ST. GEORGE – After nearly two years, the long battle over which ambulance company best serves St. George continues. Last week a 66-page recommendation was sent to the Utah Bureau of Emergency Medical Services, choosing Gold Cross over Dixie Ambulance. The recommendation lauds Gold Cross as the superior emergency medical service provider the city deserves, while blasting Dixie Ambulance for being “woefully inadequate” in many areas relating to patient care, which ultimately places it in violation of state law.
The recommendation was written by Maxwell Miller, who acted as the presiding officer over a hearing between the two ambulance services from Dec. 3-6, 2012. He agrees with the arguments put forth by Gold Cross’s lawyers and witnesses that Dixie Ambulance lacks the proper staffing, response times, protocols and finances needed to be in compliance with state code. During the hearing, Gold Cross’s lawyers also asked the presiding officer to recommend that Dixie Ambulance’s 911 paramedic transport licenses be revoked.
The management of Dixie Ambulance does not agree with the assessment, and go as far as to call the hearing a “kangaroo court” and the recommendation a “ridiculous document.” They also feel pieces of testimony and evidence were ignored. They are now speaking out.
The entire recommendation can be read here.
On Jan. 24, a large box full of documents and recorded testimony from Dixie Ambulance was delivered to the City of St. George for review. Testimonies from the December hearing are also being posted to YouTube for public view.
“The gloves and the mufflers have come off,” said Mac Miller, Dixie Ambulance’s public information officer.
This whole process started when Gold Cross Ambulance submitted an application to BEMS to take over 911 paramedic transport in St. George in June 2011.
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Videocast by Sarafina Amodt, St. George News
“First of all, big picture; speaking to the recommendation,” Dixie Ambulance’s Mac Miller said, “it reads as a sales prospectus-slash-advocacy letter for Gold Cross.”
The recommendation says nothing about actual patient care or patient outcome, he said, but rather points out every undotted “i” and uncrossed “t” it could hold against Dixie Ambulance. Gold Cross is given a gold star by comparison.
One of the major points of argument brought up in the hearing was over the “controversial” two-paramedic rule, which relates directly to accusations of inadequate staffing.
The controversial staffing rule
During the Dec. 3-6, 2012, hearing, Gold Cross’s lawyers asked Presiding Officer Miller to recommend to BEMS that Dixie Ambulance have its 911 paramedic licenses revoked because it violated state-mandated ambulance staffing rules – namely what is known as the “two-paramedic rule.”
Since November 2010, Dixie Ambulance has had one paramedic and one EMT in an ambulance. State code requires that two paramedics be at the scene of an incident to care for a critical patient. The two paramedics are also to accompany the critical patient in the ambulance to the hospital.
“Utah is the only state that thinks it takes two paramedics to equal one brain,” said Chief Tom Kuhlmann, Hurricane Valley Fire Special Service District. He testified that the fire district also staffs one paramedic per vehicle.
Guy Dansie, EMS system program manager for BEMS, said the state has issued waivers to this rule, particularly to rural agencies, allowing for one paramedic per vehicle.
Tony Randall, president of Dixie Ambulance, said Paul Patrick, director of BEMS, had given verbal approval for Dixie Ambulance to operate with one paramedic per ambulance. Additional testimony was given in support of the verbal waiver from Patrick; but without any actual documentation to back up those testimonies, Presiding Officer Miller wrote in the recommendation that he was wary to reply on words alone.
“Now, (Presiding Officer Miller) would ask after each testimony: ‘Do you have that in writing?’” Dixie Ambulance’s Mac Miller said. “Well, (in) lawyer speak: if it’s not written down, it didn’t happen.”
Ultimately, Presiding Officer Miller ruled that Dixie Ambulance was in violation of the staffing rule.
Three people are mentioned in the recommendation as testifying to the verbal waiver, those being Randall, fellow Dixie Ambulance owner Mike Miller, and Kuhlmann.
Not mentioned in the recommendation is the testimony of Capt. Arnold Butcher of the Davis County Sheriff’s Office. Butcher is the commander of DCSO’s Patrol/Paramedic Division. He testified the deputy-paramedics are also staffed one per vehicle. Two paramedics are always dispatched when an incident occurs, yet a second one is only needed between 25 and 35 percent of the time, he said.
Butcher said this method of staffing was also deemed appropriate by Patrick – yet, like the others, he also lacked written verification.
Dixie Ambulance’s Mac Miller said that, while Dixie Ambulance did not receive a written waiver, it has a recording of a conversation in which he identifies the voices as Patrick and Randall. He said that this recording proves the company’s staffing method was discussed on the date of the recording, which he said was March 29, 2011.
In extensive interviews with parties and others related to the “ambulance war” issues, and in testimony at the hearings, no retraction of the approved arrangement indicated in the audio provided has been made; rather, it has been interpreted in various ways and challenged as not binding because the arrangement was not made in writing. Mac Miller said the recording was not submitted into evidence during the hearing.
“Actually, we’re working on revising the rules throughout the state,” said Guy Dansie, EMS system program manager for BEMS. Utah is the only state that still employs the two-paramedic rule, he said, though the new rules could change that. The new rules should also clear up potential staffing issues, he said.
However, the rules are not retroactive, Patrick said, and any new rules that may be friendly to Dixie Ambulance will not be applied when BEMS makes its final ruling.
“Let’s reassert the fact,” Mac Miller said, “that (Dixie Ambulance complies) with the law as it is written now. We have two paramedics on every paramedic call. We are in compliance. That being said, the statute is going to change – which won’t require two paramedics.”
License modification vs. revocation
If Gold Cross is granted a 911 paramedic license for St. George, Patrick said Dixie Ambulance’s own license would not be revoked, but modified to no longer cover the specified area.
If Dixie Ambulance is found to be in violation of state EMS rules, Patrick said the license may be subject to a form of discipline and not necessarily revocation. However, if revocation occurs as Gold Cross’s lawyers argued it should, then Dixie Ambulance loses its ability to operate altogether.
Utah code does not allow for the creation of “orphaned areas” due to the removal of an EMS provider. Areas involved can issue an RFP, or Request For Proposal, which is basically a call for bids from ambulance companies.
While the RFP process and/or transition to a new provider takes place, the recommendation states Gold Cross has already committed to provide service in the so-called orphaned areas until a more permanent solution is settled upon.
Calls to Gold Cross Ambulance concerning the recommendation were referred to the Utah Bureau of Emergency Medical Services.
- Ambulance War: Gold Cross recommended over Dixie Ambulance
- Perspectives: Making sense of the ambulance war
- Ambulance war scapegoat? St. George Dispatch responds to hearing testimony
- Ambulance war: Broken system, dispatch delays? Decision pending
- Ambulance war: Contest for territory raises solvency, staffing issues at hearing
- Public support for Dixie Ambulance floods hearing
- Public hearing to discuss ambulance service in St. George; Dixie Ambulance receives negative audit
- Dixie Ambulance Voices its Opinion on Gold Cross’ Application; Gold Cross Says System is Broken
- Letter to the Editor: Consider the Cost
- Gold Cross Could Replace Dixie Ambulance if Application is Approved
- Gold Cross Submits Application to Provide 911 Ambulance Services in St. George
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