Michigan won't intercede in paramedic rule feud

8/3/2005

MONROE - The state's top emergency medical service official said yesterday his office would not rule on a request by a member of the Monroe County emergency medical authority to reduce the number of paramedics from two to one in the county's ambulance service.

"It should be left to the locals to make those decisions," said John Hubinger, who directs the state's community health policy development division, which oversees the EMS department.

Monroe County officials have been sparring for years over the issue, which has been raised again as the county's medical authority prepares a request for proposals for a new ambulance service.

The former provider, Hart Medical EMS, opted out of its contract in April because of financial difficulties. Hart's owner, Richard Levine, contends some of his company's money woes were related to the two-paramedic system.

Mr. Hubinger said Monroe and Oakland are the only counties in the state that require the two-paramedic system. State protocol calls for a paramedic and an emergency medical technician as the acceptable measure for ambulance staffing, he said.

Monroe County's Medical Control Board established its two-paramedic policy years ago at the direction of board director Dr. Jeffrey Couturier, a Monroe Mercy Memorial Hospital emergency room physician.

In a recent interview, Dr. Couturier defended the two-paramedic system. He said the county's rural setting required its ambulances to have more trained personnel on board, and that he has heard few direct complaints about the system.

Jan Jay, a member of the county's emergency medical authority, which chooses the ambulance service but has no voice in protocol, petitioned Mr. Hubinger to rule on the issue after asking Dan Wakeman, Mercy Memorial's president and chief operating officer, to intercede.

In a response to Mr. Jay, Mr. Wakeman said, "The concern expressed in your letter has been discussed in the past with [Dr. Couturier]. At the time, he was unwilling to compromise on the issue. I will approach [him] again to see if there may be a compromise to be found in the future."

Mr. Wakeman said yesterday he has yet to discuss the issue at length with Dr. Couturier, but that he might in the near future. As the hospital's director, Mr. Wakeman said the state mandates that he has final authority over the Medical Control Board.

"As we get closer to the point where the [request for proposals] go out for a new ambulance service, I may sit down and talk with him," he said.

Mr. Wakeman, who sits on the state's EMS coordinating committee, said the argument Mr. Jay and others have proposed has some merit.

"I would think that [if] one paramedic, one EMT is the common model throughout the state, it should be explored," Mr. Wakeman said.

Several officials at ambulance companies that will compete for the county's business have spoken out against the two-paramedic system.

"I would rather run one paramedic and one EMT," said Richard Bage, president and chief operating officer of MedCorp Inc., a Toledo-based ambulance company.

Mr. Bage said one of the key issues, other than expense, is a nationwide shortage of paramedics. Burnout and hospital hirings of paramedics for their emergency rooms are the primary reasons, he said.

Mr. Bage said the county's refusal to subsidize its ambulance service adds to the financial risks any service provider faces.

In addition to Mr. Jay, ambulance authority Chairman Mike Demski and member Philip Koenigseker have voiced their support for the one-paramedic, one EMT system.

Mr. Koenigseker said many of the county's fire departments have paramedics on staff who can provide backup to ambulance service paramedics.

Mr. Demski said he also is concerned about the paramedic shortage and potential financial drain of a two-paramedic system.

Mr. Wakeman said the controversy needs to stop and the issue addressed.

"The reality is there needs to be a compromise. Most of the counties in the state have come to a reasonable compromise on the issue. It something we have look at, too."

Contact George Tanber

at gtanber@theblade.com

or 734-241-3610.