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Enclosed is a copy of a letter we received dated July 31, 1984 from the Indian River Memorial Hospital, Department of Social Services in which the director of that department voiced concern over the problems they were having in obtaining ambulance trans- portation for their patients. The letter states that within the past months C &.J was unable to provide transportation for 42 out of 61 cases, whichwere inappropriately termed"non-emergencies". We found no mention of the hundreds of patients that we have done transfers on and no mention of the excellent care our patients and their families receive. At the time we received the letter we spoke with Mary Kaplan, Director of Social Services and explain- ed the fact that we are a private service that does non -emergency transfers and that the vast majority of her cases were indeed, true "emergencies". We also mentioned that it would be too cost- ly for us to consider becoming an advanced life support service as the equipment and drugs were very costly and that the disadvantage would be having an ambulance sit and wait for a transfer to occur. Many counties subsidize services to do this but without assistance it is generally too costly for a small private service. Commonly, through no fault of Social Services the receiving hospi- tal may say that they have no available beds and they will call the discharging hospital on quite short notice when a bed becomes avail- able for the patient. On numerous occassions when these beds become available the receiving hospital will require the patient to be at their facility -within a very short period of time. Many times we would be able to take the patient in the early afternoon as soon as we finish calls we have scheduled for the morning, however, the hospital will say that the patient has to leave immediately, which is not always possible for us to do. As you can see it is not that C & J is refusing transfers it is just that we are here to provide your residents with local non -emergency transportation as the Com- mission has determined our function to be. We feel that if we are issued a certificate such as ours -that we have aresponsibility to provide the services requested by the Commission. If we are expected to provide "emergency" ambulance services in the county it should be so stated in the certificate. We have served Indian River County for 7 years and it is not that we have diminished our services bu rather an increase in the num- ber of out of town transfers that are emergencies and of course an increase in the population in=the county. We find it unusual that the "refusals" are for the out of town transfers, yet the Indian River County Volunteer Ambulance Squad (I.R.C.V.A.S.) has been do- ing all of the neonatal team transferes that come in to the local airport. These teams are comprised of neonatal specialists and in essence are not Ambulance Emergencies. If we had been out of town on all of the 61 transfers Ms. Kaplan talked about in her letter, would the Volunteers be taking all of the "non -emergency" transfers such as the local Doctor Office and Nursing home calls? The question here being is our function to be changed from its previous description and are complaints being directed to the right party. It seems that the problems are many and that they do not lie as the sole responsibility of one single non -emergency service. It seems rather illogical to have the "non -emergency" service doing the emrgency calls and the "emergency" service doing the non -emergency calls. It is understandable that Indian River Memorial has a growing con- cern regarding this issue. Mr. O'Grady blames C & J.'s inability to accept referrals as directly affecting the patients' dischrage being delayed. He also suggests that it may cause additional ex- pense to the patient and inconvenience to the family. It is un- reasonable for C & J to take the blame for a shortage of Ambulances whether they be emergency or non -emergency vehicles. Secondly, Mr. O'Grady states that I.R.C.V.A.S. performed the transfers and that it is beyond the stated goals of the Volunteers to provide "emerg- ency" transportation services. Obviously, if I.R.C.V.A.S. holds the Certificate of Public Convenience and Necessity as the Emerg- 3 BOOR 58 F 1. r U40