Unpaid calls plague county ambulance service

News editor

Eighty-year-old Rosemary Ritter of Marion was preparing to go shopping with her daughter last week when she became the latest example in a worrisome trend regarding Marion County ambulance use.

Like 33 others in the past two months, Ritter — whom her daughter, Jean Buller, describes as stubborn — refused to go to a hospital despite urgings of the ambulance crew that Buller had called after Ritter fell in the dark.

The county spending $50 or more to respond to Buller’s call was at least justified by the fact that Ritter had been injured. Large bruises on her knee and arm were still noticeable Monday afternoon.

That wasn’t the case on another call Monday, when three Hillsboro ambulance workers, at a cost of at least $75, drove 11 miles one-way merely to help a 76-year-old man, who knew he was not injured, get back on his feet after he, too, fell in the dark.

Another no-transport call Monday involved a Peabody household, known for its frequent calls to 911, that was concerned about a child’s fidgeting in her sleep.

Patients like Ritter and the others undoubtedly are thankful emergency medical technicians were there to check on them.

However, the way the county ambulance service is organized, if no one is transported to a hospital, the county must absorb the full cost of the call without being able to bill the patient.

Calls that don’t require transportation to a hospital also take crews and equipment away from their base — in the case of the Goessel call, for nearly an hour — during which time an actual emergency requiring transport to a hospital might have occurred.

“It seems to be going in waves,” ambulance director Steve Smith said of the trend toward ambulance calls not resulting in trips to hospitals.

In Ritter’s case, the refusal was understandable.

She normally uses a walker, but “I didn’t use it that night,” she said. “I’d better start using it, hadn’t I?”

When she fell, hurting her knee and arm, both she and Buller feared the worst. The daughter called 911 and requested an ambulance be sent to the home they share.

“I told her not to move,” Buller said.

Ritter didn’t heed her daughter’s advice, however. With help from a grandson, she was sitting on the seat of her walker when the ambulance arrived.

Attendants encouraged her to go with them to the hospital to get her injuries checked out, but she didn’t want to. Instead, she made an appointment the next day at St. Luke Hospital, where X-rays indicated no problem.

“Somebody who’s 80 years old, you never know,” she said.

Calls such as this may provide peace of mind for patients, but they can be costly. Whenever an ambulance is called, the county pays each responder $25, or $50 for a regular two-person crew. There have been 105 patient refusals so far in 2013. There were 157 in 2012.

Fuel costs also are high, and wear and tear accumulate. However, unless a patient is transported, no one is billed for the call.

“It’s pretty easy to see it takes a chunk out of the budget,” Smith said.

He recalled a week when an ambulance responded to the same address five consecutive days, never taking a patient to a hospital.

The ambulance service has a few such “frequent fliers” — mostly people who can’t afford to see a physician, Smith said. Many would be better off in assisted living facilities, he said, but can’t afford those services, either.

Smith said it was rare for an ambulance crew to be needed at an emergency at the same time as a call that doesn’t result in a hospital trip, but that could change if the ambulance service is condensed to two or three ambulances.

If EMTs are at a call that clearly isn’t an emergency, they can leave if a more urgent call comes in, Smith said.

In an attempt to discourage overuse of ambulances by “frequent fliers,” the county has modified its billing policy somewhat.

If someone calls an ambulance twice in six months, the county notifies the person that, on any calls beyond his or her next one, the county will bill him or her for fuel and the responders’ time.

Still, regardless of how many false alarms ambulance workers go on, they treat every call as an emergency, Smith said.

He has been to a call when one of the frequent fliers had an actual emergency.

“You can’t turn them down,” he said. “You never want to take those folks for granted.”

 

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