STANLEY — On April 21, 2020, a woman six months pregnant went to Mountrail County Medical Center in Stanley, reporting severe abdominal pain. She was briefly assessed by a nurse practitioner, Richard Laksonen, in the entryway of the hospital. Laksonen determined that MCMC could not handle the situation, so he elected to have the patient sent to Trinity Hospital in Minot.

For reasons that remain unclear, Laksonen directed the woman and her family to drive her to Minot themselves, assuring them that he would let the county sheriff and highway patrol know to expect them on the road, driving at high speeds due to the emergency.

Shortly after Laksonen made his call to Mountrail County 911, the patient herself made a call of her own, requesting an ambulance. Stanley Ambulance Service responded, picking up the patient, who was experiencing potential pre-term labor, on the route to Minot. SAS is staffed by a company called Ambulance Resources, managed and owned by Ken Rensch of Bismarck.

“My paramedics got there, and they were going to take her back to the hospital and she said, ‘No, I was just there,'” Rensch said. The command log concludes with their arrival at Trinity a little over an hour later.

Rensch and his company were contracted first in 2013 to provide relief to Stanley’s ambulance service. Having a functioning and specialized ambulance service is critical to the survival of emergency patients in rural communities, where drive times of an hour or more are the norm. Like most rural ambulance services, Stanley’s was staffed mostly by volunteers, but it found itself drowning under the volume of calls that cropped up during the Bakken oil boom. One of the local volunteers on the SAS at the time was Harry Braddock, who has lived in Stanley for 17 years.

“Before it was losing money, and we didn’t have the proper training and equipment. We asked ourselves, ‘How do we keep this service going?'” Braddock said, “Ken changed all of that. We went from a single paramedic to a full crew. We used to have a good relationship with the hospital, but that went to crap.”

This was just one of several instances in which Laksonen, who is currently in federal prison for Medicare fraud convictions in Michigan, was accused of diverting patients away from MCMC.

Initial allegations regarding an incident from March 25, 2020, were reported to the North Dakota Department of Health by the New Town Ambulance Service paramedic manager Mason Terry. According to Terry’s narrative from the complaint, Laksonen screened a patient with a possible broken foot in the parking lot of the hospital — due to COVID-19 protocols on hospital entry — before instructing the ambulance to deliver the patient to Elbowoods Memorial Clinic in New Town. Elbowoods is a tribal clinic that lacks an emergency department and is not a trauma designated center.

The Department of Health and the Center of Medicare Services soon investigated the matter and found that no Emergency Medical Treatment and Labor Act (EMTLA) violations had occurred.

While he wasn’t directly involved in the survey investigating the complaints, Dr. Jeffrey Sather, the state medical director of Emergency Medical Services, was briefed on the matter. Sather would later speak with MCMC CEO Stephanie Everett about the appropriateness of Laksonen’s actions, and MCMC providers were given a consult and education related to EMTALA. Sather is also the medical director of emergency services for Trinity Hospital in Minot, which owns 50% of MCMC.

Rensch was made aware of the incident with the New Town ambulance when the ambulance service he managed in Parshall experienced similar diversions at MCMC. He reached out to then State Health Officer Mylynn Tufte on May 11, 202. At this time, Rensch himself did not formally file a complaint on behalf of any of the services he manages. Tufte would order a review of the prior New Town complaint, but no further action was taken regarding either case.

In an email from May 13, 2020, Department of Health staff said that the actions of Laksonen “met the ‘letter of the law’ but, perhaps, not the spirit of the law.” One chain concluded with the comment that the matter “trends toward local politics…”

The complaints made against MCMC may have resulted in only slight correction by regulators for the rural hospital, but it seemingly has resulted in a souring of the relationship between the hospital and the local ambulance.

Future coverage will explore how this acrimony has led to allegations of retaliation by MCMC, affecting not only the Stanley ambulance, but ultimately the patients and residents of the community that they serve.