > I can respect that, and hope to try and make things better. > > Personally, I couldn't work with a system that blatently placed dollars > ahead of the patient's welfare anymore, and had to do something about it. > This thread hits on that very same problem, and maybe I should have > remained > quiet. In the end, I lost the battle with & quot;the system & quot;. Maybe > I should > have just stayed quiet, gone on to complete my paramedic, and spent the > next > 20 years working for a big-city EMS, closing my eyes to the current > situation in front of me. > > I hope you continue to offer your wisdom and opinions Wes. In my > opinion, > it would be a great loss to not have heard them at all. > > > > > > > > > > A modest proposal > > > > To the usual offenders: > > > > Well, it appears that I have ruffled everyone's feathers by explaining > the > > current state of affairs as the law allows. I attempted to explain how > the > > law allows the government to make certain intrusions upon the free > market > > in an attempt to protect the public and better distribute scarce > resources > > (I.E. a limited number of non-emergent transfer patients). In return, > > from several of you, I have received little but pissing, moaning, and > > whining. Most of you say how it should be, not understanding the how > and > > why of where we're at now, which may well be because of the previous > > abuses brought on by an unregulated ambulance marketplace. The puerile > > behavior strikes me as a temper tantrum from the illegitimate > love-child > > of Ayn Rand and Rush Limbaugh, moaning about & quot;freedom of > choice & quot; and & quot;free > > enterprise, & quot; with little, if any understanding of basic economics, > much > > less the law. > > > > Therefore, I issue you my modest proposal. Let's go back to a > completely > > unregulated EMS system. A basic first aid card is all you need to drive > a > > very fast Cadillac or Buick ambulance. We can't put any medical > equipment > > in the ambulance, because you want to get to every scene before your > > competitor. Remember, you'll be competing with funeral homes for > business, > > and dead patients are more profitable. No need for a 911 system because > > you can just jump calls from listening to the police scanner. I'd > > recommend the name F & amp;B Ambulance for your new venture. Remember, > any > > standards for EMS are communist plots from Hillary Clinton to deprive > you > > of your God-given right to make a fast buck. > > > > In a few months, the usual complainers will post on here asking why EMS > > isn't taken seriously. Two quotes come to mind. One comes from a > gentleman > > who may have lived just after 1 A.D. & quot;Physician, heal > thyself. & quot; The other > > comes from a cartoon character, & quot;We have met the enemy and he is > us. & quot; > > > > This will be my last post on EMS ordinances, and probably on many > topics. > > I'm going to join Gene, Dr. , and many others in sitting on the > > sidelines, watching the children bicker. You kids have fun! I'll be > around > > watching and laughing, but contributing to other EMS internet forums > where > > actual topics related to patient care are discussed. > > > > See y'all around. I'm going back to EMS Utopia... > > > > Cheers! > > -Wes Ogilvie, MPA, JD, EMT-B > > Attorney at Law/Emergency Medical Technician > > Austin, Texas > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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