Guest guest Posted February 11, 2007 Report Share Posted February 11, 2007 Speaking about HIPPA... that was a 30yo male inmate with SVT and bradycardia (beats me how that happens maybe ST with PJCs?) with chest pain on 02/08/07 out of Groesbeck. Did we all get that information? ;P Come on now. Sounds like someone is about to go postal on an ex- employer - Operations Manager and is venting. So were you fired because the management did not questioned your treatment, ignored the wishes of the sending ER and the ER that accepted and went somewhere else? This patient had already been seen in the ER for 6 hours and you made the decision enroute to change the desination due to unstable? To alert medical control. Transport to a facility that has not accepted this patient. An inmate. Can you understand why that may be frustrating to the facility? And why documentation at this point is your friend. Your medical control is the one you need the back up from for prescribing not you and orders to go to closes facility lies with him/her your medical control. I hope you had their name in your chart as a verbal order. By the way, you could have refused to take this call from facility to facility if you thought the patient was too unstable from the get go. Let me let you in on a little secret, it is called EMTALA. Hospital ERs live and breath by it. Read about it here: http://www.emtala.com/ with respect, Penny Engelking LP > > To Whom it May Concern, > > This email is to inform you of recent actions taken by higher > management > at Guardian EMS. > > I have been a paramedic for 4 years, with some of that being spent > with > MCHD EMS and the past 16 months spent at Guardian. I also spent the > early > part of my EMS career with Guardian (2001 to 2003), and as a result > have > seen severaly Operations Managers come and go, as well as several > supervisors come and go. > Never before have I been so disheartened with the actions of an > Operations > Manager as I have been with those of Joe Fowler. The actions taken > resulted form a call that I took on 02-08-07 that was going from > Groesbeck > ER to Mother Francis in Tyler. The call came out as a 30 year old > male > with chest pain on a monitor with IV. We arrived at Groesbeck > Hospital to > find that our patient was unstable (blood pressure of 77/30, SVt at > 150 > bpm with frequent intermittent runs of bradycardia at 40-50 bpm, > active > chest pain, and the only medical interventions over 6 to 7 hours > were IV > with normal saline and a G.I. cocktail to rule out that the chest > pain was > related to his stomach and not his heart. No cardiac medications > given). > The ER nurse had greeted us with a 6 foot long EKG strip showing the > SVT > and Brady rhythms and had stated, " I've never seen this before " . > I voiced my belief that the pt was not stable, especially for a 2 to > 2 1/2 > hour transport. I called Medical Control and the doctor on duty > stated > that he agreed that the patient was not stable enough to make a 2 to > 2 1/2 > hour transport, advised going to a closer hospital, and also advised > on > giving the patient 150 mg Amiodarone over 10 minutes. I was then > told by > the ER nurse that " I considered him unstable too when he first got > here, > but he's been like this for 6 or 7 hours. Nothing is going to > change. " The > Er refused to give Amiodarone to our patient prior to transporting, > so we > loaded our patient into the ambulance. Did I mention the patient was > an > inmate? Because apparently that was a very important aspect of the > call. > I made the decision to take the patient to the closest higher level > care > hospital due to his unstable condition. St ph in is 73 > miles to > the south, Palestine Hospital is 70 miles northeast and Waco is 79 > miles > west of Groesbeck. St ph's in is a higher level care > hospital > with a good cardiology unit. So I made the decision to divert to > , > which was a one hour transport as opposed to the 2 to 2 1/2 hour > transport > to Tyler. The fact that the closest higher level care hospital was > in a > southerly direction is also very important, so keep this in mind. > I gave the patient 150 mg Amiodarone for his rapidly cycling > SVT/Brady > rhythm, and we left. 15 to 20 minutes into the transport the pt > converted > to Bradycardia at 52 bpm and stated " I feel much better. " . We > arrived at > SJRHC ER, give a report and drop off the patient. Then the feces hit > the > fan, so to speak. > Bottom line and to make a long story shorter, my patient care was > " excellent " , but my understanding of the financial aspects of the > call > lacked something to be desired. SJRHC ER were upset and called > yelling > about " who's going to pay this bill for this inmate? " , as well as the > esteemed cardiologist with 40 years of experience who called to > inquire as > to where I got my medical degree from...Yale or Harvard, because I > seemed > to think I knew more about this patient's condition than he did, as > he had > treated him for several hours in his ER. Here's where I remind you > about > the G.I. cocktail and IV and no cardiac medications. > Bottom line, I was terminated from employment. Reason? Although my > patient > care was " excellent " , I need to have a better understanding of how > precertification for inmates works, and should have called AOC prior > to > our leaving the hospital and gain assistance from them. I " skipped " > several steps in the process, and headed in a southerly direction > rather > than a northeast one (Mother Francis lies to the northeast of > Groesbeck). > It doesn't matter if St ph was a better hospital, one hour > away...it > was in a southerly direction and therefore null and void. > So to all my former coworkers, please make sure that you keep the > financial aspects of the call your TOP priority, with patient care > secondary. After all, like I was told, we are in this business to > make > money. I'm not related to my patient, so why should I care what > happens to > them?--quote courtesy of Joe Fowler. > Note to higher management...I got into this " business " of being a > paramedic because I DO care about people, whether I am related to > them or > not. Whether they are an inmate or not matters little to me. Bottom > line, > patient care will always be my number one priority. To fire me for > diong > something wrong involving patient care is one thing, but to fire me > for > doing the right thing is something else entirely unethical. > Unless you are standing next to me at my patient's bedside or with > me in > the back of the truck, you are not there to make the decisions with > me. I > did what was right for my patient, bottom line. > > Sincerely, > Tara Gibbs, EMT-P, former Guardian employee. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2007 Report Share Posted February 11, 2007 I have no dogs in this fight, except for fairness and propriety. Good reply, Mike, agree totally. " A prudent man foresees the difficulties ahead and prepares for them; the simpleton goes blindly on and suffers the consequences. " Proverbs 22:3 --------------------------------- Cheap Talk? Check out Yahoo! Messenger's low PC-to-Phone call rates. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2007 Report Share Posted February 11, 2007 Maybe it's just me, but I'd have put the patient on my stretcher in the ER, then before loading into the ambulance, gone ahead and treated them in front of the ER staff. Sounds like the right medical treatment was given... Then the ER staff could learn something, and if the patient becomes more unstable, I could divert right back to the ER I'm standing in. Then again, I'm just evil like that when need be... Mike PS - Here you go, Bastrop County - EMS for profit, not EMS for patients! > Speaking about HIPPA... that was a 30yo male inmate with SVT and > bradycardia > (beats me how that happens maybe ST with PJCs?) with chest pain on > 02/08/07 > out of Groesbeck. Did we all get that information? ;P > > Come on now. Sounds like someone is about to go postal on an ex- > employer - > Operations Manager and is venting. > > So were you fired because the management did not questioned your > treatment, > ignored the wishes of the sending ER and the ER that accepted and went > somewhere else? This patient had already been seen in the ER for 6 > hours and > you made the decision enroute to change the desination due to > unstable? To > alert medical control. Transport to a facility that has not > accepted this > patient. An inmate. Can you understand why that may be frustrating > to the > facility? And why documentation at this point is your friend. > > Your medical control is the one you need the back up from for > prescribing > not you and orders to go to closes facility lies with him/her your > medical > control. I hope you had their name in your chart as a verbal order. > By the > way, you could have refused to take this call from facility to > facility if > you thought the patient was too unstable from the get go. > > Let me let you in on a little secret, it is called EMTALA. Hospital > ERs live > and breath by it. Read about it here: http://www.emtala.com/ > > > with respect, > > Penny Engelking LP > > > > >> >> To Whom it May Concern, >> >> This email is to inform you of recent actions taken by higher >> management >> at Guardian EMS. >> >> I have been a paramedic for 4 years, with some of that being spent >> with >> MCHD EMS and the past 16 months spent at Guardian. I also spent the >> early >> part of my EMS career with Guardian (2001 to 2003), and as a result >> have >> seen severaly Operations Managers come and go, as well as several >> supervisors come and go. >> Never before have I been so disheartened with the actions of an >> Operations >> Manager as I have been with those of Joe Fowler. The actions taken >> resulted form a call that I took on 02-08-07 that was going from >> Groesbeck >> ER to Mother Francis in Tyler. The call came out as a 30 year old >> male >> with chest pain on a monitor with IV. We arrived at Groesbeck >> Hospital to >> find that our patient was unstable (blood pressure of 77/30, SVt at >> 150 >> bpm with frequent intermittent runs of bradycardia at 40-50 bpm, >> active >> chest pain, and the only medical interventions over 6 to 7 hours >> were IV >> with normal saline and a G.I. cocktail to rule out that the chest >> pain was >> related to his stomach and not his heart. No cardiac medications >> given). >> The ER nurse had greeted us with a 6 foot long EKG strip showing the >> SVT >> and Brady rhythms and had stated, " I've never seen this before " . >> I voiced my belief that the pt was not stable, especially for a 2 to >> 2 1/2 >> hour transport. I called Medical Control and the doctor on duty >> stated >> that he agreed that the patient was not stable enough to make a 2 to >> 2 1/2 >> hour transport, advised going to a closer hospital, and also advised >> on >> giving the patient 150 mg Amiodarone over 10 minutes. I was then >> told by >> the ER nurse that " I considered him unstable too when he first got >> here, >> but he's been like this for 6 or 7 hours. Nothing is going to >> change. " The >> Er refused to give Amiodarone to our patient prior to transporting, >> so we >> loaded our patient into the ambulance. Did I mention the patient was >> an >> inmate? Because apparently that was a very important aspect of the >> call. >> I made the decision to take the patient to the closest higher level >> care >> hospital due to his unstable condition. St ph in is 73 >> miles to >> the south, Palestine Hospital is 70 miles northeast and Waco is 79 >> miles >> west of Groesbeck. St ph's in is a higher level care >> hospital >> with a good cardiology unit. So I made the decision to divert to >> , >> which was a one hour transport as opposed to the 2 to 2 1/2 hour >> transport >> to Tyler. The fact that the closest higher level care hospital was >> in a >> southerly direction is also very important, so keep this in mind. >> I gave the patient 150 mg Amiodarone for his rapidly cycling >> SVT/Brady >> rhythm, and we left. 15 to 20 minutes into the transport the pt >> converted >> to Bradycardia at 52 bpm and stated " I feel much better. " . We >> arrived at >> SJRHC ER, give a report and drop off the patient. Then the feces hit >> the >> fan, so to speak. >> Bottom line and to make a long story shorter, my patient care was >> " excellent " , but my understanding of the financial aspects of the >> call >> lacked something to be desired. SJRHC ER were upset and called >> yelling >> about " who's going to pay this bill for this inmate? " , as well as the >> esteemed cardiologist with 40 years of experience who called to >> inquire as >> to where I got my medical degree from...Yale or Harvard, because I >> seemed >> to think I knew more about this patient's condition than he did, as >> he had >> treated him for several hours in his ER. Here's where I remind you >> about >> the G.I. cocktail and IV and no cardiac medications. >> Bottom line, I was terminated from employment. Reason? Although my >> patient >> care was " excellent " , I need to have a better understanding of how >> precertification for inmates works, and should have called AOC prior >> to >> our leaving the hospital and gain assistance from them. I " skipped " >> several steps in the process, and headed in a southerly direction >> rather >> than a northeast one (Mother Francis lies to the northeast of >> Groesbeck). >> It doesn't matter if St ph was a better hospital, one hour >> away...it >> was in a southerly direction and therefore null and void. >> So to all my former coworkers, please make sure that you keep the >> financial aspects of the call your TOP priority, with patient care >> secondary. After all, like I was told, we are in this business to >> make >> money. I'm not related to my patient, so why should I care what >> happens to >> them?--quote courtesy of Joe Fowler. >> Note to higher management...I got into this " business " of being a >> paramedic because I DO care about people, whether I am related to >> them or >> not. Whether they are an inmate or not matters little to me. Bottom >> line, >> patient care will always be my number one priority. To fire me for >> diong >> something wrong involving patient care is one thing, but to fire me >> for >> doing the right thing is something else entirely unethical. >> Unless you are standing next to me at my patient's bedside or with >> me in >> the back of the truck, you are not there to make the decisions with >> me. I >> did what was right for my patient, bottom line. >> >> Sincerely, >> Tara Gibbs, EMT-P, former Guardian employee. >> >> >> > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2007 Report Share Posted February 11, 2007 Sounds like the cost of patient care, costed the patient.........care Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2007 Report Share Posted February 11, 2007 >>that was a 30yo male inmate with SVT and bradycardia (beats me how that happens maybe ST with PJCs?) with chest pain on 02/08/07 out of Groesbeck. Did we all get that information?<< Sounds like tachy/brady that occurs with sick sinus syndrome. In which case, being already hypotensive, it may not have been a good idea to administer amiodarone, a medication whose two most common side effects are hypotension and bradycardia. Perhaps some fluids and tincture of time? As far as the rest of the post - not appropriate for a public forum. This is the kind of opinion you share with friends, not with an internet discussion list. Even if they *were* unjustified in terminating you, airing your grievance in this way just makes *you* look like an ass, not them. And no doubt the innumerable EMS operations managers no doubt lurking on this list have just made a mental not of your name - and not in a good way. -- Grayson, CCEMT-P, etc. MEDIC Training Solutions http://www.medictrainingsolutions.com/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2007 Report Share Posted February 11, 2007 I am the paramedic that rode this call, and this email was not meant to be shared on a public forum. I think whoever posted this was trying to do me a favor and did not realize that there was some info in this email that I did NOT want shared on a public forum. I want this pulled off this site ASAP, please. I have written a post specifically for this site, and this is NOT IT. PLEASE REMOVE THIS POST. THANK YOU.This email was intended to be private, not displayed for everyone to see, and I feel badly that someone used this email for these purposes. > > To Whom it May Concern, > > This email is to inform you of recent actions taken by higher > management > at Guardian EMS. > ................................................................. > > Sincerely, > Tara Gibbs, EMT-P, former Guardian employee. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2007 Report Share Posted February 11, 2007 I take exception to this post, and realistically, any post that chooses to flame/slam/degrade/insult/or otherwise insinuate anything disparaging in a public forum. No HR department, no self respecting Ops manager, would dare come out and defend a decision in a public forum without paying huge bucks to an attorney to defend them in the immediately filed lawsuit. That instantly makes this a one sided post, pretty much carte blanch to say whatever you want to without the need to defend your statements. Seems to me you were terminated, and correct me if I am wrong, for diverting to another hospital other than the one that the patient was received at. Following complaints from the sending facility, the sending physician and the facility that you diverted to. It also appears that you had already made up your mind to transport to a facility other than the one that accepted him before you even loaded and/or transported him. Did you discuss your concerns with the physician at the sending facility? The cardiologist that had treated him? Before you transported? Calling for orders to override written orders before you even leave the facility? Did you begin a formal grievance process if there is one? Did you contact DSHS to make sure that they are functioning within the rules? I could go on, but you get my point, the difference is that you have the opportunity to post in your defense, those that you flame may not have that same chance. Hatfield Cost of Patient Care To Whom it May Concern, This email is to inform you of recent actions taken by higher management at Guardian EMS. I have been a paramedic for 4 years, with some of that being spent with MCHD EMS and the past 16 months spent at Guardian. I also spent the early part of my EMS career with Guardian (2001 to 2003), and as a result have seen severaly Operations Managers come and go, as well as several supervisors come and go. Never before have I been so disheartened with the actions of an Operations Manager as I have been with those of Joe Fowler. The actions taken resulted form a call that I took on 02-08-07 that was going from Groesbeck ER to Mother Francis in Tyler. The call came out as a 30 year old male with chest pain on a monitor with IV. We arrived at Groesbeck Hospital to find that our patient was unstable (blood pressure of 77/30, SVt at 150 bpm with frequent intermittent runs of bradycardia at 40-50 bpm, active chest pain, and the only medical interventions over 6 to 7 hours were IV with normal saline and a G.I. cocktail to rule out that the chest pain was related to his stomach and not his heart. No cardiac medications given). The ER nurse had greeted us with a 6 foot long EKG strip showing the SVT and Brady rhythms and had stated, " I've never seen this before " . I voiced my belief that the pt was not stable, especially for a 2 to 2 1/2 hour transport. I called Medical Control and the doctor on duty stated that he agreed that the patient was not stable enough to make a 2 to 2 1/2 hour transport, advised going to a closer hospital, and also advised on giving the patient 150 mg Amiodarone over 10 minutes. I was then told by the ER nurse that " I considered him unstable too when he first got here, but he's been like this for 6 or 7 hours. Nothing is going to change. " The Er refused to give Amiodarone to our patient prior to transporting, so we loaded our patient into the ambulance. Did I mention the patient was an inmate? Because apparently that was a very important aspect of the call. I made the decision to take the patient to the closest higher level care hospital due to his unstable condition. St ph in is 73 miles to the south, Palestine Hospital is 70 miles northeast and Waco is 79 miles west of Groesbeck. St ph's in is a higher level care hospital with a good cardiology unit. So I made the decision to divert to , which was a one hour transport as opposed to the 2 to 2 1/2 hour transport to Tyler. The fact that the closest higher level care hospital was in a southerly direction is also very important, so keep this in mind. I gave the patient 150 mg Amiodarone for his rapidly cycling SVT/Brady rhythm, and we left. 15 to 20 minutes into the transport the pt converted to Bradycardia at 52 bpm and stated " I feel much better. " . We arrived at SJRHC ER, give a report and drop off the patient. Then the feces hit the fan, so to speak. Bottom line and to make a long story shorter, my patient care was " excellent " , but my understanding of the financial aspects of the call lacked something to be desired. SJRHC ER were upset and called yelling about " who's going to pay this bill for this inmate? " , as well as the esteemed cardiologist with 40 years of experience who called to inquire as to where I got my medical degree from...Yale or Harvard, because I seemed to think I knew more about this patient's condition than he did, as he had treated him for several hours in his ER. Here's where I remind you about the G.I. cocktail and IV and no cardiac medications. Bottom line, I was terminated from employment. Reason? Although my patient care was " excellent " , I need to have a better understanding of how precertification for inmates works, and should have called AOC prior to our leaving the hospital and gain assistance from them. I " skipped " several steps in the process, and headed in a southerly direction rather than a northeast one (Mother Francis lies to the northeast of Groesbeck). It doesn't matter if St ph was a better hospital, one hour away...it was in a southerly direction and therefore null and void. So to all my former coworkers, please make sure that you keep the financial aspects of the call your TOP priority, with patient care secondary. After all, like I was told, we are in this business to make money. I'm not related to my patient, so why should I care what happens to them?--quote courtesy of Joe Fowler. Note to higher management...I got into this " business " of being a paramedic because I DO care about people, whether I am related to them or not. Whether they are an inmate or not matters little to me. Bottom line, patient care will always be my number one priority. To fire me for diong something wrong involving patient care is one thing, but to fire me for doing the right thing is something else entirely unethical. Unless you are standing next to me at my patient's bedside or with me in the back of the truck, you are not there to make the decisions with me. I did what was right for my patient, bottom line. Sincerely, Tara Gibbs, EMT-P, former Guardian employee. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2007 Report Share Posted February 12, 2007 Welcome to the internet. Rule 1) No email is ever private. The recipient can forward it on at any time... Rule 2) Once posted, always posted. Even if the mods pull it from the Yahoogroup, it'll sill be in thousands of people's in-boxes, just waiting to be replied to or forwarded at a later date (most likely not intentionally to harm anyone). Rule 3) People are not always who they say they are. Reference the shirt with the pic of the " comic guy " from the Simpsons and the phrase " I'm the 13 year old girl you chatted with last night... " Mike > I am the paramedic that rode this call, and this email was not meant > to be shared on a public forum. I think whoever posted this was > trying to do me a favor and did not realize that there was some info > in this email that I did NOT want shared on a public forum. I want > this pulled off this site ASAP, please. I have written a post > specifically for this site, and this is NOT IT. PLEASE REMOVE THIS > POST. THANK YOU.This email was intended to be private, not displayed > for everyone to see, and I feel badly that someone used this email > for these purposes. > >> >> To Whom it May Concern, >> >> This email is to inform you of recent actions taken by higher >> management >> at Guardian EMS. >> ................................................................. >> >> Sincerely, >> Tara Gibbs, EMT-P, former Guardian employee. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2007 Report Share Posted February 12, 2007 I hope there is some way that you find the person who did this ! happyclam76 wrote: I am the paramedic that rode this call, and this email was not meant to be shared on a public forum. I think whoever posted this was trying to do me a favor and did not realize that there was some info in this email that I did NOT want shared on a public forum. I want this pulled off this site ASAP, please. I have written a post specifically for this site, and this is NOT IT. PLEASE REMOVE THIS POST. THANK YOU.This email was intended to be private, not displayed for everyone to see, and I feel badly that someone used this email for these purposes. > > To Whom it May Concern, > > This email is to inform you of recent actions taken by higher > management > at Guardian EMS. > ................................................................. > > Sincerely, > Tara Gibbs, EMT-P, former Guardian employee. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2007 Report Share Posted February 12, 2007 Oh man o man, this sounds more like " troll fodder " to me. This letter whether it was meant or not meant for this list server probably should never have been posted here. BAD JuJu whomever you are (really) But hey, that is just me.. A.Dempsey EMT-I/FF kdempseyjr@... Cost of Patient Care To Whom it May Concern, This email is to inform you of recent actions taken by higher management at Guardian EMS. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2007 Report Share Posted February 12, 2007 WOW, everyone take a deep, deep breath and now exhale; Ok, before this really, really gets way out of control I just want everyone to remember when you had that call " the one that haunts you " for what ever reason and you maybe regret the decision you made and learned from it while I hope doing the patient " no harm " . Bottom line, major lessons here; 1. Do no harm, and alway err on the side of the patient - patients lives are priceless and jobs can be found throught the country - inmate or not 2. Never allow your mouth or fingers to over ride your (you know), while you may feel you did no wrong the amount of info here borders bigger problems, and someone already pointed out it makes you look foolish (i put it in calmer terms) 3. Everyone here has had one of these calls and learned from it; let it go, learn and move on Good luck W Dempsey wrote: Oh man o man, this sounds more like " troll fodder " to me. This letter whether it was meant or not meant for this list server probably should never have been posted here. BAD JuJu whomever you are (really) But hey, that is just me.. A.Dempsey EMT-I/FF kdempseyjr@... Cost of Patient Care To Whom it May Concern, This email is to inform you of recent actions taken by higher management at Guardian EMS. --------------------------------- 8:00? 8:25? 8:40? Find a flick in no time with theYahoo! Search movie showtime shortcut. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2007 Report Share Posted February 12, 2007 , if you had to run that call and you felt that your patient maynot have survive it what would have done? Add to that this thought, in the privet world calls mean money, the more you run the more the company makes. I have worked in the privet sector for many years and yes, it is true that call volume does take priority over patient care. So I do not judge the medic because I was not there so unless you are in her shoes can you truly judge? question, oh yes. Judge, no. In your favor, you asked alot of questions, but you did sound like you were judging. Hatfield wrote: I take exception to this post, and realistically, any post that chooses to flame/slam/degrade/insult/or otherwise insinuate anything disparaging in a public forum. No HR department, no self respecting Ops manager, would dare come out and defend a decision in a public forum without paying huge bucks to an attorney to defend them in the immediately filed lawsuit. That instantly makes this a one sided post, pretty much carte blanch to say whatever you want to without the need to defend your statements. Seems to me you were terminated, and correct me if I am wrong, for diverting to another hospital other than the one that the patient was received at. Following complaints from the sending facility, the sending physician and the facility that you diverted to. It also appears that you had already made up your mind to transport to a facility other than the one that accepted him before you even loaded and/or transported him. Did you discuss your concerns with the physician at the sending facility? The cardiologist that had treated him? Before you transported? Calling for orders to override written orders before you even leave the facility? Did you begin a formal grievance process if there is one? Did you contact DSHS to make sure that they are functioning within the rules? I could go on, but you get my point, the difference is that you have the opportunity to post in your defense, those that you flame may not have that same chance. Hatfield Cost of Patient Care To Whom it May Concern, This email is to inform you of recent actions taken by higher management at Guardian EMS. I have been a paramedic for 4 years, with some of that being spent with MCHD EMS and the past 16 months spent at Guardian. I also spent the early part of my EMS career with Guardian (2001 to 2003), and as a result have seen severaly Operations Managers come and go, as well as several supervisors come and go. Never before have I been so disheartened with the actions of an Operations Manager as I have been with those of Joe Fowler. The actions taken resulted form a call that I took on 02-08-07 that was going from Groesbeck ER to Mother Francis in Tyler. The call came out as a 30 year old male with chest pain on a monitor with IV. We arrived at Groesbeck Hospital to find that our patient was unstable (blood pressure of 77/30, SVt at 150 bpm with frequent intermittent runs of bradycardia at 40-50 bpm, active chest pain, and the only medical interventions over 6 to 7 hours were IV with normal saline and a G.I. cocktail to rule out that the chest pain was related to his stomach and not his heart. No cardiac medications given). The ER nurse had greeted us with a 6 foot long EKG strip showing the SVT and Brady rhythms and had stated, " I've never seen this before " . I voiced my belief that the pt was not stable, especially for a 2 to 2 1/2 hour transport. I called Medical Control and the doctor on duty stated that he agreed that the patient was not stable enough to make a 2 to 2 1/2 hour transport, advised going to a closer hospital, and also advised on giving the patient 150 mg Amiodarone over 10 minutes. I was then told by the ER nurse that " I considered him unstable too when he first got here, but he's been like this for 6 or 7 hours. Nothing is going to change. " The Er refused to give Amiodarone to our patient prior to transporting, so we loaded our patient into the ambulance. Did I mention the patient was an inmate? Because apparently that was a very important aspect of the call. I made the decision to take the patient to the closest higher level care hospital due to his unstable condition. St ph in is 73 miles to the south, Palestine Hospital is 70 miles northeast and Waco is 79 miles west of Groesbeck. St ph's in is a higher level care hospital with a good cardiology unit. So I made the decision to divert to , which was a one hour transport as opposed to the 2 to 2 1/2 hour transport to Tyler. The fact that the closest higher level care hospital was in a southerly direction is also very important, so keep this in mind. I gave the patient 150 mg Amiodarone for his rapidly cycling SVT/Brady rhythm, and we left. 15 to 20 minutes into the transport the pt converted to Bradycardia at 52 bpm and stated " I feel much better. " . We arrived at SJRHC ER, give a report and drop off the patient. Then the feces hit the fan, so to speak. Bottom line and to make a long story shorter, my patient care was " excellent " , but my understanding of the financial aspects of the call lacked something to be desired. SJRHC ER were upset and called yelling about " who's going to pay this bill for this inmate? " , as well as the esteemed cardiologist with 40 years of experience who called to inquire as to where I got my medical degree from...Yale or Harvard, because I seemed to think I knew more about this patient's condition than he did, as he had treated him for several hours in his ER. Here's where I remind you about the G.I. cocktail and IV and no cardiac medications. Bottom line, I was terminated from employment. Reason? Although my patient care was " excellent " , I need to have a better understanding of how precertification for inmates works, and should have called AOC prior to our leaving the hospital and gain assistance from them. I " skipped " several steps in the process, and headed in a southerly direction rather than a northeast one (Mother Francis lies to the northeast of Groesbeck). It doesn't matter if St ph was a better hospital, one hour away...it was in a southerly direction and therefore null and void. So to all my former coworkers, please make sure that you keep the financial aspects of the call your TOP priority, with patient care secondary. After all, like I was told, we are in this business to make money. I'm not related to my patient, so why should I care what happens to them?--quote courtesy of Joe Fowler. Note to higher management...I got into this " business " of being a paramedic because I DO care about people, whether I am related to them or not. Whether they are an inmate or not matters little to me. Bottom line, patient care will always be my number one priority. To fire me for diong something wrong involving patient care is one thing, but to fire me for doing the right thing is something else entirely unethical. Unless you are standing next to me at my patient's bedside or with me in the back of the truck, you are not there to make the decisions with me. I did what was right for my patient, bottom line. Sincerely, Tara Gibbs, EMT-P, former Guardian employee. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2007 Report Share Posted February 12, 2007 I work/have worked in the Groesbeck area off and on for a few years. I am sure all of us have run into nurses/physicians that did or did not treat patients as we feel they should have. That can and does happen at a lot of facilities, probably everyday. The staff at Groesbeck do care about the patients, even the inmates, and do their best....most of the time. Just like the rest of us, we do the best we can and most of the time it works out to satisfy our peers or supervisors. Now in your post you did make some errors. One of the big ones that I observed was the distances. It is only about 40 miles to Waco where they have two very good facilities for cardiac care, one being Providence Health Center and the other being Hillcrest Baptist Medical Center. I have made the trip many times with patients from Groesbeck. This makes me wonder where your station was and was that a consideration in your decision or not? The trip to Waco normally takes about 45/50 minutes and a trip to BCS normally takes about 80/90 minutes. The trip to Tyler takes about 2 1/4 hrs. The BCS facilities in my opinion are no better or no worse than any of the other facilities, Waco or Tyler, so again I can see where you might have been questioned about your choice of facilities. I am sure the staff at Limestone Medical Center in Groesbeck would have been most happy to give you information concerning any of the closer facilities if you had of told them that you were going to go somewhere nearer and would have most likely assisted you in securing the transfer properly. But, then again, if one goes into a facility and begins to let personnel know that they are not taking care of a patient the " right " way and you do not use tact, then you probably will not get any help or suggestions. Especially if they don't know you from Adam. I know also, that if that patient was unstable enough to not be transferred to Waco or any other facility by ground, the staff would have called a medivac in and transported him/her. It does happen as this is a small rural hospital albeit a very good one. My $1's worth. Thanks, Dean > > > Cost of Patient Care > > To Whom it May Concern, > > This email is to inform you of recent actions taken by higher > management > at Guardian EMS. > > I have been a paramedic for 4 years, with some of that being spent > with > MCHD EMS and the past 16 months spent at Guardian. I also spent the > early > part of my EMS career with Guardian (2001 to 2003), and as a result > have > seen severaly Operations Managers come and go, as well as several > supervisors come and go. > Never before have I been so disheartened with the actions of an > Operations > Manager as I have been with those of Joe Fowler. The actions taken > resulted form a call that I took on 02-08-07 that was going from > Groesbeck > ER to Mother Francis in Tyler. The call came out as a 30 year old > male > with chest pain on a monitor with IV. We arrived at Groesbeck > Hospital to > find that our patient was unstable (blood pressure of 77/30, SVt at > 150 > bpm with frequent intermittent runs of bradycardia at 40-50 bpm, > active > chest pain, and the only medical interventions over 6 to 7 hours > were IV > with normal saline and a G.I. cocktail to rule out that the chest > pain was > related to his stomach and not his heart. No cardiac medications > given). > The ER nurse had greeted us with a 6 foot long EKG strip showing the > SVT > and Brady rhythms and had stated, " I've never seen this before " . > I voiced my belief that the pt was not stable, especially for a 2 to > 2 1/2 > hour transport. I called Medical Control and the doctor on duty > stated > that he agreed that the patient was not stable enough to make a 2 to > 2 1/2 > hour transport, advised going to a closer hospital, and also advised > on > giving the patient 150 mg Amiodarone over 10 minutes. I was then > told by > the ER nurse that " I considered him unstable too when he first got > here, > but he's been like this for 6 or 7 hours. Nothing is going to > change. " The > Er refused to give Amiodarone to our patient prior to transporting, > so we > loaded our patient into the ambulance. Did I mention the patient was > an > inmate? Because apparently that was a very important aspect of the > call. > I made the decision to take the patient to the closest higher level > care > hospital due to his unstable condition. St ph in is 73 > miles to > the south, Palestine Hospital is 70 miles northeast and Waco is 79 > miles > west of Groesbeck. St ph's in is a higher level care > hospital > with a good cardiology unit. So I made the decision to divert to > , > which was a one hour transport as opposed to the 2 to 2 1/2 hour > transport > to Tyler. The fact that the closest higher level care hospital was > in a > southerly direction is also very important, so keep this in mind. > I gave the patient 150 mg Amiodarone for his rapidly cycling > SVT/Brady > rhythm, and we left. 15 to 20 minutes into the transport the pt > converted > to Bradycardia at 52 bpm and stated " I feel much better. " . We > arrived at > SJRHC ER, give a report and drop off the patient. Then the feces hit > the > fan, so to speak. > Bottom line and to make a long story shorter, my patient care was > " excellent " , but my understanding of the financial aspects of the > call > lacked something to be desired. SJRHC ER were upset and called > yelling > about " who's going to pay this bill for this inmate? " , as well as the > esteemed cardiologist with 40 years of experience who called to > inquire as > to where I got my medical degree from...Yale or Harvard, because I > seemed > to think I knew more about this patient's condition than he did, as > he had > treated him for several hours in his ER. Here's where I remind you > about > the G.I. cocktail and IV and no cardiac medications. > Bottom line, I was terminated from employment. Reason? Although my > patient > care was " excellent " , I need to have a better understanding of how > precertification for inmates works, and should have called AOC prior > to > our leaving the hospital and gain assistance from them. I " skipped " > several steps in the process, and headed in a southerly direction > rather > than a northeast one (Mother Francis lies to the northeast of > Groesbeck). > It doesn't matter if St ph was a better hospital, one hour > away...it > was in a southerly direction and therefore null and void. > So to all my former coworkers, please make sure that you keep the > financial aspects of the call your TOP priority, with patient care > secondary. After all, like I was told, we are in this business to > make > money. I'm not related to my patient, so why should I care what > happens to > them?--quote courtesy of Joe Fowler. > Note to higher management...I got into this " business " of being a > paramedic because I DO care about people, whether I am related to > them or > not. Whether they are an inmate or not matters little to me. Bottom > line, > patient care will always be my number one priority. To fire me for > diong > something wrong involving patient care is one thing, but to fire me > for > doing the right thing is something else entirely unethical. > Unless you are standing next to me at my patient's bedside or with > me in > the back of the truck, you are not there to make the decisions with > me. I > did what was right for my patient, bottom line. > > Sincerely, > Tara Gibbs, EMT-P, former Guardian employee. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2007 Report Share Posted February 12, 2007 I would have started by dealing directly with the cardiologist that sent the patient. Then I would have involved my Medical Director and let him/her deal with the cardiologist directly, the two of them can handle it amongst themselves. If I was truly uncomfortable with it, then I would have refused the call after letting my Medical Director know. The latter of these would have had the support of my Medical Director at least, and by then administration would have been involved as well. Mike had a good thought, and that would have been to initiate treatment prior to leaving the facility, then remaining there if the patient didn't improve or the condition worsened. What I would NOT have done, was to post to a public forum, making disparaging remarks about a company and naming specific employees. I am well aware of how the private sector operates, and if your company forces you to take call volume over patient care, then you are working for the wrong company. I have worked (past tense) for some of them in the past, and always move on to someone who is concerned with patient care on an equal or greater level than monetary value. If I sounded like I was judging, then perhaps you took it the wrong way. It was a one sided post, as many here are. The difference is, as I stated, that the author had the ability to defend herself/himself, whereas no one from Guardian dared to post in response to avoid a lawsuit. No self respecting HR or Operations person would dare post to a public forum giving specific reasons for an employee's termination. Unfair, unbalanced argument. If in fact the company did place money over care, then I take issue with that. There are 3 sides to every story, mine yours and what really happened, and in cases such as these, and posts such as these, I feat we will never know what really happened. Every argument needs a devils advocate, I merely played one here on behalf of the company. Regards, Mike Cost of Patient Care To Whom it May Concern, This email is to inform you of recent actions taken by higher management at Guardian EMS. I have been a paramedic for 4 years, with some of that being spent with MCHD EMS and the past 16 months spent at Guardian. I also spent the early part of my EMS career with Guardian (2001 to 2003), and as a result have seen severaly Operations Managers come and go, as well as several supervisors come and go. Never before have I been so disheartened with the actions of an Operations Manager as I have been with those of Joe Fowler. The actions taken resulted form a call that I took on 02-08-07 that was going from Groesbeck ER to Mother Francis in Tyler. The call came out as a 30 year old male with chest pain on a monitor with IV. We arrived at Groesbeck Hospital to find that our patient was unstable (blood pressure of 77/30, SVt at 150 bpm with frequent intermittent runs of bradycardia at 40-50 bpm, active chest pain, and the only medical interventions over 6 to 7 hours were IV with normal saline and a G.I. cocktail to rule out that the chest pain was related to his stomach and not his heart. No cardiac medications given). The ER nurse had greeted us with a 6 foot long EKG strip showing the SVT and Brady rhythms and had stated, " I've never seen this before " . I voiced my belief that the pt was not stable, especially for a 2 to 2 1/2 hour transport. I called Medical Control and the doctor on duty stated that he agreed that the patient was not stable enough to make a 2 to 2 1/2 hour transport, advised going to a closer hospital, and also advised on giving the patient 150 mg Amiodarone over 10 minutes. I was then told by the ER nurse that " I considered him unstable too when he first got here, but he's been like this for 6 or 7 hours. Nothing is going to change. " The Er refused to give Amiodarone to our patient prior to transporting, so we loaded our patient into the ambulance. Did I mention the patient was an inmate? Because apparently that was a very important aspect of the call. I made the decision to take the patient to the closest higher level care hospital due to his unstable condition. St ph in is 73 miles to the south, Palestine Hospital is 70 miles northeast and Waco is 79 miles west of Groesbeck. St ph's in is a higher level care hospital with a good cardiology unit. So I made the decision to divert to , which was a one hour transport as opposed to the 2 to 2 1/2 hour transport to Tyler. The fact that the closest higher level care hospital was in a southerly direction is also very important, so keep this in mind. I gave the patient 150 mg Amiodarone for his rapidly cycling SVT/Brady rhythm, and we left. 15 to 20 minutes into the transport the pt converted to Bradycardia at 52 bpm and stated " I feel much better. " . We arrived at SJRHC ER, give a report and drop off the patient. Then the feces hit the fan, so to speak. Bottom line and to make a long story shorter, my patient care was " excellent " , but my understanding of the financial aspects of the call lacked something to be desired. SJRHC ER were upset and called yelling about " who's going to pay this bill for this inmate? " , as well as the esteemed cardiologist with 40 years of experience who called to inquire as to where I got my medical degree from...Yale or Harvard, because I seemed to think I knew more about this patient's condition than he did, as he had treated him for several hours in his ER. Here's where I remind you about the G.I. cocktail and IV and no cardiac medications. Bottom line, I was terminated from employment. Reason? Although my patient care was " excellent " , I need to have a better understanding of how precertification for inmates works, and should have called AOC prior to our leaving the hospital and gain assistance from them. I " skipped " several steps in the process, and headed in a southerly direction rather than a northeast one (Mother Francis lies to the northeast of Groesbeck). It doesn't matter if St ph was a better hospital, one hour away...it was in a southerly direction and therefore null and void. So to all my former coworkers, please make sure that you keep the financial aspects of the call your TOP priority, with patient care secondary. After all, like I was told, we are in this business to make money. I'm not related to my patient, so why should I care what happens to them?--quote courtesy of Joe Fowler. Note to higher management...I got into this " business " of being a paramedic because I DO care about people, whether I am related to them or not. Whether they are an inmate or not matters little to me. Bottom line, patient care will always be my number one priority. To fire me for diong something wrong involving patient care is one thing, but to fire me for doing the right thing is something else entirely unethical. Unless you are standing next to me at my patient's bedside or with me in the back of the truck, you are not there to make the decisions with me. I did what was right for my patient, bottom line. Sincerely, Tara Gibbs, EMT-P, former Guardian employee. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2007 Report Share Posted February 12, 2007 What, exactly, is the " privet " world? Mike > , if you had to run that call and you felt that your patient > maynot have survive it what would have done? Add to that this > thought, in the privet world calls mean money, the more you run the > more the company makes. I have worked in the privet sector for many > years and yes, it is true that call volume does take priority over > patient care. So I do not judge the medic because I was not there > so unless you are in her shoes can you truly judge? question, oh > yes. Judge, no. In your favor, you asked alot of questions, but you > did sound like you were judging. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2007 Report Share Posted February 12, 2007 > Mike had a good thought, and that would have been to initiate > treatment prior to leaving the facility, then remaining there if the > patient didn't improve or the condition worsened. ::blush:: Thanks, Mike! I have my moments (get out your calendar and mark it down!)... Mike, the " other " Mike Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2007 Report Share Posted February 12, 2007 That would be the section of the nursery that sells plants suitable for hedges. Maxine Pate ---- Original message ---- >Date: Mon, 12 Feb 2007 20:26:09 -0600 > >Subject: Re: Cost of Patient Care >To: texasems-l > > What, exactly, is the " privet " world? > > Mike > > > > > , if you had to run that call and you felt > that your patient > > maynot have survive it what would have done? Add > to that this > > thought, in the privet world calls mean money, the > more you run the > > more the company makes. I have worked in the > privet sector for many > > years and yes, it is true that call volume does > take priority over > > patient care. So I do not judge the medic because > I was not there > > so unless you are in her shoes can you truly > judge? question, oh > > yes. Judge, no. In your favor, you asked alot of > questions, but you > > did sound like you were judging. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2007 Report Share Posted February 12, 2007 lverrett wrote: " Add to that this thought, in the privet world calls mean money, the more you run the more the company makes. " Got some news for you...calls mean money in EVERY place...private, public, open, closed, up, down, ambulance, fire truck....calls mean money. And to maintain this it is important for organizations to keep the customers satisfied...whether you are responding to a 911 call, a 7-digit call, a sick person, a transfer, a structure fire...a call for a prowler....whatever it is. So, when an employee completely disregards SOP, protocols, procedures, etc...it forces an employer to take action to protect the expectations of our customers. Whether this is a " finger-wagging " a " smack on the wrist " or a separation from the organization is a complex (should be) decision. So, as a medical technician, if we have concerns regarding the ability of a patient to survive, our first step should be to consult a higher educated medical professional who is going to be held responsible for our actions...and then follow that advice...when we step outside of this process, then we are on our own and we must be willing to suffer the consequences. Dudley Cost of Patient Care To Whom it May Concern, This email is to inform you of recent actions taken by higher management at Guardian EMS. I have been a paramedic for 4 years, with some of that being spent with MCHD EMS and the past 16 months spent at Guardian. I also spent the early part of my EMS career with Guardian (2001 to 2003), and as a result have seen severaly Operations Managers come and go, as well as several supervisors come and go. Never before have I been so disheartened with the actions of an Operations Manager as I have been with those of Joe Fowler. The actions taken resulted form a call that I took on 02-08-07 that was going from Groesbeck ER to Mother Francis in Tyler. The call came out as a 30 year old male with chest pain on a monitor with IV. We arrived at Groesbeck Hospital to find that our patient was unstable (blood pressure of 77/30, SVt at 150 bpm with frequent intermittent runs of bradycardia at 40-50 bpm, active chest pain, and the only medical interventions over 6 to 7 hours were IV with normal saline and a G.I. cocktail to rule out that the chest pain was related to his stomach and not his heart. No cardiac medications given). The ER nurse had greeted us with a 6 foot long EKG strip showing the SVT and Brady rhythms and had stated, " I've never seen this before " . I voiced my belief that the pt was not stable, especially for a 2 to 2 1/2 hour transport. I called Medical Control and the doctor on duty stated that he agreed that the patient was not stable enough to make a 2 to 2 1/2 hour transport, advised going to a closer hospital, and also advised on giving the patient 150 mg Amiodarone over 10 minutes. I was then told by the ER nurse that " I considered him unstable too when he first got here, but he's been like this for 6 or 7 hours. Nothing is going to change. " The Er refused to give Amiodarone to our patient prior to transporting, so we loaded our patient into the ambulance. Did I mention the patient was an inmate? Because apparently that was a very important aspect of the call. I made the decision to take the patient to the closest higher level care hospital due to his unstable condition. St ph in is 73 miles to the south, Palestine Hospital is 70 miles northeast and Waco is 79 miles west of Groesbeck. St ph's in is a higher level care hospital with a good cardiology unit. So I made the decision to divert to , which was a one hour transport as opposed to the 2 to 2 1/2 hour transport to Tyler. The fact that the closest higher level care hospital was in a southerly direction is also very important, so keep this in mind. I gave the patient 150 mg Amiodarone for his rapidly cycling SVT/Brady rhythm, and we left. 15 to 20 minutes into the transport the pt converted to Bradycardia at 52 bpm and stated " I feel much better. " . We arrived at SJRHC ER, give a report and drop off the patient. Then the feces hit the fan, so to speak. Bottom line and to make a long story shorter, my patient care was " excellent " , but my understanding of the financial aspects of the call lacked something to be desired. SJRHC ER were upset and called yelling about " who's going to pay this bill for this inmate? " , as well as the esteemed cardiologist with 40 years of experience who called to inquire as to where I got my medical degree from...Yale or Harvard, because I seemed to think I knew more about this patient's condition than he did, as he had treated him for several hours in his ER. Here's where I remind you about the G.I. cocktail and IV and no cardiac medications. Bottom line, I was terminated from employment. Reason? Although my patient care was " excellent " , I need to have a better understanding of how precertification for inmates works, and should have called AOC prior to our leaving the hospital and gain assistance from them. I " skipped " several steps in the process, and headed in a southerly direction rather than a northeast one (Mother Francis lies to the northeast of Groesbeck). It doesn't matter if St ph was a better hospital, one hour away...it was in a southerly direction and therefore null and void. So to all my former coworkers, please make sure that you keep the financial aspects of the call your TOP priority, with patient care secondary. After all, like I was told, we are in this business to make money. I'm not related to my patient, so why should I care what happens to them?--quote courtesy of Joe Fowler. Note to higher management...I got into this " business " of being a paramedic because I DO care about people, whether I am related to them or not. Whether they are an inmate or not matters little to me. Bottom line, patient care will always be my number one priority. To fire me for diong something wrong involving patient care is one thing, but to fire me for doing the right thing is something else entirely unethical. Unless you are standing next to me at my patient's bedside or with me in the back of the truck, you are not there to make the decisions with me. I did what was right for my patient, bottom line. Sincerely, Tara Gibbs, EMT-P, former Guardian employee. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2007 Report Share Posted February 12, 2007 Mike asked: >>What, exactly, is the " privet " world?<< Apparently, a world with very large, well-manicured hedges. I don't know if they have private ambulance services there or not. -- Grayson, CCEMT-P, etc. MEDIC Training Solutions http://www.medictrainingsolutions.com/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2007 Report Share Posted February 12, 2007 Good job Maxine, you actually sent me to the dictionary with that one.... Mike Re: Cost of Patient Care >To: texasems-l@yahoogro <mailto:texasems-l%40yahoogroups.com> ups.com > > What, exactly, is the " privet " world? > > Mike > > > > > , if you had to run that call and you felt > that your patient > > maynot have survive it what would have done? Add > to that this > > thought, in the privet world calls mean money, the > more you run the > > more the company makes. I have worked in the > privet sector for many > > years and yes, it is true that call volume does > take priority over > > patient care. So I do not judge the medic because > I was not there > > so unless you are in her shoes can you truly > judge? question, oh > > yes. Judge, no. In your favor, you asked alot of > questions, but you > > did sound like you were judging. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 13, 2007 Report Share Posted February 13, 2007 I think it is a world with lots of privet ambulances and flight services. > > Mike asked: > > >>What, exactly, is the " privet " world?<< > > Apparently, a world with very large, well-manicured hedges. I don't know if they have private ambulance services there or not. > > -- > Grayson, CCEMT-P, etc. > MEDIC Training Solutions > http://www.medictrainingsolutions.com/ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 13, 2007 Report Share Posted February 13, 2007 LOL...love me or hate me, I always give credit where credit is due..... Mike > > > Mike had a good thought, and that would have been to initiate > > treatment prior to leaving the facility, then remaining there if the > > patient didn't improve or the condition worsened. > > ::blush:: > > Thanks, Mike! I have my moments (get out your calendar and mark it > down!)... > > Mike, the " other " Mike > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 13, 2007 Report Share Posted February 13, 2007 No Mike you did not come sounding like that. I was having a moment is all. Good reply. Goes to show that in ever call there is something to be learned. OH, by the way 'privet' is what you get when you mispell private Hatfield wrote: I would have started by dealing directly with the cardiologist that sent the patient. Then I would have involved my Medical Director and let him/her deal with the cardiologist directly, the two of them can handle it amongst themselves. If I was truly uncomfortable with it, then I would have refused the call after letting my Medical Director know. The latter of these would have had the support of my Medical Director at least, and by then administration would have been involved as well. Mike had a good thought, and that would have been to initiate treatment prior to leaving the facility, then remaining there if the patient didn't improve or the condition worsened. What I would NOT have done, was to post to a public forum, making disparaging remarks about a company and naming specific employees. I am well aware of how the private sector operates, and if your company forces you to take call volume over patient care, then you are working for the wrong company. I have worked (past tense) for some of them in the past, and always move on to someone who is concerned with patient care on an equal or greater level than monetary value. If I sounded like I was judging, then perhaps you took it the wrong way. It was a one sided post, as many here are. The difference is, as I stated, that the author had the ability to defend herself/himself, whereas no one from Guardian dared to post in response to avoid a lawsuit. No self respecting HR or Operations person would dare post to a public forum giving specific reasons for an employee's termination. Unfair, unbalanced argument. If in fact the company did place money over care, then I take issue with that. There are 3 sides to every story, mine yours and what really happened, and in cases such as these, and posts such as these, I feat we will never know what really happened. Every argument needs a devils advocate, I merely played one here on behalf of the company. Regards, Mike Cost of Patient Care To Whom it May Concern, This email is to inform you of recent actions taken by higher management at Guardian EMS. I have been a paramedic for 4 years, with some of that being spent with MCHD EMS and the past 16 months spent at Guardian. I also spent the early part of my EMS career with Guardian (2001 to 2003), and as a result have seen severaly Operations Managers come and go, as well as several supervisors come and go. Never before have I been so disheartened with the actions of an Operations Manager as I have been with those of Joe Fowler. The actions taken resulted form a call that I took on 02-08-07 that was going from Groesbeck ER to Mother Francis in Tyler. The call came out as a 30 year old male with chest pain on a monitor with IV. We arrived at Groesbeck Hospital to find that our patient was unstable (blood pressure of 77/30, SVt at 150 bpm with frequent intermittent runs of bradycardia at 40-50 bpm, active chest pain, and the only medical interventions over 6 to 7 hours were IV with normal saline and a G.I. cocktail to rule out that the chest pain was related to his stomach and not his heart. No cardiac medications given). The ER nurse had greeted us with a 6 foot long EKG strip showing the SVT and Brady rhythms and had stated, " I've never seen this before " . I voiced my belief that the pt was not stable, especially for a 2 to 2 1/2 hour transport. I called Medical Control and the doctor on duty stated that he agreed that the patient was not stable enough to make a 2 to 2 1/2 hour transport, advised going to a closer hospital, and also advised on giving the patient 150 mg Amiodarone over 10 minutes. I was then told by the ER nurse that " I considered him unstable too when he first got here, but he's been like this for 6 or 7 hours. Nothing is going to change. " The Er refused to give Amiodarone to our patient prior to transporting, so we loaded our patient into the ambulance. Did I mention the patient was an inmate? Because apparently that was a very important aspect of the call. I made the decision to take the patient to the closest higher level care hospital due to his unstable condition. St ph in is 73 miles to the south, Palestine Hospital is 70 miles northeast and Waco is 79 miles west of Groesbeck. St ph's in is a higher level care hospital with a good cardiology unit. So I made the decision to divert to , which was a one hour transport as opposed to the 2 to 2 1/2 hour transport to Tyler. The fact that the closest higher level care hospital was in a southerly direction is also very important, so keep this in mind. I gave the patient 150 mg Amiodarone for his rapidly cycling SVT/Brady rhythm, and we left. 15 to 20 minutes into the transport the pt converted to Bradycardia at 52 bpm and stated " I feel much better. " . We arrived at SJRHC ER, give a report and drop off the patient. Then the feces hit the fan, so to speak. Bottom line and to make a long story shorter, my patient care was " excellent " , but my understanding of the financial aspects of the call lacked something to be desired. SJRHC ER were upset and called yelling about " who's going to pay this bill for this inmate? " , as well as the esteemed cardiologist with 40 years of experience who called to inquire as to where I got my medical degree from...Yale or Harvard, because I seemed to think I knew more about this patient's condition than he did, as he had treated him for several hours in his ER. Here's where I remind you about the G.I. cocktail and IV and no cardiac medications. Bottom line, I was terminated from employment. Reason? Although my patient care was " excellent " , I need to have a better understanding of how precertification for inmates works, and should have called AOC prior to our leaving the hospital and gain assistance from them. I " skipped " several steps in the process, and headed in a southerly direction rather than a northeast one (Mother Francis lies to the northeast of Groesbeck). It doesn't matter if St ph was a better hospital, one hour away...it was in a southerly direction and therefore null and void. So to all my former coworkers, please make sure that you keep the financial aspects of the call your TOP priority, with patient care secondary. After all, like I was told, we are in this business to make money. I'm not related to my patient, so why should I care what happens to them?--quote courtesy of Joe Fowler. Note to higher management...I got into this " business " of being a paramedic because I DO care about people, whether I am related to them or not. Whether they are an inmate or not matters little to me. Bottom line, patient care will always be my number one priority. To fire me for diong something wrong involving patient care is one thing, but to fire me for doing the right thing is something else entirely unethical. Unless you are standing next to me at my patient's bedside or with me in the back of the truck, you are not there to make the decisions with me. I did what was right for my patient, bottom line. Sincerely, Tara Gibbs, EMT-P, former Guardian employee. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2007 Report Share Posted February 14, 2007 I feel for the paramedic that got terminated but I also think that we as " Thinking " medics need to realize that there are times when the requested/approved hospital might not be the most appropriate for the patient's condition at the time. I was faced with a similar decision long ago and did what was in the best interest of a patient thoroughly angering her family. They wanted to go to a hospital that was farther than the nearest and we were already facing a 20-25 minute transport with an elderly lady in severe respiratory distress, Clearly unstable.I don't remember particulars except that she was in severe distress and not moving a lot of air, also was tachycardic. We started out Code 1 to the requested hospital but when the patient did not respond to treatment and I asked my partner to upgrade to Code 3 and reroute to the closest hospital, which we did. However we/I was fortunate in two ways, #1 my medical director was on duty int he ER at the time and backed me up and so did the company I was working for. My suggestion is that when faced with this type of situation you can suggest another hosital or start out for the requested one and if things don'e work out or the patient does not respond to treatment you can always upgrade and go to a closer more appropriate hospital. It is much easier to justify doing it that way then just arbitrarily making a decision to go to a different hospital. I am not saying this paramedic was wrong, but I th ink thinking it through a little more would have been a better idea, unless medical direction told her to go to a different hospital,which according to the posts did not happen. Anita NREMTP/LP Take care and stay safe always. " Commit to the Lord whatever you do, and your plans will succeed. " (Proverbs: 16:3) May God Smile on you today. --------------------------------- Never Miss an Email Stay connected with Yahoo! Mail on your mobile. Get started! Quote Link to comment Share on other sites More sharing options...
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