Sunday, September 21, 2008

Peoria Emergency Medical Services Timeline (Update X 4)

Ethics/Emergency Medicine

OSF in Peoria has done egregious things during the past decade. OSF-SFMC is the largest medical center in downstate Illinois.

The OSF-Emergency Room is overcrowded and understaffed and the Medical Center does not allocate enough hospital beds to accommodate the ER patients that are waiting. Studies have shown increased morbidity for patients that wait excessive amounts of time in the ER hallways.

OSF has turned away dying Haitian kids who have been operated at OSF in the past and need surgery again. Haitian Hearts has offered substantial funds for their care to no avail. Two patients have died in the last two years and four more OSF Haitian Hearts patients are in Haiti now and need repeat heart surgery soon or they will die too. A recent letter to the OSF-CHOI International Committee regarding these patients went unanswered.

A few years ago OSF-SFMC closed their Psychiatric Unit. It was not making enough money. Peoria’s psychiatric patients are given poor care and with the closure of this unit their care was compromised even more.

And, in my opinion, OSF has helped create a monopoly regarding ambulance services in Peoria. And in my opinion this has delayed and hindered the care of many Peorians who call 911. There is conflict of interest here and this is what this article will describe in a timeline.

The timeline will consist of articles in the Journal Star, excerpts from articles in medical journals, articles off the Internet including Peoria's Medical Mafia , discussions I have had with people regarding Peoria’s EMS, and my comments regarding the situation.

Here is a brief summary of the timeline with the full text below the summary.


1. February 18, 1996—Peoria Journal Star editorial stating that the Peoria Fire Department should not go into the ambulance business. Dr. George Hevesy concurs. Editors don’t report that Hevesy receives a salary from Advanced Medical Transport (AMT).

In February, Andrew Rand, Executive Director of AMT, is interviewed by InterBusiness Issues (II), a local magazine. Mr. Rand is asked this question and responds:

II: But since the fire department already responds to some 911 medical calls, they say it is a natural extension of their services to take over the paramedic ambulance service.

AR: I would think that workers trained to spray the wet stuff on the red stuff are not trained to meet the standards of our people who use very skilled procedures to insert tubes in patients’ lungs, needles in their veins, apply electricity to their hearts and administer lifesaving medications and other treatments. This is hardly an extension of putting out a house fire. The medical training of fire personnel is minimal in comparison to an advanced life support system. The services they provide presently include basic CPR, bandaging and minor splinting. In the grand scheme of an acute life-threatening injury or emergency, the firefighter’s role is very brief and limited. The role of our paramedics is very substantial to the total time spent caring for a patient.

My comments:

Wow...Mr. Rand knows how to spin.

Jumping ahead 6 years to 2002, Rand said that if AMT got the contract from the City of Peoria for the next 10 years, he would agree that the PFD could upgrade their emergency medical care and this would improve quality of care. And this would not be "brief and limited care" as Rand describes above. And Rand didn't explain how EMS is based out of many municipal Fire Departments in Illinois, and somehow these firefighters are "educable" regarding providing advanced care to 911 patients.

And Mr. Rand did not describe how he had the local Project Medical Director, Dr. George Hevesy, in his back pocket. Also, when this interview was done, Peoria did not know that just a few years later, AMT would be found guilty by federal investigators of Medicare fraud and fined over 2 million dollars. So, even though Mr. Rand gave the impression he cared about Peoria's taxpayers, AMT was ripping them off. The three Peoria hospitals paid the fine, which caused local health care to increase all the more.

Unfortunately, it is all about money.

2. May 1, 1996---Ernie Russell, Peoria Fire Chief, states that the PFD wants to upgrade services. Ambulance plan blocked again.

3. November 17, 2002—My OP-ED article stating that the PFD should be allowed to advance its medical care for Peorians.

4. December 2, 2002---Journal Star article reporting that Andrew Rand, Director of Advanced Medical Transport, is worried about the PFD upgrading their services.

5. January, 2003---Journal Star article reporting that AMT wants a contract with City for next 10 years. Peoria Fire Department Union disagrees and plan voted down by Peoria City Council. A follow up Journal Star editorial is about the same as their editorial in 1996. It supports AMT and the doctors that advocate for AMT. (You just have to read the Firehouse Forums article written about this vote, Dr. George Hevesy, the Advanced Medical Transport Medicare fraud, and conflict of interest in Peoria. I have it copied for you. It is very good and written from the inside of Peoria's EMS.)

6. December 15, 2003---The Catholic Diocese of Peoria states they can do nothing about the alleged ambulance monopoly in Peoria…largely supported by OSF. They advise me to discuss this situation with Rome.

7. 2004---Multiple Forum articles by my brother, Tom Carroll, and me discussing multiple EMS topics, the danger of the ambulance monopoly in Peoria, and the Peoria Fire Department being forced to sell its only ambulance.

In September, a consulting firm from California, studies the EMS situation in Peoria and reports to the City Council. They think that having four advanced life support units run by the PFD would be reasonable.

Council Member Ardis also expressed his concerns regarding emergency services in the Fifth District. He discussed the inexpensive option of establishing four-ALS engine companies. He said he would be interested in exploring this in lieu of spending $1 million to open a new fire station. He said Council should look at this in terms of policy direction.

No action is taken and the PFD stays at Basic. Where were Drs. George Hevesy and Rick Miller advising that PFD medical upgrades happen?

8. February 1, 2005---The City Council voted to sell the only PFD ambulance they owned. The Project Medical Director and previous Director of the Emergency Department at OSF, Dr. Rick Miller, did not allow them to staff or use it to respond to 911 calls by Peorians. It sat in a garage on Galena Road until it was sold on e bay.

9. July 5, 2005—I addressed the City Council and told them of a man who was denied advanced life support after collapsing in a Peoria restaurant. The next day the Journal Star had an article quoting Dr. Rick Miller and Andrew Rand who stated that I was making inflammatory statements. However they did not deny that the horrible event I described happened. And behind the scenes Miller makes changes which allows the PFD to upgrade their care a little bit. I think this news about the patient in the restaurant frightened Dr. Miller when he realized the serious ramifications for Peoria's EMS.

10. June, 2008---Bus accident occurs in Peoria. Peoria Fire Department watches as Peoria City Link (public bus transportation) transports injured to local emergency departments. My Forum article describing this “killed” by Journal Star editor.

11. July 7, 2008---Peoria City Council votes unanimously to approve a contract between the PFD and the City which will allow, for the first time ever, two Peoria Fire Stations to offer advanced life support for Peorians. (The Journal Star does not report this historic vote.) Hopefully, as time passes, more PFD firefighters will advance from Basic to Paramedic and the entire city will be covered by firefighters who will provide advanced life support.

12. My recommendation on a course of action regarding conflict of interest.


Detailed Description of Peoria's EMS Timeline:

February 18, 1996:

Peoria Journal Star Editorial---

The Journal Star editors did not think that the Peoria Fire Department should go into the ambulance business.

“What we have heard is a medical community speaking up in support of AMT…George Hevesy, emergency services director at St. Francis Medical Center, says he fears city-run service would lack the expertise, the funding and the medical supervision to provide a high quality of care.”

This was an amazing statement by Hevesy because he was in charge of all the emergency agencies in central Illinois including the PFD and if the PFD lacked the expertise or lacked the medical supervision, that was Hevesy’s responsibilty.

The Journal Star did not report that Hevesy was on AMT’s payroll and that their was obvious conflict of interest. Hevesy was in charge of about 70 EMS units in central Illinois.

Hevesy later told the Peoria City Council that there would be “duplication of services” if the Fire Department went into the paramedic/ambulance business. This would become the PAEMSS mantra for the following decade to attempt to monopolize advanced emergency medical care for AMT…the company that was paying Dr. Hevesy.

Here are excerpts from the document stating that Hevesy receives a salary from AMT that I obtained through the Freedom of Information Act filed with the Illinois Department of Public Health:

“The stipend is justly provided to the EMS Medical Director for oversight and consultation provided to this comprehensive EMS provider. This EMS provider accounts for the majority of the System’s EMS responses and interfacility transfers. Additionally, this EMS agency provides a unique regional critical care (inter-facility) transfer service under the direct medical control of the EMS Medical Director.

”This stipend does not create an agreement or atmosphere which makes the EMS Medical Director answerable to or directed by the EMS provider. Nor has it influenced the Medical Director’s assistance of other providers.The Peoria Area EMS Medical Advisory Board and the Ambulance Board of Directors, consisting of representatives of the Peoria area hospitals, have reviewed the stipend and believe there is no potential or actual conflict of interest.”

My comments:

The “EMS provider” stated above is AMT. I wonder what the PFD would say about influencing the medical director’s assistance with regards to the PFD? The Ambulance Board of Directors must be the AMT Board of Directors because there are no other ambulances in Peoria.

This is truly an amazing document.

Locally and nationally, people in EMS believe this represents "conflict of interest".

Firefighters stated that they “tap their toes nervously” and wait for AMT to arrive when they have a patient with severe breathing problems and are unable to help the patient other than give basic life support, even though the PFD had firefighters with advanced skills (Intermediate and Paramedics). Firefighters in the Peoria area have told me that Hevesy “obstructed” their departments when they attempted to upgrade their services for their citizens. The municipal fire departments are not paying Hevesy---AMT is. AMT is the only paramedic and transport service in the city of Peoria.

Three are two fundamental ethical premises that guide prehospital medical care. The principle of justice implies that the system be fair and equitable. The principle of beneficence requires that actions and intentions are in the best interest of the patient.

Are these ethical premises adhered to in Peoria?

May 1, 1996:

There was an interesting article in the PJS headlined: “Ambulance Plan Abandoned–Fire Department to Add Defibrillation Program”.

The article seems like it could almost have been written yesterday.

AMT was worried that the PFD would go into the ambulance and transport business. Andrew Rand, AMT’s Director was worried about the financial ramifications for AMT if the PFD advanced to paramedic and transport.

Peoria Fire Chief Ernie Russell stated, “When we first started looking at this we had to answer was the service being offered now at a quality that we wanted. We said “no”. We wanted quicker response and the defibrillation ability…”

However, the decision was made once again for the PFD to stay at basic level. The PFD couldn’t even give basic drugs and the 911 patient had to wait for AMT to arrive at the scene to receive defibrillation (electrical shock to the heart) and advanced drugs. (The Peoria Fire Department eventually bought their own defibrillators to shock hearts during a cardiac arrest in ‘96 or ‘97. And AMT had been shocking cardiac arrest victims for years.)

November 17, 2002:

I wrote an Op-Ed article that said that the PFD should be allowed to upgrade to Paramedic and transport, i.e. take patients to local emergency departments in a PFD ambulance.

“As a physician who worked at OSF St. Francis Medical Center for 20 years, I know that the AMT paramedics, municipal firefighters and volunteer fire departments do their very best under difficult circumstances in urban, suburban and rural areas. The many firefighters I have spoken to have been frustrated that they have not been permitted to attain and use these life-saving skills. Lives hang in the balance during these crucial minutes, and care that is late or sub-optimal contributes to poor outcomes. The Peoria firefighters know this all too well, as they have witnessed patients that they couldn’t give paramedic care to and deteriorate when they couldn't even "load and go."

Dr. Todd Nelson, a graduate of the OSF-ED Residency program in Peoria is now an EMS director in Manitowoc, Wisconsin. He wrote a Forum article disputing what I had written in the Op-Ed. He is associated with the University of Wisconsin School of Medicine.

Dr. Nelson was recruited by OSF in Peoria and it is my gut feeling that he was asked to write this article. He tried to instill fear with his article.

His article starts with the following paragraph:

“Just imagine your house catches on fire. A lengthy time passes prior to the firefighters arriving, so it burns to the ground. The reason for the delay was that the crew normally at your fire station had been called out on an emergency medical call. This left nobody at the station to provide protection against a fire. If firefighters are to assume the additional duties of providing advanced life support and transporting of patients to area hospitals, the above scenario may become reality.”

The scenario that Dr. Nelson describes is obviously hypothetical. A separate fire and cardiac arrest elsewhere in the same precinct happening at the same time in Peoria is unlikely. And if this DID happen, AMT would be called for the medical emergency. It is not impossible but it is a stretch and takes a leap of faith to believe what Dr. Nelson is writing.

Dr. Nelson used the same mantra, “duplication of services”, that Dr. Hevesy had used years before to contest the PFD moving into the advanced life support and transport business. Neither doctor of course wanted to see AMT lose any business… and Dr. Hevesy was being paid by both AMT and OSF.

Dr. Nelson ended his article with this sentence:

“Why then increase their (PFD) responsibilites even more by having them (PFD) acquire and maintain skills needed to provide quality ALS care?”

What Dr. Nelson left out of his article, of course, was that the PFD already had licencsed Paramedics who could have used their skills right then at the scene of a medical emergency if the Project Medical Director (the doctor in charge of all ambulances in the area) had allowed them. And Dr. Nelson should not have worried himself about the fire fighting responsibilities of the Fire Department.

Shouldn’t Dr. Nelson, being an EMS physician in Wisconsin, have advocated that the best trained and earliest arriving provider give the care? And the PFD could have provided quality ALS at the scene to dying people when minutes are precious… if they were allowed. But they were not allowed to...

Neither Dr. Hevesy or Dr. Nelson should be worried about the PFD fighting fires. Neither are experts in this area. Money and relationships were guiding them to say what they said.

(I sent Dr. Nelson an e mail recently asking him what he thought about the new 2008 policy in Peoria which will allow the PFD to give advanced life support at the scene…something he did not even mention as a good alternative when he wrote his forum article in 2002. I received no response from Dr. Nelson. Addendum: I finally did receive a response from Dr. Nelson. And believe it or not, he is medical director of two municipal fire departments that provide advanced life support with Paramedics. Hmmm...)

December 8, 2002

Another Journal Star article about the PFD wanting to be allowed to give better medical care--

“The city of Peoria wants to upgrade its fire department from offering basic life support services as it does now to becoming an intermediate service that can also administer medication in emergency situations.”

My comments when this article was written: There are 3 levels of prehospital care: Basic, Intermediate, and Advanced. Advanced is the same as Paramedic care. The PFD still is just Basic which is the lowest level. Up until just a few years ago, the PFD couldn’t even give an aspirin at the scene of a heart attack even when aspirin is most useful when given early and can decrease mortality up to 40%. The project medical director was Dr. George Hevesy for most of the 90’s and he was on AMT’s payroll as well as OSF’s payroll. AMT is the only Paramedic provider in Peoria even though the PFD has firefighters who are Paramedics and Intermediates.

The article went on to report that most ambulance services are certified to provide advanced life support services (Paramedic). However…"for years AMT has balked at the fire department entering this arena". Andrew Rand, director of AMT, stated that AMT is willing to help the fire department advance to the Intermediate level, but it (AMT) does not want the department to transport patients. Rand went on to say, “They can provide more comprehensive care than they do now (in 2002)”.

My comments: Why would Mr. Rand be stating this? He did not want to lose the transport business to the PFD. And AMT makes very big money.

Where was Dr. Hevesy in this? He was being paid by AMT. So, as it turned out, because AMT did not get the 10 year contract that they wanted several weeks later, the PFD was still at Basic life support and cannot transport, and cannot give life sustaining drugs during a cardiac arrest in 2005.

I would like to see Dr. Hevesy’s written directives that the PFD must increase its level of services to the citizens of Peoria. Did he write any or did he just support AMT as the only paramedic providers in town as he picked up his check from them as their “Corporate Medical Director”.

The Journal Star continued:

“Proponents of letting the fire department transport patients argue that the fire department should be in the ambulance business because it is usually first on the scene of an emergency situation and provides basic life support. They argue that two or three minutes can make a difference in saving a life. In addition to transporting patients, proponents want the firefighter to be able to administer the necessary drugs and bill the patient for the service.”

My comments at the time of the article: Medical studies have shown that advanced life support definitely helps with chest pain patients and patients who are short of breath. The PFD gets thousands of these 911 calls per year and can only give basic life support with very basic medications. This seems like a travesty to me but most people just simply don’t understand this and when they see the PFD truck with RESCUE painted on the side, they believe it. Frequently firefighters do RESCUE people, but not with the advanced life support drugs they should be able to carry and use.

Dr. Rick Miller was the current project medical director and former director of the OSF ED when this article was written and the PFD did not advancing its care rapidly under his guidance either.

I have spoken to many people involved in emergency medical systems in the state of Illinois, and they know how it plays in Peoria.

The Journal Star article continued: “Rand disputes that the fire department is usually the first responder.”

“That is absolutely false,” Rand said.

My comments: Rand was proven wrong two years later by the Matrix study done in 2004 which showed that the PFD arrived approximately 2 minutes quicker to the scene involving life threatening situations.

Councilman Jim Ardis went on to say in the PJS article,”If we want to have a highly trained fire and medical department in the city , there is nothing that AMT can do to prevent us from doing so”. “I don’t think that anyone can make the argument that anybody would not want the best trained people to be there for them all the time in case of an emergency. Why would you not want that?”

My comments: Councilman Ardis (now Mayor Ardis) was exactly right.. The EMS system in Peoria is shrouded in conflict of interest. (In early 2003, AMT lost the vote for the 10 year contract they wanted, but they continued to monopolize the paramedic industry in Peoria with the help of OSF and the physicians who should be protecting you in a 911 crisis.)

I sent a letter regarding this conflict of interest to OSF leaders including Jim Moore, Sister Judith Ann, Gerry McShane, Joseph Piccione, and Howard Wiles (the compliance officer for OSF Corporate) in May of 2002 (approximately 7 months before the PJS article above). I received no response from anyone of the above. Joe Piccione, the OSF corporate ethicist told me in the fall of 2001 that I was mandated to report conflict of interest, but when I did, no one responded.

OSF is of course one of the main supporters of AMT and the base station for all emergency response services in Central Illinois.

I picketed OSF with a sign stating that OSF and AMT had a monopoly of paramedic services during the summer of 2003. Sue Wozniak, CFO at OSF and AMT board member scolded me one afternoon as she was leaving work for picketing the hospital. I asked her what she thought about Hevesy receiving a salary from AMT when he was director of ALL ambulances in Central Illinois. She said it was a good idea that Hevesy “stepped away from this” as he was PROMOTED to director of the Emergency Department at OSF. Incredibly, she stated that Hevesy was still paid by AMT. I couldn’t believe that she would admit this. I thought that she would require that I go through the Freedom Of Information Act again to get this information.

I kept the Catholic Diocese of Peoria informed regarding this conflict of interest. I believed then and believe now that it needed the pastoral care of Bishop Jenky and that he should stop this at OSF and its “affiliate” AMT. If OSF wouldn’t provide checks and balances for itself, maybe the Bishop would.

I presented this to Monsignor Rohlfs and Patricia Gibson in the Monsignor’s office in the spring of 2003. I told them that I wanted to petition the OSF Sisters for a Catholic tribunal court. Patricia Gibson and Monsignor had helped me write one petition in December of 2002. Monsignor Rohlfs told me that if I petitioned the Sisters for ANYTHING, the Diocese would come out against me in the media. I asked him what he meant by this and he replied that the Diocese would “come out against Haitian Hearts in the media.” I told him that I needed to do this and presented this to Bishop Jenky the next day at the chancery.

Bishop Jenky told me “there will be no tribunal against OSF….it is a $1.6 billion industry, doctor.” True to form, after I filed the petitions for the tribunal court (one being for conflict of interest regarding emergency medical services—see below),the Diocese advised me to go to Rome to solve this problem and the Diocese pulled their nominal support for Haitian Hearts while I was working in Haiti reported on a front page Journal Star article in mid-July, 2003.

January 11, 2003--

The Journal star had an article that headed up the Local section with big headlines-

AMT Wants City to Sign 10 Year Contract:

“Representatives of Peoria’s sole ambulance service want the city to sign an agreement giving them exclusive rights to continue treating and transporting patients for the next 10 years.

“Every time you turn around the fire department is proposing to start up ambulance service,” said Andrew Rand, Advanced Medical Transport executive director.” “We want to create some stability…who needs to be in fear of municipal takeover? It’s a distraction to our principle goal of tending to patients.”

The article continues:

“For several years, city officials have discussed the option of allowing the Fire Department to expand its role to include transporting patients to the hospital and providing advanced life support, the highest level of Paramedic care.”

Mr. Rand was fighting for his business. It would not have have hurt AMT’s pocketbook if the PFD Paramedics were allowed to treat the patient at the scene. AMT would have still transported the patient because the PFD was not allowed to transport and even had to sell the only ambulance they owned on e bay.

George Hevesy was brought into the picture again, as he was in 1996, to fight for AMT, the company that he worked for. He was also Director of the Emergency Department (ED) at OSF, moonlighting in other ED’s in the State, working for a company that placed ED physicians in ER’s, and Director of Region II EMS for the Illinois Department of Public Health. He was very busy while the OSF-ER carried the lowest patient satisfaction scores at OSF-SFMC.

According to this article, Hevesy claimed that if Peoria firefighters took up that role ---paramedic and transport---it would threaten to fragment the current EMS system and potentially jeopardize patient care.

What this translates to is that Hevesy was fighting for AMT that paid him to make statements such as these.

Again Hevesy tried to scare the public like Dr. Nelson did a few months before.

Hevesy asked “Does that mean two ambulances will be racing to be first at the scene?” He added that firefighters also might then be distracted from their primary role which is fighting fires--the same tactic used by Dr. Nelson.

Hevesy even told the City Council that he feared “duplication of services”, which was just what Dr. Nelson was “worried” about.

What Hevesy should have done, if he was not going to sanction the PFD becoming a transport agency, was to demand that the PFD Paramedics be allowed to treat patients at the scene. (This is what has happened now in 2008.) But Hevesy and Rand and OSF were afraid if the PFD administered life saving drugs at the scence, it would not be long before they were able to use an ambulance and take people to hospitals and this is where AMT would have lost money. The patient may have done better by arriving at the hospital quicker, but I don’t think this was their priority.

January 14, 2003:

Journal Star article had a headline:
“Firefighters Union Opposes AMT Deal”

The article reported that the Peoria City Council was to vote later in the day regarding the franchise agreement between the City and AMT. The proposed franchise agreement would have allowed AMT to treat and transport patients in Peoria for the next 10 years. It also stated that if there was an agreement to this effect that the PFD would be allowed to upgrade training from Basic to Intermediate (NOT Paramedic) so the PFD could administer some drugs at the scene.

However, even with Peoria hospital support of AMT, Dr. Hevesy talking to the City Council, the editorial board at the Journal Star, and multiple people like Dr. Nelson and others writing the Journal, the City said “no” to AMT. The City Council voted down an agreement that would have prevented city firefighters from upgrading their medical training to Paramedic or moving into the ambulance business anytime soon.

So finally, after all of these years, the City said no to AMT and Peoria’s hospitals that support AMT. The City did not want handcuffs put on the PFD to stop the PFD from providing better care. And these restraints were put on the PFD by the very people that should have been helping the PFD provide more advanced care for Peorians.

In this article, Peoria’s late Fire Chief Roy Modglin hit it right on the head:

“No private business, not-for-profit should be allowed to limit the level of (medical) service provided to citizens. If this City Council want to allow our city firefighter to be doctors, that should be our perorgative.”

Ironically, local doctors were trying to STOP the PFD from upgrading its medical service.

(And I heard from a very good source that a local Project Medical Director approached the PFD and said that if he were paid by the PFD, they would upgrade their services for Peorians. I think he thought if Hevesy was paid by AMT, why shouldn’t he be paid for upgrading the PFD services. The PFD refused this offer from the local doctor because they felt they were dealing with the "devil in disguise".)

Also, Council members stated that if they would have voted for the agreement between AMT and the City, it would not have held AMT accountable for its performance. What this meant was response time and other parameters. AMT and OSF, of course, did not want people to know that AMT was about one and one half minutes behind the PFD to life threatening emergencies.

And predictably once again the editors of the Journal Star were not happy with this decision by the City.

An editorial a few days later stated that the Peoria Fire Department does not need to be in the transport business.

The editorial contained an interesting paragraph that quoted Dr. James Hubler, who was acting EMS director and Tony Ardis, President of the PFD Union.

“James Hubler, EMS Director at OSF Saint Francis, says that if Peoria were to go its own way, area residents would end up with a fragmented system that would damage the quality of care. Ardis Argues that the hospitals’ judgement is biased because they helped set up AMT and share some high-ranking personnel. Could be.”

It is more than a “could be”.

Dr. Hubler had actually been working behind the scenes with the PFD to help them upgrade so they would be allowed to use four PFD vehicles for transportation. However, late one night when Andrew Rand and Dr. Rick Miller heard about this, they discussed it on the phone and with community support were able to stop this upgrade. Dr. Hubler would eventually resign as EMS Director. He had run-ins with Andrew Rand and Dr. Hevesy, who was Hubler’s boss, would support Rand and AMT and not Dr. Hubler.

The Journal Star Editorial concluded:

“But when the experts say a system as critical as ambulance service is best left the way it is, Peorians should be extremely reluctant to throw it out, whether or not money could be made.”

The “expert” of course was mainly Dr. Hevesy and again, as they had done in 1996, the Journal left out that Hevesy was paid by AMT.

Now read this if you want a great perspective of Peoria's EMS up till this point on the time appeared in Firehouse Forums on March 6, 2003 and was written by FFMEDIC51:

03-06-2003, 05:36 AM

OSF St. Francis and the Management at Advanced Medical Transport of Central Illinois (AMT) will lead people to believe that the Emergency Medical Services (EMS) System in Peoria is one of the best and progressive systems in the nation. The Peoria EMS system is flawed and has been for years. They feel there is no reason that the Fire Department should enter into providing ALS care because it would compromise over all patient care and fracture the great system we now have in place. WOW!!!!! What a load that is. Working in the Peoria area for 15 years as a Paramedic, I worked in the system when the transition was made from Mobile Medics to AMT in 1990. Paramedics who worked in the system, including the Fire Departments (paid and volunteer) were optimistic about the new ambulance service. Some of the reasons that the Peoria hospitals restructured Mobile Medics were because there were only two advanced life support (ALS) ambulances and three basic life support (BLS) ambulances covering the City of Peoria. Peoria County was served by a very small BLS private ambulance service. The advantage to the hospital based Paramedics were the experience that they carried, low turnover, good moral, and patient care was excellent. The problem was not the quality but the quantity of ALS ambulances.

The hospitals then decided to create a third service (non-for-profit) owned by the hospitals and managed using a board of directors. Each hospital would have a representative on the board and the rest would consist of powerful private sector business leaders. AMT was created. One thing that was funny was that the Project Medical Director (PMD) (who was over every EMS provider in the Peoria EMS system) was on AMT’s payroll as their Corporate Medical Director. He has since been promoted to the Director of Emergency Medicine at OSF St. Francis (our system resource hospital) and still holds the title of Cooperate Medical Director with AMT. Isn’t this conflict of interest? I found in the early stages of AMT that management at AMT wasn’t interested in working with other departments within the Peoria EMS system. They were mainly interested in monopolizing every aspect of EMS. They’re only competition was small private services and the Fire Departments. AMT purchased all the smaller ambulance companies, but the Fire Departments would be a thorn in their side causing a threat to always be there. They are currently trying to keep all the fire departments at the basic level and getting in the way of advancing their care.

Three years ago AMT paid out over 3 million dollars to our state and federal governments, because of a settlement, over a charge against them of Medicare/ Medicaid fraud. Talk about screwing the public. Hardly anything was said about this and it was kept quite. The hospitals and private sector did a good job keeping the lid on that whole mess by taking care of the fine. They are currently on probation. Another misconception is the fact that AMT received a perfect score on a national accreditation, which was advertised a great deal in the media. The truth is that they had to pay approximately $20,000 to receive that accreditation and the Medicare / Medicaid fraud was never brought to the surface to the accreditation company.
Another problem with AMT is that the workforce doesn’t retain experienced paramedics. The average medic works about one year, gets experience and leaves for other services or fire department jobs. This inexperience causes the EMS system and ultimately the patient to suffer. The PMD doesn’t even trust his medics on the street, making the Peoria area system behind in the times as far as advancement. I found it interesting how fast the system catered to AMT and when the local fire departments wanted to upgrade their services from BLS to ILS (intermediate life support) or paramedic level. The fire department ran into many obstacles because of AMT. It was said that the Fire Department was trying to put AMT out of business. AMT threatened a huge negative smear campaign against Fire Based EMS and Firefighters. They say the fire service wants to justify their existence. The truth is Peoria Firefighters or any Firefighters don’t have to justify their existence or their jobs. The Peoria Fire Department has been providing service to the citizens of Peoria for over 125 years and will be here long after AMT is a memory. There is no reason why the Fire Department shouldn’t be able to provide advanced life support (ALS). They have been trying for the last 12 years. They have Paramedics on staff now and they are in the process of training more.

The latest act against the Fire Department was the 10-year contract. AMT wanted exclusive transport rights in the City of Peoria good for 10yrs paying only $60,000 a year to the city in exchange for the 911 dispatching and the fire department supplying help to them when it is needed. Also the contract stated that the Peoria Fire Department could in no way upgrade to Paramedic level within the contract (Why not?). There would be no accountability for their poor response times, number of ambulances available for 911 calls, and no penalties if the service were to deteriorate further. The contract didn’t mention that any other private company could come into the city and operate at the paramedic level, but SPECIFICALLY excluded the fire department from doing so. Talk about paranoid. This contract was brought to the Peoria city council with representatives from all three hospital administrations, AMT’s board of directors, Project Medical Director, and Emergency Medical Director. The vote was close but it failed. I am sure that this is not a closed issue. This contract will be modified slightly and brought back to the council.

I really find it a shame… AMT does have the potential to be one of the best EMS providers in the system; the management of that company could work with the fire department, treat their employees better with higher pay and incentives for retention. AMT management made a choice early on to compete with the providers and not work with them. I wish that it was a different situation but unless there is a big change in management and changes throughout the resource hospital, I feel it’s going to get much worse before it gets better. There is no reason the Firefighters should roll over on this issue and keep quite while the system suffers. They have tried on numerous occasions to work with AMT management and OSF St. Francis to improve this situation and ultimately improve overall Pt. care. The Firefighters priority is the Pt. and the community they serve and I’m sure most street Paramedics priorities are the same. I have no doubt the Fire Department will be providing ALS services in some capacity soon. It’s a win win for the city and the citizens. Some forget why we are here in the first place. “It will play in Peoria” It’s just a matter of time…
The person that posted above is a fire fighter on a fire fighter's forum and he has his bias...but he seems pretty fair and objective as he described the situation in Peoria.

A fire chief in a very large city in Illinois told me, “You have a very unfortunate situation in Peoria.” He was referring to OSF’s monopoly of the Paramedic and transport situation in Peoria and OSF’s influence in Springfield at the Illinois Department of Public Health.

November, 2003

I wrote Bishop Daniel Jenky expressing my concerns regarding the ambulance monopoly in Peoria which was supported by OSF.

I received this letter in reply:

412 N. E. Madison Avenue Peoria, Illinois 61603-3720
Telephone 309-671-1550 FAX 309-671-1558
December 15, 2003


Dear Doctor Carroll:

Bishop Jenky is in receipt of your fourth petition regarding OSF St. Francis and the alleged monopoly carried on by the Advanced Medical Transport Company at OSF St. Francis.

After taking canonical counsel on the matter he wishes to state once again that any such issue involving the Third Order of St. Francis would have to be taken up by Rome itself rather than the diocese, as it is an "Exempt Religious Congregation of Pontifical Jurisdiction". It is the considered opinion of our canonists that the Bishop would have no jurisdiction over the issues which you have presented.
I know that this will come as a disappointment to you but it is truly futile to continue asking for a diocesan tribunal against a congregation of pontifical jurisdiction.

With warmest personal regards, I remain

Sincerely in Christ,

Monsignor Steven P. Rohlfs, S.T.D.
Vicar General-Chancellor

February 28, 2004

My brother, Tom Carroll, wrote this article published in the Journal Star Forum:

Let fire department transport critically ill patients

The Peoria Fire Department purchased one or two ambulances recently. A Feb. 3 Journal Star editorial asked, " ... what good is a fire department ambulance if it can't transport patients to the hospital?" Good question. Perhaps a better question is, "Why can't the fire department transport patients in the first place?"

Fire department personnel, many of whom are trained paramedics, are the first responders to emergency medical calls every day. However, the fire department is not allowed to transport patients to a hospital and cannot provide advanced medical care at the scene. Trauma patients must wait for paramedics from Advanced Medical Transport, a private ambulance company, to arrive. Since patient survival improves with faster response, the firefighters should be allowed to use their skills.

Control of ambulances and emergency medical services lies in the hands of the project medical director. The OSF-employed physician who held this post for nine of the last 12 years, Dr. George Hevesy, was paid a salary by AMT. Freedom of Information documents from the state of Illinois reveal that OSF administrators knew and approved of this arrangement. There is an immense conflict of interest when a project medical director accepts money from a private ambulance company. Small wonder the fire department is not competing with AMT in the paramedic and transport business.

OSF should not allow an employee to accept money from an ambulance company he or she regulates. OSF also needs to explain why corporate profits have been given greater importance than fast emergency response times. City Manager Randy Oliver's commission on emergency services must address this conflict of interest.

The present project medical director, Dr. Rick Miller, needs to assure Peoria that the Peoria Fire Department will be adequately trained and allowed to transport patients in their new ambulances and that financial gain will not be allowed to override the public's right to the fastest and most efficient medical care possible.

Tom Carroll

July 27, 2004

I wrote the following article describing Peoria’s medical mafia limiting emergency care. I compared Peoria’s situation to the corrupt Illinois Health Facilities Planning Board. (This Board’s president was Stuart Levine. He worked with OSF officials allowing OSF to build the Center for Health. Levine was found guilty in 2008 of multiple illegal activities.)

”Re. July 16 editorial, "Send corrupt health facilities planning board to morgue":

The Journal Star states that in Illinois, "Any board with this much authority over this much money becomes a trough of corruption." Truer words could not have been written. For 30 years lobbyists, attorneys and politically connected people have influenced the decisions made by this nine-member board regarding construction of new hospitals and expansion of existing ones in Illinois.

Unfortunately, similar conflicts of interest and cronyism are currently occurring in Peoria. The stakes are very high here with lives and money on the line.

In Peoria we have one paramedic transport company, Advanced Medical Transport (AMT). Its medical director is Dr. George Hevesy, who happens to be the medical director of OSF-St. Francis' emergency department. Dr. Hevesy is salaried by both OSF-St. Francis and AMT. OSF is the main supporter of AMT and is also the base station for all emergency medical services in central Illinois.

The AMT board of directors, composed of prominent Peorians, has the support of the OSF-St. Francis board of directors. Dr. Hevesy's relationship with the Illinois Department of Public Health in Springfield, which regulates paramedics and ambulances in the state, is well known in emergency medicine circles throughout Illinois. And finally, the Peoria City Council, which will decide if AMT remains in total control of paramedic care and transport in Peoria for the next decade, will consider the findings and recommendations of a California-based consulting firm.

Some members of the council suspect a pre-existing relationship between AMT and this California firm. One needs a scorecard to keep track of this local health care travesty.

In the meantime, the Peoria Fire Department continues to respond to medical emergencies, can only provide basic life support (not paramedic care) and cannot transport patients, even with its one ambulance. The PFD obviously does not enjoy the support of the abovenamed individuals, boards and state agencies.
The real loss, of course, is for Peorians who suffer an out-of-hospltal medical emergency.

State-of-the-art, pre-hospital emergency care is not offered in Peoria, not because we can't, but because our medical mafia will not allow it.

Dr. John Carroll

September 28, 2004:

The Matrix Consulting Group presented its findings to the Peoria city council regarding Emergency Medical Services (EMS) in Peoria. The city hired Matrix for $79,000. Currently, Peoria has two EMS responders: the Peoria Fire Department (PFD) and Advanced Medical Transport (AMT) a private, ambulance company co-owned by the three Peoria hospitals. AMT responds to 911 calls, provides three levels of life support: basic, intermediate, and advanced (paramedic), and transports all Peoria patients. The PFD responds to 911 calls and is only permitted to provide basic life support. They are not allowed to transport patients.

Two gentlemen from the California-based firm made a very polished PowerPoint presentation accompanied by an impressive-looking 149 page report. The presentation covered issues ranging from PFD organizational issues to paramedic and transport services provided in Peoria by AMT. Matrix’s primary recommendation, after all was said and done, was for Peoria to make no changes in ambulance service. How and why they arrived at this conclusion remains a mystery. Their report contains evidence that suggests changes to ambulance service could be beneficial to Peorians. Furthermore, data crucial to evaluating EMS and ambulance service is no where to be found in the report.

According to the report, the current EMS system in Peoria is supervised by the Illinois Department of Public Health (IDPH), which maintains a district office in Peoria. When I spoke to a representative from the office, he stated that he was unaware of the contents of the Matrix study and had only general data from AMT. He was unable to answer my specific questions regarding how Peoria pre-hospital patients suffering from chest pain, breathing problems, cardiac arrest, or trauma had done over the last decade.

The Matrix report states that AMT’s performance data was also submitted to the project medical director (the doctor in charge of all EMS and ambulances in central Illinois) who is located at OSF St. Francis Medical Center. When I spoke with the emergency services manager in the EMS office at OSF, she stated they had no aggregate data regarding how AMT performed in 2003 or for any year. How could the project medical director not have this data? Data that normal EMS systems collect would include: successful cardiac resuscitation in the field, survival to hospital admission, survival to hospital discharge, etc. Where is Peoria’s data?

Consistent with my conversations, the Matrix report contains absolutely no data about patient outcomes. The report states that performance data is provided to IDPH and the project medical director, but my conversations with individuals from these offices indicates that this data has not been compiled or analyzed.

The Matrix report continues with a chart depicting the average response time by the PFD and AMT to life-threatening emergencies. The PFD arrival is almost two minutes quicker than AMT. The consultants go on to explain how medical research shows that advanced life support (ALS) may help people with chest pain and breathing problems. Indeed, patients suffering severe trauma incur five percent increased mortality for each minute that they are not transported (remember Princess Diana?) The PFD is not permitted to provide ALS or transport patients. Of the more than 9,000 EMS calls the PFD responded to in 2003, 1,800 were for breathing problems, 900 for chest pain, and 1,700 for trauma.

Based on the above, Matrix outlined a plan that would “increase the level of service” by allowing four fire department engines to be staffed with paramedics to respond to “targeted areas” in Peoria. If the PFD could provide ALS, lives would be saved as Matrix notes that “early establishment of intravenous fluids and certainly advanced airway management will be beneficial in certain cases.” The seriously ill or injured patient would no longer have to wait for AMT to arrive for advanced interventions.

Matrix then did a cost analysis of the above and stated that for a “relatively low cost of approximately $100,000 per year . . .the city could move to a four company ALS engine company system.” What Matrix overlooked was the fact that the PFD firefighters who are currently paramedics could provide their expertise for the four engines if only the project medical director would agree. This may be difficult because the medical director’s supervisor at OSF is the corporate medical director at AMT.

The Matrix report states that the PFD recently acquired a transport capable ambulance. They state that since there are no “service gaps” (i.e. AMT is always available) the PFD ambulance is not necessary. Many EMS providers in the Peoria area and families I have spoken with give numerous examples of “service gaps.” Patients and Peoria firefighters have waited precious minutes for AMT to arrive at the scene. AMT has even called the PFD for help when AMT finds themselves overextended responding to emergencies. Matrix notes that AMT maintains the “proprietary nature” of its staffing and financial information and so this information was not contained in the report. Just imagine if the PFD wouldn’t reveal where they were located or their operating budget.

Matrix’s conclusion that there are no gaps in service is incorrect. However, their advice to sell the only existing PFD ambulance may be sound since it sits unused for emergencies. According to the Matrix report, “the PFD has applied to the project medical director for permission to outfit the ambulance with various basic and life support materials and equipment. This request has been, to this point, denied by the medical director. . .”

In conclusion, evidence and healthcare statistics regarding emergency medical services in Peoria are glaringly absent from the Matrix report. Conclusions based on invisible or non published data are opinions and nothing more. If leaders are to make credible decisions about Peoria’s EMS and ambulance services, these judgments must be based on complete, unbiased, accurate data. We should ask the question: why is such critical information so hard to come by?

December 12, 2004

Should Peoria Fire Department sell its only ambulance?

What will the city do with the one Peoria Fire Department ambulance that sits alone and unused? Will It be sold for something more important than saving people's lives?

In September, the Matrix Consulting Group evaluated Peoria's emergency medical services. Matrix reported that the fire department's average response time to life- threatening emergencies was almost two minutes faster than Advanced Medical Transport's. Since the fire department can only provide Basic life support, patients frequently wait until AMT arrives for Paramedic intervention.

One plan formulated by the consulting firm to improve service was to target certain areas with four non-transport fire department engines. These vehicles would be staffed by Firefighter/Paramedics who would provide advanced life support. The fire department has Paramedics who could provide their expertise for these engines.

The problem is the two physicians who have controlled ambulances in Peoria for the last two decades don't support the fire department's advancing from basic life support service to advanced life support. Unfortunately, Peoria Firefighter/Paramedics are not allowed to use their Paramedic skills at emergencies.

Matrix noted the fire department has applied to the physician in charge of ambulances to outfit its only engine with various basic and advanced life support medications and equipment. That request was denied.

The boards of directors of our local"health-care Industry," and the doctors who have been responsible for ambulances in Peoria, need to disclose their private interests and explain why seiling the one and only fire department ambulance Is beneficial to sick and Injured pre-hospital patients In Peoria.

Dr. John Carroll

February 23, 2005:

Let Peoria Fire Department Operate its Ambulance

On Feb. 1 the Peoria City Council voted to sell the only fire department ambulance, which has been sitting idle in a garage. It was never allowed to respond to 911 calls. Numerous firefighters who are certified paramedics are not allowed to use their skills. They have been wasted.

To help rectify this situation, I will purchase the PFD's ambulance at its present market value and donate it back to the PFD if these conditions are met:

1. This ambulance will be used for sick or injured Peorians and staffed by PFD firefighters/paramedics allowed to use their advanced life support skills in Peoria.

2. Doctors George Hevesey and Rick Miller have been directors of the Emergency Department at OSF for the past 15 years. They have controlled all ambulances in the area. Both physicians need to publicly declare any fees, stipends, salaries or other benefits they've received from their relationship with Advanced Medical Transport, the only company allowed to operate in Peoria.

3. OSF's Emergency Medical Services Department needs to provide health-care data for the past decade to the city manager and City Council revealing how Peoria's pre-hospital patients did when cared for and transported by AMT. This data was conspicuously absent in the 149-page consultant's report that evaluated fire and emergency medical services in Peoria last year.

The medical ambulance debacle in Peoria, plagued by conflicts of interest, needs to end.

Dr. John Carroll

July 5, 2005

I addressed the Peoria City Council at the Citizen’s Forum and presented this tragic situation that occurred in Peoria:

The PFD responded to greater than 9,000 health-related 911 calls in 2003. They can provide only BLS at the scene and cannot transport. Even though the PFD has paramedic firefighters, they are not allowed to use their skills in Peoria. With that background, consider the following vignette and put yourself in this patient's place and see what you think:

Several weeks ago, a man in Peoria who was eating in a Peoria restaurant, collapsed, and bystander CPR was started. 911 was called. The PFD arrived and shocked the patient who was pulseless. His pulse returned. AMT arrived and attempted to place a breathing tube to help the man breathe and protect his airway. For one reason or another, this was not accomplished. Insertion of tubes can be very difficult in emergent situations. The PFD firefighter on the scene was not allowed to attempt the tube-a memo had been released that very morning stating that firefighters can only provide Basic life support even if they are Paramedics. Another firefighter had been placed on a 90 day suspension when he put a tube in another patient several weeks prior to establish the airway for the patient. The patient described above in the restaurant died.

Just think if that man were you or a family member of yours?

Here are questions that the family of this gentleman or anyone with an interest in EMS in Peoria could ask at a neighborhood meeting:

1. Why wasn’t the PFD paramedic allowed to help with his ALS skills in Peoria but can do so in surrounding areas?

2. The family of the deceased man should ask Andrew Rand, Director of AMT, why he stated in a PJS article (Dec. 8, 2002) that they did not want the PFD in the ambulance business for years. (When the PFD shows up earlier than AMT at the scene, shouldn’t they be able to offer the best possible care to the patient?)

3. Miller and Hevesy need to be asked why Joliet, Rockford, and Springfield firefighters can act as paramedics while at work and the firefighters in Peoria cannot.

The next day, July 6, 2005, the following article appeared in the Journal Star:

PEORIA - Criticism of the city's private ambulance service by a former emergency room physician is being downplayed but could still lead to discussion on how to improve the system.

Dr. John Carroll, who worked for 21 years at OSF Saint Francis Medical Center before he was fired in 2001, told the City Council on Tuesday of a recent incident in which a man at a Peoria restaurant went into full cardiac arrest and later died while a Peoria Firefighter/Paramedic on the scene wasn't allowed to try to help save him.

"Just think if that was your family member," Carroll told the council. "Valuable minutes really shouldn't be wasted at the scene" waiting for the city's ambulance service to arrive.

Carroll has been critical of Advanced Medical Transport, the city's only ambulance provider, since at least 2002, but some question whether his accusations are personally motivated by his firing.

"Dr. Carroll has been critical of our operations for some time now. I don't recall ever having the chance to speak with him personally," said Andrew Rand, AMT's executive director. "It's regrettable that these sort of anecdotal references are made that are unsubstantiated."

Rand noted that the AMT was recently given its second perfect score from the Commission on Accreditation of Ambulance Services, making it the only private provider in Illinois thus recognized.

"We have an excellent system," said Dr. Rick Miller, Emergency Medical Services Medical director. An employee of St. Francis, Miller has the responsibility of certifying people as paramedics and EMTs and overseeing their education. If there are any problems and someone has to be reprimanded, he is also involved.

"To say (firefighters) are standing around is inflammatory and an insult to the fire department," Miller added.

Firefighters can perform CPR, control a patient's airway, ventilate a
patient, give oxygen and administer several medications. They can
also use a defibrillator, which could be the most important tool for
a cardiac patient, Miller said.

Those firefighters who are also system-certified paramedics can
also use their skills to assist AMT paramedics if they request help -
a relatively new change allowed by Miller.

It's also an example of what appears to be a sea change in the
relationship between the fire department and AMT. Just a couple years ago, the fire department wanted to get into the ambulance transport business over AMT's objections. But now both sides say they are working together like never before.”

My comments at the time of the article:

This article and Rand and Millers statements are very misleading. If the above "anecdote" did not happen, I am quite sure that OSF and AMT would have let everyone know at the Journal Star. The firefighter felt terrible that he was not allowed to insert the breathing tube as the family watched. (The firefighter had already shocked the patient and he had a heart beat and needed a secure airway.)

The "new change" referred to in the article by Dr. Miller is very difficult to understand. Quite simply, it means that Miller caved in and if AMT ASKS the PFD paramedic to insert the tube into the patients airway, the PFD paramedic can now do it.

What if AMT is not on scene and the patient needs the tube"? Under, Miller's "new change", the patient has to wait. This is unbelieveable. The brain cannot go without oxygen for very long. Also, remember, that the PFD paramedics cannot provide advanced life support at the scene like AMT can and does. (By the way, the same PFD paramedics frequently work outside of the Peoria Fire Department and can insert the tube when needed and can provide advanced life support. Why can't they provide the same in Peoria?)

I do think that the PFD firefighters and the AMT paramedics work well at the scene. But the real problem is behind the scene by the officials and doctors making policy.

And finally, the second "perfect score" by AMT, referenced by the Journal Star, was probably paid for too, as was their first "perfect score".

Here are questions I asked Drs. Miller, Hevesy, and Andrew Rand on Peoria's Medical Mafia blog after presenting to the Council:

1. Dr. Miller, when you made your policy change during the summer of 2005, did it have anything to do with the man’s death at the restaurant? Why won’t you allow the PFD paramedics to put tubes in people who need them to breathe or protect their airways without AMT having to ask the PFD to perform this service? “A” stands for AIRWAY in the A,B,C’s of resuscitation. What happens if the PFD is at the scene first, which is not uncommon, and AMT is not there to ask the PFD to insert the tube? Why won’t you let the PFD carry the tubes on their rigs in the first place?

2. Are you all against the PFD advancing their status to paramedic? If so, why? What about an Intermediate level of service for the PFD? This only takes about 400 hours of training (instead of 1200 hours for paramedic training) and, Mr Rand, you even stated in the Journal Star in 2002, you would help the PFD advance to Intermediate service if the PFD would not go into the transport business. You suggested that Intermediate service would be more "comprehensive" than the basic service they give now. Why didn’t you help them advance to Intermediate service which could help save lives in Peoria? Because you didn’t get the 10 year contract that you wanted? Dr. Miller, could you have pulled some strings at the “resource hospital”, OSF, to get a good price on training some firemen to the Intermediate level? (OSF and AMT control the majority of the emergency medical technician education in Peoria as well.) Dr. Miller, where are your memos that the PFD should at least advance to the Intermediate level so that they could perform a more comprehensive service? Are you aware of the optional model offered by the Department of Transportation that would allow Basic providers to learn advanced airway techniques like the endotracheal tube and laryngeal mask airway? Some municipal fire departments around the state take advantage of this, why not Peoria? Where are your directives requesting that the PFD become more versed in securing the airway?

3. Dr. Hevesy, where are your memos from all your years as director of the ambulances in the Peoria area that the PFD should be giving basic drugs? Why did you not insist that the PFD give aspirin at the scene to people with chest pain, albuterol spray to people suffering from asthma and emphysema, and adrenalin to people having severe allergic reactions? You let AMT do it. Why not the PFD? Also, where are your memos that the PFD should be shocking people in with ventricular fibrillation? All basic units should have been doing this since at least the early 90’s. AMT was saving Peorians’ lives with this technique. You obviously knew this. Were you an advocate for the PFD using defibrillators and where is the proof? Please don’t say it would be “duplication of services” again because the oxygen starved brain does not care about this concept.

4. Dr. Miller, are you aware that some nursing homes in the area call AMT directly when there is an emergency in the nursing home and that they don’t call 911 first? Does this seem sound to you? What if AMT is tied up on another call and the firefighters get a late call for the geriatric patient and then they arrive late also. Remember, Rick, you won’t let the PFD perform advanced life support for the old person, so what is going to happen some of the time? Do you think the families of these people know that 911 is NOT being called for their mother when they moved her there? I have heard that AMT paramedics will call the PFD for help in situations like this when AMT can’t get there in a reasonable amount of time. This doesn’t sound good, does it?

5. Rick, Andrew, and George, how would the Peoria Area EMS system work in light of a mass casualty? Glad we don’t live on the gulf coast with you guys running the show. A bad tornado in Peoria could be devastating. The PFD could respond but not offer advanced support or transport the patients. Sounds bad, guys.

6. Andrew, is AMT paying Dr. Miller for his services as project medical director? You have been paying Dr. Hevesy for years, right?

7. Do any of you believe the statement of conflict of interest submitted to the Illinois Department of Public Health that states there is not even the “potential” for conflict of interest with Hevesy collecting a salary from AMT? Who wrote that statement and gave that statement to IDPH from the Peoria Area EMS? Was OSF involved with this statement?

8. When I have spoken to different experts around the United States about emergency medical services in Peoria, they all laugh or grimace when they realize that Hevesy has been on the payroll at AMT and the PFD languishes in its basic non transport role. Why the reaction? (The new president of the American College of Emergency Physicians, Dr. Fred Blum, was definitely chagrined with the news when I spoke to him in West Virginia.)


July 3, 2008:

I submitted the following article to the Journal Star Forum on July 3, 2008.....several days before the Peoria City Council voted to allow the Peoria Fire Department to provide Paramedic services.

The Journal Star did not run this article:

A recent Journal Star article reported an accident in Peoria where a CityLink bus was rear ended by a car. According to the article, at least 13 people were "sent to the hospital" for evaluation. The accompanying photo showed the Peoria Fire Department (PFD) rescue firefighters caring for the injured bus passengers that they had placed on stretchers.

According to the article accident victims sat on the sidewalk waiting for additional Advanced Medical Transport (AMT) ambulances to arrive. The reason these people had to wait, is that the PFD is not allowed to transport emergency patients. The PFD had their own rescue vehicle several years ago but were not allowed to use it for transport…so they sold it.

What was not reported in the article was that AMT asked CityLink to help out. CityLink graciously sent a van and transported injured victims to the hospital.

Isn't this amazing when CityLink needs to transport patients who may have broken necks while the PFD cannot? And unless the policy has recently changed, if any of the bus accident victims were seriously injured at the crash scene, the PFD paramedics could not have provided paramedic support for the victims if AMT was not present.

As reported by the Journal Star a couple of years ago, when no other transport agency was quickly available, the Dunlap Fire Chief transported one of his own Dunlap firefighters who had lost consciousness at the scene of an emergency. To protect his firefighter, he had used common sense but crossed the powers that be who control our local Emergency Medical Services. Because of his action the Dunlap Fire Chief came very close to losing his job.

Something seems wrong here.

The paramedic and ambulance transport monopoly in Peoria, fueled by conflict of interest and the mighty dollar, is not patient friendly. This bus accident helps show Peoria is not ready for a more serious mass casualty.

John A. Carroll, M.D.

July 7, 2008

The Peoria City Council voted unanimously last night to OK the new Peoria Fire Department contract.

For the first time ever, the Peoria Fire Department firefighters will be able to act as paramedics (without the oversight of Advanced Medical Transport) and provide advanced life support at the scene of a medical emergency.

Over the last few years the Peoria Medical Society told me that they did not see a need for this change to be made in Peoria, the Catholic Diocese of Peoria referred me to the Pope regarding Advanced Medical Transport and their "alleged monopoly" of local pre hospital care, and the OSF Corporate Ethics Committee and the OSF Compliance Officer refused to hear my concerns over this dangerous issue. And Dr. George Hevesy, who was receiving salaries from OSF-SFMC and Advanced Medical Transport when he was director of ambulances (Project Medical Director), told the Peoria City Council years ago that allowing the Peoria Fire Department to get involved with advanced life support was "duplication of services".

Many patients that have called 911 in Peoria and had to wait long periods of time for paramedic care probably would disagree with the above statements.

Obviously everything is not transparent here and OSF and their present Project Medical Director (who works under Dr. Hevesy in the OSF Emergency Department) had to agree with this policy improvement, or it would not have happened.

The Peoria Fire Department still cannot transport patients to local hospitals, so Advanced Medical Transport will not lose their income in transportation.

And most importantly many patients will be treated earlier when precious minutes can mean the difference between life and death. Too bad this common sense decision took so many years to occur.


When people call 911 for a medical emergency they are frequently distraught. Something bad is happening to someone close by. It may be a family member or someone they don’t know. They just know that someone needs help right away.

These people who call are usually very happy to have ANYONE come and help.

Peorians need to be able to trust the professionals who set policy for 911 response.

Just imagine how enraged Peorians would be if they knew that for the past decade that when the PFD arrived with a Paramedic/Firefighter, that he/she was not allowed to provide advanced life support for the victim. Who would even believe this scenario?

New England Journal of Medicine, August 19, 2003:

“A conflict of interest is a set of conditions in which professional judgment concerning a primary interest (such as a patient's welfare or the validity of research) tends to be unduly influenced by a secondary interest (such as financial gain). Conflict-of-interest rules, informal and formal, regulate the disclosure and avoidance of these conditions.”

My question is: Did Drs. George Hevesy and Rick Miller avoid these conditions? In other words, did accepting a salary from Advanced Medical Transport lead one to believe that Dr. Hevesy was “avoiding these conditions”. Many people I have spoken with over the years would say no.

The New England Journal of Medicine continues:

“The primary interest is determined by the professional duties of a physician, scholar, or teacher. Although what these duties are may sometimes be controversial (and the duties themselves may conflict), there is normally agreement that whatever they are, they should be the primary consideration in any professional decision that a physician, scholar, or teacher makes. In their most general form, the primary interests are the health of patients, the integrity of research, and the education of students.”

Were EMS patients the primary concern in Peoria for the past 15 years?

My recommendation would be that Drs. Hevesy and Miller be reviewed by the University of Illinois Ethics Group and by the American Medical Association Ethics Group to see if they have complied with medical ethics standards of these two institutions. If Drs. Hevesy and Miller have not followed ethics protocols or if they have obstructed care to 911 patients in any way over the years, I believe their medical licenses should be revoked.

Monday, September 15, 2008

OSF is Afraid

OSF in Peoria is afraid.

They don't want the story out.

What story?

The story that describes how they are letting their Haitian patients die miserable deaths.

Like Heureuse.

The President of OSF Healthcare System, Sister Diane Marie, is one of the remaining Sisters at OSF. She has very little control over day to day management of the medical center.

Here is what Sister recently wrote in "Connections"--an OSF pamphlet:

"While the world outside of OSF gears up for a new focus on collabortion and team-building, we can take great pride and give thanks for our Foundational Value of teamwork and for our tradition of caring for the sick, the poor, and the dying. We are well-positioned to continue and enhance our service to patients and to extend our Mission of caring "with the greatest care and love"."

Why would Sister be writing this? This is nonsense. Just ask Heureuse.

Today, I e mailed,,,,, and

I tried to send this this post regarding Heureuse.

All of the e mails bounced back to me because OSF has blocked my e mails.

For good reason OSF obviously don't want these Children's Hospital of Illinois Foundation members receiving my e mail. OSF's policy denying care to Heureuse is against all that the Sisters preach (and write about) and the U.S. Bishops demand regarding Catholic health care.

Thursday, September 11, 2008

This is Not What They Wanted

This is not what they wanted.

OSF, AMT, and the physicians that have not advocated and pushed for change, must be shaking their heads. They have written and had their own lapdogs write articles to the Journal Star stating that EMS in Peoria was fine.

Everyone in the central Illinois EMS circle know who these people are and why they needed to control the Peoria Fire Department.

Their machinations just didn't work. Shame on these institutions and individuals for protecting each other instead of the public.

It will take time, but the Fire Department will advance further and give people in Peoria the emergency care they deserve.

Sunday, September 7, 2008

Hurricaine Ike

OSF-Saint Francis Medical Center and Catholic Diocese of Peoria, are you reading the news?

Photo from the Miami Herald.

Bishop Wenski

I first met Father Thomas Wenski in the late 90’s. My eighty year old mother and I stayed in his large rectory with an interesting mix of individuals. There were young law students representing Haitian refugees as well as Haitian-Americans working for Father Wenski.

I think Father charged my mom and me $6 dollars per day and this included three meals that we prepared ourselves in the simple rectory kitchen.

His rectory was located in Little Haiti in Miami and was guarded by two German shepherds. The neighborhood was dangerous. I found a bullet that had been shot on the sidewalk and two Haitian market owners were killed by burglars one Saturday on a bright sunny afternoon.

Fr. Wenski is an advocate for Haitian immigrants and for Haiti. His rectory was next door to a Catholic Church and a large school that seemed to have been vacated years before by middle class Miamians who wanted to flee this part of Miami. Father used this school for Haitians to teach them English and various other skills. He also ran a legal center across the street to give the Haitians as much free legal representation as possible.

Fr. Wenski was very matter of fact and practical. I wouldn’t describe him as warm and fuzzy, but he was very efficient in his work for Haitians. He said mass in the church nearby at 6 PM on weekdays in fluent Creole.

In the last 10 years Fr. Wenski has become a Bishop and is currently the Bishop of the Diocese of Orlando. He is also the chairman of the USCCB Committee on International Justice and Peace.

The following article is from the Catholic Post in Peoria:

U.S. church official says Haiti desperately needs political stability

PORT-AU-PRINCE, Haiti (CNS) -- Haiti desperately needs political stability so that jobs can be created to lift the poor out of a critical situation, said the chairman of the U.S. bishops' Committee on International Policy. "The situation is critical, although there is still a glimmer of hope," Bishop Thomas G. Wenski of Orlando, Fla., told Catholic News Service July 16. "Haiti now needs a solid success story so that hope does not disappear." Bishop Wenski, who visited Haiti in mid-July, said that in a private meeting earlier that day, Haitian President Rene Preval expressed his thanks for the work of the Catholic Church in advocating for the Haitian Hemispheric Opportunity Through Partnership Encouragement Act and for the job opportunities it could create. The U.S. HOPE Act II, as it is known, allows the United States to import Haitian textiles and could create 30,000 jobs in Haiti where, the bishop said, it is estimated that every job feeds an extended family of 10 people, so "30,000 jobs could feed 300,000 people."

I doubt Bishop Wenski would be thrilled with the Catholic Diocese of Peoria and the way the Diocese supported OSF when the 1.6 billion dollar OSF Medical Center in Peoria cut all funding for Haitian Hearts.

Saturday, September 6, 2008

And in Peoria...

So while Heureuse hides from hurricaines and fights through her heart failure in Port-au-Prince, the Catholic Diocese in Peoria is building.

Bishop Jenky should have helped Heureuse.

Heureuse's Seaside Home

Here is Heureuse, the outside of her home, and her kitchen.

Her echocardiogram showed that the hole between the lower chambers of her heart has opened up again and her heart is shunting blood in the wrong direction.

She needs surgery soon.
And we just got done spending $104 million dollars for the four day Republican National Convention.

Photos by Frandy

Wednesday, September 3, 2008

Physician-Industry Relationships---Not Just About Free Pens

There is an article in this weeks Journal of the American Medical Association (JAMA) regarding unhealthy physician-industry relationships.

It is copied at the bottom of this post.

Dr. George Hevesy received a salary from Advanced Medical Transport in Peoria while he was acting as Project Medical Director for the Peoria area. Dr. Hevesy is also Director of the Emergency Department at OSF. Amazingly, when I spoke with Sue Wozniak CFO at OSF-SFMC about Dr. Hevesy's relationship with AMT, she commented that it was a good idea when Dr. Hevesy resigned as Project Medical Director since he was receiving a salary from AMT. (Wozniak is on the Board of Directors at AMT which may be a negative conflict of interest too.)

Here is a summary of the article and some of my comments about Peoria's conflict of interest:

1. Research has shown that stipends from industry do influence a physicians behavior. AMT gave Dr. Hevesy a stipend for years. Dr. Hevesy controlled all the ambulances and their protocols in central Illinois. Interestingly, Dr. Hevesy also works for the Illinois Department of Public Health Region II Emergency Medical Services.

2. The media was relentless exposing physician-industry relationships around the United States. That does not include Peoria, where this relationship was hid.

3. Many medical centers in the United States have conflict of interest policies. Does this include the University of Illinois College of Medicine in Peoia (UICOMP)? And if there is a policy at UICOMP, would the dean actually look to see if Dr. Hevesy is still paid by Advanced Medical Transport in Peoria?

4. Change comes from the top. Deans of medical schools need to demand that patient need has to be more important than physicians being paid by industry. If AMT's stipend to Dr. Hevesy over many years helped keep other ambulance services functioning at lower levels of service, this would be negative conflict of interest.

5. The dean of the medical school has most influence over the academic medical center (like OSF-SFMC) faculty versus a community hospital. Thus, the UICOMP dean should strongly influence conflict of interest policy at OSF-SFMC. But Peoria is so tight, will the dean actually take on OSF-SFMC?

6. OSF-SFMC and UICOMP have residency programs where young doctors are trained. The young physicians need to know that relationships with industry are not always healthy and can be harmful to patients. Dr. Todd Nelson, a former resident physician in the Emergency Room at OSF, wrote an article in the Journal Star a few years ago lauding Peoria's EMS system. The EMS situation has recently changed for the better in Peoria. Too bad Dr. Nelson wasn't taught enough about EMS ethics while he was in training at OSF.

JAMA- 2008;300(9):1067-1069.

Over the past 2 years, policies governing the relationship between physicians and pharmaceutical and device companies have undergone remarkable changes. A 2004 task force appointed by the American Board of Internal Medicine Foundation (ABIM) and the Institute on Medicine as a Profession (IMAP) found existing guidelines to be lax.

At that time, the industry's Pharmaceutical Research and Manufacturers of America (PhRMA) Code ignored many salient issues, such as disclosure, speaker's bureaus, and ghostwriting and set only modest boundaries around dispensing food, gifts, and travel reimbursements.

The American Medical Association's ethical guidelines largely duplicated PhRMA’s; however, on such practices as gift taking, it was even more permissive.

The American College of Physicians acknowledged the influence of gifts on physician practices but did not prohibit them.

Government bodies, including the Office of the Inspector General of Health and Human Services, essentially endorsed the PhRMA Code.

Academic medical centers did not set a better example. Few of them had rigorous policies, and the exceptions received little notice.

At that same time, pressure to strengthen the governance of physician-industry relationships was mounting. First, a substantial body of research indicated that gifts, stipends, and honoraria from drug companies influenced physicians' treatment decisions.

Second, the media were relentless in exposing drug company–physician misconduct, which ranged from false statements and billing to off-label promotion of products to outright bribery.

Third, whistleblowers were alerting federal and state prosecutors to drug and device company illegalities, leading to successful prosecutions that resulted in millions of dollars in settlements and fines. From 2000 to 2004, 12 major health care fraud settlements led to pharmaceutical companies paying almost $4 billion in criminal and civil fines. The largest was the 2001 TAP/Lupron case, with an $875 million settlement.

Taken together, these developments were making the status quo unacceptable.

In January 2006, the ABIM-IMAP task force published its policy recommendations on conflict of interest.

The proposals captured significant media and academic attention and stimulated many academic medical centers (AMCs) to reconsider their guidelines. In April 2008, a task force appointed by the Association of American Medical Colleges (AAMC) issued recommendations on conflict of interest, and in June 2008, the association's executive council approved them.

With only a few exceptions, the positions in the 2 documents are similar, providing them with presumptive standing in the field.

Both proposals are much more exacting than earlier guidelines on physician-industry relationships. The proposed guidelines prohibit all gifts (zero-dollar limit), whether on- or off-site, and prohibit food provided by industry: "Industry-supplied food and meals are considered personal gifts and will not be permitted or accepted."

Both proposals recommend that product samples are centrally managed to "distance the company and its products from the physician."

The AAMC would also restrict industry representatives' access to physicians, requiring credentialing mechanisms and formal appointments and invitations. Both propose that industry funds for continuing medical education and travel to bona fide medical meetings should be distributed not by academic departments but from a central medical center office. Both prohibit ghostwriting and differ only on speaker's bureaus. The ABIM-IMAP task force prohibits these activities; the AAMC proposals "strongly discourage" them.

The AAMC report does not make reference to the many positive changes that some of its members have already made. At least 25 medical centers from both the public and the private sectors and from all regions of the country, including Boston University, University of Massachusetts–Worcester, and Yale University; University of Pennsylvania and Pittsburgh University; the universities of Michigan, Wisconsin, and Chicago; and the entire University of California system, now have in place strong conflict-of-interest policies.

These AMCs have been joined by such health care delivery organizations as the Henry Ford Health Systems (Detroit), Kaiser Permanente (northern California), and the US Veterans Administration network.

How did these changes come about?

Immediately after the publication of the ABIM-IMAP recommendations, the Pew Charitable Trusts contacted IMAP to explore strategies to promote their enactment. The discussions, joined by Community Catalyst, a national consumer advocacy organization, led to the establishment of the Pew-funded Prescription Project. Under its auspice, and with additional funding to IMAP from the Attorney General Consumer and Prescriber Grant Program, IMAP has been investigating the origins and consequences of the policy innovations and providing technical assistance to AMCs.

Presuming that the AAMC recommendations will further stimulate change, in this Commentary we report on findings to date to help facilitate the process.

Change has come from the top down. The dean's office has typically taken the lead in inspiring, formulating, and enacting new policies. Almost everywhere, the dean has had ready allies on the faculty. In particular, chairs of pharmacy and therapeutics committees, seasoned in industry strategies to influence purchasing and prescribing decisions, have often been supporters. Many deans have also been assisted by faculty, such as a professor of medicine who carried a supply of inexpensive pens in her white coat and, whenever she saw a colleague holding a pen with a drug company logo, took it away and substituted one of her own unmarked pens.

So too, deans have been prodded to tighten their conflict-of-interest policies by medical students and house staff. But in the end, medical centers are hierarchical places, and at universities like Yale, Stanford, Pennsylvania, and Pittsburgh, it was the deans who appointed and charged the task force to draft new policies, and together they presented and defended the documents before the governing committees (the faculty practice group, the department chairs, the faculty council). With approvals forthcoming, the new policies were announced. In no case that we know of was a dean's support for a rigorous policy derailed, voted down, or even substantially weakened.

What motivated the leadership? Deans and faculty leaders had read journal articles on the power of gifts to physicians. They had scanned the media stories and were eager to preempt the issue rather than be publicly embarrassed.

Beyond that, many of them expressed a vigorous and unqualified commitment to the principles of professionalism. They insisted that scientific knowledge and patient need, not marketing, had to drive medical decision making. Athletes might display company brands on their clothing, but physicians should follow a higher standard to protect their own and their profession's integrity.

What kept other deans from acting?

First, there was a fear that pharmaceutical companies would retaliate by withholding research funds, a fear exacerbated by a shrinking National Institutes of Health budget and an increasing dependence on industry support. Second was a fear that faculty members who were unhappy about the policy would leave for another institution that would not restrict their activities. Third, deans hesitated to tackle the issue in light of the complicated structures of their institutions. Could one policy cover not only the medical school faculty but also community physicians, nurses, dentists, physical therapists, and public health practitioners? Although no dean we spoke to minimized the importance of conflict of interest, some among them preferred to live with the problems they were familiar with rather than face those they could not predict.

It is too early in the process to evaluate fully the effects of the new policies.

Some first impressions, however, may be offered. Thus far, there has been no significant movement of faculty from AMCs with strong policies to those with weak policies. Undoubtedly a few "silent departures" have occurred, but they remain the exceptions. Also, no one has reported a decrease in pharmaceutical company research funding. This ought not to be surprising because pharmaceutical company innovation, and profits, require the knowledge that resides in academic basic science and clinical departments. Deans have also proven adept at initiating change that first affects faculty in the major allied hospitals, leaving for a later stage the community physicians in more distant facilities.

When new policies are introduced, discussions are often heated. Some deans have been accused by faculty members of depriving their children of a college education by taking away drug company payments. But once the policies are in place, passion dissipates. Advantages outweigh disadvantages. Faculty members welcome the time saved by not meeting with pharmaceutical representatives or having to fend them off. They discover that product samples are not as necessary as they had thought; in some places, physicians are able to dispense vouchers for samples or have the samples stored in and distributed from a central commissary.

No one seems to care much about pens, notepads, or even the disappearance of free lunches, certainly for themselves, with only occasional regrets for their staff. Some departments are subsidizing food at grand rounds or setting aside a reserved line in the cafeteria for residents so they will not be late for a meeting. There is also an increasing number of accounts of physicians taking personal pride in turning down speaker's bureau invitations. "My school does not allow it" is an efficient and sometimes welcome way out.

The AMCs are just beginning to devise monitoring and enforcement procedures, locating oversight (usually in the deans' offices), and setting up hotlines for questions or complaints or Web sites for disclosure reports. A number of universities (such as Pennsylvania, Pittsburgh, Wisconsin, and Michigan) have focused their enforcement efforts on the vendors. If a pharmaceutical company representative violates the rules on gifts, meals, registration, or formal appointments, they are first warned; if they persist in their violations, they are suspended and eventually banned. Under such circumstances, as would be expected, vendors are compliant.

Although some faculty members have asked whether they might be fired for accepting a drug company pen, they have learned that the goal is less on implementing a schedule of penalties or appointing a gift police than on changing the culture of the institution. The objective is to promote a shift away from a sense of entitlement among physicians and, even more important, among residents and medical students. Are there gaps in adherence? Of course there are, and they particularly occur off-site. But more noteworthy is the prevailing compliance and good will. The new policies lose their controversial character rather quickly. The faculty moves on—and this should encourage other AMCs to appoint their own task forces to design and implement change.

As change becomes embedded in medical centers, it will be vital to analyze outcomes both qualitatively and quantitatively. There are many important questions to be answered: Do attitudes and practices change over time? Do house staff and medical students experience the change in terms of an intensified commitment to professionalism? Do disclosure requirements affect appointments to formulary committees or teaching assignments? As visits from pharmaceutical representatives decline, do physicians' prescriptions for generics increase? What effect on research funding might occur? Does the pharmaceutical industry devise new strategies that undercut the policies, and if so, how do the AMCs respond?

Last, but certainly not least, will AMCs make sufficient progress to obviate the need for government intervention?

Corresponding Author: David J. Rothman, PhD, Center on Medicine as a Profession, Columbia College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032 ( ).
Financial Disclosures: None reported.