Clinton man's death puts spotlight on EMT woes 

click to enlarge Southern Paramedic image

The death of former City Attorney Brett Blakney of Clinton May 4 for lack of transportation to a major trauma center played out against a history of legal battles in Clinton and Van Buren County over ambulance service.

Blakney, 43, the owner of the Black Dog Grill restaurant, was taken to Van Buren County Memorial Hospital at around 10 p.m. May 3 after a man punched him and knocked him to the ground outside the restaurant. Blakney was able to identify his attacker to police but later became unresponsive at the hospital and an emergency room nurse there told police that unless he was transported to a major trauma center "he's going to lay here with that head injury and bleed to death."

By the time the hospital determined that no helicopter would be available because of fog, Southern Paramedic had sent one of its two ambulances in Clinton to Little Rock with another patient and regulations didn't allow its second ambulance to leave the county, CEO Gary Padget said. Blakney died of head trauma at the hospital around 4 a.m. May 4.

A spokesman for the hospital said it "contacted multiple services" to transport Blakney but wasn't able to find one "immediately available."

Emergency Medical Services rules and regulations currently require that 911 calls take precedence over hospital-to-hospital transport, which meant Southern could not release its one ambulance in Clinton for out-of-county transfers until the second had returned to the county.

Southern Paramedic drove out another ambulance service, Vital Link, which had entered into an exclusive contract with the city of Clinton in 2005 and 2009. The Van Buren Quorum Court passed a resolution in 2009 to use Southern for calls originating outside Clinton, but the service also responded to calls inside the city, in violation of the city's franchise agreement with Vital Link. After a flurry of claims and counter-claims in court, the city's suit against Southern ended up in circuit court, where Judge Rhonda Wood ruled that Southern qualified for an exemption from the city's franchise as a "not-for-hire on a fee-for-service basis," which the judge interpreted to mean the ambulance was not available for hire by the general public where payment would be per transport. The Supreme Court refused on appeal to rule on the case, saying Clinton's release of Vital Link from its contract made the issue moot.

The city had released Vital Link after it threatened to sue, saying the county hospital's insistence on using a competitor was costing it money. Clinton Mayor Roger Rorie said this week that he predicted the day the city had to give up its franchise with Vital Link that "we will have a fatality due to the ambulance service." Unlike Southern, Rorie said, Vital Link owns ambulances in neighboring counties. Southern services Arkansas, Lonoke, Monroe, Prairie and Woodruff counties, none contiguous to Van Buren County.

In the wake of Blakney's death, the Clinton City Council passed a resolution asking the Quorum Court to work with it to find a solution to the ambulance problem. The Quorum Court responded with a resolution creating a 13-member committee made up of Clinton aldermen, Van Buren County justices of the peace, the mayors of Clinton, Fairfield Bay, Shirley and Damascus and EMT and fire personnel, giving it 90 days to come up with recommendations for improvement.

Though it wasn't mentioned specifically, Blakney's death prompted much discussion at the May 15 meeting of the state Trauma Advisory Council about the need for change in ambulance and trauma rules and regulations.

Dr. Todd Maxson, the state Health Department's medical consultant, said the trauma system should create an urgent trauma transfer rule, adding, "The [trauma] patient has to have the same priority as a person calling 911."

TAC member Dr. Clint Evans, an emergency room physician, also said that Level 4 hospitals — the lowest level of service in the trauma system — need "education" in which patients need ambulance transport and which do not. He said non-emergencies — he cited a three-hour transport for a broken arm — were wasting resources, and "they've got, on the hospital's end, to do a better job."

Evans recommended the council define an urgent trauma transfer rule immediately, but the council would have no regulatory authority to enforce it until the rule was adopted and approved by the state legislature, a process that takes months. The rule will be drafted by the council's quality assurance group instead.

Dr. James Graham, chair of the Trauma Council, in an interview before the meeting, said ambulance service in rural areas of Arkansas was a "major challenge" and crucial to "making the system work right. If you had your druthers, you'd staff five or six [in a county] and never run out of one." Instead, some ambulance services are volunteer — "they're having a chili dinner to put gas in the truck."

To assure ambulance back-up, the trauma system enacted a rule this year that transport services receiving trauma dollars have "backfill agreements" should they be unable to respond to emergency calls. Forms setting out the agreements were to have been filed with the state Health Department by March 31. The council learned that fewer than 50 percent — 41 out of 116 of the ambulance services getting trauma dollars — have filed their backfill agreements, also known as mutual aid agreements.

Graham expressed surprise that checks had gone out to ambulance services that had not filed their backfill agreements. If they do not do so by the end of the fiscal year, they will lose their trauma dollars in fiscal year 2013.

The Health Department said Southern Paramedic, which received $14,205 in fiscal year 2012 in trauma funding, was one of the companies that had not filed its backfill agreements with the state. (Southern CEO Padget said the Health Department often loses forms and that he believes the company filed its backfill information.)

Southern uses its entire system as backfill. When Blakney needed an ambulance, the closest would have taken an hour and a half to reach Clinton, Health Department spokesman Ed Barham said. Clinton is an hour and 20 minutes from Little Rock.

Southern received a total of $92,071 from the state for the six counties it serves.

Clinton Mayor Rorie said the "city of Clinton is going to give it every chance possible," referring to the work of the 13-member committee. "We're determined to solve this." JP Dale James, who drafted the quorum court resolution, said the committee would study how other counties handle their ambulance contracts and said he feels "very positive" something will be worked out.


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