County EMS Audit Returns 14 Violations; All Were Corrected
The Emergency Medical Commission and the Indiana Department of Homeland Security released an audit of the Washington County Ambulance Service where it did not meet 14 of 51 audited requirements.
The violations include expired medications, not enough meds, and supplies on the trucks.
This audit was performed on January 28, 2020 and was released to Scott McFelea, former ambulance service director, Steve Young, the service’s training officer, and to Dr. Jeff Morgan, the medical director of the ambulance service.
There were 11 sections under four categories – Provider Operations, Vehicle and Equipment, Communications and Advanced Life Support.
According to Washington County Council President Karen Wischmeier said all of the violations were corrected.
Wischmeier said current ambulance director Nick Oleck and Dr. Morgan fixed all of the issues that were unmet in the audit.
“I was not given a copy of this report until the new director (Nick Oleck) gave it to me,” said Wischmeier.
She said Oleck was a former supervisor of the Scott County Ambulance Service prior to being hired earlier this year as the Washington County Ambulance Director.
She said at the time the audit was performed, McFelea was the ambulance director and the operations manager.
Phillip Marshall is the president of the ambulance board as well as president of the Washington County Board of Commissioners.
Wischmeier is vice-president of the ambulance board and President of the Washington County Council.
County Councilmember Rondale Brishaber is also on the board.
“By having an ambulance board in place, you have a fiscal oversight from the council with a 2-1 vote,” said Wischmeier. “Any large purchases that are made, then they need to be addressed and approved not only by the board but also by the commissioners. If you put all three commissioners on that board, you’ve lost the additional oversight of the board. Now it’s all one unit…there’s not further discussion made.”
“I was told that the issues within the ambulance service began long before I stepped onto the board on 01/01/2020,” Wischmeier said.
McFelea was appointed as the interim ambulance director in July 2019.
He was given 6 months to address the issues within the department, Wischmeier said.
“The board was under the impression from the department that things were being addressed, however they were becoming aware of other issues through members of the public,” Wischmeier wrote in an email.
Then in December 2019, she said, an outside source contacted Homeland Security regarding the concerns within the department.
Homeland Security came down in January and conducted the audit inspection which resulted in the report.
“The board was told that the audit was fine and that they passed everything,” said Wischmeier.
“We asked McFelea to step down from the leadership role in early February.
She said Oleck was hired near the end of February and he was given a copy of the audit report from Homeland Security within a day or two from his first day.
She said Oleck was given 18 days to resolve the issues on the audit report and he fixed them within less than two weeks.
VIOLATIONS BY SECTION
The department met all three items of the Reports and records section.
Under Audit and Review, the department met six of eight areas with a deficiency reported as “problem identification and resolution” and “method identifying needs for staff development.”
Notes from the IDHS were that the “audit and reviews are done monthly during monthly in-service training,” “Medical Director isn’t involved in the audit and reviews” and “Reports are pulled based on what in-service is being performed that month.”
The second section of Training was all met according to state standards.
The notes under that section read, “training records were lost when the last training officer terminated employment” and “training officer advised that he does hard copies and electronic files.”
Under operating procedures, the department received five compliance marks and four non-compliance marks, including:
Medication and supplies have not exceeded the expiration date
- Written defined sanitation procedure
- Vehicle equipment, supplies, and storage comply with code
- Vehicle and equipment check sheets completed per shift and on file.
Notes under this section include – “all trucks aren’t inspected daily. Should be completed daily on all trucks. Narcs aren’t checked daily either. No sanitation procedures for cleaning of the trucks.”
Under the Certification of Ambulance Service Providers, the only two items the department met were staffing and scheduling and established signs and protocols.
Those three items not met were:
Medical Director fulfills the following responsibilities
- Participates in Audit and Review (not met)
- Participates in Skills Review/Evaluation (not met)
- Is available to staff for consultation and assistance
Notes on this section included “medical director is hard to contact. doesn’t read emails regular[ly] unless directed to check his email. [the] medical director isn’t involved in audit and review. it’s done inhouse by [the] training officer.”
There was an item not met under Vehicles and Equipment. However, there is a note to see [the] inspection form that is attached to the audit, however, the copy provided to WSLM did not have any attachments.
The item under insurance was met, with the note – “all vehicles are county-owned and maintained.”
All items under Communication were met with the note “dispatching [is] done by a county dispatch center”
The three items under the Emergency Medical Services Vehicle Radio Equipment were all met. There were no notes in this section.
One item under Advanced Life Support was listed as unmet was an item called “Medication Per Protocol, Properly Stored and Not Expired” with the following note – “Protocols don’t list type and quantities of drugs required”
The next section included items listed as Advanced EMT and Paramedic.
Those items unmet were
- All Advanced Life Support medications are present, sufficient quantity and not expired
- Is the provider giving specialty care (exceeding Indiana curriculum)
- If yes, above, does protocol/medical director cover this?
There were no follow up notes for these items.
“Homeland Security performs these audits in order to make sure a department is meeting state standards,” she said.
“Any ill things on this report about Dr. Morgan, are in my opinion, probably not his fault. I don’t feel he did anything wrong due to a lack of communication from the department,” stated Wischmeier.
“There was a strong lack of communication in that department,” said Wischmeier.
Attached is a copy of the audit – Washington Co EMS Provider audit 2020
