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‘In the best interest of our patients’

Did MCMC retaliate against Stanley Ambulance?

STANLEY — Controversy continues to surround Stanley Ambulance Services two years after Mountrail County Medical Center in Stanley changed direction in its relationship with the local ambulance company.

When representatives from MCMC and Stanley Ambulance Services (SAS) convened for a meeting on June 1, 2020, Ambulance Resources owner Ken Rensch hoped that dialogue and communication would help clear the air between the hospital and the ambulance. The meeting came some months after complaints against nurse practitioner Richard Laksonen and MCMC were made to the Department of Health by the New Town Ambulance Service.

Instead, a recording of the meeting shows Rensch was rebuked by Laksonen, who said the ambulance was “overreaching” for questioning decisions to transfer MCMC patients to other medical centers, and that on advice of counsel the hospital would be “going in a different direction for transfers due to recent events.”

A letter sent to MCMC by McGee, Hankla, and Backes, its attorney, cited two incidents from March 11 and May 26, 2020, in which Rensch contested the emergent nature of some transfers, which the hospital believed he didn’t have a right to do. MHB recommended that the hospital report Rensch to the North Dakota Department of Health and Emergency Medical Systems. The letter concluded saying that the hospital should consider utilizing a different ambulance service.

The hospital would go on to exclusively utilize Community Ambulance Service and NorthStar Criticair in Minot, both of which are owned by Trinity Health and currently operate as Trinity Health First Response. Representatives said the hospital was making this decision “in the best interest of our patients.”

Two days later, a special meeting was held with the SAS board, Rensch, and the Mountrail County Medical Foundation board on June 3, 2020. On a recording of the public meeting, MCMF President and Mountrail County State’s Attorney Wade Enget confirmed the decision was partially due to Rensch bringing complaints lodged by New Town’s ambulance service with the state health department to the attention of then State Health Officer Mylynn Tufte.

“So, something happened with New Town and Parshall, and we’re getting blamed for it?” Rensch asked during the meeting.

“That’s not what I’m saying. I’m saying that it affects the relationship because you have a relationship with them,” Enget had said.

Laksonen fired off a flurry of complaints against Rensch and SAS to state regulators, leveling a variety of allegations and complaints for every single transfer call handled by SAS from MCMC over a two-week period. Rensch and the Stanley Ambulance responded to the complaints, saying they were spurious and retaliatory. The Department of Health reviewed the matter, concluding in September 2020 that no EMS violations occurred in any of the 12 incidents Laksonen filed complaints on.

Laksonen is currently in federal prison after pleading guilty on Aug. 8, 2021, to charges related to $4.7 million in Medicare fraud during a period he worked in Michigan. He will be released in September 2023.

After the pair of meetings and the deluge of complaints from Laksonen, Rensch formally filed complaints of his own with Bridget Weidner, the director of the Division of Health Facilities in the health department.

The patient’s cost

On June 10, 2020, MCMC CEO Stephanie Everett sent a letter to the editor of the Mountrail Country Promoter, offering some clarification to the community regarding the decision. The letter said that the hospital “cares deeply about its patients’ well-being” and that the only changes patients would experience is a different ambulance service during transfers to different hospitals. The letter did not explain why the hospital was taking this action.

Based on open records obtained by The Minot Daily News that tracked transfers out of MCMC, the SAS was passed over for approximately 150 transfers from June, 2020 until August 2021. The effects on the hospital’s patients, and on the Stanley Ambulance Service, were immediate.

If a patient was in desperate need of a transfer from MCMC to anywhere in the state, they would have to wait for Community Ambulance to be contacted, assemble a crew, drive nearly an hour to Stanley from Minot, and then transport them to their destination, while SAS and its two full crews sat unused minutes away, deliberately left on the shelf.

SAS medical director Dr. Paul Olson was also in attendance at the June 3 meeting. He shared an anecdote in which Community Ambulance was unable to get a crew together to transfer a stroke patient in Stanley, leading to a helicopter being flown in by NorthStar, all in order to not utilize SAS in any way.

For context, the average helicopter medivac can cost anywhere from $25,000 to $45,000, and comes with less technical capabilities than a typical ambulance in the SAS fleet, which can make the 50-minute drive to Minot for around $3,000 round-trip.

Documents tracking inter-facility transfers from MCMC indicate that such a volume of air ambulance flights to any destination were not the norm for the hospital. From the period beginning June 3, 2018-June 1, 2020, MCMC used air ambulance services one time on June 27, 2019. All other transfers in that interval utilized only SAS ambulances.

Of the 150 transfers diverted away from SAS after the meetings in June, roughly half were sent instead to air ambulance solutions like NorthStar Criticair. Of that number, over 40 of them were flown to Trinity Hospital in Minot.

Hospitals are required by federal regulations to provide good cause for utilizing air transport, either due to the severity of the patient’s condition or if ground ambulances are unavailable.

“They were saying ground ambulances weren’t available. They contacted other ambulances, but they didn’t call us, the licensed provider in the area,” Rensch said in a phone call with The Minot Daily News.

After Rensch’s complaints to the health department, the North Dakota Attorney General was looped in. A 2017 memorandum from the Attorney General had previously addressed the issue of which ambulance services should be utilized by hospitals for inter-facility transfers, establishing the precedence favoring local solutions. Christopher Price, the director of the Division of Emergency Medical Systems, would send an email to MCMC CEO Stephanie Everett on June 24, 2020, bringing the 2017 memo to her attention and directing the hospital to utilize the local ambulance.

When the discrimination continued, Price sent Community Ambulance a cease-and-desist letter on Dec. 4, 2020, which MCMC’s attorneys contested, finding ambiguity in the statute. This ambiguity was addressed by legislation in the 2021 session that codified the emergency nature of inter-facility transfers, forcing the hospital to use SAS as they were the “closest appropriate service.” However, the damage was already done by the time MCMC began using SAS again.

“Right now, they are utilizing us for transfers, but the retaliation is still happening,” Rensch said.

Price of local politics

MCMC’s decision resulted in a financial shortfall for the Stanley ambulance, which led to the board taking out a loan in 2021, in turn leading to an increase in the local mill levies, upsetting local taxpayers in 2022.

This discontent increased attendance at SAS board meetings, culminating in the election of a new board president and secretary on April 5. The new board quickly filed a motion to declare Ambulance Resources in default of contract with the board.

The parties spent time at their May 11 meeting discussing “the shortcomings of Ambulance Resources,” in which Rensch and SAS manager Joelle Muckle were lightly grilled on various company procedures, concerns about accounting practices and response times during inclement weather.

Ambulance Resources’ lawyer Jesse Walstad later took the podium to address the motion introduced at the prior meeting, saying that proper communication could mitigate the misunderstandings between Ambulance Resources and the board. Walstad hoped that closing such communication gaps would help them “forego what could become a convoluted contract dispute in favor of a productive dialogue.”

After Walstad finished, the board met in private for an executive meeting to discuss concerns related to the Ambulance Resources contract and other legal matters. The details of what was discussed have not been made public, and the SAS board has not replied to interview requests.

It remains to be seen whether the relationship between the community’s hospital and ambulance service will become amicable and cooperative once again, but it also remains murky exactly why it grew so acrimonious in the first place. MCMC leadership has not replied to multiple requests for comment on these matters. Rensch for his part, is unsure of the future.

“It all depends on if this stuff keeps going on. Who knows what could happen?” Rensch said.

The contract between Ambulance Resources and the Stanley Ambulance Service will end Jan. 1, 2023. The next open meeting of the ambulance board is scheduled for Wednesday at Stanley City Hall at 7 pm.

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