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STANLEY — Controversy continues to surround Stanley Ambulance Services two years after Mountrail County Medical Center in Stanley changed direction in its relationship with the local ambulance company.
When representatives from MCMC and Stanley Ambulance Services (SAS) came together for a meeting on June 1, 2020, Ambulance Resources owner Ken Rensch hoped dialogue and communication would help clear the air between the hospital and ambulance. The meeting came months after complaints against nurse practitioner Richard Laksonen and MCMC were filed with the Department of Health by the New Town Ambulance Service.
Instead, a recording of the meeting shows Rensch being reprimanded by Laksonen, who said the ambulance was “exceeding” to question decisions to transfer MCMC patients to other medical centers, and that, on the advice of counsel, the hospital would “Going in a different direction for transfers due to recent events.”
A letter sent to MCMC by McGee, Hankla and Backes, his lawyer, cited two incidents from March 11 and May 26, 2020, in which Rensch challenged the emergent nature of certain transfers, to which the hospital believed he was not entitled. TO DO. MHB recommended that the hospital report Rensch to the North Dakota Department of Health and Emergency Medical Systems. The letter concluded by saying that the hospital should consider using a different ambulance service.
The hospital would continue to exclusively use the Community Ambulance Service and NorthStar Criticair in Minot, both of which are owned by Trinity Health and currently operate as Trinity Health First Response. Representatives said the hospital is making this decision “in the best interest of our patients.”
Two days later, a special meeting was held with the SAS Board of Trustees, Rensch, and the Mountrail County Medical Foundation Board of Trustees on June 3, 2020. During a recording of the public meeting, the MCMF Chairman and Mountrail County State’s Attorney Wade Enget confirmed the decision was partly because Rensch took complaints made by the New Town Ambulance Service to the New Town Health Department. state to then-state health officer Mylynn Tufte.
“So something happened with New Town and Parshall, and we’re being blamed?” Rensch asked during the meeting.
“That’s not what I’m saying. I say it affects the relationship because you have a relationship with them,” Enget had said.
Laksonen launched a flurry of complaints against Rensch and SAS with state regulators, raising a variety of allegations and complaints for every transfer call SAS handled from MCMC over a two-week period. Rensch and Stanley’s ambulance responded to the complaints, saying they were misleading and retaliatory. The Department of Health reviewed the matter, concluding in September 2020 that no breach of the EMS had occurred in any of the 12 incidents for which Laksonen had filed a complaint.
Laksonen is currently in federal prison after pleading guilty on Aug. 8, 2021, to charges related to $4.7 million in Medicare fraud during a time he worked in Michigan. It will be released in September 2023.
After the pair of meetings and the deluge of complaints from Laksonen, Rensch formally filed her own complaints with Bridget Weidner, director of the Health Department’s Division of Healthcare Facilities.
The cost of the patient
On June 10, 2020, MCMC CEO Stephanie Everett sent a letter to the editor of Mountrail Country Promoter, offering clarification to the community regarding the decision. The letter said that the hospital “cares deeply about the well-being of his patients” and that the only changes patients would experience would be a different ambulance service when being transferred to different hospitals. The letter did not explain why the hospital was taking this action.
Based on open records obtained by The Minot Daily News that tracked transfers out of MCMC, SAS was skipped for approximately 150 transfers from June 2020 to August 2021. The effects on hospital patients and on the ward Stanley ambulance were immediate. .
If a patient desperately needed a transfer from MCMC to anywhere in the state, they would have to wait for the community ambulance to be contacted, assemble a team, drive nearly an hour to Stanley from Minot, then transport them to their destination. , while SAS and its two full crews sat a few minutes unused, deliberately left on the shelf.
SAS Medical Director Dr. Paul Olson was also present at the June 3 meeting. He shared an anecdote in which Community Ambulance was unable to assemble a team to transfer a stroke patient to Stanley, which led to a helicopter being transported by NorthStar, all in order not to use SAS in any way.
For context, the average helicopter medical evacuation can cost between $25,000 and $45,000 and comes with less technical capabilities than a typical SAS fleet ambulance, which can make the 50-minute journey up to to Minot for about $3,000 round trip.
MCMC inter-facility transfer tracking documents indicate that such a high volume of air ambulance flights to any destination was not the norm for the hospital. Between June 3, 2018 and June 1, 2020, MCMC used air ambulance services once on June 27, 2019. All other transfers during this interval used only SAS ambulances.
Of the 150 transfers diverted from SAS after the June meetings, around half were instead sent to air ambulance solutions like NorthStar Criticair. Of this number, more than 40 of them were airlifted to Trinity Hospital in Minot.
Hospitals are required by federal regulations to provide just cause for using air transportation, either because of the severity of the patient’s condition or if ground ambulances are not available.
“They were saying ground ambulances weren’t available. They contacted other ambulances, but they did not call us, the approved provider in the area,” Rensch said in a phone call with the Minot Daily News.
After Rensch’s complaints to the health department, the North Dakota attorney general was put on hold. A 2017 memorandum from the Attorney General previously addressed the issue of which ambulance services should be used by hospitals for inter-facility transfers, prioritizing local solutions. . Christopher Price, the director of the Emergency Medical Systems Division, would email MCMC CEO Stephanie Everett on June 24, 2020, bringing the 2017 memo to her attention and ordering the hospital to use the local ambulance.
When the discrimination continued, Price sent Community Ambulance a cease and desist letter on December 4, 2020, which MCMC’s attorneys disputed, finding ambiguity in the law. This ambiguity was removed by legislation in the 2021 session which codified the emergency nature of inter-establishment transfers, obliging the hospital to use SAS because they were the “nearest appropriate service.” However, the damage was already done by the time MCMC started using SAS again.
“Right now they are using us for transfers, but retaliation is still happening,” Rensch said.
Local Politics Award
MCMC’s decision resulted in a shortfall for the Stanley Ambulance, leading the council to take out a loan in 2021, in turn leading to increased levies from the local factory, upsetting local ratepayers in 2022 .
This dissatisfaction increased attendance at SAS board meetings, culminating in the election of a new chairman and board secretary on 5 April. The new council quickly filed a motion to declare Ambulance Resources in default of a contract with the council.
At their May 11 meeting, the parties spent time discussing “ambulance resource shortfalls,” in which Rensch and SAS Director Joelle Muckle were lightly quizzed about various company procedures, concerns about accounting practices, and weather response times.
Ambulance Resources lawyer Jesse Walstad then took the floor to address the motion tabled at the previous meeting, saying good communication could alleviate misunderstandings between Ambulance Resources and the board. Walstad hoped that bridging those communication gaps would help them. “forgo what could become a convoluted contract dispute in favor of a productive dialogue.”
Following Walstad’s termination, the board met privately for an executive meeting to discuss Ambulance Resources contract concerns and other legal matters. Details of what was discussed have not been made public and the SAS board has not responded to interview requests.
It remains to be seen whether the relationship between the hospital and the community ambulance service will once again become friendly and cooperative, but exactly why it has become so acrimonious remains unclear. MCMC management did not respond to multiple requests for comment on these issues. Rensch, for his part, is uncertain about the future.
“It all depends on whether this stuff continues. Who knows what could happen? Rensch said.
The contract between Ambulance Resources and the Stanley Ambulance Service will end on January 1, 2023. The next public Ambulance Board meeting is scheduled for Wednesday at Stanley Town Hall at 7 p.m.
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