Hospitals turning away ambulances even as some ban diversion

Riccardo Colella, head of Emergency Medical Services for the State of Wisconsin and Milwaukee, discusses the message hospitals want to send when they are closed to ambulances. He spoke to a conference in Dallas March 1, 2019.

Riccardo Colella, head of Emergency Medical Services for the State of Wisconsin and Milwaukee, discusses the message hospitals want to send when they are closed to ambulances. He spoke to a conference in Dallas March 1, 2019. (Photo: John Diedrich / Milwaukee Journal Sentinel)

DALLAS – Ambulances carrying sick and injured patients are being turned away from hospitals across the country, in some cases bouncing like a pinball from facility to facility as critical minutes tick away.

A paramedic from Atlanta was diverted from five hospitals for the same patient, each saying its emergency room was too busy. He finally just ignored the diversion order and declared to one hospital: We are coming in.

“It was insane,” said the paramedic, who didn’t want his name used for fear it could cost him his job.

The paramedic spoke to a Milwaukee Journal Sentinel reporter at a recent conference in Dallas of emergency medicine officials, called “Gathering of Eagles,” where the perils of ambulance diversion were discussed.

A Journal Sentinel investigation found that diversions persist even though studies say they are ineffective and could be dangerous. A Milwaukee woman had a stroke next to the best stroke center in the area but was diverted and later died.

At one point, those in attendance were asked to raise their hands if the practice was still in effect. Dozens of hands shot up.

Paramedics in New Jersey, Chicago, suburban Philadelphia, New York and London, England, told the Journal Sentinel of daily frustration with ambulance diversion, where patients can be turned away because a hospital has determined its emergency room is too busy.

Hospitals on diversion are basically saying, “We’re closed but we are really awesome so come back when it is more convenient for us,” Riccardo Colella, medical director for the EMS system for the state of Wisconsin and Milwaukee County, told hundreds gathered for the convention.

READ THE INVESTIGATION: Wisconsin woman dies after an ambulance was turned away from best, closest hospital

SHARE YOUR STORY: Have you or a loved one experienced ambulance diversion — or are you a paramedic or other health care provider who has more information? Tell us here.

The practice began decades ago as a desperate attempt to lessen hospital overcrowding but has become common across the country, despite evidence it can endanger patients and doesn’t solve crowding long term. A growing number of cities have ended the practice, most recently Milwaukee, but it persists nationwide.

No federal agency tracks diversion, so it’s unclear how widespread the tactic is, but it is common in urban areas. Two-thirds of the nation’s largest 25 cities allow diversion or practices similar to it, including nine of the top 10, the Journal Sentinel found.

Nevertheless, the practice of diversion is largely unknown to the public; people assume they or their loved ones will be taken to the closest hospital with the best care for their condition and the one they want to go to. But none of that may be true if the hospital is on diversion.

Supporters of diversion say sending patients to an overcrowded emergency room is more dangerous than diverting them to another hospital that, ideally, can provide the same level of care.

Critics counter that diversion delays care and the same level of treatment may not be available. And that next closest hospital may itself go on diversion.

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Turning away ambulances has a minimal effect on the volume of people coming in an ER because roughly three-quarters of patients arrive on foot or by car and under federal law, they cannot be turned away.

Studies have found emergency room overcrowding is caused by bottlenecks elsewhere in the hospital and longtime practices such as scheduling elective surgeries early in the week. That is a convenience for surgeons but creates a shortage of beds all at once.

“I don’t want to vilify diversion,” Colella told the group. “There are certainly legitimate times that that has to happen. … But that should be the exception, not the routine way of doing business.”

Milwaukee mom having stroke diverted

Ambulance diversion was thrust into the spotlight earlier this year by a Journal Sentinel investigation that documented the case of Tiffany Tate, a Milwaukee woman who suffered a stroke while she was working at the cafeteria at the Medical College of Wisconsin in August 2014.

The 37-year-old mother of a teenage girl and a baby boy was 350 yards from Froedtert Hospital, the highest-rated stroke center in the area, when she had her stroke.

But Froedert was on diversion and Tate was taken by ambulance to a hospital with a lower level of stroke care. Tate later died. Experts couldn’t say if quicker care would have saved her, but they agreed she would have had a better chance.

At the time of Tate’s stroke, Milwaukee County was in the…

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