Is It Camden or ‘Communist China’? City’s Paramedic Turf Wars Get Ugly

Andrew Kitchenman | June 25, 2015 | Health Care
Lourdes Health Systems says it may have to shut doors if Cooper-friendly legislation goes through

Richard P. Miller (at podium), president and chief executive of Virtua Health System, surrounded by paramedics who work for Virtua.
It’s as if “I landed in Communist China,” said Richard P. Miller, president and chief executive of Virtua Health System, “when one person wants something and can take it from another business.”

The “person” Miller is referring to is Democratic powerbroker and sometime Christie ally George Norcross, the chairman of Cooper University Health Care. And what’s got him seeing red is a struggle over who will deliver paramedic services — also known as advanced life support (ALS) — to the city of Camden.

Virtua has been doing just that for the past 38 years. But a bill (S-2980 /A-4526) before the Legislature would transfer paramedic services from Virtua to Cooper. It also would give Cooper the right to provide ambulance services, known as basic life support (BLS).

Miller thinks Cooper is the force driving the legislation. And he’s not without allies.

Alexander J. Hatala, president and CEO of Lourdes Health System, which competes with Cooper and Virtua in Camden, joined Miller in opposing the bill yesterday. Also signing on to the opposition: Al Maghazehe, president and CEO of Capital Health.

According to Hatala, giving Cooper control of the ambulances could lead to a drop in the number of patients treated at Lourdes. He asserts that it could ultimately force Lourdes to shut its doors, eliminating 2,000 jobs.

Cooper representatives say that the need for the bill was initially prompted by the fact that University Hospital no longer wants to operate ambulance services. Cooper said residents would benefit from combining paramedic and ambulance services within the operations of the city’s largest hospital.

Under state rules, ambulances are supposed to take trauma patients to the nearest appropriate trauma center, taking other patients to either the nearest hospital or to the hospital of their choice if they express a preference.

Hatala suggested that a Cooper-operated ambulance crew would no longer offer a choice.

“Are they going to make the right decision on behalf of the patient or are they going to make the decision that benefits their organization?” Hatala asked.

Norcross spokesman Dan Fee noted that the bill wouldn’t change the state rules governing ambulances.

Fee also responded to a comment by Miller that the bill “takes 16 percent of Virtua’s business away,” referring to the city patients the system serves, “and gives it to a competitor.”

“Mr. Miller’s comments crystalized this issue. He’s focused on Virtua’s profits and everyone else is focused on the quality of care that Camden residents receive. Camden residents deserve the highest quality, continual care that every other community gets.”

Cooper and Camden County officials have recently raised concerns about Virtua’s ALS response times. Camden County Director of Public Safety Robin Blaker raised as a source of concern that in 27 percent of emergency calls, Virtua paramedics arrived more than the industry-standard eight minutes after the call was placed. The other 73 percent met the standard.

And Dr. Stephen E. Ross, director of Cooper’s trauma center, noted that Camden is the only New Jersey city in which its trauma center doesn’t also operate its paramedic services. He said the city was faced with an emergency, because University Hospital is seeking to stop offering the BLS ambulance services in the city.

“We believe this offers Cooper an opportunity to provide a high-quality, integrated EMS program for the city by taking on the responsibility,” for both BLS and ALS, Ross said. He said this would allow Cooper to offer more integrated, coordinated care.

Ross noted the importance of quick responses in emergencies.

“Are the response times as poor in the rest of the county?” Ross asked. Virtua operates paramedic services throughout Camden County, and would continue to operate them everywhere but the city if the bill becomes law.

Hatala questioned why the bill circumvents the state government’s established certificate-of-need process that currently governs which organizations operate paramedic services (BLS is determined by each municipality). He noted that this process allows both paramedic providers and members of the public to weigh in before any changes are made.

Instead, the bill changing Camden providers is on its way to passing within 17 days of being introduced in the Senate and 14 days in the Assembly.

“It really makes no sense, because the system is not broken,” Hatala said. “There is no emergency.”

He noted that Lourdes has received national attention for its cardiac services , which he said treats twice as many heart patients as Cooper at half the cost.

He said the bill “represents the worst in the legislative process itself — fast-tracking a bill like this” without comments from the public. “This is a great example of why Joe Public really does not believe in the system today .”

He noted that the transfer would cost the state $2.5 million — an amount that wasn’t disclosed when the health committees in each legislative house released the bill last week.

Miller said Virtua currently provides the paramedic services at an annual cost of $1.2 million.

Miller used the example of former Gov. Jon S. Corzine, who was transported by AtlantiCare’s ambulance and Virtua’s helicopter before being treated by Cooper after a major car crash. Miller said Corzine benefited from a coordinated response that required multiple hospitals.

“Why is this legislation being ramrodded through the Legislature in less than two weeks without assessing its impact, simply because one man wants it and New Jersey taxpayers will have to pay for it?” Miller said, adding that the bill “has made a mockery” of the certificate-of-need regulations.

Miller raised the specter that Cooper is using the bill as a wedge toward extending its control of paramedic services throughout Burlington, Camden, and Gloucester counties.

He called on Assembly Majority Leader Louis Greenwald, Assemblywoman Pamela Lampitt, and Sen. Jim Beach, Democrats who represent the Burlington and Camden County district where Virtua Voorhees Hospital is located, to oppose the bill.
Miller added that his first thought on reflecting on the situation was to ask himself: “ What in God’s name is happening in this state?”

Miller said he was “stunned” that state Department of Health officials haven’t spoken out to defend the current certificate of need process. In response, a state spokeswoman said department officials don’t comment on pending legislation.

[related]Maghazehe contrasted with the extended, yearlong process that resulted from changes to maternal-child health services in Mercer County. “We had to go through hell to get this done,” Maghazehe said of the work that Capital Health did on the certificate of need in that process.

Cooper, Lourdes, and Virtua currently participate in the Camden Coalition of Healthcare Providers, which has gained national attention under Dr. Jeffrey Brenner for its work in coordinating patient care and targeting healthcare to the patients who need it most. Miller said the bill could affect the relationship between the providers.

Brenner, who’s also the medical director of Cooper’s Urban Health Institute, said that the continued collaboration of all three health systems “is important to the work of the coalition and we’re staying out of this conflict.”

Both houses of the Legislature are scheduled to vote on the bill today. The opponents have said they hope Gov. Chris Christie vetoes it if it reaches his desk.

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