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