Woman wonders why ambulances won't take you where you tell them

Feels policy

delayed treatment for her husband

By CHANCE PRIGGE

Journal Staff Writer

FAIRFAX -- In June 2001, Inez Kanerva's husband Carl suffered a stroke at their Fairfax home and she called 911.

She said she'll never make that call again.

Carl can no longer speak, walks with a walker and needs assistance with daily activities such as going to the bathroom.

"I strongly believe that with earlier treatment he'd still be able to speak," Kanerva said.

After Carl's stroke occurred, a Fairfax ambulance arrived and the rescue squad said he had to be taken to Redwood Falls in accordance with its policy.

Kanerva protested, saying she wanted him to go to New Ulm Medical Center in New Ulm. But the rescue crew wouldn't take him there, so he was brought to Morton, where he was transferred to a North Memorial Hospital ambulance and taken to Redwood Area Hospital.

"I didn't want him to die," Kanerva said, "so I just let them take him -- which was a mistake."

Carl, 86 at the time, had a blood clot and needed a CT scan. When the Redwood Area Hospital couldn't perform one, he was taken to Willmar for the test.

But he wasn't treated there. After the CT scan he was brought back to Redwood Falls for treatment.

"He didn't get any kind of treatment for at least four hours," Kanerva said.

She said she could have driven Carl to New Ulm, where his records are, in about 20 minutes, and he could have had a CT scan and received treatment in less than an hour.

Redwood Area Hospital has had CT scan equipment for the last two years, but it can only be operated when the one person who can run it is present. Otherwise, patients are sent elsewhere.

"I thought that when you called a rescue squad they had to do what you wanted to do," Kanerva said.

Since the incident she's been trying to understand who's running the rescue squads and why there was a lack of knowledge when it came to taking care of a stroke victim.

Fairfax city clerk Marcia Pelzel said the town's ambulance service follows a protocol that requires it to bring patients in an emergency to the nearest hospital, which is in Redwood Falls.

"Our responsibility is to get the patient to the nearest medical facility for an emergency," Pelzel said. "It's based on case-by-case and the gravity of the situation."

She said their job is to get the fastest care for a patient, not know what kind of equipment is available at the hospital.

Gary Wingrove, manager of Gold Cross Ambulance in Minnesota, said Kanerva's situation is not an exception.

"For something that can be life threatening, like a stroke or heart attack, it's not uncommon for the medical director to want the patient to go to the nearest hospital," Wingrove said.

But he said the problem of not letting patients go to the hospital they want has been an issue since the inception of the Emergency Medical Treatment and Active Labor Act of 1986 (EMTALA). The act was created to prevent the refusal of patients at hospitals because of insurance reasons.

Wingrove said some people in the industry feel an essentially well-meaning act went too far.

"Someone decided to classify ambulances as hospital property (in the act), and that's where all this trouble came in," Wingrove said.

According to the act, hospital-owned ambulances must take patients to their hospitals for treatment. Otherwise, it's considered refusal to treat patients.

An intercept such as Carl's is common if a better-equipped ambulance can take a patient, Wingrove said.

The Fairfax ambulance provides only basic life support, while North Memorial's has advanced life support.

Wingrove said he and others are trying to change the act to exclude ambulances from being considered hospital property.

"This is a problem for the state," Wingrove said. "And it's a regulation we've complained about recently."

He said some modifications have been made to EMTALA but haven't gone far enough.

Kanerva said she wants to make sure what happened to Carl never happens to anyone else.

"This is something that should be corrected," she said.

She said she's spoken with attorneys but can't get one because it's too hard to prove that Carl's speech loss could be attributed to the time he waited for treatment or that it could have been prevented if he had been sent to New Ulm.

Kanerva said she'd rather drive to New Ulm than call for a rescue squad.

"I'm 81 years old, but I can still drive well," she said.