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Fl - <br />N 0 V 14 1994 BOOK 8 pear s"A <br />C & J AMBULANCE SERVICE, INC. <br />P. O. Box 3421 <br />FORT PIERCE, FLORIDA 33454 <br />November 12, 1984 <br />Board of County Commissioners <br />Indian River County <br />1840 25th Street <br />Vero Beach, Florida 32960 <br />Dear Sirs: <br />We are in receipt of the letter from Mr. Brandenburg dated Nov- <br />ember 9, 1984 and from Indian River Memorial Hospital dated Nov- <br />ember 6, 1984 regarding the refusal by C & J Ambulance Service to <br />do transfers from January 3, 1984 through this date. <br />Perhaps we should begin by saying that we were "not available" to <br />do most of these transfers and it would appear from the wording in <br />the letter from Mr. O'Grady that we just "refused" to take these <br />transfers. Certainly, a private ambulance service that receives <br />no subsidies of any kind, would not blatantly refuse transfers <br />which are our livelihood, however, if we are unavailable, it means <br />just that. We have many transfers that are scheduled in advance <br />and it is possible that we are not available at the time the hos- <br />pital requests a transfer. It would be illogical to refuse ambu- <br />lance transfers when we are in business to provide ambulance trans- <br />portation. <br />Our Certificate of Public Convenience and Necessity in Indian Riv- <br />er County was originally issued on September 21, 1977 and has been <br />renewed annually since then. The certificate specifically states <br />that C & J Ambulance Service will provide quality "non -emergency" <br />ambulance service, comply with all the requirements of Emergency <br />Medical Services and will meet the requirements of State Legisla- <br />tion. The fact is we are a licensed Basic Life Support Service, <br />however, our certificate states that we will provide only "non- <br />emergency" ambulance service for your county. This.type of ser- <br />vice would include Hospital to residence, Hospital to Nursing <br />Homes, Hospital or Residence to International Airports or Resi" <br />dence to Doctor's Offices and return. These types of transfers <br />are often set up weeks in advance so it is not uncommon for us to <br />have appointments scheduled at the time the hospital calls for us <br />to do a transfer. <br />When an "emergency transfer" to Orlando, Gainesville or any re- <br />gional medical center occurs we may very well be unavailable due <br />to the above mentioned causes. It would be unreasonable not to <br />schedule or cancel appointments that have been made in advance in <br />order to have an ambulance waiting for an out of town transfer. <br />Another factor in these transfers is the nature of the illness of <br />the patient. We feel that Indian River Memorial will attest to <br />the fact that the vast majority of out of town transfers are pa- <br />tients that are in Intensive Care Units or Progressive Care Units <br />being transferred to a regional medical center or hospital able <br />to treat cardiac insufficencies or cardiac dysrrhythmias. These <br />patients generally go to the receiving hospital for cardiac cath- <br />eterizations and are ordered by the discharging physician to be <br />transported by ambulance with advanced life support capabilities. <br />These capabilities which are required are far greater than the <br />skills of our Emergency Medical Technicians, thus the discharging <br />hospital sends a nurse to accompany the patient with cardiac mon- <br />itors and quite often cardiac medications. These transfers are by <br />no means considered "non -emergencies" as the patient may require <br />advanced life support measures at any time during the trip. Again <br />we go back to our certificate and its guidelines which state that <br />we are to provide "non -emergency" ambulance service. <br />2 <br />