At the cajoling of audience members, CCMH CEO Jeff Tindle is allowed to briefly speak to the CCAD board before the meeting was abruptly ended on Nov. 17. (KMZU)

CARROLLTON — More than three weeks have passed since hospital CEO Jeff Tindle was silenced at a bizarre outdoor board meeting of the Carroll County Ambulance District. Armed with a letter describing Carroll County Memorial Hospital’s months-long ordeal of unreliable interhospital transfers – and the ambulance district’s refusal to transfer sick Covid-positive patients to more acute hospitals – Tindle and his board of directors asked for the ambulance district’s support for the allowance of a state license to take care of their own transfers. The hospital went as far a purchasing its own truck.

CCAD President Caren Bittiker seemed unaware of the problem at the Nov. 17 meeting.

“We are taking transfers,” she told Tindle.

“You are not taking Covid transfers,” he rebutted. “Your executive director said you are not going to do that.”

“Well, we have been taken some,” she replied.

“No, Caren, you have not,” he countered.

“Well, we can’t answer your questions at all. We are not going to, until we have legal counsel,” she said.

And while the meeting was hurriedly being adjourned, Tindle asks with inflections of desperation and anger, “You are forcing the governor’s office and the office of public administration to override this. Is this what you want?”

Promises made by the Missouri Department of Health and Senior Services to intervene on Nov. 16 have passed without resolution – at least not publicly.

“We have been working with the Carroll County Ambulance District to ensure that all applicable laws are being followed,” state health department communications director Lisa Cox wrote in part.

She says her agency cannot divulge additional information as it continues its investigation into the district.

Call logs obtained by Carroll County 911 show a distinct shift in the ambulance district’s position on whether it transports CCMH Covid-positive patients to higher care hospitals.

Earlier in November, the ambulance district refused service, even when the hospital deemed it an emergency.

According to those records, CCMH called 911 at 11:26 a.m. on Nov. 8 for an Advanced Life Support crew to transport an emergent Covid-positive patient to St. Luke’s North Hospital in Kansas City.

Three minutes later, 911 was notified the ambulance district is “not taking this call.”

It happened again two days later with another patient sick with the coronavirus. That request to St. Luke’s on the Plaza in Midtown Kansas City was also refused. The memo states, “They (the ambulance district) are not going to take the transfer. They are not ready for Covid patients. They will call CCMH to advise.”

Not only did the county ambulance service not pick up the patient, it didn’t find alternate means, such as mutual aid. Like numerous times before in recent months, the hospital had to fend for itself, according to CEO Tindle.

KMZU asked three regional EMS directors about refusal of service. They asked not to be identified as not to become embroiled in Carroll County’s contentious situation.

All three said as the authority for Emergency Medical Services for their districts, it’s their duty to act when asked to respond to an emergency.

“It may be delayed due to a higher priority call, but we never refuse,” says one administrator.

“We are the ambulance district,” another says. “We are considered the medical authority for transportation in the district,” adding, “We always handle emergencies; our calls are stacked by priority. We don’t second-guess doctors if they are calling for an emergency.”

Another said it more bluntly: “It is their duty to respond in a tax-supported district. They (the hospital) are another customer. If they can’t respond, it’s on them to find transportation through a mutual agreement.”

 Tindle flatly calls the denial of emergency service a violation.

“It’s illegal for them not to take a patient regardless of their health status. I believe the state bureau of EMS has probably had a conversation with them and raised that question, because it was shared with them as a complaint,” he says.

 The state’s response was more muted, referring to state regulations requiring “prompt response for emergency care originating from their ambulance district.”

 Additionally, the state points to regulations that require ambulance services to have a “medical control plan” approved by its medical director and administrator which specifically addresses the transfer of patients between medical facilities.

CCAD Medical Director Dr. Dave Gustfason referred questions regarding the district’s protocols for emergency call response, mutual aid and overall standard of care to administrator Mario DeFelice. KMZU provided those questions to him in writing on Nov. 24. DeFelice has not responded.

Since Nov. 20, the district began transferring CCMH patients sickened with COVID-19 to other facilities, according to 911 call logs.

 Tindle, as well as county officials are hearing through current ambulance staff intermediaries this reversal of policy is a temporary maneuver. He calls it “the most frightening information we’ve heard yet.”

 “They’ve told their staff they won’t be continuing to do Covid (transfers),” Tindle says of the reports. “That was just an exercise to get people off their back. They told staff when inclement weather occurs, they will discontinue doing transfers.”

The hospital CEO still considers his reliance on emergency transfer services from CCAD as fragile, placing the hospital in a precarious situation under the backdrop of a statewide response to the upswing in COVID-19 hospitalizations.

“All I can tell you is that the bureau of EMS has told us, unless we have a letter of support from Carroll County Ambulance District, no application can be considered,” he says. “I’ve worked with district’s attorney and I’ve submitted all this paperwork and my letter again asking for support. It was apparently announced there’s no way in the world they would sign it,” he says, referring to in-house communications at CCAD.

“I don’t know where else to go with it,” he says. “Because in my world, the healthcare world, there’s only one subject that anyone will broach right now and that’s the distribution of the (COVID-19) vaccine.”