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Ambulance rides are costly

It happened this past December – a skier at Sierra-at-Tahoe Ski Resort incurred an apparently serious head injury on the slopes. Paramedics arrived at the scene and wanted to transport him to the hospital, but the injured man didn’t want to go.

He wasn’t coherent enough to sign a release, however. So he went, like it or not.

It happened this past January – a good Samaritan helped to rescue a man from a burning building, and at first refused treatment from paramedics on the scene. He then accepted a ride to the hospital – which he thought would be free of charge – but later received a bill for more than $600.



What are your rights if you are injured or taken ill, and paramedics deem it necessary to transport you by ambulance? Can you refuse to go? How much will you be charged? Can you just take a cab?

“The policy is really the same throughout the United States,” said Randy Schrader, the deputy director of the El Dorado County Emergency Medical Services Agency. “Paramedics are obligated to transport injured parties to a higher level of medical care, regardless. There are operating procedures to determine when that is necessary.”




The problem is that many people don’t want to go to the hospital by ambulance, mainly because of the expense involved. And it can be an expensive ride. Lake Tahoe Ambulance, the main service provider for South Lake Tahoe, has a base rate of $450 – plus $11 per mile – for ambulance transport. In addition, services such as oxygen, medication, cervical collar or an IV, are extra charges.

The base rate is the same throughout El Dorado County, which is actually at the lower end of the cost scale in California and Nevada.

In El Dorado County, a portion of the cost for ambulance service is picked up by the taxpayers, through benefit assessments. But that’s not the case in Nevada. The Tahoe-Douglas Fire Protection District, which also has ambulance service, charges a base rate of $475, plus $10 per mile. That cost is incurred totally by the patient.

“Occasionally we’ll have people who call an ambulance, and then find out the cost involved and decide they don’t want to go,” said Jim Hardison, a fire fighter/paramedic with Tahoe-Douglas. “Usually if they call us, there’s a reason for it. And if the situation warrants it, we try to convince them to go (in the ambulance).”

But occasionally people just refuse to get on board, and that’s their right.

“We can’t be in the business of kidnapping people,” said Chuck Staub, Lake Tahoe Ambulance CEO. “If you’re an adult, and you have all of your faculties about you, you have the legal right to say no.”

Some people refuse treatment or transport even though that decision may have dire consequences.

“If someone really needs treatment or transport, and they refuse, then we advise them of the consequences,” said Tahoe-Douglas Fire Chief Tim Smith. “If it could result in their death, we tell them that. If they still don’t want to go, then they must sign a service refusal form, and we try to get a witness.

“Speaking frankly, that form and five cents will get you a cup of coffee,” Smith said. “But we’ve been fortunate; we’ve never had a situation where a citizen has come back and tried to hold the district liable.

“It’s one of the most difficult situations our paramedics have to deal with,” Smith said. “They have to make a field judgment as to whether the (victim) is coherent enough to make a decision (on transport). If he isn’t, and it warrants it, we take him. But if he’s coherent, he has the right to refuse.”

There are little-known exceptions to the above rules, however.

“Typically there is law enforcement on the scene (of an injury or accident),” Staub said. “If they deem that a person is a danger to himself, law enforcement officers can take a person into custody so that paramedics can transport him to the hospital.

“Also, if you are a minor, with no parent or guardian on the scene, if the paramedics decide you should go, you go.”

Some accident victims can get downright cranky. Like the guy who got dinged on the ski slope and couldn’t even remember his own name. Yet he tried to refuse the ambulance ride. Basically, if you’re that out of it, the decision is out of your hands.

But what about the good Samaritan, who thought he was getting a free ride to the hospital, because another accident victim was going in the ambulance anyway?

“Generally, I would agree (that he shouldn’t be charged),” Schrader said. “If that’s a specific case I’d be happy to look into it. But it doesn’t sound right to me.”

TAKEOUT:

Lake Tahoe Ambulance will continue to be the main service provider for South Lake Tahoe for at least a year. LTA’s contract was extended “through mid-year of 2000,” said El Dorado County Emergency Medical Services Deputy Director Randy Schrader.

“There are still some long-term issues to be addressed,” Schrader said. “(Our agency) has filed our report with the Board of Supervisors, and the final disposition of this is up to them.”

Lake Tahoe Ambulance has held the city contract for the past six years. But in recent months, two other agencies had expressed interest in making bids to take over the contract, including the Lake Valley Fire Protection District. The Board of Supervisors is scheduled to discuss the issue in its regular meeting on Tuesday, July 27.

“I hope (the board) makes a decision soon,” said Lake Tahoe Ambulance CEO Chuck Staub. “Right now we’re under extension. But would be nice to get a permanent decision.”


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