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Potential EMS audit raises questions

Friday, January 11, 2013 by Michael Kanin

Concerns have surfaced over a call for a complete audit of the Austin-Travis County Emergency Medical Service following an earlier investigation that revealed questionable financial procedures.


In an interview with In Fact Daily, Austin City Council Member Bill Spelman worried about the ability of the office of City Auditor Ken Mory to handle such a large project as a full audit, which the City of Austin’s Public Safety Commission has called for.


“We just don’t have the resources to look at everything,” he said. “The best use of our relatively small audit staff, I think, is to look at very specific problems.”


In late October, the city auditor’s office reported that an audit found EMS would routinely leave bags of cash and checks out in the open as part of their financial services operation, including on one occasion $208,128 in cash and checks undeposited in an open container. (See In Fact Daily, Oct. 31, 2012.) 


Spelman, who serves on the Council’s Audit and Finance Committee, said this week, “If the biggest concern is that we’re not collecting most of our (EMS) billings, then we can audit that. … If the biggest concern is that we have vacancies that are unfilled, that’s something which is auditable too, presumably – although I’m not sure we need an audit for that. I think we can probably get staff to explain to us what’s going on.”


“This seems to be a generalized worry about EMS,” Spelman concluded. “And generalized worries about EMS are not things that you can audit. We don’t like the way EMS is being run? Well, okay, let’s be specific first, and let’s try to fix that.”


Mayor Pro Tem Sheryl Cole, the chair of the Council’s Audit and Finance Committee, told In Fact Daily that the committee would soon take up the issue of the potential audit.


“Travis County/Austin EMS is a critical city service and performs high relative to benchmarks throughout the country,” she said via email. “However, we must consider any concerns regarding its operation that may impact our citizens. The Public Safety Commission recently (unanimously requested) an audit of EMS and I plan to put this item up for discussion at our next Audit and Finance Committee meeting.”


Council Member Mike Martinez said that he would be in favor of an audit – so long as Council can find a spot for it in the auditor’s schedule. He noted that the auditor’s office operates on a pre-determined annual audit plan, and that, without additional funding and resources, a comprehensive look at EMS might have to wait until next year.


However, mentioning his experience on both Capital Metro’s board and on Council, Martinez said, “For the most part, audits are good things.”


City of Austin Public Safety Commissioner Mike Levy described the issue in stark terms.


“I would be urging the Council to act as soon as possible in charging the auditor to begin a process of examining every aspect of medical and management of EMS,” Levy said earlier this week. “I don’t think we can wait any longer for the sake of the patients.”


EMS Chief of Staff James Shamard offered no direct comment on the potential audit. However, Austin-Travis County EMS Association President Tony Marquardt balked at the idea, should it include input from an external consultant.


Levy is a vocal critic of service management. On Monday, he pointed to “six or seven” paramedic resignations in December that he suggested were directly related to service morale. To support his concerns, Levy cited a University of Texas study that appears to be deeply critical of morale issues in the EMS department.


“(The study) said that the only organizations that he has measured … that had lower morale than Austin EMS were prison guards,” Levy said. “These are the kind of issues – when you have paramedics leaving in large numbers – those are fairly significant issues, don’t you think?”


Shamard disputed Levy’s statement. “We’ve had the lowest turnover, the lowest attrition that we’ve had, I think since I’ve worked here, up until the last couple of months,” he said.


Shamard then turned to address Levy’s direct accusation. “There are some details that I am not at liberty to get into about some of those individuals, but it wasn’t everybody just picking up and leaving because they weren’t happy with the organization,” he said.


In November, Austin voters approved at least two significant measures that will affect EMS functions in the coming years. They include a new civil service employment system for EMS employees and a tax increase for Travis County Central Health that will support a new University of Texas medical school. Marquardt initially cast his objections to an audit in terms of the numerous changes that the service will see in coming years.

Marquardt said, “I’d just like suggest that Austin-Travis County EMS is … going to go through some pretty dramatic changes due to Civil Service, due to affiliation with the new medical school and frankly, health care reform. To recommend to Council to pay for consulting of any kind, wherever the money comes from – (it) may not be the most opportune time to do that.”


In response to Marquardt, Levy ran down his worries. “Tony, I understand what you’re saying but given the challenges that we see and the problems we see that exist I don’t think that we can wait much longer to bring the auditor in to look at opportunities and problems and how they can be fixed,” he said. “Waiting any longer isn’t, in my opinion fair to the patients in the community who we have the primary responsibility of serving.”


When Commissioner Ramey Ko tried to pin down Marquardt on a timeline, Marquardt’s more immediate concerns surfaced. Traditionally, outside consultants focus on either consolidation or privatization, he said.


Spelman confirmed that portion of Marquardt’s statement.


Marquardt continued to note issues in a service study commissioned by Travis County. “It had an agenda in mind before it was hired,” Marquardt said of the firm contracted to perform the Travis County study.


Later, Marquardt clarified his position. “I don’t have a problem with the City Auditor, or any city employee, or their integrity – that’s all fairly solid in our city,” he said. “The problem is we have a finite amount of consultants in the EMS industry, and most of them are agenda-driven, depending on who is funding the study. So, even the best intentions with any governmental entity would be challenged with the same challenges that the industry faces when you are talking consultants.”


Levy suggested that any study of the medical side of the service would likely have to include some external help. According to Marquardt, the best approach would be “to affiliate with the medical school and move forward in research and evidence-based medicine.”

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