KEN IGE / KIGE@STARBULLETIN.COM
The state Emergency Medical Services and Injury Prevention System Branch was criticized yesterday by state Auditor Marion Higa for "grave deficiencies" relating to contract and personnel management. Above, EMS personnel tended to a victim at King and Punchbowl streets last night.
Ambulance system faulted State health officials have shirked their responsibilities of managing the state's emergency ambulance system, says state Auditor Marion Higa.
A report by state Auditor Marion Higa
says the Emergency Medical Services
is sloppily managed
By Pat Omandam
pomandam@starbulletin.com"I don't always agree with the auditor," said Bruce Anderson, state health director, yesterday. "But I think in this case the auditor has accurately identified a number of problems in the program that need attention."
In an 36-page audit expected to be released today, Higa cited "grave deficiencies" relating to contract and personnel management at the department's Emergency Medical Services and Injury Prevention System Branch, which oversees the ambulance system.
Those findings included inadequate administration of more than $34 million in annual contracts, most of it for ambulance services, as well as lax control over billings and collections in which $400,000 went uncollected on Oahu in fiscal year 2000-2001.
"Even more alarming, a potential $1 million went uncollected for ambulance services provided in Maui, Hawaii and Kauai counties during fiscal year 2000-2001," Higa said in the report. "This loss of potential revenue is directly attributable to the branch's failure to adequately monitor or enforce its contracts."
Anderson said the $1.4 million in uncollected fees reported in the audit are not based on verifiable data. He acknowledged part of the problem is that the branch did not maintain the records necessary to verify them.
"So again, this is an area where I think sloppy record-keeping is a problem, and we'll need to improve the accounting for the billings," Anderson said.
The branch's mission is to reduce deaths, injuries and permanent long-term disabilities due to medical emergencies. It contracts with the four counties and private companies to provide ambulance service.
Statewide ambulance contracts represent $34.3 million, or 94 percent, of the branch's $36.5 million in general-fund appropriations for fiscal year 2001-2002.
The fees charged for ambulance services range from $375 to $2,250 per trip, depending on the type and level of service. The money is deposited in the state general fund.
In 1999-2000, ambulance fees deposited totaled $12 million. Last year, it deposited $11 million.
Higa also noted management problems with the branch's 13 employees. They include inadequate control over employee leave, the lack of accurate position descriptions and performance appraisals, and indifference to the branch's working environment.
The problems have resulted in possible leave abuse, low staff morale, suspicious patterns of sick leave and a hostile work environment with the potential for violence, she said.
Higa cited incidents, in April 2001 and March 2002, where an allegedly hostile employee displayed anger in the workplace. Employees acknowledge that fear exists among some of their co-workers, she said.
"One employee responded that the department has not been supportive, noting nothing had been done to address the potential workplace violence situation," Higa said. "This same employee reported being scared that one of the branch employees will stab or shoot someone at the branch."
Anderson said mediators from the University of Hawaii Program for Conflict Resolution, who met with staff, did not believe there was an immediate threat of violence. He said anger-management and workplace-violence training has been provided to all of the branch's employees.
State of Hawaii
