Saturday, February 26, 2011

Forget Wisconsin, The Real Threat Is In Rutland

UPDATE: FF Newcomb's case is scheduled to be heard before the Rutland Board of Selectmen this coming Mon., March 7, at 5 p.m. at Rutland Town Hall, 240 Main St. The Professional Fire Fighters of Massachusetts is planning a significant presence there as are firefighters from many local departments, but this issue could have implications for anyone who works for a town or city.

Wisconsin's evil genius, Gov. Scott Walker, and his attempts to fulfill the dream of a couple of Texas billionaire brothers bent on setting the middle class in America back by about five decades is getting lots of press right now.
But in a quiet corner of central Massachusetts, equally sinister moves are afoot.
The Rutland Board of Selectmen is waging war on public safety employees statewide by attempting to deny justly-earned benefits to a dedicated town employee who suffered a career-ending injury serving a town resident in time of need.
By extension, the Rutland selectmen are threatening the livelihoods of tens of thousands of Massachusetts public safety workers who may find their towns and cities, like Rutland, ready and willing to turn their backs to employees injured in the line of duty.
Rutland selectmen are splitting linguistic hairs so finely that Bill Clinton would blush, and targetting a hardworking Firefighter/Paramedic who made the mistake, apparently, of giving his employers an honest effort in the misguided belief that Rutland officials would A) obey the law, and B) uphold their end of the bargain.
Anyone who works for a municipality needs to pay attention to what's going on down Route 122A, because in the end, if what Rutland selectmen are trying to do is allowed to stand, precedent may be set and no firefighter in Massachusetts who goes on medical calls will be protected if injured.
First, a little background:
Paul Newcomb is a 43-year-old Firefighter/Paramedic for the Rutland Fire Department.
I've known Paul for a long time, and can vouch that in addition to being a really good guy, Paul is also a hard-working man that any taxpayer would be proud to have on their town's payroll.
A little over a year ago, Paul was lifting a patient on an ambulance call and ruptured a disc in his back, an injury so devastating that surgeons removed the disc, placed titanium rods in his back and implanted a electrical nerve stimulating device in the hopes he might regain some nerve function in his legs.
Worst of all for Paul -- doctors told him his days as a Firefighter/Paramedic were over.
This was not someone who was looking forward to ending his career. From my own personal conversations with Paul over the years before his injury, this was a guy who enjoyed being a firefighter and a paramedic.
After brooding about the end of his career, Paul eventually submitted paperwork for a medical retirement.
Massachusetts firefighters who are injured on the job are covered under a state law commonly referred to simply as "111F," in reference to its location in Chapter 41 of the Massachusetts General Laws.
Under the law, Paul has been able to collect his regular town salary while awaiting news about his medical retirement.
Once approved for a medical retirement, Paul would be able to collect 72 percent of his most recent salary, as per state law.
But an interesting thing happened on the way to Paul Newcomb's well-deserved medical retirement.
Someone on the Rutland Board of Selectmen had an idea:
How about we defy common sense, ignore the laws we're bound to uphold, screw our employee out of 40 % of his annual income while waiting for the formal medical retirement, and in the process hang every cop and firefighter out in the wind?
Well, maybe that's not exactly a quote, but that's what they're trying to do in Rutland.
See, some esteemed Rutland Selectman, echoing President Clinton's famous question ("That depends on what the definition of 'is' is"), stretched the English language to the limits of credulity, reasoning that since Newcomb was on a medical call and not fighting a fire, and since paramedics aren't covered under a firefighter's medical disability law, Newcomb might not be eligible for a firefighter's 111F benefits as he awaits his medical retirement, allowing the town in the meantime to pay him under its workers' compensation policy, which is a cheaper alternative for the town.
It doesn't matter that Paul was working as a Firefighter/Paramedic when injured. It doesn't matter that he was working on an ambulance run by the Rutland Fire Department. It doesn't matter that 95 % of the work of a fire department in a community like Rutland is ambulance work.
Selectmen figured that if they could make that claim, run it up a flagpole and see if anyone saluted, then they could pay Paul under the town's workers' compensation insurance, saving Rutland some money, but resulting in a 40 % reduction in pay to to a man who'd already sacrificed his health permanently serving a town whose leaders couldn't care less.
This is so ludicrous that the mind barely knows where to begin.
For one thing, Paul's job title was clearly "Firefighter/Paramedic."
Secondly, as part of his job Paul was REQUIRED to perform ambulance duties as part of the ambulance service provided by the Rutland Fire Department.
Firefighter disability retirements aren't reserved only for firefighters injured fighting fires. There's actually a separate chapter of state law for that.
Of course, even a cursory review of medical retirement records (they're not hard to find) shows that few firefighters medically retired due to injuries on the job got those injuries at fires.
I wonder if, even in cities like say, Worcester, which doesn't run an ambulance but does provide first responder duties, would the Rutland Board of Selectmen suggest that a Worcester firefighter who suffered a permanent, career-ending injury while on a medical call is also not eligible for 111F while awaiting a traditional medical disability retirement?
What's going on in Rutland is as much a threat to the livelihoods of firefighters and police officers as anything going on in Wisconsin or elsewhere.
Fortunately, other boards of selectmen have tried to pull similar stunts and have failed miserably. Let's hope this one does, too.
The Rutland Board of Selectmen has scheduled a meeting for March 7 to debate the matter further.
If you want to express your displeasure to them directly by letter or
telephone, here is the address for the Rutland Board of Selectmen:

Rutland Board of Selectmen
Attention: Sheila Dibb, Chairman
246 Main St.
Rutland, MA 01543

(508) 886-4100

Tuesday, February 22, 2011

Jumping the Shark

I think we've finally jumped the shark here in Massachusetts EMS.
A committee has recently been formed to tackle a pressing and completely new and unforseen problem here in Emergencyland: The Bay State Edition.
That idea:
We need to make sure we get two paramedics on the scene of some ALS calls in Massachusetts.
("Some," apparently being synonymous with "all," but more on that later)
Those of you NOT currently hitting yourselves in the heads with tackhammers probably don't work in Mass EMS, and thus need a little history.
See, until recently, the state required that all ALS units be staffed by two paramedics.
Ergo, all ALS calls were serviced by two paramedics.
Then at the behest of people looking to either minimize expense, maximize profits, or both, those regulations were watered down so that, with the state's blessing, some services could operate an ALS unit with only one paramedic on-board, partnered by either an intermediate or basic EMT.
Not a great set-up, but the system had adapted, made peace with the arrangement.
THEN, this past Thanksgiving season, quietly and under the cover of darkness -- WHAM! That regulation was thrown out the door competely by the state legislature under the guise of planning for the next flu epidemic (you know, like the one we DIDN'T have last year) so now, in Massachusetts, all you need to have an official ALS unit is a single paramedic on-board.
So next time you call 911, try not to think about the fact that you're relying on the emergency planning accumen of a bunch of state reps and senators who can't balance the state budget, keep promises to roll back the income tax, or build a tunnel without going 15 times over budget.
As the various boards and committees left picking through the wreckage wrought by our elected overseers begin their work, one of their missions is to figure out A) do we need two medics on ALS calls?, and B) if so, which calls, and C) how the heck do we do THAT?
Now, I'm in favor of dual paramedic staffing, but not for the typical reasons.
I concur with the forces calling for single-medic ALS units who point out that there is very little evidence in the medical literature that dual medic units produce concrete improvements in patient outcomes.
There has even been some conjecture that state data indicates patients treated by dual medic units have fared worse, if the number of complaints generated by dual medic units vs. other configurations are an indication (which I don't think they are).
I also concur that the calls two paramedics are legitimately needed for are few and far between.
But I support the dual medic configuration for two reasons:
1 -- although it is a consideration that I am sure that those in charge of our profession could care less about, I think dual medic is a better configuration for the two paramedics themselves. Like my Nana always said, many hands make light work. Two medics on an ALS unit allows for perfect distribution of labor, and, I would argue, happier employees. Anyone who's ever worked P-B as the medic knows the joy of a shift consisting of three chest pains, a shortness of breath, a hypoglycemic and one sad person. Good shift for the basic, bad shift for the medic. With a two medic system there's no debate or worry over who does what, you just split the calls down the middle
2 -- I think skills dilution is less of a problem with dual medic ALS units. If every ALS unit were forced to consist of two medics, that would by necessity cut down on the total number of ALS units even while the total number of calls stays constant, meaning more medics would see more sick patients.
Of course, this being Massachusetts, we're working diligently on applying a $1,000 solution to a $10 problem that we created in the first place.
The current proposal, as I understand it, would call for a second ambulance to be dispatched to certain ALS-level calls, although from my early perusal of the list of qualifying chief complaints, pretty much ANY ALS call would get a second ambulance dispatched to it.
This might not be much of a problem in urban systems with ambulances to spare (all you city guys try not to spit coffee out of your noses when you read that -- that stuff'll burn...), but what happens in my neck of the woods, in the suburban-rural interface?
As I understand it, any ALS call would have to involve multiple communities, leaving two towns unable to adequately provide ambulance service, instead of one.
And who's going to pay for the increased cost of call-backs at local ambulance and fire services to cover while the primary ambulance crew is chasing down yet another chest pain in a neighboring town?
My guess is that certain folks think amending the new law with these regs might in some way aid the wet dream that is regionalization.
I think regionalization is by far the best model for EMS delivery, but I am a lifelong Massachusetts resident, and thus know better than to believe in Santa Claus, the Easter Bunny, and statewide regional cooperation.
This is a horrible idea on so many levels, unless of course you think that what the EMS system in Massachusetts needs is additional complexity.
Just stop the madness and put two medics back on the bus.
Jumping sharks is dangerous.