By Jared Chausow
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At a November 18 meeting, the medical director of the city's Emergency Medical Services, Lorraine Giordano (who has since announced she will be stepping down from that position), told the New York City Regional 911 Ambulance Destination Advisory Committee that it could no longer hold meetings with the sanction of the fire department. Though the fire department, which oversees EMS, denies responsibility for the shutdown, spokesman David Billig acknowledges that committee meetings have been "postponed" with none scheduled in the foreseeable future.
The committee, which is made up of local hospital administrators, doctors, and nurses, has an 18-year history of creating emergency guidelines and beefing up less stringent requirements set by the state. Its emergency department standards call for hospitals to have a higher number of nurses and physicians than the state mandates, for example, and require that emergency physicians be board-certified, while the state does not. The latest version of the group's 911 emergency department standards were scheduled to go into effect on January 1, but the committee now lacks the authority to enforce these rules.
Why is the fire department coming down on the watchdog committee now, even as concerns about terrorism and medical mistakes run high? Some claim the suspension is the result of mounting tensions between the city and the committee, which reached a boiling point over an incident at Lincoln Hospital, a beleaguered public facility in the South Bronx.
About a year and a half ago, that hospitalwhich was undergoing major changes as the result of its relatively new affiliation with the nearby St. Barnabas Hospitalhad fired several trauma surgeons. "There was a question of whether [the hospital] could meet trauma standards" is how Mark Henry, medical director of the state EMS program, remembers the period of inadequate staffing.
In response, the committee sent a letter to the hospital saying it would ask 911 to suspend emergency deliveries to Lincoln if the situation wasn't corrected. Health and Hospitals Corporation spokesperson Jane Zimmerman says ambulances were briefly diverted from the hospital, while members of the committee say service was never interrupted.
What all seem to agree on is that the incident spurred the city to question the role of the committee, which HHC's Zimmerman refers to as "a self-serving group who overstepped their authority" during the Lincoln episode.
"The city was upset because they thought due process wasn't followed," says Henry.
Some on the committee see larger financial motives behind the move, however. "We cost the city money," says one member who asked to remain nameless. Or, as another committee member puts it, "This is about who's going to be in control of the health system. Administrators are telling the doctors, 'Sit down and shut up.' They just want the bean counters in charge," he says, adding, "If the clinicians can't say this is how we need to take care of the patients, who's going to do it?"
According to the fire department's Billig, however, the suspension of the group's activitieswhich he says may be temporaryis due to a technical matter. Billig says the shift of responsibility for EMS from the Health and Hospitals Corporation to the fire department created new concerns over legal liability. He wouldn't say why the committee's activities are being suspended now, while responsibility for EMS changed hands back in 1996.
The State Department of Health, which has worked with the committee on setting both hospital and ambulance standards, acknowledges that the authority of both the 911 committee and a state emergency advisory committee that works with it have been the subject of debate in recent months. According to DOH spokesperson Rob Kenny, the state's reevaluation came at the request of "people within the EMS system" and resulted in a decision to curtail the authority of the state committee to ambulance-related matters. Kenny says the city's 911 committee would be similarly restricted should it continue to function.
The fire department did not respond to questions about whether the committee's more stringent emergency recommendations will be followed during its suspension. But committee members and other emergency specialists say they're hopeful the city will find a way to enforce the high emergency standards the group has historically promoted.
"The work should definitely continue," says EMS's Henry. "If the physicians threw up their hands and said, 'We'll just let money make the decisions,' that would be a huge problem. I don't think anyone wants that to happen."