Ambulance panel haggles over quality review process


LEE COUNTY – A retired Keokuk physician is asking for quality review metrics to be a part of the oversight of the Lee County EMS Advisory Council.

At a Monday meeting of the council, councilmember Dr. Philip Caropreso pushed for a quality review component for the council to allow for the review of areas of concern in treatment.

Council chairman Jim Steffen, an EMS instructor at Southeastern Community College and career EMS supervisor, said a current review system is in place in the county.

Lee County EMS Director Dennis Cosby said he thinks that group comprised of Fort Madison Community Hospital health officials meets quarterly to review treatment data of EMS staff.

Cosby cited federal HIPAA regulations as a hurdle in having the committee review cases for treatment issues, but said he didn’t have a problem with the committee reviewing cases, as long as they keep it basic.

“I wouldn’t say it’s unnecessary, as long as we keep it to general terms,” Cosby said.

“I have no problem listening to issues you have as long as we do it in a way to keep everyone out of trouble with the government.”

Caropreso said he had spoken with EMS officials across the country, and the council may be misunderstanding HIPAA rules.

Steffen said there was no need to duplicate the work of the current review board.

“I don’t think we need to duplicate a lot of that work. That’s not our job,” Steffen said.

Caropreso said he completely disagreed with Steffen.

At the last meeting of the council, Fort Madison Fire Chief Joey Herren and Keokuk Fire Chief Gabe Rose asked the council where fire officials would go with concerns over treatment and protocols observed.

Both agreed that past practices, which seem to be part of the integration to the county-run operation, didn’t adequately address concerns about treatment and protocols of EMS service on their end.

Steffen said Cosby was hired in part because of his experience dealing with those issues.

“Dennis is the one who’s responsible for the EMS program and the quality of the program, and he answers to the Board of Supervisors, who answer to the voters,” Steffen said.

“The county hired Dennis for a reason – because they trusted him to run the service.”

Lee County Supervisor Garry Seyb Jr., said he considers the council to have a “50,000 foot purview” of the operations and not a role of micromanaging the day-to-day issues that crop up.

“In mulling this over in my head back and forth, I see the ambulance group looking at this from 50,000 feet and making recommendations from that view, not at the micro level dealing with an employee.” Seyb said.

“Dennis should be reviewing all calls in my opinion. The No. 1 and No. 2 in the service should be reviewing all calls and putting a critical eye to it and then refer bigger issues to the Medical Director. Dennis is getting paid a pretty good salary to do that. If were gonna go down the road that Dr. Caropreso is talking, what’s going to be the authority level of this group.”

The medical director for the EMS services currently is Dr. David Wenger-Keller at FMCH.

Caropreso has been a part of the committee since it’s inception and was part of Cosby’s hiring process.

“I was actively involved in Dennis interview, and he did an outstanding job,” Caropreso said. “But what you’re proposing is too limited and too narrow.”

Steffen said it’s his experience that when a issue arises in care of a patient a review takes place and then remediation and retraining begin if necessary.

Caropreso asked how the council would know that Cosby is recommending that course of action.

“The flip answer is I’ve known Dennis for years and he’s not going to let anything go. That’s what an EMS director does. The core of his job is to the people who call 911 for quality service,” Steffen said.

“I refuse to believe that Dennis wouldn’t refer people for retraining. If you believe that, than we need to find a new director, but I have every confidence he will.”

Caropreso said he believed Steffen’s statement to be true, but said the system was still to narrow.

“I believe what your saying is true, nevertheless, the plan is too narrow,. There can be omissions, oversights and missteps along the way and this should be a mutually supportive process of all parties.”

Lee County Auditor Denise Fraise, who also sits on the council, said the group isn’t trained to make medical decisions, but a subcommittee comprised of health care experts might be in order.

Steffen said the board could help by looking at aggregate data, but said ultimately medical decisions lie with the medical director.

“I think this board can help with pattern recognition and help with making sure something is getting done,” he said.

“The final decision of what this looks like does not lie with this board, the Board of Supervisors or Dennis, but the Medical Director, and that person’s word is final.”

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