Patients needing transfer from St. Luke's Wood River Medical Center to an out-of-area hospital could face increasing delays, as local fire departments say they can't keep up with demand.
"They seem to be calling us more and more and it's getting harder and harder to fill that [need]," said Bart Lassman, chief of Wood River Fire & Rescue. "What used to be a few of these calls has turned into quite a few."
The districts provide emergency services and transport patients to the hospital under contract with the county ambulance district.
When the hospital needs to transfer a patient from St. Luke's Wood River Medical Center to another facility such as St. Luke's in Twin Falls or St. Alphonsus Medical Center in Boise for care and cannot transport via helicopter, it often requests that the fire departments provide the transfer.
The departments provide the service—but they don't have to, according to the contract.
"When St. Luke's requests a transfer, there is nothing to compel Ketchum or Wood River to do it," said Tom Bowman, county commissioner and ambulance district commissioner.
Bowman added that the fire departments don't have a contract with the hospital, and therefore could have tough decisions to make when called on for an out-of-area transfer.
The main problem, it appears, is lack of staffing. Both Ketchum and Wood River are required to keep two staff members on duty 24 hours a day, seven days a week. However, these staff members are meant to be on call for emergency services, not transfers.
Lassman said his department staffs transfers with volunteers who get paid when they respond to a call, but getting volunteers to respond has become more difficult recently.
"We can't make them do it," he said. "We can ask them to, and if they can do it, great."
Ketchum Fire Chief Mike Elle said he used to be able to staff the transfers without a problem, but volunteer hours have gone down over the years as the economy has improved slightly.
"When the economy was really bad, I had volunteers all over the place who were willing to drive to Boise and make a little money," Elle said. "Now, people are burned out. They don't want to get up and leave their families in the middle of the night to drive for 10 hours."
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Bowman and Elle said the Ketchum Fire Department sent out three pages for a single transport earlier this month and got no response from volunteers. The request was eventually filled by volunteers at Wood River Fire & Rescue. Sharon Kensinger, vice president of patient services at St. Luke's Wood River Medical Center, said the hospital has not significantly raised its number of transfer requests over the past few years.
Though Wood River Fire & Rescue responded to 90 requests in 2010 and Ketchum responded to 31, Kensinger said that's only a "modest" increase of 10 patients from 2009.
"It feels very challenging to [Elle and Lassman] because they don't have a crew," she said, adding that there has never been a life-threatening delay or a transport request that wasn't filled.
An additional problem is that fire departments are losing money on the transfers. The cost of an ambulance to bring a patient from Ketchum to Boise is generally billed to the patient or the patient's health insurance, but fire departments say they're still losing money.
"What we recover from billing doesn't begin to pay for the wear and tear of six hours of driving," Lassman said, especially in the case of Medicare patients. Medicare only reimburses the district 40 cents for every dollar, Lassman said.
Despite the stress on the fire departments, Kensinger said, St. Luke's is satisfied with the level of service it is receiving. However, she said, the hospital is and will continue to meet with county and fire department staff to solve the problems.
"Our primary mission is to get the medical care to our patients as quickly as possible," she said. "We want to hear what their difficulties are."
Elle and Lassman agreed that with more full-time staff, the departments could respond to requests for transfer more quickly and reliably.
"If interfacility transfers are going to be guaranteed, we need to have staff who do just that," Elle said.
Lassman said those positions could be funded by St. Luke's.
"We don't believe it should be the burden of the taxpayers in the district to pay for something the hospital needs done," he said.
Kensinger said the hospital is still in discussions, and she said she remains optimistic that a compromise can be reached between the hospital and the ambulance providers.
"There is nothing going on that we are not prepared to work through," she said.
But until then, Bowman said, dependence on the fire departments to provide interfacility transfers remains uncertain at best.
"You just hope it's not you in the hospital needing the transfer," he said.
Katherine Wutz: kwutz@mtexpress.com
An ambulance from the Ketchum Fire Department drives through town on Friday. Though the Fire Department and Wood River Fire & Rescue currently help transport patients from St. Luke’s Wood River to other hospitals, fire chiefs say these transfers are causing staffing and funding difficulties. Photo by David N. Seelig
