Nathan Littauer Hospital officials have given sworn statements as part of a lawsuit that indicate having only one ambulance service authorized to transport patients out of the hospital is causing problems for the facility and its patients, including delays of as long as "three to five hours."
Dr. Trevor Black, an emergency room physician at Nathan Littauer Hospital for four years, and Dr. Gary Wakeman, a six-year veteran of the hospital, gave sworn affidavit statements in support of the Empire Ambulance Service of Troy's lawsuit against the state Department of Health and the Adirondack-Appalachian Regional Emergency Medical Service Council (AAREMS).
Empire wants AAREMS, which regulates the operational authorities of ambulance services in six counties, including Fulton and Montgomery, to stop blocking its application to take control of the certificates of need of two Fulton County ambulance services that shut down last year: the Ambulance Service of Fulton County (ASFC) and the Johnstown Area Volunteer Ambulance Corps (JAVAC).
Black and Wakeman state having only one ambulance service — in this case the Greater Amsterdam Volunteer Ambulance Corps — available to provide Advanced Life Support services for Nathan Littauer's hospital transfers has not been a good thing.
Black states his hospital would be better served with more ambulance agencies that can provide ALS operating in Fulton County.
"I have had numerous critical patients requiring transport out of Nathan Littauer Hospital that had to wait for an extended period of time because of delayed ambulance response by the sole-authorized ambulance provider that now exists," Black states.
Wakeman was more explicit in his account of the cost of only having GAVAC available for ALS.
"Since the loss of services of ASFC and JAVAC, I have observed delays in the transfer of seriously and critically ill patients due to the availability of only one service that provides such transfer services and is providing that from a central office in Amsterdam -- a thirty minute's drive away," Wakeman stated. "Some of these transfers have been delayed as much as three to five hours. Recently, I had a patient being managed for septic shock who did not leave our facility to go to Albany Medical Center Medical Intensive Care Unit for longer than 90 minutes. Such delays are dangerous and medically unacceptable."
Empire filed its latest request for a court injunction in the ongoing dispute in Albany County Supreme Court Friday. The filing included statements from Black, Wakeman, Nathan Littauer Vice President Geoffrey Peck, and ASFC Director and Vice President Alan Mendelsohn.
Peck states Nathan Littauer Hospital and its patients were better served when there were more ambulance services capable of providing ALS.
"At present, three ambulance crews are covering an area where as many as ten had previously been available to NLH and residents of our region," Peck stated.
The Greater Amsterdam Volunteer Ambulance Corps [GAVAC] was given the operational authority to provide ALS services throughout Fulton County in 2019 — including the lucrative hospital transfer calls Black and Wakeman refer to — after the abrupt shutdown of the ASFC in February when the entity ran out of cash to make payroll. JAVAC shut down only about a month later, and now GAVAC has the primary authority to respond to ambulance calls in all of the former territory of ASFC and of JAVAC.
Initially after the ASFC shutdown, JAVAC and GAVAC had worked together as part of patchwork of ambulance services assembled to cover the territory. During that time Nathan Littauer Hospital inked a non-binding agreement with JAVAC for it to provide for the hospital's transfer calls, but GAVAC disputed whether JAVAC had the authority to be the primary service for those calls, asking AAREMS to rule on the issue. JAVAC shut down before a ruling was ever made, leaving GAVAC in sole control of the hospital calls. At the time, both GAVAC and JAVAC told authorities the revenue from the hospital calls was vital for them to remain financially viable in Fulton County.
Since then, Empire Ambulance Service has partially revived the ASFC and JAVAC, providing personnel to the two entities, enabling them to provide Basic Life Support [BLS] services. BLS includes administering oxygen, insulin and other basic care, but not painkilling narcotics, which require the ALS license. Ambulance services are also able to charge higher fees for ALS calls. In order to provide ALS services, Empire needs AAREMS and New York state to sign off on its applications for the ASFC and JAVAC to transfer their full operational license, known as the certificate of need, to Empire. Empire has also applied for licenses to administer controlled substances for each of those ambulance companies.
Empire, through its attorney Tim Hannigan, has filed requests for court injunctions to require the AAREMS to stop blocking its application to take over JAVAC and ASFC and to stop the state Department of Health from issuing charges against those ambulance services that could result in the ambulance licenses for the two entities either being revoked or limited. According to Empire's lawsuits, the only reason given so far by the state Department of Health for the charges against ASFC and JAVAC was the temporary shutdown of those services, a rationale Hannigan argues in his court filings is "unprecedented" and possibly a violation of state law.
Empire has filed two lawsuits in the matter, one each for JAVAC and the ASFC, and both allege a coordinated attempt by AAREMS, its chairman Thomas Pasquarelli, who is also the GAVAC executive director, and the state Department of Health to stop Empire from providing ALS services in Fulton County.
Empire's injunction request includes a chronology of what it considers the improper actions taken by AAREMS, Pasquarelli, and the state Department of Health in the time between June and December.
Empire contends that AAREMS, under Pasquarelli's chairmanship, raised false procedural objections to Empire's application for ASFC's license during the months between June and December.
"On June 21, 2019, AAREMS wrote and advised that the application was incomplete because an electronic redacted copy did not contain a signature page for the Statement of Purpose and Intent," wrote Hannigan for Empire's court filing. "Upon receipt of that letter, counsel for Empire contacted AAREMS. Thereafter, AAREMS confirmed that both signature pages for the Statement of Purpose and Intent – one executed on behalf of Empire, one executed on behalf of ASFC – were included in the three physical copies of the Transfer Application of Ambulance Service of Fulton County, Inc. that were transmitted via FedEx Overnight Mail to AAREMS on June 6."
Hannigan's legal filing for Empire states AAREMS held its Sept. 19 meeting, but did not act on the application to transfer ASFC's license to Empire, stating the council had to wait until a "final determination was made in an enforcement action by NYSDOH."
Hannigan said this assertion was news to Empire and the ASFC, because no state Department of Health "Hearing and Statement of Charges" had yet been served on ASFC.
The ASFC was served with a Notice of Hearing and Statement of Charges from NYSDOH dated August 30, on Sept. 30.
"For reasons unknown, both the Notice of Hearing and Statement of Charges contain a handwritten date of August 30, 2019," reads the court filing.
Hannigan argues the NYSDOH has offered no reason for the charges other than the suspension of the ASFC's operations from February until when Empire began supplying them with personnel for BLS calls.
ASFC Director and Vice President Alan Mendelsohn's sworn affidavit states ASFC management met with Pasquarelli on Feb. 13. He said Pasquarelli gave ASFC advice that proved to be the opposite of what would then happen.
"Various issues were discussed with Mr. Pasquarelli, including ASFC's concern over whether an EMS call needed to be run every 30 days to maintain our certifications," said Mendelsohn in his sworn statement. "At his meeting with us, Mr. Pasquarelli informed ASFC that our concern was not a basis for worry, and that neither the State nor the AAREMS council has ever taken negative action against an entity's Certificate of Operating Authority based on a failure to answer or respond to calls."
Mendelsohn said the ASFC proceeded according to Pasquarelli's statements.
"Mr. Pasquarelli's statement allayed the concerns of ASFC, and we relied upon his statement to inform our ongoing operations and decisional processes up to and including submission of the underlying application to transfer the certificate of need held by ASFC to Empire Ambulance," he said.
The Daily Gazette has sent three emails to Pasquarelli seeking comment on Empire's lawsuits and the allegations in the recent court filing on Friday. Pasquarelli has not yet responded to the emails.
Hannigan said the NYSDOH enforcement action against the ASFC, and similar charges against JAVAC, have been used as the reason by the state to deny Empire's applications for controlled substance licenses for those entities, which if granted would enable them to provide ALS services.
Hannigan said the NYSDOH hearing to address the charges has been adjourned without a new court date since Oct. 31, enabling AAREMS to hold up Empire's application to take over the ASFC's license and the JAVAC license.
Hannigan argues the state's actions violate the law and have caused irreparable harm to the ambulance services he represents and the general public. He said he hopes Albany County Supreme Court will take action on the dispute sometime during the spring of 2020.
Read the petition filed in the case: