My involvement in the ambulance diversion issue in Jefferson County is as a private citizen only. I just happen to be a paramedic.

The Darlene Sanders case brings the diversion situation in Jefferson County into a particularly bright light. Ms. Sanders was a victim of a diversion plan administered in secret with the participation and cooperation of several agencies.

These public agencies (the Louisville Fire Department, Jefferson County EMS and the Anchorage Fire Department) are not the target of my complaint.

My target is the Jefferson County Medical Society and its EMS Committee, and its arrogant presumption to know what's good for the people of our community, and the hospitals that pushed for diversion. In the letter barring me from attending meetings of the EMS committee, Lelan K. Woodmansee, JCMS' executive director, stated that (to paraphrase) "JCMS is unaware of your (Jay Reeves') authority to represent the public." To be honest, I'm unaware of the JCMS' authority to oversee the operation of ambulances in Jefferson County.

That is why I filed an Open Meetings Complaint with the Attorney General's office. I believe that if diversion is going to be carried out by public agencies, then the public has a right to be informed of how it is being administered. The committee prohibits direct comment from those most affected: people who call for ambulances. Then, as the messengers of the EMS committee, EMS crews get to take the wrath of the public!

If, as the JCMS attorney says, "(members of public agencies) are not fulfilling any legal obligation or requirement imposed by state law or regulation" and that they participate on the committee "as volunteers...," then wouldn't it follow that participation in the diversion plan would also be voluntary? The EMS Committee is not elected and answers to no one but themselves.

Hospitals, on the other hand, answer to the Federal government through a regulation called the Emergency Medical Treatment and Active Labor Act (EMTALA) which mainly deals with access to emergency care in emergency rooms and transfer of patients between hospitals. It more or less is an "anti-dumping and ER open door law." Those signs you see in ERs saying "You have the right to be treated here regardless of your ability to pay" came from this. It is part of the regulation commonly known as COBRA.

This regulation makes provisions for hospitals to be on "diversionary status," but it also states"

"If, however, the ambulance staff disregards the hospital's instructions (on diversion) and transports the individual on to hospital property, the individual is considered to have come to the emergency department." (42 CFR 489.20) When a patient "come(s) to the emergency department" then the hospital must treat them (but not necessarily admit them to a bed).

Darlene Sanders died because of a delay in treatment (according to a coroner's inquest). As EMS providers we know that drug overdose patients often take time to display signs and/or symptoms. Ms. Sanders wanted help; the fact that she took a bus across town to the hospital of her choice (Baptist Hospital East) proves that. But the ambulance crew had to tell her she could not be transported there due to diversion, a policy she had a good chance of never hearing of, or any right to express an opinion on directly.

She deserved better. EMS deserves better. Our community should demand better.