After changes to appease county governments, the bill to address ambulance transfer times is raring to go for its final dispatch

Dwayne Oliver and Doug Byers of Lee County's ambulance service
refit one after a run. (Photo by Ryan C. Hermens, Lexington Herald-Leader)

UPDATE: March 29, The Senate passed HB 777 with a committee substitute 34-2. The House concurred in the Senate changes, giving the bill final passage. 

By Melissa Patrick

Kentucky Health News

After yet another round of negotiations, a House bill aimed at improving ambulance transfer times nears a vote on the Senate consent calendar, used to pass bills without further discussion.

"All parties came to the table and I think we all agree," Rep. Ken Fleming, R-Louisville, the bill's sponsor, told Kentucky Health News. "We know it's not perfect. We do have a lot of work ahead of us in the task force, and then we're gonna really peel this whole issue back even further to make sure that we deliver the best quality of care for patients." 

Fleming told the Senate Health and Welfare Committee March 16 about a friend's sister who died while waiting on transport, and of organs that had barely made it to the hospital on time to save a life.

The Kentucky Association of Counties objected to parts of House Bill 777 and Chairman Ralph Alvarado asked them to go back to the negotiating table to work our their differences.

Senate President Pro Tem David Givens, R-Greensburg, was touted as being instrumental in finding consensus. He said KACo still does not support the bill, "but I sense that their opposition has now been moved to a place of neutrality." The bill is being pushed by the Kentucky Hospital Association.

Fleming said one change would require the Cabinet for Health and Family Services to send a notice to all cities and counties that a hospital has proposed to establish an ambulance service. The legislative bodies of the affected cities and counties would have 30 days to respond, and lack of response will be deemed support.

Another change would "sunset" the new rules in 2026, while allowing "all actions taken by cities, counties and hospitals, exemptions from obtaining a certificate of need and any certificate of need" granted under these new rules to remain in effect on and after this date.

A certificate of need is, in effect, a license to operate a health-related service. "Kentucky and Hawaii are the only states that regulate ambulance services under a certificate-of-need provision," notes Alex Acquisto of the Lexington Herald-Leader. And Kentucky does that with an independent Kentucky Board of Emergency Medical Services, comprised of EMS personnel.

The bill would make the board an independent agency of the state government, which would investigate all complaints about ambulance services, while leaving discipline to the board, and create a task force to do a thorough review of "the need, or lack thereof, for the certificate-of-need process for ambulance services."

Fleming said that will be one of the task force's biggest assignments. "There are 48 states that do not have certificate of need when it comes to ambulances," he said, "so we've got to figure out why are we an outlier."

Rep. Ken Fleming

The task force was a way to scale back the original version of the bill by deferring action on some points. "We're going to have to roll up our sleeves," Fleming said. "It's just going to be good, healthy discussions." He said it will be important for the task force to look at EMS workforce issues because that is a challenge that keeps coming up. 

Among other things, the bill would reform the certification requirements to allow cities, counties and hospitals to transport patients under certain conditions; make it easier for patients to register complaints; and exempts organ-procurement organizations from speed limits and traffic-flow patterns while transporting a human tissue in an emergency.

Stories of ambulance delays abound.

Acquisto's story begins with the story of an emergency patient at the St. Claire Regional Medical Center in Morehead with a ruptured blood vessel in his esophagus who waited five and a half hours for an ambulance (helicopters were not available because of rain) and was finally transported to Lexington in an ambulance from Ohio, which hospital CEO Donald Lloyd told her is "not permitted."

Acquisto reports that a survey done by the hospital association found that the average wait time for patients to be transported was seven to eight hours, with 90% of those requests to transfer a patient to a higher level of care, according to Nancy Galvagni, president of the association.