Following is all of the information presented to the WSMC Board of Directors on Wednesday, June 25, 2014. The response to the presentation was an email from CEO Scott McFarland saying the ” Board of Directors voted to continue to provide after hour coverage and Monday through Friday clinical staffing for the next two month This provides time for members of my staff and committee member from DV to continue discussions.”
PRESENTATION TO THE WESTERN SIERRA MEDICAL CLINIC
BOARD OF DIRECTORS
Wednesday, June 25, 2014
By Ingrid Larson & Jacie Epperson, representing DCAC
My name is Ingrid Larson. I am a resident of Downieville. I am chairperson of the Downieville Clinic Advisory Committee . This committee recently formed in reaction to your proposed decrease in services in Downieville This Committee is supported by the Western Sierra County community. Over 150 residents attended the recent “forum” and at least 75 have been actively attending our committee meetings. Many are writing letters. I have brought copies, including a recent letter from Congressman LaMalfa to Scott McFarland.
We are not here to tell you how to manage the Clinic. Rather, we are here to point out the critical necessity of continuing 24/7 emergency & urgent care in Downieville. Otherwise, both residents and visitors are at risk.
Our proposals and comments are intended to show you, the Board of Directors, that there are alternative solutions that can be developed and our Committee is dedicated to that end.
History of 24/7 care in Downieville
The Western Sierra County community has had daily clinic services for 38 years including response to medically urgent and emergency situations on a 24/7 basis.
We believe the community has the right to continued 24/7 services.
We believe 24/7 is a “required service” for this community under the 330 Grant
We are a “frontier” county
We are over an hour drive to the nearest medical facility
24/7 care has always been a part of our Mission Statement;
it was part of the original 330 Grant;
it was part of the Merger with Miner’s Clinic;
it is required by the Sierra County Jail medical services Contract
it is part of the most recent 330 Grant application:
“WSMC in Sierra County is the only medical facility that is available twenty-four hours a day, seven days a week to provide services to our County’s permanent population of 3,174 and the only medical providers available to the 687,000 tourists who visit the two national forests in Sierra County each year.”
We believe that the community has the right to participate in a dialogue with the Clinic before decisions are made that substantially impact services in Downieville. That is why we are here today.
Risks of proposed cuts
The basis for our requested delay in the proposed cuts is the real risk of morbidity and mortality.
So, I defer at this time to Jacie Epperson is an R.N. and the EMS Supervisor for Downieville Ambulance. Jacie:
Downieville Ambulance EMS: by Jacie Epperson (see Jacie’s presentation)
Proposed Interim Schedule
We propose an Interim Schedule for the next 6 months so more time can be spent working out a viable solution regarding services in Downieville.
The proposed Interim Schedule provides for a rotation among 3 providers and will continue 24/7 coverage.
One person will work Monday through Thursday, 8 hours per day in the Clinic and 16 hours of on call coverage Monday through Wednesday. A second provider will start on Thursday at 5 PM and will take calls until Monday morning at 8 AM. That provider will also work in the Clinic on Friday for 8 hours and will take regular appointments for Saturday and will respond to all urgent care and emergency care needs during the on call hours. The third provider rotates every other Thursday night through Monday morning.
Benefit to Grass Valley clinic:
We believe our proposal will benefit the Grass Valley Clinic and its backlog of new patients. We suggest that some of those patients could be seen in Downieville as a way to get them into the system. Some Grass Valley patients are already doing this. This would better utilize the Downieville Providers and create a more cohesive Provider Team.
It is our belief that the proposed change in services requires a formal change in scope through HRSA before it can be enacted, because the Board’s proposal is, in fact, a dramatic and substantial decrease in the scope of service in Downieville rather than a mere change to the hours of operation.
Currently, medical care coverage in Downieville is 8760 hours a year [365 days x 24 hours]
Your motion reduces the medical care coverage to only 1248 hours [52 weeks x 3 days at 8 hours per day]
This is a reduction of 86 % in medical care coverage in Downieville.
And, we submit that the logical consequences of your decision, which cannot be ignored include the very existence of Western Sierra Medical Clinic in its entirety being jeopardized and the risk of losing lives.
Therefore, in closing
We respectfully request that you vote today to suspend further implementation of your May 22, 2014 decision regarding the decrease in the Downieville Clinic hours pending further dialogue with the community towards a workable solution.
We request that you ask management to implement an interim schedule like the one proposed here starting when the current Downieville Provider leaves, through January 3, 2015.
We are convinced that the co-existence of both clinics is advantageous to the mission of the entire organization
We want the people of Western Sierra County to continue having the outstanding medical care they have had for the last 38 years.
We do not want to lose any more services than we have since the merger:
We have lost Physical Therapy Services, Dental Services have been reduced, Behavioral Health Services have been changed to Telemedicine, we have lost direct Nutrition Services, our RN case management services have been shifted to Grass Valley, and now our days of service and hours of critical care coverage are on the verge of being reduced.
We urge that financial adjustments be found elsewhere than Downieville.
It is not only about money; it is about people and saving lives.
We want to work with you.
Please, work with us. We respectfully request that you give this matter your utmost consideration. Thank you.
Downieville Ambulance EMS Supervisor Jacie Epperson
Downieville EMS Ambulance
The ambulance service operates 3 ambulances to cover the entire portion of the western side of Sierra County. This encompasses 500 square miles of mountainous area. Our response area borders the Yuba Pass to the north, the Plumas County line in the Lakes Basin Recreation area and finally to the Yuba County line to the south. The response area encompasses the towns of Sierra City, Downieville, Pike City and Alleghany. We have two ALS ambulances stationed in Downieville and one BLS ambulance stationed in Alleghany.
We are staffed by volunteer EMTs, AEMTs and an RN who respond to calls 24/7/365. Nor Cal EMS protocols are followed for each call and the AEMTs practice under Limited ALS protocols. We have a total of 8 personnel who are active responders. Responders do not have a duty to remain in the area, so the number of available personnel varies. They are not paid for on call. They are only paid for the time they spend with the patient in the ambulance.
Our personnel response time to the ambulance is usually under five minutes.
Our response time to the scene varies depending on the location of the call. Trail rescues for injured mountain bikers may take more than an hour to get to the victim.
We do not have a hospital in Sierra County, therefore the patients must travel to Grass Valley, Truckee or Portola (summer only), an average of 50 to 60 miles over windy mountain roads.
Our transport times are 1.5 hours which means that an ambulance and crew are out of the response area for 3 to 4 hours.
It is possible that we may have back to back calls, multiple calls at the same time or an incident for which we need both ambulances on scene.
Helicopter transports are required for the most critical trauma and medical patients in which time is a major factor. Inclement weather can be a factor in this response.
So, I ask each of you, what happens to the sick or injured person who needs assistance and they are within the confines of a town and could seek help at the clinic or from the provider on call at the clinic? Will they be forced to drive 50 to 60 miles to the nearest hospital before they can have medical intervention because the clinic is closed? Telemedicine will not be the answer. Telemedicine cannot push the narcotics for pain control, or the ACLS drugs that are needed. Sick and injured need the human interaction with the provider.
I would like you to imagine that you are visiting our area and you fall and break a hip or leg, or you have chest pain, perhaps you are having a heart attack and need immediate medical intervention. Are you willing to go without the advanced life support intervention that is required and that is beyond the scope of practice of the AEMTs in Sierra County? How would you feel if something happened to a child of yours and they had to wait for help because the clinic was not available? These are the situations that we are faced with if you choose to stop provider coverage at the Downieville clinic, 24/7.
For the EMS personnel, you are removing our designated alternate base station, our safety net for EMS. I believe that this move will place our residents and visitors who fall ill or become injured in jeopardy. People will die.
Since January 1, 2014 until June 23, 2014, Downieville ambulance has responded to 67 9-1-1 calls. 59 of these calls resulted in transports.
37 calls were ALS and 22 calls were BLS.
49 calls were after clinic hours of 08:30 to 17:00 or 73%.
Weekend calls: 26 total or 39%
Holiday when clinic was closed: 1
52 contacts or 78% were made with the clinic either by phone, radio and/or clinic notification during dispatches.
9 transports were terminated at the Downieville clinic.
The clinic provider accompanied the patient on the ambulance on 12 of these calls or 18%. 9 of these calls were after clinic hours or 75%.
Downieville ambulance strives to provide the best possible care in the timeliest manner to achieve the best possible out comes for our patients. The Downieville WSMC site providers and the EMS system have a collaborative team approach for patient care, and we are proud of how successful this collaboration has proven to be. We know they are there when we need them.
Cancelling the 24/7 care will place barriers to getting our patients the best care possible. It is a necessity, not a nicety.
Please consider carefully what the consequences of your decision ,for those of us who live and visit in Sierra County , will be.
Letters to the WSMC Board of Directors: