Buried under last week's headlines about whether unionized fire department ambulance drivers diverted patients away from St. Barnabas hospital in the Bronx is a much bigger and more meaningful shift in the city's emergency landscape. The 911 system has been directing more and more patientsand the business they generatetoward private hospitals and away from public ones. The practice reflects a growing competition for paying patients and, some fear, an erosion of public services for others.
Indeed, the real ambulance news last week wasn't the diversion but the giant step the city took toward privatization of emergency services. For the first time ever, a private, for-profit company has been allowed to answer calls in the 911 system, subcontracting with St. Barnabas to do so. Previously only city-employed emergency medical workers and ambulance drivers working directly for some hospitals responded to 911 calls.
And who landed this plum, unprecedented deal? Steve Zakheim, MetroCare's chief operating officer, is a longtime ambulance-company owner who has contributed to Giuliani's Solutions America PAC and cohosted a fundraiser for the mayor's Senate bid.
Zakheim, who, though he remains in charge, sold most of his ambulance company last year, said his political contributions have nothing to do with MetroCare's latest contract. Zakheim says he met Giuliani only twice and that the mayor "wouldn't know me from a hole in the wall."
The 911 deal was made privately between St. Barnabas Hospital and MetroCare, though the city has given its approval by allowing MetroCare to answer 911 calls and supplying its ambulances with radios and other equipment.
It may be lucky for Zakheim that the MetroCare contract was not subject to competitive bidding. In 1997, Metropolitan Ambulance, which merged with Transcare to become MetroCare and was also owned by Zakheim, settled a federal investigation of bills for unnecessary ambulance rides by agreeing to pay the government $400,000 and be subject to oversight for five years.
However the MetroCare deal came about, there are real reasons to be concerned about it and the privatization it heralds. The fire department's protocols require most patients to be taken to the nearest hospital. But private, for-profit ambulances may be inclined to deliver patients to the hospitals that pay them, which are not necessarily the closest.
"This can be a problem if, in fact, people are not going to places where they get the most optimal care for what they need," says Howard Berliner, a professor of health policy at the New School.
There is evidence that the increasing number of ambulances that work for private hospitals already steer patients to the privates rather than the nearest hospital. According to fire department records, in 1998, ambulances working for private hospitals brought 90 percent of deliveries back to private hospitals and only 10 percent to the city's public hospitals, while city ambulances made 63 percent of deliveries to private hospitals and 37 percent to public hospitals. In some of these cases, patients may have requested specific hospitals (fire department rules allow patients to choose their destinations if they're not too sick, as long as their choice isn't more than 10 minutes from the nearest hospital).
Since emergency medical services was transferred from the Health and Hospitals Corporation to the fire department in 1996 (a controversial move supported by the mayor), the number of ambulances run by private hospitals has increased, mostly in wealthier neighborhoods, where hospitals can expect to pick up insured patients.
According to fire department spokesman Michael Regan, additional ambulanceswhether hospital-run or independent for-profits, like MetroCarecan only make the city safer. Regan says the city is committed to maintaining the current level of emergency workers no matter how many private companies come aboard, so additional ambulances will give the fire department more resources to put into less affluent neighborhoods.
But the fire department's emergency workerswho are unionized, while MetroCare workers are nottend to hold a dimmer view of the trend. They worry that their new, private competitors will not only bring down wages, but also create a two-tiered system in which poorer patients will get worse service.
"These freelancing ambulances can roam around the city cherry-picking the most profitable work," says Robert Ungar, an attorney for Local 2507, which represents emergency medical technicians and paramedics. "That will result in confusion and chaos at emergencies throughout the city."
Research: Cara Buckley
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