My letter to Kathy Hart, Medicaid director, ended with “Ms Hart, do you realize how horrible this system is? Patients can’t get rides and providers can’t get paid because Medicaid Transport is so poorly managed. Elderly sick women in wheelchairs are fighting with tired, sweat-soaked transport drivers because of mistakes Medicaid Transport is making. Medicaid Transport is the cork in the bottle, and it is causing all of us an enormous amount of distress.
“We are sick citizens who have paid our taxes and voted every year, and now we are reduced to this abuse! All we want is to be able to go to the doctor to try to ease our pain, or get some measure of healing. When you go to the doctor, Ms Hart, you stick your keys in the ignition and go wherever you want to. The only way we can get to the doctor is locked through a single telephone number. We have no options, no choices. This causes frustration, anger, depression and despair. Why bother to try to take care of ourselves, we wonder? Why not just give up and die?
“That’s what Medicaid Transport is doing to a lot of fine people who are old and sick.
“Please tell me what you’re going to do to fix the problems.”
The contract for dispatching Medicaid transportation had been moved from the agency in Onondaga County to an agency on Long Island. Kathy Hart was trying to violate their contract and had asked for my help in doing so. I submitted information documenting some of the problems, including dialing sixty times before I broke through the busy signal, and being on hold for 41 minutes. The operator in Long Island told me that (a) she was the only person working Medicaid calls; (b) she was having to put numbers into “the Medicaid box” about three times before they’d work; (c) they were taking calls for 5000 accounts, and (d) doctor’s calls get priority.
This really rankled: doctors get priority. We live in a society where doctors matter and patients don’t. I’m getting up in the morning and reading the Holy Bible, which says that Jesus came for the poor and the sick, and that they—hey, me!—matter to God. Nowhere in my bible does it say that physicians come first. Jesus and his apostles healed the sick. In 2002, in Upstate New York, the sick come last; doctors come first. That riled me. And besides—those 5000 accounts that the telephone answering service is serving—aren’t they all paying the same amount to buy service? How come the money that Medicaid pays to the answering service doesn’t buy the same level of service as the money that a doctor pays to the answering service?
So Kathy Hart violated the Long Island contract and it was let to Rural Metro. According to their website, “Rural/Metro is a national leader in private ambulance and fire protection services in 21 states and nearly 700 communities from coast to coast. Rural/Metro is a national leader in private ambulance and fire protection services in 21 states and nearly 700 communities from coast to coast. . . Rural/Metro’s EMS professionals provide more than 1.3 million 911 emergency and interfacility [sic] ambulance transports annually. Our firefighters respond to more than 60,000 calls for assistance each year. Our experienced and proven management team is supported by 21 zone executives and local operations managers with an average of 24 years of industry experience.” So you would figure they would know what they’re doing, right?
The way the Medicaid transportation system works is this. First, you have to apply for Medicaid transportation; it does not come automatically with Medicaid. Then you have to call the Medicaid transportation dispatch office. They verify that you are covered by Medicaid, take your ride order—in which you specify the company with which you want to ride—and then send the order to that company. Brain surgery might be a little tricky, but dispatching Medicaid transportation orders is not, nevertheless, Rural Metro couldn’t get it right and every time I reached out to the general manager at Rural Metro he told me that he didn’t have anything to do with Medicaid transportation.
Excuse me? He runs Rural Metro and Rural Metro’s got the contract, so what is going on here? How can he disavow responsibility for the failure of his employees to perform their jobs correctly? Well, there was a little kink that I didn’t understand.
Rural Metro (“50 Years of Service Others” [sic]) sent out a letter. Before reading any further, you need to know that “sic” is Latin for “thus” and the shortened form of sic erat scriptum, which means “thus it was written.” In other words, when you are quoting someone who has written something that is wrong and you know it, then you stick sic in there to alert your readers to the fact that you know this is wrong but it’s actually what the original author wrote. So here’s part of the letter:
50 Years of Service Others [sic]
IMPORTANT NOTICE REGARDING
ONONDAGA COUNTY MEDICAID TRANSPORTATION
Medicaid transportation is not an entitlement. You do not automatically get Medicaid transportation because you are receiving Medicaid assistance.
To receive Medicaid transportation you must . . .
If you believe you have a special medical condition, you, or a representative, must complete the front page of the enclosed form. You must then forward the form to your PRIMARY CARE PHYSICIAN who will complete the reverse side of the application. Your primary care physician is the ONLY person authorized to confirm the accuracy of your transportation abilities. Forms completed by any one [sic] other than your primary care physician will NOT BE REVIEWED and all transportation will be DENIED. The physicians’ staff, at the direction of the physician, may enter patient information but the psychic in [sic] must sign the verification statement.
All forms will be evaluated in accordance with the standards set in the Americans With [sic] Disabilities Act. (ADA). [Sic]
The mailing of t he [sic] forms have been [sic] electronic recorded in our computer system and is expected to be returned [sic] . . .
Please mail the completed form to:
Rural Metro Medical Services
C/O: MAS Transportation
488 W. Onondaga St.
P.O. Box 671
Syracuse, NY 13201
If you have a question about these forms, call Medicaid transportation at 315-701-7500.
If you disagree . . .
Revised 7/08/2003 [sic]