MAST ambulances race to the city's emergencies -- but who's going to rescue MAST from its own injuries?

Internal Bleeding 

MAST ambulances race to the city's emergencies -- but who's going to rescue MAST from its own injuries?

It was Easter Sunday of 1997, and David Thayer had just come home from a family feast at his grandparents' house when his phone rang. It was his buddy, Elmo Wilcox, who was whooping it up at D.J.'s Bar on State Avenue in Kansas City, Kansas. Wilcox wanted to take his prized bike -- a 1980 Harley Sturgiss Wideglide with lots of chrome trim -- out for a ride, and he wanted Thayer to go with him. Over the din of the bar, Wilcox hollered out to the bartender, "We need three more shots!"

Thayer had been friends with Wilcox since their days at Eisenhower Middle School in Kansas City, Kansas, and they had been through some rough times. Wilcox had lived with Thayer at his Overland Park home for six months during Wilcox's divorce, and he worked as a driver for Thayer's company, V.I.P. Limousines. So Thayer spared no words in warning Wilcox not to bike drunk.

"I said, 'You need to get your butt home and put your bike up and go get your car. You can drink all you want in your car, but go put that bike up. You don't drink shots and ride your bike!'" Thayer remembers. Wilcox did not heed his friend's advice.

Wilcox left the bar on his bike with two other guys behind him. The three roared up to a red light in front of Wal-Mart at 65th Street. Wilcox drove through the stoplight, speeding up the hill at about 90 miles per hour. As he topped the hill, a long-bed Chevy pickup turned in front of him, and Wilcox smashed into it at full throttle. He wasn't wearing a helmet.

Thayer's phone rang again. It was another buddy of his, a firefighter who had responded to the scene of Wilcox's wreck. "Your buddy Elmo's been in an accident, and it doesn't look good," the firefighter told him. Thayer rushed to the emergency room at the University of Kansas Medical Center, where he found Wilcox's father, stepmother, brother, and ex-wife -- and Wilcox's high-school sweetheart, Michelle Miller, a Metropolitan Ambulance Services Trust paramedic whose coworkers had alerted her to the accident.

After Wilcox had been in surgery for two hours, a doctor came out and began describing the injuries. If Wilcox lived, the doctor said, he would lose an arm and a leg and would be hooked up to bags for all of his bodily functions. The accident had left him ripped open from the inside of his left leg across his stomach, and he had severe head injuries.

Before she left the emergency room, Miller took Thayer aside. Her coworkers had told her about what had happened at the scene of the accident. She told Thayer that rescue workers could have had Wilcox to the hospital 20 minutes sooner if a power struggle hadn't broken out between the MAST emergency medical crews and the firefighters at the scene.

"The fire truck blocked the ambulance in," she told him in a hushed voice.

She said the firefighters had called in a Life Flight chopper and had prevented MAST crews from taking the patient straight down College Parkway to I-70 East and to the hospital. Then the firefighters shut down heavily traveled State Avenue so the chopper could land.

Miller still gets angry about what happened to the man she used to go roller skating and joyriding with when they were teenagers. "There was no reason for the fire department to call a helicopter, because there was perfect access where they were," she tells the Pitch. "You use your helicopter for your remote areas, like west of I-435. At 72nd and State Avenue, there's no reason to have a helicopter. What was involved in landing that chopper in the middle of that mess was just asinine. And why wait 15 minutes for the chopper to fly over and land?" she rants. "It was all about who's gonna have the most power on the scene, and the kid's dead now. Would that extra 20 minutes have saved him? Who knows."

When the waiting family members were informed that Wilcox was dead, four hours had passed from the time he had been brought in.

Even before the pronouncement, Thayer knew his friend was in bad shape and wouldn't have wanted to live as an amputee anyway, so he only half-listened to what Miller was telling him.

Miller, who no longer works for MAST, says that while MAST crews "probably wouldn't have the balls" to blatantly try to control an accident scene the way firefighters did, patients can still become pawns in a power struggle between the entities -- one that has been going on since the firefighters first proposed taking over emergency medical services for Kansas City.

That unhealthy competition with the fire department may just be the most obvious example of internal problems at the ambulance-service provider. But when MAST's own employees try to correct those problems from within, company management only half listens. Or worse yet, according to some former and current employees who spoke with the Pitch, those outspoken employees lose their jobs.

Several employees of Emergency Providers Inc., the employee-owned company that provides ambulance services for MAST, spoke to the Pitch about the situation. Frank Lowry (not his real name), an emergency medical technician and father who loves his job and is known to coworkers as stoic and hardworking, says he wants the public to know about problems at MAST but wants to stay on management's good side. He and others say that MAST and EPI management have "lost the whole purpose of why we're here -- saving lives."

Current and former employees say that the structures of MAST and EPI and a weak union cause many employees to keep quiet when it comes to their concerns about management decisions that affect employee morale and public health.

The Metropolitan Ambulance Services Trust public-utility model was first developed for use in Tulsa, Oklahoma. In 1979, Kansas City, Missouri, conducted a feasibility study for using it here. Through the early '70s, Kansas City had operated a public ambulance system and then used the services of four private contractors. The service was riddled with problems, including slow response times and lack of service to some areas of the city -- partly due to confusion among the private companies over who should respond to a call. The headquarters of a clearinghouse for emergency requests was located at Linwood and the Paseo, but each company also had a private phone number. The year Kansas City began studying Tulsa's model, the employees of all the local ambulance companies got together and formed Local I-34 of the International Association of Firefighters. The private companies then merged, and shortly after the feasibility study, the city formed MAST.

The new entity would be overseen by Kansas City, Missouri's health director and an emergency-physician advisory board. MAST chose Medevac Inc. to operate the system; the company did so until Medevac employees decided in 1988 to form Emergency Providers Inc. Through an employee stock ownership plan, employees purchased EPI in 1989. Now more than 300 of EPI's 405 employees own stock in the company.

After the employee purchase, EPI continued to staff, dispatch, and maintain ambulances for MAST. In 1993, the city awarded EPI another five-year contract to operate the MAST system. Response times and coordination continued to improve, and in 1995, EPI and MAST jointly bid on and won a contract to take over ambulance services in Kansas City, Kansas, and Edwardsville, Kansas. (MAST now also serves 14 other Missouri municipalities, mostly in southern Platte County.)

MAST would handle the financial elements of the system -- a $30 million-a-year budget -- pay EPI each month, and own the ambulances and most of the equipment. EPI would staff the system. The ambulance service soon gained a favorable reputation nationwide and became known for quick response times, with ambulances often arriving on the scene in eight minutes or less. Now, MAST Executive Director John A. Sharp says, "Our clinical care and response times are the envy of the nation. MAST is the only ambulance system in Kansas and Missouri that's nationally accredited. You don't get that unless you are consistently providing an excellent level of service."

Then, in 1998, Kansas City firefighters proposed taking over emergency medical services. They argued that because of the many fire stations around the area, they could provide quicker response times, and they griped that MAST was not notifying them of emergencies in a timely manner. A January 2000 report by City Auditor Mark Funkhouser, however, found that although the fire department was "concerned about a perceived delay" in notifying firefighters of emergencies, there was no evidence to support the firefighters' argument that MAST was deliberately putting off notifying them.

Still, Funkhouser's report admonished the two agencies to "collaborate rather than compete."

Sharp says conflict between his agency and firefighters is "ancient history."

"We are working much more closely with the fire department since 1999. We're not at loggerheads anymore," he says.

But some EPI employees say that the hostility between firefighters and emergency medical workers that still occasionally breaks out at the scene of an emergency has been exacerbated by EPI management's efforts to keep the union fearful of losing EPI jobs to firefighters.

Although EPI employees are represented by Local I-34 of the International Association of Firefighters, they also own stock in EPI -- an arrangement that some of them say is uncomfortable and leads to poor representation of union members. Some employees say that the union has refused to file their grievances and represent them assertively -- they're given the impression that "fighting the company is fighting ourselves."

"Seems to me they're both sleeping in the same bed," one current EPI employee says of management and the union. "It's ridiculous."

But EPI spokesman Don Pickard says he is disturbed that employees would air their concerns publicly instead of going through the union's grievance procedures or taking advantage of what he calls an open-door policy at EPI, where managers are always willing to talk to employees and welcome complaints.

"This is an employee-owned company, and unfortunately, they think 'employee-owned' means they have a say in every little thing that comes up," Pickard says adamantly. "This is still a business."

Pickard says that in an employee-owned company, employees should be concerned with the same things any owner would worry about -- bottom line, revenue, public image, marketing. That outlook, employees say, is not conducive to actively challenging management through union channels.

One former MAST paramedic, Kathryn Harris, says she managed to alienate herself from the executive board of Local I-34 when, in her role as a union steward, she recommended that the union meet with the firefighters' Local 42 just to hear what members had to say about a possible takeover of emergency medical services.

"I figured there was no harm in getting together with them just to hear what their intentions were," she says. She didn't understand that the issue was a "touchy subject" for her fellow union members, who feared for their job security.

Harris started working for EPI in February 1996. Her career as a paramedic was going well, and after a year she applied for and got a promotion to field training officer. She taught classes for other paramedics in advanced cardiac life support and sometimes ate lunch and joked around with the managers who also taught classes. Harris had her first run-in with management, however, when as a union steward she went to a union meeting with documents to argue for keeping in place a shift structure an employee had instituted. The worker had been promoted to Kansas operations manager and then demoted after making the shift change in question.

"I presented a summary of events and defended her actions," Harris says, noting that after the meeting, EPI retained the new shift structure.

Shortly after that incident, in March 1998, a close friend of Harris', a fellow paramedic, shot and killed himself. Harris was traumatized by the loss, and her doctor recommended a leave of absence. She took two weeks off under the Family and Medical Leave Act. But when she returned to work one morning, the director of human resources told her she would not be able to work that day. Her boss told her she would have to submit to a drug test and a six-hour psychological evaluation to return to work, but he didn't say why. She presented him with the collective bargaining agreement for Local I-34, which stated that drug and alcohol tests could be ordered only because of motor-vehicle accidents while on duty, illness or injury resulting in worker's compensation claims, or probable cause that an employee is under the influence of drugs or alcohol. Random tests could be conducted in the case of previous positive drug tests or severe attendance violations.

Production Manager David Shost told Harris that management was ordering the tests because of a recent behavior change, and he called Harris' actions toward managers, in her role as a union steward, "aggressive." Harris pointed out that because she was a union steward, meetings with management on behalf of union members could not be used against her. And later, Shost sent a memo to the Local I-34 president withdrawing the request for a drug and alcohol screen. "I apologize for the use of the word 'aggressive' when referring to her behavior towards management," Shost wrote.

Harris filed grievances with the union anyway, but the union's executive board refused to pursue her complaints. Unable to get help from the very union for which she was a steward, Harris turned to the U.S. Department of Labor. She filed a complaint over having to submit to the psychological evaluation, and she was suspended by EPI during the investigation. The Department of Labor recommended that the company return Harris to work immediately without the examination. A Department of Labor investigator, however, told Harris that EPI had sent a letter saying that the management "respectfully disagreed" with the department's finding.

Harris finally took and passed the psychological exam and returned to work. After that, however, she was never scheduled as a field training officer. From then on, she says, she knew her job was in jeopardy. And Harris' health problems weren't over. She needed surgery and took extra time off, so EPI allowed other employees to bid for her shift in violation of the employees' collective bargaining agreement.

Harris filed a grievance with the union, and again, her representative refused to pursue it. She was cleared to return to work after 89 days, one day before managers could have legally given away her shift, but was unable to complete a required lifting test for three more days. The paramedic who had bid for her shift offered to trade it back to her, but managers wouldn't allow it. However, Harris says, EPI higher-ups often kept shifts open for longer than 90 days for favored employees.

Further serious medical problems required another surgery and more time off in 1999 -- and it was during the summer of that year that Harris approached the union about meeting with firefighters. On March 15, 2000, she was fired for excessive attendance violations.

Harris had been disciplined as soon as her attendance violations reached the limit of 28 points. Accruing more points can result in a one-week suspension, then termination. According to the current collective bargaining agreement, an employee cannot call in sick without accruing points -- a run-of-the-mill sick day earns an employee four points, while being tardy or leaving work early because of illness is worth two points. That policy, Frank Lowry says, means that taking just seven sick days during the year can result in a disciplinary one-day suspension. He says the policy forces employees to come to work coughing and sneezing with colds, flu, bronchitis, and other illnesses so they can keep their jobs.

"People do it all the time," Lowry says. "In a business where we are around sick people 365 days a year, we are bound to get sick. It's not unusual for us to have colds and stuff in the middle of July. So if I come in to work sick, and if I'm going into an (intensive care unit) to pick somebody up, and if I'm coughing and hacking at an ICU, I'm infecting that entire ICU because they're already at their weakest."

EPI managers say employees are free to cover their sick days under the Family and Medical Leave Act so they don't accrue violation points but they must visit a doctor every time they are sick -- even with a cold -- to be eligible.

Lowry admits that he has run up more than 28 attendance violation points, despite coming in to work sick, but his bosses have not disciplined him for it. EPI managers follow the rules only for some people, he says.

"Their attendance policy is out of control," says paramedic Eddie Neffler (who did not want his real name used because he is in good standing with EPI managers). Because he tends to be outspoken when he sees problems at EPI, he has been vigilant about keeping his attendance violations well below 28 points. Neffler, who speaks calmly and measures his words carefully, says that although he has known some good employees who have been fired, some of them gave management an excuse to do so by running up attendance points.

"Some people would see (employees who say they were fired unjustly) as bitching whiners," he says. But he knows of one employee who has 96 points but has not been disciplined. For two years in a row, Neffler says, managers have disciplined those they chose to "go after" and then taken everyone else's attendance-violation points down to zero to give them a second chance.

Michelle Miller, the paramedic who went to the emergency room after Elmo Wilcox's motorcycle accident, believes she too was unjustly fired. In fact, Harris says she may unwittingly have caused Miller's firing because she cited Miller as an example of someone who had high attendance-violation points but had not been disciplined. Miller is a single mother whose son has serious medical problems. Some of her coworkers say she was repeatedly late to work and occasionally lost her temper.

Miller, who started out as an emergency medical technician, says she was doing fine with the company until she became a paramedic (EMTs have less training and perform fewer procedures than paramedics). She had driven 100 miles almost every day to attend paramedic training in Fort Scott, Kansas, and finally got her certification. Then she was increasingly absent from work so she could accompany her son to the hospital. Miller began to use the Family and Medical Leave Act to take time off to care for her son, and her conflicts with EPI managers over attendance subsided.

In March, shortly after Harris was fired, Miller says the company got rid of her by citing attendance violations and an incident that occurred while transporting a frail newborn between hospitals. Miller says she got angry when her partner balked at doing the transfer because he was afraid he wouldn't finish his shift on time. When he refused to help doctors and nurses prepare the ambulance, Miller says she went back to help, muttering, "Sorry my partner's an asshole!"

After that incident, she says, management refused to talk to the nurses involved but gave her a verbal warning, a written warning, a one-day suspension, and a one-week suspension all in one afternoon. She was fired for attendance violations and for "refusing to help the neonatal intensive care unit team on a call," according to her termination papers. She filed grievances with the union but says that union representatives refused to return her phone calls.

"They are not on your side. They're on management's side," she says of the union. "You show them the contract in black and white. They wrote it, and they'll still tell you you're wrong."

At the same time EPI managers are firing competent employees they dislike, they sometimes endanger the public by refusing to fire employees they like, employees say.

Lowry cites the case of one longtime paramedic, whom he calls "the darling of management, even though they know" the employee can't perform the duties sufficiently.

The paramedic, Lowry says, works as an advanced cardiac life support trainer but cannot properly insert a tube into a patient. The paramedic's current partner is another paramedic, even though an ambulance crew normally consists of one paramedic and one EMT. The problem, Lowry says, is that by law EMTs aren't allowed to intubate patients. This paramedic was certified, he says, because classes and tests make use of dummies, not real people.

"Anybody can stick a tube in a dummy," he says. "It's a whole different ballgame when you're sticking a tube down a real throat."

But EPI spokesman Pickard, who has a backgound in emergency medicine, says he "would be shocked" to hear of such an employee. When the Pitch first asked him about the employee, he said there were no teams in which two paramedics worked together and that there was always one highly trained paramedic with an EMT. When pressed, however, Pickard admitted that the paramedic worked with another paramedic. But Pickard denies Lowry's allegations that the two paramedics work together so that the other partner can legally perform intubations. The spokesman says the two work together by choice.

Darryl Coontz, the quality improvement supervisor for EPI, who uses a sophisticated system to monitor employees' performance, says the paramedic did have a problem with intubation but he worked with the paramedic informally to correct it. Intubation rates have improved dramatically since August 1999, when Coontz developed an airway intubation lab for all new paramedics.

But Lowry says the paramedic has been through more than five partners, some of whom have requested to be assigned a new partner after they've had to answer the paramedic's excessive questions or after seeing that the paramedic does not properly triage an accident scene. He calls the situation "very scary" and says that according to company policy, an employee can be terminated after three partners request to be moved.

Coworkers say the paramedic has earned favor by getting along well with management and not causing problems.

After seeing how managers get rid of certain employees, others are afraid to make too much of an issue about problems. For example, some EPI employees are upset about a change in the way ambulances are stocked and checked before going out on the streets -- but they're not willing to confront management. Miller remembers that some employees objected in 1999 when management first announced that employees from the equipment department -- many of whom had only high school degrees and no medical training -- would check the ambulances, and that paramedics and EMTs were not to come in 15 minutes early to make sure the equipment was in working order.

"For the most part, that's a business decision," Pickard says. "Paramedics and EMTs are paid higher salaries because they have years of training, and they should be out on the street. The system we've got in place is, I think, very good." He says equipment handlers, who must be 21 and go through an orientation, check supplies and place them in an equipment room, sealing them to ensure integrity.

But some employees say the system is still flawed. One paramedic was on her way to a call when she noticed she did not have a heart monitor in her ambulance. Instead of disciplining the employee who had stocked and checked the ambulance, however, managers wrote up the paramedic for the infraction.

"In the morning when you came in, you'd never know if your truck is going to be ready ... or if you're missing equipment," Miller remembers. "They told us it would work out great -- you're going to come in, pick up your drugs, pick up this equipment, jump on the truck, and go. You don't have to check out the truck. The paramedics said, 'What happens if we get out there and we don't have certain equipment? That's our license on the line.' And they said, 'Oh, no, don't worry; it won't be that way.'"

But Lowry says that's exactly how it is now. He says that when paramedics and EMTs arrived early to check their own ambulances, crews almost never left without a piece of equipment. Now, he says, about once a week an ambulance leaves without an important medical device and that crews discover they are missing minor supplies, such as Band-Aids, about once a day.

"I used to check my ambulance diligently," Lowry says. "I don't do it anymore. If I get back out on a call and don't have a piece of equipment, I'm the one the family's looking at. (The equipment handlers') job is to check the monitors to make sure they work, but they don't even know how the monitors are used."

Even so, EPI CEO Jud Palmer says the vehicles have "become a lot more reliable" since equipment handlers came on board. For example, he says, some paramedics hadn't been doing a good job of checking the fluid levels on the vehicles.

Some employees say they are frustrated that EPI managers sometimes implement new blanket policies rather than admitting that company procedures aren't working. That's what happened when management classified all 911 calls as emergencies, calling for lights and sirens, even though citizens sometimes call an ambulance for a minor matter, such as a child with a cough or diaper rash, or even view it as a taxi service.

Pickard describes the incident that led to the policy, which some paramedics say needlessly endangers the public for nonemergency calls. In the late 1980s, MAST gave a lower priority to vehicle accidents where no police officers or firefighters were on the scene to verify the accident. Such calls were classified as "Code 3," meaning the ambulances were to use no lights or sirens. But when MAST sent an ambulance to an unconfirmed wreck in south Kansas City, it turned out "three or four kids had wrapped a Camaro around a tree," Pickard says. There were fatalities, and as a result, MAST eliminated Code 3 and required an emergency response to all 911 calls. "We decided to err in the best interest of the public," Pickard says.

But employees argue that the problem could have been solved by giving an emergency priority to unconfirmed accidents but keeping Code 3 for nonemergencies.

"When you see an ambulance running emergency in this city, they may be running emergency to a hangnail, and I am not kidding," Lowry says. "And that concerns me because when I turn those lights and sirens on, I'm not only risking my life but I'm risking the lives of the public in this city."

Pickard contends that such issues should be addressed within the company. But some employees say they will not feel comfortable doing so until internal changes allow for a stronger union. One employee says the city should take over and eliminate MAST's middleman: EPI management.

But Neffler says he has had some success talking through problems with EPI managers and that employees themselves shoulder a large part of the blame for a weak union. "The union is only as strong as the people who support it, and there's just a lack of interest," he says. "There's really no active participation, and then when people get in trouble with management, they want (the union) to come and save the day."

Pickard agrees, saying that employees should get behind the union and campaign for different union representatives if they do not feel adequately represented.

But that approach hasn't worked for union steward Kathryn Harris. Harris says her lawyer sent a letter to EPI's human resources department in 1999 when Harris first thought she was in danger of losing her job. The letter outlined each area in which EPI managers had violated the union's collective bargaining agreement. Human resources responded, telling her the claim appeared "to be based on the contract between EPI and Local I-34. Grievances arising under that contract must be processed under that contract." With the union refusing to pursue her complaint, Harris says, she had no recourse.

"There were protections that I was not afforded because I was a member of a union, and they are supposed to go to bat for you," Harris says. "Now I have nowhere to turn."

That's something current employees might want to bear in mind before they sound an alarm about problems at MAST.


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