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August 29, 2007


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Dwight Hines

This essay was a guest column in the local newspaper this last Sunday. I think it shows some of the problems that can happen when records are not public.
We need to think about a common strategy between Florida and Oregon that includes the Access-Information people in the Council of Europe.

Dwight E. Hines
150 Nesmith Ave.
St. Augustine, Florida 32084

August 24, 2007

St. Augustine Record, Letters to Editor
St. Augustine, Florida

Dear Sir or Madam:

According to the June 29, 2007, “St. Augustine Record”, emergency medical services (EMS) in St. Johns County answered 20,000 calls, according to Chief Hall.  On July 4, 2007, the St. Augustine Record reported that there were 16,000 calls.  A small table shows the range of estimated costs.

Call Mileage Annual
Total Calls Cost Subtotal Charge* Total

16,000 $300 $4.8 Million 1.12 Million $5.92 Million

16,000 $550 $8.8 Million 1.12 Million $9.92 Million

20,000 $300 $6 Million 1.4 Million $7.4 Million

20,000 $550 $11 Million 1.4 Million $12.4 Million

Note that there are millions of dollars of differences between the annual total cost of 20,000 calls and 16,000 calls.  At the lower medical level of $300, the difference is 7.4 - 5.2 = one million four hundred thousand ($1,400,000) dollars.  At the level of greater medical need ($550), the difference between 16,000 calls per year and 20,000 calls per year is two million four hundred eighty thousand ($2,480,000) dollars.  First, less than one million dollars will more than pay for one year of a medical clinic in St. Augustine, part of an area that has the highest infant death rate in Florida, with almost three times as many black infants dying as white infants.

According to the St. Augustine Record, a new mobile electroencephalograph (EKG) in the St. Johns County EMS ambulances will allow better treatment of patients by sending the patient’s EKG to Flagler Hospital before the patient gets there.  The St. Augustine Record also stated that Flagler Hospital will not charge for the EKGs that are phoned in from EMS.  One fact that is bothersome is that the St. Johns EMS is not in compliance with Chapter 119, Fla. Stat. (2007), open records act, and thus tax payers will not be able to know how the adoption of the new EKG technology shifts the number of ambulance calls from basic life support ($300.00 per call) to advanced life support ($550.00).  In times of tight budgets, I predict the shift will be large and continuing.   

Other real questions that can not be answered, because of unavailable data from the St. Johns EMS — even though EMS is required to collect and maintain parts of the data — are how many patients who are brought to Flagler Hospital by St. Johns EMS leave alive?  How comparable is that number to other hospitals.  What is the size of the disparity between those leaving alive who are black and those who are white?  What is the national rating for Flagler Hospital for cardiac treatments for patients brought by an EMS?  In other words, given what we know about how often medical technology does not improve outcomes (see Peter Guinta’s review of “False Hope for Breast Treatments”, St. Augustine Record), would it be healthier for the people of St. Johns County to be taken directly to the Baptist Medical Center in Jacksonville instead of Flagler Hospital?  Would it be healthier for a person to drive himself to the hospital instead of waiting for St. Johns EMS (time taken to respond to calls, time of arrivals to Flagler Hospital are not available, a violation of Rule 1B-26.003, Florida Administrative Code and the Florida Open Records Act).

Finally, applying adverse inferences to EMS’s failures to provide records, as required by rules and law, allows strong statements in Florida State Courts and Federal courts that St. Johns County EMS is more than likely to contribute significant statistical and substantive proximal causes to the high infant death rates in St. Johns County, as well as to contribute significant statistical and substantive proximal causes to the approximately 3 fold ethnic disparity in infant deaths. 

Odd, isn’t it, that some people feel that the Florida Administrative Rules and the Florida Open Records Act have no real value in the quality or the extent of our lives.


Dwight Hines

*Because the data are not available on mileage per call, we conservatively estimated an average of 10 miles per call at the standard rate of $70.00 per mile. Multiplying the number of calls by the average miles keeps “distance” in the estmated computations and will allow for more sophisticated multiple imputation methods to be used later.

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