Compromise bill to address hospitals' issues with ambulance services passes first hurdle; aimed at delays in transfers

Update 3/16/22: House Bill 777 was heard in the Senate Health & Welfare committee today, but was delayed after the Kentucky Association of Counties objected to parts of it. Chairman Sen. Ralph Alvarado asked the stakeholders to go back to the negotiating table and try to work out their differences before they vote on it. 

By Melissa Patrick
Kentucky Health News

With input from 13 stakeholders, a compromise version of a bill to improve ambulance responses to both emergent and non-emergent transfers is headed to the full House for consideration. 

Rep. Ken Fleming, R-Louisville

Sponsor Ken Fleming, R-Louisville, told the House Health and Family Services Committee that it had taken more than 1,000 hours of work to produce House Bill 777, with input from a range of lobbying interests. This is the third numbered version of the legislation to be filed, which is unusual.

Previous versions included things like response time requirements, putting regulatory authority in the Cabinet for Health and Family Services and eliminating of the need for any new emergency medical service to get a certificate of need from the state. All those provisions caused an uproar among EMS workers and some of their allied associations, but HB 777 appears to be more palatable, with only a few concerns voiced to the committee Thursday. 

"This bill has not been an easy task," Fleming said. "It reflects the stakeholders . . . being open-minded, and their willingness to serve patients, and their determination to do the right thing." 

Fleming said the bill "moves the ball forward" in dealing with issues of transportation between health-care facilities, the main impetus for the bill. 

"I have many examples where patients were not transferred from one facility to another from either eight hours or several days," he said. 

The bill was the brainchild of the Kentucky Hospital Association. Its president, Nancy Galvagni, spoke of long delays that hospitals experience when trying to get patients to the level of care that they need, especially in rural areas. In an earlier interview with Kentucky Health News she told of patients who had died waiting on a patient transfer and psychiatric patients who were being refused transport. 

"The problem we're seeking to address isn't a hospital problem. It's not an ambulance problem. It's not a local government problem. It's a patient problem," she said. "And I think we all understand that we just can't do things the way we've always done when people's lives and their health is in the balance."

A key provision in HB 777 would establish a task force to meet between legislative sessions to study emergency medical services and make recommendations to the General Assembly. It would require the Kentucky Board of Emergency Medical Services to create a special committee to study a list of specific issues defined in the bill, such as response times and needs of patients with behavioral-health issues. 

Both lawmakers and stakeholders praised the idea of the task force, which was not included in previous versions of the legislation.

The director of KBEMS, Mike Poynter, told Kentucky Health News in a statement that it was unfortunate that the agency had been mentioned as part of each of the three bills filed on this issue. In an earlier interview, Poynter told KHN that while there is always room for improvement, "I don't think KBES is broken and I have the statistics that can back that up."

"We do believe that House Bill 777 is the best compromise we can come to at this time," Poynter said in a statement. "We wish that KBEMS and other EMS professionals would have been brought to the table before any of this legislation took draft. . . . We would welcome more time to sit at the table with all affected stakeholders to create a more pro-active plan, rather than be forced into a reflex, expedited reaction."

Poynter also spoke to the resiliency, passion and expertise of EMS workers. "Like we always do, the EMS family adapts and will find solutions to problems no matter what. EMS professionals don’t do what they do because they have to, they do so because they feel called to do so."

The bill would also reform aspects of the certificate-of-need requirements to allow cities, counties and hospitals to transport patients under certain conditions without obtaining a certificate. For example, a hospital could create an ambulance service limited to transporting patients from that hospital.

Galvagni told Kentucky Health News that Kentucky is one of only two states that has a certificate-of-need process for ambulances, which she said creates a barrier to care. 

Conjuna Collier, senior vice president of risk management at Masonic Homes of Kentucky, told Kentucky Health News that the certificate-of-need portion of the bill is important due to the challenges ambulance services face in managing emergency calls and inter-facility transfers. 

Collier said that they have transfer issues "on a daily or weekly basis," including patients discharged from the hospital early in the morning but not arriving at the next facility until late in the evening to "way up in the middle of the night." She said they also struggle to get Covid-19 patients transferred and get patients to and from dialysis in a timely manner. 

"Of course, a heart attack is going to come before picking up a 90-year-old at a dialysis appointment, but then there still is that service that's not getting provided for that resident," she said, later adding, "There just needs to be more of them." 

Dr. Walt Lubbers, an EMS physician, medical adviser for the Kentucky Board of EMS and a representative of the Kentucky EMS Association, said the bill offered a "reasonable compromise on a whole lot of things."  

"It provides good stability for letting the folks that know about EMS continue to regulate EMS, as well as a reasonable change to the complaint process," Lubbers said. "And it recognizes that we don't think we're done and that we can't walk away with this being the only EMS bill that any of us ever think of."

Harlan County Judge-Executive Dan Mosley said he wasn't at the meeting to support or oppose the bill, but to voice concerns and to ask that they "look at it further" and "slow it down."  

He said he gets many calls from people who can't get transported from Harlan Appalachian Regional Healthcare Hospital to UK HealthCare in Lexington or that an ambulance did not make it to their home. "This happens more often, more times than it should," he said. 

Mosley said his concern is around the shortage of personnel in emergency medical services, and what would happen if more services are allowed to open that could further dilute their workforce and services.

"The goal has to be what we can effectively do that improves the service to our citizens, not only those that are in the hospital, but those that are at home that need to call 911 and expect and deserve that that ambulance gets there to help them," Mosley said. "Until we address the human shortage element in this industry. I'm afraid efforts like this will have unintended consequences." 

Kevin Pharis, director of Grayson County EMS, told Kentucky Health News that removing all of the certificate-of-need requirements, as proposed in the previous bill, would not fix the problem because "We do not have the personnel to staff ambulances that we already have." He said paramedics are leaving for better pay better pay and working conditions in hospitals, and the cost to become a paramedic versus what they are paid is a problem.

The bill doesn't deal with staffing, but that is part of budget discussions because sponsors recognize that staffing is an issue, said Rep. Kim Moser, R-Taylor Mill, a recent co-sponsor of the bill and chair of the committee. 

The hospitals' Galvagni said, "House Bill 777 does not give all parties what they desire, but we feel it's an important first step to addressing the needs of our patients. . . . We're very proud that we were able to work out a solution to move this issue forward." 

HB 777 would also: 

• Require the health cabinet to investigate and hold hearings regarding complaints related to ambulance services, while leaving disciplinary enforcement to KBEMS;
• Make it easier for patients to register complaints;
• Give the cabinet complete and immediate access to all data and records of KBEMS and its contractors;
• Make KBEMS an independent agency of state government, rather than part of the Kentucky Community and Technical College System;
• Add KBEMS to the list of boards and commissions for which the Department of Professional Licensing in the Public Protection Cabinet provides administrative services, technical assistance and advice;
• Exempt organ-procurement organization vehicles from speed limits and traffic-flow patterns while transporting a human organ or tissue in an emergency situation; and
• Create a Technical Advisory Committee on Emergency Medical Services to advise regarding Medicaid EMS issues.

Other organizations involved in crafting the bill are the Kentucky League of Cities, the Kentucky Association of Firefighters the Kentucky Psychological Association and Advocacy Network; the Kentucky Association of Counties; the Kentucky Association of Healthcare Facilities;, the nursing-home lobby; the Kentucky Center of Assisted Living; the Kentucky Ambulance Providers Association; the Kentucky Association of Public-Safety Communications Officials; and the Kentucky Emergency Number Association.