Ga. Reforms Call for More Accountability to EMS Councils

The Atlanta Journal-Constitution

State officials are about to assert unprecedented control over how emergency medical service providers are selected, with reforms they say will wring out politics and conflicts of interest while saving lives.

Under new rules expected to take effect this spring, regional EMS councils will have to give the state detailed performance data on ambulance service before even considering a change of providers. Those performance measures will drill into how quickly and how well ambulances help infants and children in respiratory distress, victims of gunshots, stroke sufferers and people in cardiac arrest.

If the councils fail to provide data or to adhere to specific rules that will govern their selection processes, the state will likely reject any changes, said David Newton, director of EMS and Trauma in the Georgia Department of Public Health.

“If you didn’t follow the procedure, guess what, you’ve got to start over,’’ Newton on Thursday told a room of a few dozen EMS leaders who serve on the state’s Emergency Medical Services Advisory Council. “And that’s obviously not what anyone wants.”

The moves are the latest in a series of reforms Newton has been firing off in his first year as the state’s top EMS leader. His goal has been to bring more accountability to EMS providers in Georgia, following criticisms of gaps in state oversight.

Among the critics, the Atlanta-based Georgia Ambulance Transparency Project raised questions about potential conflicts-of-interests by ambulance executives and EMS operators on the regional councils. Fire chiefs in the Atlanta metro area also have raised concerns that regional council decisions don’t reflect community needs.

What’s more, an Atlanta Journal-Constitution investigation last June found that state has failed in its duty to ensure the quality and reliability of Georgia’s emergency medical services system. State standards are vague and oversight weak, leaving the system vulnerable to breakdowns and political pressures, the AJC reported.

At Thursday’s address to EMSAC leaders, Newton made it clear that the state would no longer tolerate arbitrary decision-making by the councils.

“So, if someone says, in a written form, I would like the X-Y-Z emergency response zone examined because they were mean to my grandmother, that’s probably not a good thing to do,” Newton said.

In moves late last year to reform the selection process, Newton announced that the state planned to implement a rule limiting the number of representatives from any one organization on the regional councils.

Yet another reform will require each council member to complete a conflict-of-interest statement that discloses personal affiliations and financial interests. Leaders of the Ambulance Transparency Project had urged the state to require the disclosures, concerned that ambulance executives were able to sway decisions that may not be in the public’s best interest.

To improve transparency, the state also made it clear that regional councils must comply with the state’s open meetings law. A pending goal will require council members to undergo training on open meeting requirements.

But the most profound change is a requirement that regional councils conduct uniform assessments of the existing level of service in each geographical zone, even before anyone vies for a contract.

To conduct the assessments, agencies would have to submit data from patient trip reports to Newton’s office, which they are already required to do but sometimes don’t.

Newton also would like agencies to report performance data established under the National Highway Traffic Safety Administration’s EMS Compass initiative. The initiative depends on standardized measures of performance to improve the quality of care to patients.

For example, the state wants providers to show the councils that they are transporting patients to the hospitals that are equipped to meet their needs, Newton said.

If a patient has experienced severe burns in a car fire after an accident, the state would want to know if the EMS agency transported the victim to a Level One Trauma Center, which can provide the highest level of care.

In other cases, the state wants to know if ambulances are notifying hospitals when stroke victims are on the way, or documenting the dosage of the medications being provided to pediatric patients being transported.

“That has a clinical significance to their survivability,’’ Newton said.

Most members of the EMS advisory council supported the proposals, including the adoption of a conflict-of-interest policy and statement.

Lee Oliver, vice president of operations with Metro Atlanta Ambulance Service, said he wanted to make sure the disclosures could withstand any legal challenge. He was concerned that the conflict-of-interest questionnaires could go too far, creating false perceptions of conflict.

But other EMSAC members urged that the group support the idea.

“Historically, we’ve all been involved in zoning matters,’’ EMSAC member Reg James said. “We’ve all had questions about the people involved, and there were some self-serving activities that were going on.

“This is a first attempt at getting some visibility, clarity and transparency into the people who are making decisions on behalf of these communities,” James said.

Newton said that attorneys for DPH are reviewing the proposed disclosure forms.