Sunday, May 30, 2010

A Potentially Costly Mistake

People who are in charge of governments of any scale sometimes make decisions whose consequences can affects large numbers of their constituents. I’m not referring to events in the Gulf of Mexico and British Petroleum’s inability to stop that horrible oil spill that is going to ultimately impact the entire globe. I’m talking about something that happened that is much more local in scope. And I can actually get my hands around this one.

I found out at the end of this past week that Rockingham Ambulance has lost the contract for the city of Manchester. The new contracted EMS provider for the city is going to be American Medical Response. I personally think this is rather ironic, considering it was AMR who had the contract in Manchester before Rockingham. Actually, it was Chaulk Ambulance which no longer exists because AMR bought them out. And AMR, as a company, left Manchester approximately 5 years ago because there was no contract work up here that they could get.

Even though I had issues with Rockingham and the way management treated me before I left to go to Cataldo, overall I think Rockingham should not have been relieved of the contract for Manchester. I believe it will be a mistake that the mayor of Manchester will have regretted making, for a number of reasons. Mainly, I believe that Rockingham is a much better organized operation than AMR, when it comes down to resources. Rockingham has, for the most part, well-trained personnel who do a really good job when it comes down to patient care. Plus they are up to date when it comes down to equipment that is used on board their ambulances. And, as far as what needs to be done, things do get done. Plus, I have a number of friends that are still employed by Rockingham, and many of them will potentially lose their jobs because of this.

As for AMR, I worked for that company before I became a Paramedic. I worked in Haverhill and Newburyport, Massachusetts while I was there, and I would occasionally pick up overtime on the New Hampshire seacoast and up in southern Maine. As with Rockingham, I have friends that still work there. Different areas, of course, but they still work there just the same.

One of the things I noticed while I was an employee there was the way that management treated the clinical and operations staff. It was much worse than anything Rockingham could do. At least in Newburyport, anyway; if you worked in Somersworth, NH or the southern Maine stations (Eliot, Berwick, Scarborough) it was slightly better. But Newburyport had some personnel that were excellent and others that were not. And the ones that were not were incredibly scary to work with. One of them caused me to injure my hip while carrying a patient. But that was a long time ago…

I don’t know the circumstances of Rockingham’s dismissal, but from what I had indirectly been told it was financial on the part of the city of Manchester. And while I know that many cities and towns are having a hard time, was this something that could be compromised?

There may be more to the story, but I really, truly think the mayor wasn’t considering the well-being of his constituents when this decision was made. And I think that this will jump up and bite someone on the rear end and the end of the day.

If this doesn’t happen, I will be incredibly surprised. But for now, it’s where I stand.

If I am ever able to learn more about the circumstances of this change I am sure I’ll write about them. But for now I am wondering what the story is behind it.


Anonymous said...

Its called LOW BIDDER!!

Walt Trachim said...

I know that.... There has to be more, though; I've heard that Manchester Fire ultimately wants to run EMS on their own but I don't know if that's true or not. I can't help thinking that this was an interim sort of thing. Only time will tell, though.

TOTWTYTR said...

It's about money, but you know that. Most citizens, and probably fewer politicians, know anything about the differences in quality of care between different ambulance services. To them, the ambulance shows up and takes people to the hospital. It drives people like us crazy, but the cities and towns where the people making these decisions know or care about this stuff is very small.

Anonymous said...

Rockingham or AMR-although the name on the side of the ambulance will change, the care will, without a doubt, remain the same or potentially even get better. The city of Manchester does a fine job in overseeing their 911 medical provider. With a new contract, the oversight will be even more stringent. The number of paramedic staffed 911 ambulances are increased under this contract; that can only benefit the citizens of Manchester. In addition, there is a subsidy to the City of Manchester for dispatching services. That will put the fire department in a much better situation at a time when the Chief is faced with a continuing shrinking budget and increasing personnel costs. I applaud the foresight of this Chief in making the budget work for all while increasing emergency services available to the city of Manchesters residents. Rockingham Ambulance has done a fine job in the city. In this contract, General Manager Chris Stawasz's hands were tied on directions from his corporate executives. He has done well with Rockingham and should be commended for his work. Unfortunately, corporate may be the "death" of Rockingham if their decisions stand come next year in Nashua.
Paul Robidas and the corporate executives from AMR will provide a high quality service to the citizens of Manchester and without a doubt will be around for quite a while.
Remember, change is not always "bad." Rest easy Manchester, when you dial 911 in an emergency, professionals will arrive providing high quality medical care.
Rockingham Ambulances moto says it all. "We serve so others may live" This is true not just of Rockingham personnel, but of EMT's and Paramedics regardless of the name on the side of the truck.

Walt Trachim said...

I hope you're right about the level of care.

As with what could happen in Nashua, that remains to be seen.

I've known Chris Stawasz for the better part of the past 30 years. We graduated from the same high school a year apart (I'm the older one :). As far as I'm concerned, the man is a stand-up individual. I also know Jim Burkush, the Chief of the Manchester FD. Another stand-up individual. Both of them have jobs to do, and the actions they both have taken, circumstances being what they are, make sense.

I totally disagree with you regarding the company. And I especially disagree with you about Paul Robidas. I had some experience dealing with that management team when I worked there and I truly wasn't impressed. As much as I was frustrated by some of Rockingham's decisions over the five-plus years I worked there on a full-time basis, I never saw them make decisions that would negatively impact patient care. I, however, did see that on multiple occasions when I worked for AMR. And the results were never in the patient's favor.

Needless to say, I would never go back to AMR, regardless of what kind of offer was made to me.

Anonymous said...

I work for AMR and have never had an issue with Rock. We all are trying to do a very hard job. What angers me is some rock employee's are telling people that because of a few bad employee's we all are bad. Just like rock we both have some very good people and some not so good employee's. Heck I was told by a medic recently that does not work for either company but had his dad transported by rock after an MI and was not happy by the way he and his dad were treated. Some rock employee's have been bringing up AMR's faults but seem to forget their own. Remember the medicare fraud? Billing bls transports as als? AMR can and will provide high quality service that Manchester is looking for. And word has it that a number of rock employee's have already called AMR for jobs.

Walt Trachim said...

Definitely not arguing with you about RRA's faults and shortcomings, as far as the OIG/Medicare issue is concerned. Those reasons, among other things, pushed my departure. And if RRA employees are looking for work with AMR for after the handoff, that's fine, too; at least there will be some consistency in terms of people and area knowledge, etc.

I think we may be both saying something similar: your mileage may vary. I know mine has. And my issues with AMR have never been with those of us who work on the line. Some of the finest EMT's and Paramedics I know either currently work for of have worked for AMR at one time or another. My issues are with management. And truthfully, I'm not confident in management's ability to meet the city's expectations.

Just sayin'.

Anonymous said...

I don't think that is has anything to due with MFD wanting the EMS contract. There local IAFF membership is against it, there is no support for it below the BC level. It's about money - pure and simple. Some on the couple of FB sites have said it will cost thousands of dollars to equip AMR units with the electronics needed in the contract. OK. It will. I have experience in this, and it will cost around $12,000 per unit, labor included. So 10 units = $120,000. This leave $210K for the fire chief to use to save FF, and secure his budget.

The MacMedic said...

The reality is that it is and always will be about the money. With almost 30 years in EMS I have seen many cities make decisions based solely on the financial arrangements.

The other thing that I have learned is that no service has 100% top notch employees and no service has 100% incompetent slackers. Commercial EMS is commercial EMS and as long as the profit is what motivates a corporation they will do everything they can to provide a level of care that meets the minimum standard but doesn't surpass it by much.

Since communities have no statutory obligation to even provide EMS care their primary interest is having it provided at that level that meets the "minimum standard" and costs the taxpayer as little as possible. They just are not interested in having their communities provided with exceptional care.

Do I think that AMR can provide adequate care to the residents of Manchester NH? Sure. Will it be better than Rockingham? Probably not. Will it be worse? Probably not.

I have found that, for the most part, no matter which service you are talking about, no matter what uniform they are wearing the care will be pretty good. Not stellar, but certainly better than the city is paying for.

That is because most of us in EMS only know how to provide the best care possible. We don't change that level of care depending on which uniform we wear or how much our management is getting paid to provide the service. We take what resources we are given and manage to do a better job than can be reasonably expected.

Your milage may vary but this is what I have found.

The MacMedic