Sunday, February 08, 2009

Emergency Medical Services: Review examining “all aspects” of pre-hospital & inter-hospital EMS; SEMSA in lead role, health care council left out





At a news conference in Regina on Dec. 11, 2008, Health Minister Don McMorris announced the launch of a province-wide review of emergency medical services (EMS) in Saskatchewan.

A health ministry news release said the review will be conducted in consultation with the ambulance industry and regional health authorities. Its recommendations will focus on pre-hospital and inter-hospital transfers, and will form the basis for a long-term plan to improve the province’s road ambulance services.

Don Cummings, an Edmonton-based consultant, has been appointed chair of the EMS review committee.

McMorris was reported in The Leader-Post as saying the review may also look at the delivery model of emergency medical services. Road ambulance services are provided through the health regions, but about 40 operations are privately owned. Another 56 of the ambulance services are publicly owned, while 13 are non-profit. [EMS to get a checkup (Leader-Post, Dec. 12, 2008)]

Records obtained from the health ministry under freedom of information legislation, however, suggest that everything will be examined.

The scope of the terms of reference for the review committee states in part: “The review and recommendations will…Include all aspects of pre-hospital and inter-hospital EMS (EMS dispatch, First Responder groups, and road ambulance).”

The review committee will “provide recommendations for a strategic vision” and “will consider patient concerns with EMS and stakeholder views about the tools required to meet the strategic visions, including:

– patient access to service, cost to patients;

– human, capital/infrastructure and financial resources; and

– regulatory environment for EMS.”

The review will be completed by March 31, 2009.

As for consultation the terms of reference state the review committee “may consult patients and/or families, stakeholders such as, but not limited to, the Saskatchewan Emergency Medical Services Association [SEMSA], Saskatchewan Association of Rural Municipalities, Saskatchewan Urban Municipalities Association, Saskatchewan Association of Health-Care Organizations, Saskatchewan Medical Association, Saskatchewan College of Paramedics, College of Physicians and Surgeons of Saskatchewan, the Saskatchewan Institute of Applied Sciences and Technology.

“The Committee will determine the means such consultation will take – focus groups, written submissions, etc. – but in so doing will not duplicate work that is already included in or underway through the Patient First Review.”

To date there don’t appear to be any labour groups involved in the discussions.

Contacted on Feb. 4, 2009, CUPE Health Care Council President Gordon Campbell said his organization had not received an invitation to participate.

The Health Care Council represents 12,500 health care providers. They include: special care aides, licensed practical nurses, food services workers, laundry, housekeeping and activity personnel, maintenance, clerical, medical diagnostic, therapeutic and recreational workers and medical technologists and technicians.

In 2000, the Council submitted a report to the Commission on Medicare headed by health consultant Ken Fyke called A Vision for Health Care: Building a Responsive Health Care System. One of the report’s recommendations was that “The government should create a provincially-coordinated and publicly-delivered ambulance emergency service.”

The Fyke commission report, released on Apr. 11, 2001, adopted several key recommendations from an EMS review, commissioned by the provincial Health Department and released in December 2000.

Although the union urged the government to implement the Fyke report, it was disappointed the commission didn’t call for a publicly owned and administered EMS system.

“We shouldn’t allow private businesses to profit from medical emergencies,” said Steve Foley, the then president of the Health Care Council. “Private ambulance companies have no place in our public health system.” [EMS union seeks end to for-profit ambulance service: Group frustrated report didn’t recommend publicly-funded EMS system (StarPhoenix, Apr 14, 2001)]

The Saskatchewan Party government, on the other hand, seems eager to pursue more private involvement in the health system.

Last summer Health Minister Don McMorris confirmed that the government is open to looking at an increased private role in health care as part of its “patient-first review” of the health system. [McMorris looks at more private care (Leader-Post, July 26, 2008)]

In a June 27, 2008, letter to Saskatchewan Chamber of Commerce president Dale Lemke, McMorris said: “The private sector can and does deliver health services effectively within a publicly funded system. This is clearly the case with respect to ambulance and medical laboratory services. We will continue to examine whether there are benefits to further private delivery in publicly funded, publicly administered health services.”

McMorris was responding to a number of health care related policy resolutions that were passed at the Chamber’s annual general meeting in May 2008 and forwarded to him for consideration. One called on the government to “promote the establishment of a competitive environment for the provision of health care in Saskatchewan.”

One thing the health minister neglected to mention at the Dec. 11 news conference was that the EMS review committee had already been up and running for nearly two weeks before the announcement was made.

According to a Dec. 2, 2008 briefing note prepared by the health ministry’s acute and emergency services branch, the inaugural meeting of the committee took place on Friday, Nov. 28, 2008 in Saskatoon.

The document went on to say that, “Future meetings of the Committee are scheduled to take place bi-weekly from January to March with the location alternating between Saskatoon and Regina.”

Additional work of the committee detailed in the briefing note includes:

– Two key stakeholders of the review, SEMSA and the EMS Working Group, are planning separate meetings with the Committee Chair without the presence of other stakeholders including the ministry.

– During the afternoon of December 11, 2008, members of the SEMSA board will have a separate, private session with Mr. Cummings to highlight their viewpoints regarding the development of a strategic vision and prioritized recommendations within the Review.

– Members of the provincial EMS Working Group (consisting of senior-most managers from health regions that are responsible for EMS) have elected to schedule their private session with Mr. Cummings in January 2009.

Finally, the document lists the seven members of the review committee that were appointed by the deputy minister of health (in consultation with stakeholders):

– Committee Chair (based of recommendation of SEMSA) – Don Cummings, Sierra Systems, Edmonton (based on recommendation from SEMSA);

– Health Region Representatives (based on recommendation from health region CEOs) – Mike Redenbach, vice president of primary health care with the Regina Qu’Appelle Health Region, and Rod MacKenzie, manager of pre-hospital emergency medical services with the Saskatoon Health Region.

– Ministry of Health Representatives (selected by Deputy Minister) – Duncan Fisher, special advisor to the deputy minister of Saskatchewan Health, and Patrick O’Byrne, director of community hospitals and emergency services, acute and emergency services branch with Saskatchewan Health; and,

– SEMSA Representatives (selected by SEMSA Board) – Ron Dufresne, president of SEMSA, from Moose Jaw, and Trevor Dutchak, vice president of SEMSA, from Prince Albert.

The recommendation to appoint Cummings as the review committee chair is outlined in a short briefing note dated Oct. 28, 2008: “Mr. Cummings is well known in both the Health and EMS community and was instrumental in the development of the Emergency Services Chiefs of Canada [EMSCC] report The Future of EMS in Canada: Defining the New Road Ahead and the Provincial Ambulance Strategy report for Alberta Health and Wellness and the Provincial Health Services Plan for the Health Boards of Alberta.”

The Future of EMS in Canada (Sept. 2006) report is a strategic policy framework. It describes six strategic directions and provides 11 recommendations that the EMSCC say will help enhance community-based EMS across Canada.

The EMSCC envisions EMS “as a mobile health care service” and believes “that the future of EMS in Canada is at the centre of the community, providing primary health care in a mobile setting.” It feels EMS’ role must be broadened beyond the traditional model of providing pre-hospital emergency care.

Page eight of the report explains some of this stating: “EMS has the potential to increase the level of care it provides through greater training and enhanced technology. In addition, EMS has significant resources and knowledge that should contribute more to health care reform by easing staffing and emergency department space shortages. Expanding EMS’ scope of practice, using its reserve capacities, and increasing the amount of mobile health services such as augmenting home care and other primary care areas are part of this contribution.”

One of the report’s six key strategic directions is that, “A more comprehensive and inclusive approach, focused on mobilized health care in addition to traditional emergency services, is required.”

Saskatchewan residents likely don’t realize it, but the Brad Wall government got a head-start on this last summer when it implemented a six month pilot project in Saskatoon.

On Aug. 28, 2008, Health Minister Don McMorris announced the launch of a mobile health unit, or “health bus,” to provide primary care to residents in Saskatoon’s core neighbourhoods. The service features a paramedic, a Registered Nurse (Nurse Practitioner) and an exam room and will be in service 7 days a week, 8 hours a day.

According to a Dec. 18, 2008, email from the communications and media relations branch of Saskatchewan Health, between Aug. 29 and Nov. 19 the health bus served 794 clients.

The health bus project is a partnership between the Ministry of Health, Saskatoon Health Region and M.D. Ambulance, a private company.

It should be noted that M.D. Ambulance president and CEO Dave Dutchak is the Saskatchewan Chamber of Commerce’s immediate past-president and a contributor to the Saskatchewan Party. Dutchak also serves on the SEMSA and EMSCC boards and was one of nineteen individuals interviewed for The Future of EMS in Canada report.

EMS Review Committee member Trevor Dutchak is the CEO of Parkland Ambulance Care Ltd. in Prince Albert (also a private company) and is Dave Dutchak’s nephew.

At a news conference in Saskatoon on Oct. 23, 2003, during the provincial election campaign, Saskatchewan Party Leader Edwin Hermanson and health critic Rod Gantefoer refused to rule out the privatization of many health-care services.

Hermanson said a Saskatchewan Party government would not rule out private MRI clinics and would review support services.

Dave Dutchak, the then president of SEMSA, said he was glad to hear emergency services will be a priority for the Saskatchewan Party. [Sask. Party’s health platform worries union (StarPhoenix, Oct. 24, 2003)]

A few days later on Oct. 29, 2003, SEMSA held a news conference in Saskatoon to express frustration with the provincial government, saying the NDP has not met with the association to discuss the association’s concerns with the state of EMS in the province.

“We are facing serious issues that require government leadership and participation to solve,” Dutchak said.

Following the press conference SEMSA delivered a two-page document entitled Proposal for Partnership to the Saskatoon cabinet office.

“We’ve been successful in having the Saskatchewan Party sign this document. It just provides a framework for how we’re going to work together to reconcile issues,” SEMSA executive director Shirley Antonini said. [EMS facing ‘crisis’: group (StarPhoenix, Oct. 30, 2003)]

The close working relationship between all those involved still seems strong today.

A Sept. 9, 2008, briefing note estimated the cost of the EMS review at approximately $100,000, which the ministry “will attempt to absorb” within the current 2008-09 budget allocation.

The document also indicates that: “There is a consensus among the Ministry, the RHA’s and Saskatchewan Emergency Medical Services Association on a number of EMS issues. Budget proposals are therefore under development in the Ministry to address three of these issues in the 2009-10 budget.”

Exactly what these issues are is unclear because the ministry severed that section of the report.

However, the record does say that the ministry “continues to work with SEMSA and health regions in pursuit of change to the regulatory environment affecting EMS including development of a template service contract for EMS.”

Today SEMSA represents 83 out of 109 ambulance services within the province of Saskatchewan. The organization recently announced on its website that EMS review stakeholder meetings for all members would take place at the Travelodge Hotel in Regina on Feb. 13, 2009 and in Saskatoon on Feb. 27, 2009.

“The SEMSA Board has requested the provincial govenrment [sic] to agree to an EMS Review for some time and the opportuity [sic] is now upon us. Now, it’s time to hear directly from the membership,” a posting on the SEMSA website states.

If anything is certain about the EMS review, it’s that SEMSA appears to have a central role, one that will no doubt influence the outcome.

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UPDATE: On Dec. 12, 2008, a request was made to Saskatchewan Health for a list of stakeholders that the EMS Review Committee would be consulting with as part of the review process. The ministry responded that the list was “under development” and would “be available at a later time.” Subsequent requests for the information were made on Jan. 31 and Feb. 2, 2009.

On Feb. 17, the ministry advised that “the EMS Review Committee has corresponded with the following stakeholders” to date:

Federation of Saskatchewan Indian Nations
Saskatchewan College of Paramedics
Saskatchewan Institute of Applied Sciences and Technology
College of Physicians and Surgeons of Saskatchewan
Saskatchewan Registered Nurses Association
Saskatchewan Association of Licensed Practical Nurses
Saskatchewan Association of Rural Municipalities
Saskatchewan Urban Municipalities Association
Saskatchewan Office of the Fire Commissioner
Saskatchewan Association of Fire Chiefs
Saskatchewan Professional Fire Fighters Association
Health Sciences Association of Saskatchewan
Canadian Union of Public Employees (Saskatchewan)
Service Employees International Union
Saskatchewan Government Employees Union
Saskatchewan Police Commission

The ministry also said, “In addition to the health regions and members of SEMSA, there will also be an invitation to members of the public and other interested organizations for submissions as part of the consultation process.”

It remains unclear which organizations, if any, have had face-to-face meetings with the review committee.



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