The Denver hospital understates its ambulance response time, resulting in a breach of its city contract
By Christopher N. Osher
The Denver Post
Copyright 2008 The Denver Post
DENVER — For the past four years, Denver Health Medical Center has failed to comply with its city contract because of changes in how it calculates its response times for emergency ambulance service, hospital officials said Thursday.
A paramedics union official said the shift in reporting standards allows the hospital to vastly understate the actual times it takes ambulances to arrive at emergencies after calls for help.
“No change they have made since the inception of the contract has been to the benefit of the citizens,” said Bob Petre, president of the union, IAFF 3634.
“Every change in the calculation or measurement has allowed the hospital to provide poorer-quality service.”
Hospital administrators did not respond to calls for comment. In a prepared statement, they said that officials in the city’s safety department signed off on the changes in 2004 but failed to make them official by re vising the contract the hospital has with the city.
The statement did not provide the names of any city officials who agreed to the change.
Denver’s manager of public safety, Al LaCabe, who also held the job in 2004, said the hospital’s admission Thursday is the first time he has heard that the hospital changed the way response times are calculated.
Shaun Sullivan, an assistant city attorney who handles the Denver Health contract for the city, said he recalled some discussions leading to revisions in how response times were measured but could not remember the specifics.
The news comes as Denver City Council President Michael Hancock is suggesting the city should explore whether to bring paramedics into the city’s Fire Department.
The contract states that paramedic response times are measured from “when the EMS dispatcher receives the call from the call-taker or from the Police or Fire Department” to “when the ambulance arrives on the scene.”
Petre said that in 2004, the hospital started calculating paramedic response from the time an ambulance is assigned.
He said the shift dramatically undercounts the actual response time because all of Denver Health’s ambulances are regularly in use. That means dispatchers must wait for one to come free before it can be sent to the next call. Significant delays result, Petre said, and those aren’t reflected in the way Denver Health has been calculating response times.
“They routinely run out of ambulances,” Petre said.
Denver’s Health’s new way of calculating response times was first reported this week by Westword. KMGH-TV, Channel 7, has also reported extensively on Denver Health’s ambulance service.
Impact on compliance
The way ambulance response times are calculated affects the hospital’s compliance with performance standards specified in the city contract.
The contract with Denver requires the hospital to get an ambulance to an emergency within 8 minutes and 58 seconds, 85 percent of the time. The hospital reports that is exactly the current response rate.
The hospital, in the news release, said the change in how response rates were calculated allows the hospital to calculate performance the same way the Fire Department does, which would allow for a more comprehensive evaluation of emergency medical services in the city.
The release added that a new software system does not calculate response rates as had been done previously.
But Petre said the Fire Department, which dispatches emergency medical technicians, who provide more limited care than paramedics, never has all its firetrucks or vehicles in use at the same time. If a fire station is overwhelmed responding to a medical emergency, then personnel at another fire station will immediately be dispatched, so there is no delay.
“This discrepancy was not intentional, and we are surprised that it remained undiscovered until now,” said Stephanie Thomas, the chief operating officer at Denver Health, in the release.
Questions on service
The news of the discrepancy comes as Denver City Council members increasingly are raising questions about the hospital’s paramedic services.
On Wednesday, during a meeting with the hospital’s administrators, several council members repeatedly questioned the hospital’s performance.
They also cited complaints from unnamed paramedics concerning inadequate equipment, lagging response rates and poor performance.
“The number one thing that I’m most interested in is that the citizens of the streets of Denver should have the confidence in knowing that if something happened to them or a loved one, they should have the best and fastest response for emergency care,” Hancock said at the meeting, which Denver Health’s chief executive officer Patricia Gabow also attended.