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Magen David Adom emergency services hampered by nonurgent tasks By Ran Reznick The Magen David Adom ambulance service uses mobile intensive care units for routine tasks such as transferring patients from regular hospitals to rehabilitation or geriatric facilities, thereby reducing its ability to respond quickly to genuine medical emergencies, according to both MDA workers and internal MDA documents. MDA receives public funding to keep such units on call, so they will be ready to respond in emergencies. By instead of using them for routine tasks, the organization impairs the quality of care it provides, and there have already been cases in which this policy endangered patients' lives, an internal MDA inquiry found. Advertisement Moreover, this policy violates MDA's own rules, which state that transfers between hospitals may not be done by on-call ambulances. Nevertheless, not only have senior MDA officials failed to stop this practice, despite repeated complaints to both MDA and the Health Ministry, but some have even explicitly approved it. The Health Ministry, the health maintenance organizations and the local authorities all pay MDA to keep the mobile intensive care units on standby. Nevertheless, there have been many cases in which MDA instead used these units for nonurgent tasks such as transferring patients to rehabilitation hospitals or being on call at sporting or entertainment events - tasks for which it receives additional payments. Thus it is essentially being paid twice, once privately and once publicly, for the same unit, but failing to do the job for which it receives public funding - namely, being on call. Internal MDA documents reveal that transfers between hospitals account for a significant share of the organization's income, amounting to tens of millions of shekels a year, and that is apparently the main reason intensive care units are diverted to this task. One document, for instance, cites MDA's director for the Dan region as saying: "As a district manager, I must make decide between giving service and the financial consideration." Another factor in the spread of this practice, according to both MDA employees and Health Ministry officials, is the ministry's lax supervision over the organization and MDA management's lax supervision over its own personnel. In April 2007, a veteran Jerusalem-area paramedic, Zohar Galai, wrote to the director of MDA's Jerusalem region and the head of the MDA union to complain that over the last two years, there had been "a common and routine practice" of using on-call intensive care units to conduct nonurgent transfers between hospitals. "The intensive care crews are busy moving patients from one medical institution to another, instead of providing the service that they are obliged to by law," he wrote. "My impression is that the basis for making these decisions is economic rather than professional." He added that he personally had been involved in several cases in which a call came in that required an intensive care unit, but the unit was already busy with a nonurgent patient transfer. In November 2007, having noticed no improvement, Galai complained again - this time to one of MDA's most senior officials, the head of its medical department, Dr. Zvi Feigenberg. He wrote that intensive care units in Jerusalem had conducted some 350 patient transfers, most of them nonurgent and some even planned long in advance, while they were supposed to be on call. Moreover, about half were conducted at night or on weekends, when there are fewer ambulances on call to begin with. In this letter, Galai described one shift on November 16, 2007. During that shift, he wrote, the regular ambulance - staffed by a paramedic and a driver/medic - had to perform resuscitation on three unconscious patients: two adults in the Catamon and Rehavia neighborhoods and a baby in the settlement of Beitar Ilit. At the same time, the intensive care unit - which also has a doctor on the crew - was busy with nonurgent transfers between hospitals. One month earlier, Channel 10 television's "Shomer masach" ("Screensaver") program had broadcast a report on several cases in the Tel Aviv area in which patients suffered harm because the intensive care unit, with the consent of MDA's management, was engaged in nonurgent tasks such as transfers between hospitals or being on call at sporting events. As a result, the patients were treated either belatedly or by a regular ambulance that lacked the proper medical staff. In response to this report, MDA set up an internal inquiry committee, which issued a severe report in November 2007 - though it was sent on to the Health Ministry only last week. The committee found that on four different occasions, on-call intensive care units were diverted to nonurgent purposes. This violated MDA regulations, it wrote, yet in each case, the diversion was approved by Yossi Cohen, director of MDA's Dan Region. In two of these cases, the report said, this diversion endangered patients' lives. For instance, on April 26, 2007, an ambulance came to get a Tel Aviv resident suffering from chest pains and shortness of breath only 20 minutes after it was called, in part because the on-call intensive care unit was busy with a nonurgent patient transfer (a dispatcher error also played a role). In response to the report, MDA Director General Eli Binn wrote to Feigenberg and the head of the operations department, Doron Kotler, saying that he held them "directly responsible" for failing to ensure that the regulations were obeyed. But Kotler wrote back that he lacks the tools for proper monitoring. And indeed, this was not the first time MDA's senior management had been informed about this practice: In March 2006, a Herzliya city councilman had complained to the Health Ministry about several cases in which the doctor who is supposed to staff the intensive care unit was instead sent on nonurgent missions outside Herzliya, such as being on call at sporting events. The ministry had in turn complained to Binn, noting that MDA was receiving state funding to keep the doctor on-call in his ambulance, not to turn an extra profit by renting him out to private functions. At that time, Binn responded that the Herzliya incidents were rare exceptions to the rule, and he had ordered everyone involved to be more careful. However, as the 2007 cases indicate, this order evidently had little impact. In response, MDA said that "for every vehicle that leaves an MDA station - including for the purpose of transferring patients - there is an immediately available back-up, as mandated by the regulations. At every hour of the day, dozens of ambulances are on call at MDA ... Thus the information given to Haaretz is baseless. If in the past, a few isolated exceptions to the work procedures were discovered, those cases were dealt with speedily and effectively by the management. All necessary steps were taken against those responsible for the violations and the lessons were learned." "Every year, MDA responds to some 550,000 rescue calls throughout Israel, including transferring patients between hospitals when there is an appropriate and urgent medical need," it continued. However, such transfers are authorized only after "responsible consideration, in order not to impair the quality of care given the public." As for Galai's complaints, it said, these are "utterly false." The Health Ministry said it had been informed by MDA that all district managers had been briefed on the regulations, and that "they are being implemented to the letter; no transfers are being made with on-call intensive care units." It added that it would discuss the monitoring problem with MDA's management. Bookmark to del.icio.us   Auschwitz gimmick U.K. Tory chief draws fire for calling school visits to Auschwitz a gimmick. 5 Stops in Galilee Rock hares, peach orchards, a taste of the past, and walking the Jesus trail.

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