Witness testifies hospital capacity and in‑hospital delays drive ambulance performance problems

Mr. Shelinger, a witness in the proceeding, testified that hospital discharge delays are caused by multiple factors beyond ambulance availability and simple ‘requests ÷ ambulances’ calculations. He said the working group report notes that discharge delays often stem from insufficient capacity in post‑acute care, behavioral health services and housing, and that strategic investment in those areas is essential to improving patient flow.

“Frequently there’s delays in the hospital for discharge summaries not being ready,” the witness said, listing common causes—missing transcription, patients away for tests, difficulty locating unit staff, and mechanical elevator outages—that can keep ambulance crews waiting even after they arrive at hospital property. He explained these delays create a downstream “snowball effect” that affects the rest of the crew’s shift and the system’s ability to meet scheduled and unscheduled trips.

The witness also described problems with wheelchair availability at hospitals. “Wheelchair availability is very difficult to obtain,” he said, and hospitals will sometimes request stretcher transport for patients who could be moved by wheelchair. “Looking at any year probably in the last couple years, 12 to 15% of the time we’re ending up transporting a patient by stretcher who didn’t really require [it],” he testified, adding that those trips are often written off (a GY modifier) rather than billed to Medicare because billing would be inappropriate.

Counsel and the witness also discussed on‑time performance metrics used in attachments to the record, noting that those metrics measure when ambulance personnel arrive on hospital property. The witness agreed that those measures do not capture subsequent in‑hospital delay duration and confirmed the absence of duration data in Attachment 3A. He said such in‑hospital delays—paperwork, elevator outages, added discharges—reduce the system’s capacity across the day and cannot be solved solely by adding ambulances.

The hearing heard that AMR provided monthly reports under the 2019 contract and had submitted data going back roughly five years to St. Vincent’s; however, counsel pointed out that the attachment in evidence did not show duration of delays and so could not on its own demonstrate how long crews were held at hospitals. The witness said he relied on operational experience and multiple data sources rather than a single simple equation when assessing how many ambulances are required.

The hearing officer allowed a late submission on related data to be admitted for consideration and permitted cross‑examination of the document’s preparer before recess. The proceeding was recessed briefly with further testimony expected after the break.