HomeMy WebLinkAbout2007 10 22 Regular 606 Cyndi Read EMS Transport Bill
Date: October 22, 2007
Due to time constraints, Regular Agenda Item
"606" was not discussed during the October 22,
2007 City Commission Regular Meeting.
CITY OF WINTER SPRINGS
Regular Meeting, October 22, 2007
102207_ COMM _ Regular _606_ TransportJee _Appeal
COMMISSION AGENDA
ITEM 606
CONSENT
INFORMATIONAL
PUBLIC HEARING
REGULAR X
10/22/2007
Meeting
MGR (I~EPT
Authorization
REQUEST: City Manager Requesting the Commission to Review the City Manager's
report responding to the complaint of Cyndi Read, EMS Account # 602512-0lan Appeal
for EMS Transport Bill.
PURPOSE: This agenda item is needed to respond to the City Commission's directive for
an evaluation of the above referenced complaint.
CONSIDERATION: At the October 8, 2007 Commission meeting a complaint ofCyndi Read
was discussed.
At the request of the City Manager the Commission delayed action on the complaint until such
time that the City Manager could provide the Commission with an evaluation of the matter.
This case is not ready for Commission action since all administrative procedures have not been
exhausted.
Relatedly, the Commission needs to give serious consideration to the precedence established by
this appeal. Does the Commission really desire to initiate an endless flow of people appearing
before the Commission trying to get out of paying their bill?
A more appropriate procedure could be a procedure that would allow Ms. Read's complaint to
be provided an administrative appeal to the City Manager, followed by appeal to the City
Commission if she chooses further action after receiving the decision of the City Manager. In
this case your task would be to determine if any Commission Policy had been violated.
Since these matters are technical in nature an even better procedure could be similar to that
utilized by the Code Enforcement Board. Utilizing this procedure the decision of the City
Manager would be appealable directly to a court of law rather than to a political body with little
technical training on such matters.
102207_ COMM _Regular _606_ Transport]ee _Appeal
Page 2 01'2
The advantage of these procedures is that the Commission would have a complete record from
which it would be able to make decisions, if it chooses to hear these matters on appeal from the
City Manager. If the Commission chooses not to get involved and let the matter be appealed to
a court, the Commission would not be bogged down in these type matters and the person
appealing would have the option of a totally independent review by a court. Furthermore, this
would tend to stop frivolous actions. Finally, once a full report is made, many persons will
drop the matter after being given the advantage of a factual written evaluation.
FUNDING: At issue is an $80.34 bill due to the EMS Transport Fund.
RECOMMENDATION 1 - Procedure:
It is recommended that the Commission decide how it desires to handle appeals.
Option I.
First appeal to the City Manager followed by an appeal to the City Commission.
Option 2.
First appeal to the City Manager followed by an appeal to the courts.
In either of these alternatives the Commission would not make a decision tonight. The City
Manager's Report would be forwarded to Ms. Read. If Ms. Read wanted to appeal further she
would follow the process you have chosen.
RECOMMENDATION 2 - Cyndi Read Appeal
If the Commission decides to act upon this matter as provided in my Report there is absolutely
no basis upon which Ms. Read is entitled to any relief from her $80.34 payment. Therefore, it
is recommended that Ms. Read's request for relief from paying her outstanding $80.34 bill be
denied. Additionally, Ms. Read's allegations of unprofessional conduct on the part of Winter
Springs Paramedics are groundless, and it is recommended that no further action on this
complaint is warranted.
ATTACHMENTS:
A. October 18, 2007
B. October 04, 2007
C. October 5, 2007
D. October 17,2007
E. October 18, 2007
City Manager Evaluation Report ofCyndi Read's Complaint
Complaint letter of Cyndi Read to Mayor Bush
Email of Mayor Bush to the City Manager and Fire
Department Staff
Medical Director's Independent Analysis of Cyndi Read's
complaint.
Winter Springs Emergency Medical Services Chief Independent
Analysis of Cyndi Read Complaint.
COMMISSION ACTION:
ATTACHMENT A
102207 A TT ACHMENT A
City Manager October 18, 2007 Report
Page 1 of 4
CYNDI READ APPEAL
REPORT
OF
FINDING, CONCLUSIONS AND RECOMMENDATIONS
PREP ARED BY
RONALD W. MCLEMORE, CITY MANAGER
PUBLICATION DATE
OCTOBER 18, 2007
J 02207 ATTACHMENT A
Page 2 of4
BACKGROUND: On October 4, 2007 the Mayor received a complaint from Cyndi
Read regarding emergency medical care performed by the City of Winter Springs Fire
Department on October 13,2006, Account # 602512-01.
On October 5, 2007 the Mayor forwarded the complaint to the City Manager, Acting Fire
Chief, and EMS Director for review. On October 8, 2007 this matter was raised at a City
Commission meeting. The City Manager advised the Commission not to act on this
matter until the administrative review was completed resulting in the matter being tabled.
COMPLAINT: Ms. Read believes that she should not have to pay an $80.34 insurance
co-pay to the EMS Special Revenue Fund for transport services due to a number of
allegations.
1. Ms. Read was not transported to the hospital of her choice.
2. Ms. Read was transported to the wrong hospital because the paramedic's shift was
ending and he did not want to take the time to transport her to the hospital of her
choice.
3. Ms. Read was delayed proper treatment as a result of not being taken to the hospital
of her choice.
4. The EMT in Training would not be able to administer an LV. on Ms. Read because
Ms. Read was a "tough stick" (medical jargon indicating a person upon which it is
more difficult than normal to successfully administer an LV.) resulting in three failed
attempts to administer the LV.
5. The entire experience was carried out in an unprofessional manner.
FACTS:
1. Not being Transported to the Hospital of Her Choice:
Ms. Read requested to be transported to Winnie Palmer Hospital in down town Orlando.
Paramedics decided it was in the best interest of the patient to take her to Florida North.
According to established medical protocols paramedics can override the request of a
patient if in the judgment of the paramedic the patient's well being would be jeopardized.
Decisions are based upon travel times to hospitals and patient loads at hospitals.
In this case, paramedics determined that Ms. Read's symptoms and history required
transporting her to the nearest hospital that could treat her the quickest. This decision
was based upon her high fever, delirium, and possibility of internal bleeding.
102207 A TT ACHMENT A
Page 3 of 4
An independent review of the case by Winter Springs EMS Director (attached hereto)
agrees with the decision of the paramedics.
An independent review of this case by the County EMS Medical Director (attached
hereto) agrees with the decision of the paramedics.
2. Choice of Hospitals was Decided Upon the Ending of the Paramedics Duty Shift.
Paramedics involved in this case deny that the ending time of the duty shift had any
bearing upon their choice of hospitals.
A review of the record shows that it was some eight hours before the duty shift would
end, and that the duty shift had nothing to do with the paramedic's choice of hospitals.
3. Ms. Read was Delayed Proper Treatment due to being Transported to a Hospital Not
of Her Choice.
Proper care in this and all cases begins with the earliest possible evaluation of the patient
by competent professionals who could take appropriate measures. In the judgment of the
attending paramedics the earliest evaluation by competent emergency room physicians
could be accomplished by transporting Ms. Read to Florida North Hospital. Competent
emergency room physicians at Florida North Hospital determined that it was safe to
transport Ms. Read to Winnie Palmer for further care.
Independent evaluation of this case substantiates that proper care was accomplished by
the decision of the paramedics. In fact, the Medical Director's evaluation stated that her
symptoms and history was reasonable cause for taking here to a hospital that was even
closer than the one chosen by paramedics.
4. An EMT in Training was not competent to administer an LV.
The record of this matter demonstrates that Ms. Read was under the care of two fully
accredited paramedics and that attempts to administer the LV. was performed in full by
one of the fully accredited paramedics.
Under established protocols paramedics are directed to make three attempts to administer
LV.'s when the need for LV.'s is indicated.
It is common for attempts to administer LV.'s to fail. Under established protocols
additional LV. actions are carried out by emergency room personnel in such cases.
In this case the administration of 1. V. ' s was indicated. Paramedics attempted three times
to administer LV.' s. These attempts failed. Paramedics ceased further attempts.
Paramedics carried out this procedure in exact conformance with established medical
protocols.
102207 A TT ACHMENT A
Page 4 of 4
5. The Entire Experience was Carried Out in an Unprofessional Manner.
The record of this case demonstrates that Ms. Read's case was carried out in exact
conformance with established medical protocols as documented in two independent
reVIews.
CONCLUSION:
The record of this case demonstrates that Ms. Read's complaints and allegations are
unfounded.
Ms. Read received expert care in conformance with established medical protocols and
City Policy.
There is absolutely no basis upon which to relieve Ms. Read of her $80.34 bill for
services rendered by the Winter Springs Fire Department. No such relief has ever been
rendered to any other patient. To relieve Ms. Read of this payment would be unfair to
other persons who have paid for these services.
Given the facts of this case, it is highly likely that the City could have been at risk for
negligence if the paramedics had not followed protocols and Ms. Read's medical
condition had become more problematic.
RECOMMENDATIONS:
Based upon the record of this matter the following is recommended:
1. In regards to Ms. Read's request for relief from paying her outstanding $80.34 bill
for services rendered by the Winter Springs Fire Department it is strongly
recommended that this request be denied.
2. In regards to Ms. Read's allegations of unprofessional behavior on the part of
Winter Springs Fire Department Paramedics and other EMS staff it is
recommended that no further actions are warranted regarding these allegations.
ATT ACHMENTS:
October 04, 2007
October 5, 2007
Complaint letter of Cyndi Read to Mayor Bush
Email of Mayor bush to the City Manager and Fire
Department Staff
Medical Director's Independent Analysis of Cyndi Read's
complaint.
Winter Springs Emergency Medical Services Chief
Independent Analysis of Cyndi Read Complaint.
October 17,2007
October 18, 2007
ATTACHMENT B
Page 2 of 3
All e-mail or responses to my e-mails regarding city issues should be sent to my city e-
mail address Ufun~h@:wiJ:1t~ISmil}g~n.QIg).
Confidentiality Note: This e-mail, and any attachment to it, contains information intended only for the use of the
individual(s) or entity named on the e-mail. If the reader of this e-mail is not the intended recipient, or the
employee or agent responsible for delivering it to the intended recipient, you are hereby notified that reading it is
strictly prohibited. If you have received this e-mail in error, please immediately return it to the sender and delete it
from your system. Thank you
From: cyndiread [mailto:cyndiread@bellsouth.net]
Sent: Thursday, October 04, 2007 10:44 AM
To: jfbush@winterspringsfl.org
Subject: spam: Spam: WS Fire/EMS Bill
Dear Mr. Bush,
We spoke several months ago regarding a bill that I could not get any assistance with in the
amount of $80.34 to WS Fire/EMS account # 602512-01, Cyndi Read.
At the time, I was frustrated due to the lack of response from the fire chief, due to his illness, and
administrative issues regarding his correspondence. I know that sadly, he has since passed away,
which is probably why this matter unfortunately still has not been resolved.
In our conversation, after discussing the situation regarding this account, you assured me that
this would be taken care of without any additional expense to me.
Briefly, on 10/13/06, I was transported to Florida Hospital Altamonte, as opposed to Winnie
Palmer in Orlando despite orders from my physician, and my request. I was struck down by
internal bleeding after a hysterectomy, and needed to be treated at Winnie Palmer. The
paramedic in charge argued that it was likely an infection, and his shift was ending, and I would
be treated at the closest hospital ER. End result, Florida Hospital transported me to Winnie
Palmer and both entities billed Medicare, and myself, and I was delayed proper treatment due to
the lapse in time to transport me to the proper facility.
In addition, I was delirious from running a fever of 103, yet was of sound mind enough to tell the
WS crew that I was a "tough stick", and their EMT in training would not be able to run an IV on
me, yet they insisted that she could do it. End result, 3 painful attempts....no IV. Unfortunately,
the entire experience was carried out unprofessionally, at my expense.
I was an EMT in 1982 in Kansas, and I am friends with Deputy Fire Chief of Casselberry, Dale
Metz. Not to name drop, because I know that will not get me anywhere, however, it does give
me the opportunity to double check my reasoning on why I feel like WS needs to "eat" the
balance of $80.34, and not spend anymore time threatening my credit score. I just received this
notice after thinking the matter had been resolved.
That being said (and I do apologize for sending this matter to your attention again)...would you
please advise me what to do to resolve this matter once and for all. My credit score is excellent
because I do pay my bills properly. I do not want the City of WS EMS to jeopardize it due to
their negligence.
Sincerely,
10/512007
Page 3 of 3
Cyndi Read
407.721.7519 cell
407.977.6752 home
10/5/2007
ATTACHMENT C
Page L at j
except that it ~as appropriate for the patient's condition.
Again, the balance of $80.34 will be written off with your approval.
Marc Baumgart
EMS Division Chief
407-327-7561
From: John F Bush [mailto:johnfbush@bellsouth.net]
Sent: Friday, October 05,2007 11:09 AM
To: Ron McLemore
Cc: David O'Brien; Marc Baumgart
Subject: FW: spam: Spam: WS Fire/EMS Bill
Ron, Dave and Marc:
Please look this over and see what can be done if anything. Thanks.
John F. Bush
Mayor
City of Winter Springs
1126 East SR 434
Winter Springs, FL 32708
(407) 782-6230
All e-mail or responses to my e-mails regarding city issues should be sent to my
city e-mail address Utbush@winterspringsfl.org).
Confidentiality Note: This e-mail, and any attachment ta it, contains information intended only for the use
of the individual(s) or entity named on the e-mail. If the reader of this e-mail is not the intended recipient,
or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified
that reading it is strictly prohibited. If you have received this e-mail in error, please immediately return it
to the sender and delete it from your system. Thank you
ATTACHMENT D
Page 1 of 1
Jerry Jorgensen, RHIA, CCS
From:
To:
Sent:
Subject:
"Wendy Seitz" <wendy@himexperts.com>
'''Jerry Jorgensen, RHIA, CCS'" <jerry@himexperts.com>
Wednesday, October 17, 2007 9:00 AM
Re: Patient Complaint
Ihis message is being sent on behalf of Dr. Todd Husty
RE: Patient Complaint
Having reviewed the encounter with the patient as requested, I am certain that the paramedic met the standard of
care. That is, he evaluated the patient and attempted to provide ALS treatment on the patient while transporting
her to an emergency department for further evaluation and treatment.
I do agree that we did not take the opportunity to exceed the standard of care by taking this patient to the
requested facility. Destination decisions in the field are multi facetorial and a source of constant training. The
Medical Directors welcome complaints because, at minimum, they serve as a training example. This complaint
will be used to discuss destination decisions in patients with possible post-op complications.
Interestingly, I believe the best destination for this patient (in retrospect) may have been South Seminole
Hospital. The patient would have received an evaluation in a more timely manner than an extended drive
downtown and her medical records would be available. But, most importantly, this patient needed an evaluation
by an emergency physician in a timely manner, which she received.
If I can be of further help in the resolution of this matter, please let me know.
Todd M. Husty, D.O.
by: Wendy Seitz
Executive Assistant to Dr. Todd Husty
Wendy Seitz
Executive Assistant to Dr. Todd Husty
407-679-6794
FclX 407-679-3554
The infonnatioll contained in this message may be privileged [/nd confidential [/nd protected from disclosure. If the reader of
thi::: me::::::age is Ilot the intended recipient, or an employee or agent re:::ponsil1lefor delivering this message to the intended
recipient, YOIl are hereby notified that allY dissemination, distribution, or copying of this communication is strictly
prohibited. If you haz'e received this communication ill error, plmse 11Oi/f1J us immediately by replying to the message Cind
deleting itfn)nf your computer. Tlulilk you.
10/17/2007
ATTACHMENT E
Page 1 of 1
Jan Palladino
From: Marc Baumgart
Sent: Thursday, October 18, 20074: 11 PM
To: Ron McLemore
Subject: Complaint of Cindi Read
Mr. McLemore,
This report is provided in response to your request for an independent evaluation of Cyndi Read complaint of
October 4, 2007.
Our medical director expects that if a patient is considered unstable or potentially unstable, as this patient
appears to have been with internal bleeding, the patient is required to be taken to the closest appropriate facility
to handle the condition. The reasoning behind this is that the patient would be stabilized and then transported to
the next appropriate facility. Not every patient is taken to the hospital just because they request it. The patient
stated in her letter that she had a fever of 103 degrees and was delirious, a state where patient judgment is
impaired and a sign that the patient may have a condition pointing toward instability.
The IV stick is a common problem that occurs in a moving ambulance. There are just as many times that an IV is
successfully established on a patient that expresses that they are "a difficult stick." Some paramedics are better at
IVs that some nurses at the hospital. This patient would have medically benefited from an IV and an attempt
should have been made. I approve of all of the treatment provided or attempted. I do not believe that the patient
was taken to Florida Hospital Altamonte for any other reason except that it was appropriate for the patient's
condition.
Marc Baumgart
EMS Division Chief
407-327-7561
10/18/2007