Non-ambulance corporations to take over more EMS work?

The Minister of Health and LTC has strongly endorsed the restructuring of the patient transfer industry in the South West LHIN.  This may set a new model for the private corporations that often move patients between health care facilities in vehicles that look, for all the world, like ambulances -- but are not.  

For the first time, a LHIN-wide patient transfer provider has been chosen, with the goal of standardizing equipment and staffing qualifications. Health Minister Deb Matthews states:

"This non-emergency transportation approach is precisely the type of collaborative effort that will help transform the health care system in Ontario. Standardized equipment and qualifications will lead to enhanced quality of care and safety for all the people hospitalized in the South West LHIN."

This restructuring is, no doubt, a response to the scandals uncovered in the private transfer industry over two years ago by the CBC and the provincial Ombudsman.  

Ontario residents would be better off taking a taxi to a hospital than one of the privately owned vehicles used to transfer hundreds of thousands of non-critical patients each year, provincial Ombudsman Andre Marin concluded.

It's allowed private companies to charge hundreds of dollars per patient for transports in old, beat-up ambulances operated by "kids'' with no medical training.  "They place people's lives in serious jeopardy,'' Marin said.

"These vehicles - that for all intents and purposes are ambulances - are completely without any rules,'' Marin said. "It's astounding.''

About half a million patients transfers between health care facilities occur each year in Ontario, so this represents a significant amount of work. With health care centralization and specialization on the rise, more of this work will come.

Most patient transfers were provided by highly regulated ambulance services until 2000 when a Progressive Conservative government introduced legislation allowing hospitals to use for-profit "patient transfer" companies rather than ambulances to move patients between hospitals or long-term care facilities if the patient was in stable condition. 

That turned into the disaster uncovered by the CBC and the Ombudsman over two years ago.

A CBC radio documentary interviewed patient transfer attendants and found that while some had qualifications similar to paramedics, many had no medical training beyond a basic CPR certificate. They were often paid in the range of $11 to $13 an hour.

Workers within the industry who expressed concern to their dispatch operators about their patients’ safety were routinely suspended or fired.

Workers recounted experiences to the CBC such as trucks catching on fire and lug nuts shearing off wheels. In both of those cases, patients were aboard the trucks. One worker said she was ordered by her dispatcher to drop off a homeless patient in a back alley of Toronto.

After the scandal came out, the Liberal government promised to introduce legislation "at the earliest opportunity'' that would set standards and requirements for the industry if they were re-elected.

"We became aware that people thought they were in an ambulance when they weren't, they thought that the driver had skills that they didn't have,'' Health Minister Deb Matthews said in an interview.  "So regulating to make sure that they meet certain standards is what we will do.  Exactly what those standards will be is something we're going to be working on.''

Well, it's been two years, and there has been no legislation, so this sort of private sector restructuring may be all we will be getting.

But it falls far short of the legislation promised by the Minister two years ago when the scandal of the private sector transfer companies was uncovered.

Indeed the restructuring looks designed to encourage more EMS work to migrate to the private transfer companies. The release announcing the restructuring states:

"Prior to the implementation of this LHIN-wide approach to non-emergency transportation service delivery, there were no established standards to follow, and various transportation providers, including ambulances (EMS), were called upon to transport patients. The primary mandate of EMS is to be available to respond to community emergency calls. Non-emergency transportation calls to EMS could reduce the availability of EMS in the event of an emergency."

This development adds to concerns that a regulatory college (that could elevate some patient transport workers to "paramedic" status) will encourage more EMS work to migrate to such private providers, sooner or later.  A major pre-occupation for the government has been to move work from higher paid workers to lower paid workers. 

Given the Minister's strong support for the South West plans, similar restructuring may be coming elsewhere in the province. 

The EMS Chiefs seem to be on board too, at least judging from the support from the vice-president of the Ontario Association of Paramedic Chiefs, Neal Roberts who said,"EMS services fully support this development."

Bottom line: this is one more attempt by the Liberal government to patch up yet another failed health care privatization experiment (P3 hospitals, e-Health, Ornge, chemotherapy mixing) with not much more than duct tape.  

The idea for the government behind these privatization experiments seems to be this: if it blew up in your face the first time, change a few details and try it again. 
 


Photo: Alexkess (New South Wales)