by Vincent Shu, MD
Despite there having been discussions and negotiations in recent months between Orcas Island Health Care District and UW Medicine Orcas Island Clinic, specific to the need of after hours/urgent care, district commissioners have expressed frustration in this matter because it remains unresolved. I feel compelled to give my standpoint related to this issue.
An after hours/urgent care model can help reduce 911 calls resulting in a reduction of unnecessary air transfers:
Most after hours/urgent care has been taken care of by calling 911 because of no after hours/urgent care available.
I spoke to Chief Williams who told me that when islanders call 911 for after hours/urgent care, EMTs assume jurisdiction over their care. They are abided by law to send patients to the nearest hospital as soon as possible where board-certified emergency room physicians will then take over their care.
As Orcas does not have a hospital emergency room, it poses a unique issue. EMT staff and volunteers who are incapable of accessing and have no knowledge of patients’ medical records (such as previous EKGs and others) may find insufficient data difficult in evaluating the presenting illness. As such, there is a very good chance of airlifting off-island because EMTs are concerned about potential liability risks. No one wants to be sued! This may have led to more unnecessary air transfers.
After hours/urgent care for patients is under the care of their primary care physicians. Unlike EMT staff and volunteers, PCPs are credentialed as clinicians, educated and trained professionally in diagnosing and treating a variety of acute/chronic illnesses. Gathering all the clinical data, PCPs are in a better position to reassure patients about the clinical significance of their illnesses. Therefore, after hours/urgent care under the care of PCPs is likely to reduce unnecessary air transfers.
Approval of air ambulances faces growing scrutiny from authoritative organizations specific to the medical necessity of airlifting.
For the months of January and February, 61 were patients were flown off island, averaging one air transfer every day. This appears too excessive on a small island, raising the question: how many cases are deemed, unequivocally, medically necessary; that they will die if they don’t fly off.
Twenty air transfers have been denied by Kaiser. This issue has been under investigation and negotiation among OIHCD, board of health, Orcas Fire, San Juan County council and Kaiser Permanente.
For the long-term solution, it lies in how to limit air transfers to those who are truly in need. If PCPs can assume their active role in this matter, then PCP-sponsored after hours/urgent care models would offer health care in a compassionate, caring environment, and ultimately improving a doctor-patient relationship and quality care measures.