Delayed Emergency Response

Minutes can make the difference between life and death — but does Denver Health know how to tell time?

In 1996, when Denver General was being revamped as Denver Health, the standards were reconfigured again. The hospital agreed to gradually increase the percentage of "eight minutes or less" every year, from 83 percent in 1997 to 90 percent by 2000.

"At the time, I figured that the higher standards meant that the hospital would have to add more ambulances to meet the times," Petre says.

But he was wrong. The current number of Denver Health ALS ambulances is still approximately half the number of ambulances available in similar-sized cities. Cleveland, for example, has 28 ALS ambulances for 80,000 calls annually — about the same number of calls that Denver handles with thirty vehicles — but just fourteen of them staffed as ALS ambulances. As a result, paramedics say, the workload has become daunting and response times have suffered.

"It was pretty much known that if you wanted to be a paramedic, Denver was one of the premier places to work," remembers Mike Simon, who started as a Denver paramedic in 1983 and continues to work a couple of shifts a week when not at his full-time position at Littleton Fire and Rescue, a fire-based system. "When I started, on an average ten-hour shift there were fourteen to fifteen calls. We were a very small division, so they didn't hire very many. You either got really good or you washed out." But while he still likes his Denver job, he says many of the veteran paramedics have moved on to other cities whose systems provide better pay and more opportunities for advancement.

Though defined by the city as a "core service" with the same importance as police and firefighters, Denver paramedics do not get the benefits and job protection that come with being a civil servant. Under Denver Health, they are technically private employees. And as a quasi-private agency that must serve the public, the hospital is in a budget squeeze.

Denver Health receives close to $27 million a year from the city for various services ranging from medical care for county jail inmates to emergency ambulance services. But as the number of Denver residents who are uninsured and underinsured continues to rise, so has the financial burden the hospital must bear. The non-reimbursed costs that Denver Health had to absorb for caring for patients without coverage was $100 million in 1990; in 2006, it was more than $280 million. Denver Health is one of four Level 1 trauma centers in the metro area — but one of those centers, Children's Hospital, moved out of central Denver last year. So did University Hospital, putting an increased strain on Denver Health's emergency room.

Denver Health spent $1.6 million on its paramedic division in 2007 — after the division itself brought in $14 million in insurance money and transport fees. The division feels the effect of the tight budget. The hospital administration "has basically said, 'You have to do more with less,'" says Petre. "But because you have such a high volume of calls, you abuse your employees."

Petre openly admits that he wants to see paramedics get out from under Denver Health. But he insists that the move would mean as much to the people using the paramedics' services as to the paramedics themselves — by putting a stop to the ever-lengthening response times. The fire department has units strategically placed at 31 stations around the city, which allows a response time that, on average, is two to five minutes faster than that of paramedics. If the paramedics division became part of the fire department, Petre says, ambulances could arrive just as quickly.

After the last failed attempt to move the division, Petre gave up on the political part of the job. One reason, he says now, was that Denver Health's first contract with the city called for a gradual improvement in response time, but instead, the standards were lowered. The first change he noticed was in the 1999 contract, when the phrase "eight minutes or less" was reinterpreted by Denver Health to mean anything that wasn't nine minutes. This allowed the hospital to tack on an extra 59 seconds to the requirement, thereby boosting the percentage of calls that qualified as eight minutes. In 2000 — when Denver Health was supposed to be meeting a 90 percent standard for a response time of eight minutes or less — the hospital never even gave a figure to the city, saying that a newly installed Computer Aided Dispatch system no longer allowed it to "make calculations for response time compliance in the same manner." This problem apparently took three years to fix, because the same explanation was listed for not reporting the response-time percentage in 2001 and 2002.

According to its contract with the city, Denver Health was "working with the vendor" to resolve the problem in reporting times. But Tyler Riddell, spokesman for TriTech, the vendor that provided the system to the city, says his company was unaware of any problem. While he adds that it's possible that Denver Health worked with a third party to find a solution, he says he hasn't heard of any other city having similar difficulties with TriTech software for such a long duration.

Still, citing calculating difficulties, the hospital successfully lobbied to drop the response-time criteria for the 2003 contract to 85 percent, which it met with a compliance rate of 87.7 percent. "It remained at 85% in 2004, 2005 and 2006 due to the burdensome highway construction and traffic issues associated with T-Rex," Denver Health spokeswoman Dee Martinez writes, in explaining the lowered standard.

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