Rural Mo. District Allegedly Refusing Transfers, Alternatives

Kansas City Star

Jeff Tindle has an ambulance sitting on his driveway that he would like to use.

The chief executive of Carroll County Memorial Hospital could have used it the time he drove an appendicitis patient in need of emergency surgery to another hospital in his Suburban because he said the Carroll County Ambulance District refused to do the transfer.

Or the time in October when a Carrollton police officer had to give an 18-year-old with a broken hand and an uncertain COVID-19 status a ride to the hospital because the same ambulance district did not respond to the scene.

Or the time in September when a Carrollton police captain made the 110-mile round trip to a hospital in Warrensburg to drive an emotionally disturbed patient who needed a transport because the ambulance district wouldn't do it, citing "manpower issues," according to police records.

By state law, Tindle needs permission from the Carroll County Ambulance District for his hospital to run its own ambulance. But the ambulance district won't give that permission.

So on Tindle's driveway the ambulance remains unused, even as he said the ambulance district has often refused to transfer patients from his hospital to others when they need a higher level of care than what Carroll County Memorial can provide.

It amounts to a vexing public health problem in this community of about 9,000 people in rural Missouri, roughly a 90-minute drive east from Kansas City. Residents seem at a loss to understand why it's happening or what drives the ambulance district's decisions.

And law enforcement and health officials struggle to get answers from the district, either from its new administrator, Mario DeFelice, about whom little is known but who once listed an Olathe address and may still live there, or its six-member elected board.

"The thing that keeps me up at night is trying to figure out the obstinance of the board and why they have dug in when the public asks basic service questions," Tindle said. "The only conclusion I can come to is what is it you're hiding? Why not resign your board seat and let other people straighten it out or accept help? It's just odd to me."

Ambulance district board chairwoman Caren Bittiker said the district has to triage calls in order of medical severity and available resources, adding that the district has taken care of more than 200 runs since October 12, including patient transfers for Tindle's hospital.

"We value our relationship with Carroll County Memorial Hospital and all medical facilities served by the CCAD and will continue to work with them to meet their needs and the needs of the patients who use our services," Bittiker said in a written statement.

Asked if the hospital has difficulty getting patients transferred, Tindle said, "depends on the day of the week."

Bittiker acknowledged receiving the hospital's request to operate an ambulance in the county but said no decision has been made.

The Missouri Department of Health and Senior Services has started an investigation of issues with the ambulance district and its alleged refusal to transfer certain patients, the department's spokesperson confirmed.

Bittiker said the district responded to a complaint from a former employee about staffing, and the district turned over its staffing records to the state agency to refute the claims.

Said Tindle, "They have brought in contract labor to satisfy state review of staffing."

A spokesperson for Missouri Auditor Nicole Galloway confirmed that the office has received a whistleblower complaint about the ambulance district and that its public corruption and fraud division is reviewing the allegations.

The police chief of the Carrollton Police Department is suing the ambulance district, claiming it is violating the Missouri Sunshine Law by dragging its feet in producing basic records.

DeFelice refused a request to discuss issues about the ambulance district, citing previous reporting by the Carrollton radio station and others that have "ruined any chance of a reporter getting any information."

"I don't know you and I certainly do not trust you as far as I can throw you," DeFelice said in an email. "That said, find another story."

'An Unprofessional Response'

Missouri has 115 ambulance districts, which are separate from the cities or counties in which they provide ambulance and emergency response services. It's different than how ambulance services are run in Kansas City, where emergency response has been under the Kansas City Fire Department since it took over the Municipal Ambulance Services Trust in 2010.

In Carroll County, the ambulance district makes its money from property taxes and fees it charges people it takes to the hospital.

An elected board oversees the ambulance district, and it doesn't answer to the Carroll County Commission except in limited circumstances.

One of those circumstances was when the Carroll County Ambulance District applied to secure $212,000 from the Coronavirus Aid, Relief and Economic Security Act, part of the larger $2.2 trillion economic stimulus bill that Congress passed in response to COVID-19's effect on the United States economy.

The Carroll County Commission instead suggested giving $60,000 to the ambulance district. Commissioners had conditions attached: The ambulance district would agree to pay back any improper uses of CARES Act funding and would allow the Carroll County hospital an emergency license to operate its own ambulance.

The proposal appeared to displease DeFelice, who sent the commission an email.

Carroll County presiding commissioner Stan Falke said of the email, "We just received in return what I would classify as an unprofessional response."

In his response, which The Star obtained through a Missouri Sunshine Law request, DeFelice referred to the conditions as a "quid pro quo" and that he would refer the matter to the attorney general and the office of inspector general.

"You should be ashamed of yourself for withholding money needed to take care of the citizens of Carroll County and furthermore, say that you must sign into an agreement to get money that is intended for agencies to pay their staff and keep them safe!" DeFelice wrote in the Nov. 16 email to the Carroll County Commission. "I respectfully decline this offer and I thank you for showing me how you really feel about this organization. Please do not have any further contact with my office regarding this situation as it (sic) deemed unwelcome and unwarranted."

The exchange reflected the tone and tenor of DeFelice's dealings with other local officials.

"I've had phone and email communications with him, none have gone well," Tindle said. "He tends to aggravate and agitate conversations through a little bit of arrogance that after time ends conversations without any resolution. That feeling is shared with multiple people."

Bittiker said DeFelice's response to the county commission "came from legitimate concerns that the district was being asked to provide an incentive as a term of the agreement."

"Local law enforcement, fire departments, schools and businesses all received funding based on CARES Act requests with no conditions placed on them," Bittiker said.

DeFelice took over as administrator of the ambulance district at some point in 2020. Multiple sources say there has been significant employee turnover since his arrival, coupled with big-ticket expenditures on new equipment.

"A lot of people told me they enjoyed it when they saw their neighbors come take care of them," said former Carroll County Ambulance District employee Dan Gawendenski. "Now when there's a stranger coming to take care of them they're not at ease."

Bittiker said rural ambulance districts often experience attrition and the Carroll County district fills open positions as quickly as possible with qualified candidates.

"We are fortunate to have employees who have helped us step up to address any short-term staffing challenges experienced," she said.

Information Hard to Come By

Verifying information about the Carroll County Ambulance District is difficult.

The Star submitted a request in November for records that are often readily available from other governments and usually posted on their websites for easy access: budgets, meeting minutes, employee pay and DeFelice's employment contract, among other items.

Frank Foster, a private attorney who has carved out a niche of representing ambulance districts across Missouri and for whom the Carroll County district is a client, said most of the records would not be available until the end of the year at the earliest, citing an impending departure of its office manager.

Carrollton Police Department Chief Chris Looney sued the ambulance district in October when he was told he couldn't get similarly basic records in response to his request. That lawsuit remains pending.

"Everyone is real suspicious because it seems there's a whole lot of smoke and mirrors and evasiveness to keep under wraps," he said. "What's going on?"

Foster provided the Star an operating budget "as an act of good faith."

The document showed a $2.2 million budget for 2020, thanks in large part to $1.2 million in cash available that was carried over from the previous year.

"I suspect money has been mismanaged," Looney said. "The reason I suspect that is I know they had $1.2 million in carryover last year. That tells me there's no reason for them to have cut employee benefits. They were not strapped for cash like that."

Bittiker said the ambulance district undergoes an annual audit from an outside entity, and they always come back clean.

From 2017-2019, the district was told by its accountant that an audit had identified what it considered material weaknesses in the district's handling of cash, reporting holiday gift certificates as income, among other issues.

"Our records are publicly available, and our administration and board strongly denies any accusation related to financial mismanagement," she said in a statement.

It's also a mystery to some in Carroll County about DeFelice's background and why he's the administrator of its ambulance district.

Bittiker said DeFelice has "nearly 30 years of experience in the administration of ambulance and EMS services," although she did not respond to a followup with questions about specifics of his background.

"The board has full confidence in his ability to effectively serve as director of the Carroll County Ambulance District," Bittiker said.

DeFelice in 2015 sued the city of St. Robert, Missouri, near Rolla. He claimed that he was denied employment opportunities in 2013 by the then chief of the St. Robert Fire & Rescue Division because of his age, which was 42 at the time, and because he was Hispanic.

At the time he filed the lawsuit, he listed an Olathe apartment as his residence.

DeFelice dismissed the case in 2017. Prior to the dismissal, an attorney for St. Robert filed a motion to compel DeFelice to respond to questions and requests for documents after missing a court deadline to do so.

Ryan Bertles, the attorney representing St. Robert, declined to comment.

Perspective, Advice From Nearby District

Mac Rogers, chief of the neighboring Ray County Ambulance District, said the Carroll County district has had service quality problems for years.

He also said the Carroll County district may not be doing as many hospital transfers because it prioritizes responding to scenes where someone is suffering a medical injury and isn't surrounded by doctors and nurses who can help.

Rogers said sometimes Ray County gets called by Carroll County for help under a mutual aid agreement. He said he hasn't gotten a call from Carroll County in two weeks and has heard that they're now fully staffed again.

He wonders if the controversy around DeFelice isn't the product of a new boss coming in and fixing old problems.

"There were some issues that probably should have been addressed in previous administrations and weren't," Rogers said. "You get a new guy who is aggressive and is willing to listen and then they start mudslinging from the past."

But he also acknowledges that the district may be making problems worse by its secretiveness.

"If we had that problem here, I would be addressing the public to make sure we're addressing their needs," Rogers said. "I would be open, informative and letting them know we've solved our problem and we're back to business. I wouldn't close out the public if they were asking for answers."