Red tape, confusion delay payments for ambulances that worked Katrina
Copyright 2006 Capital City Press
All Rights Reserved
By SANDY DAVIS
The Advocate (Louisiana)
When another hurricane barrels toward the Gulf Coast, the largest coalition of ambulance companies in Louisiana may not send help because the state hasn't paid the $6.6 million members say they're owed for their work during the first 30 to 45 days after Hurricane Katrina.
"Two weeks from now hurricane season starts and we're going to get called again," said James Piker, attorney for the Louisiana Rural Ambulance Alliance. "As the Alliance's legal adviser, I'm going to tell them not to go."
Piker claims the state is responsible for the bill because a state employee requested the ambulance companies send trucks, paramedics and other employees to New Orleans. Once there, the ambulances fell under the control of state officials, who dispatched them daily.
The state, however, says the Federal Emergency Management Agency should pay for the services.
"It's incumbent on FEMA and the Office of Emergency Preparedness to pay those bills," Robert Johannessen, a DHH spokesman, said.
"The reason we haven't paid the bill to the Louisiana Rural Ambulance Alliance is we do not have an appropriation for those dollars, we don't have spending authority to pay those bills, we don't have the money to pay those bills," Johannessen said.
But Piker said the alliance didn't have a deal with FEMA.
"We had a deal with the state," Piker said. "Now the state is trying to get FEMA to pay."
About 45 days after Katrina struck, FEMA did contract with the alliance to provide ambulances.
"The alliance entered into contracts with FEMA around the end of October. We've been paid about $12 million by FEMA for that period of time," Piker said. "But that's entirely different than the relationship we had the day of the storm and for the first 30 to 45 days after the storm.
"At that time, our relationship was with the state and not FEMA," he said. "It's the state that owes us the money."
Just before Katrina struck, Piker said, ambulance providers in the alliance were sent an e-mail from Steve Erwin, who works in the state's Office of Public Health in the Department of Health and Hospitals.
"The e-mail was fairly simple," Piker said. "It said, 'Send everything you have to New Orleans.' It was a 'burst e-mail' sent to all of our providers."
Piker said there were no specifics in the e-mail regarding how the ambulance providers would be reimbursed.
"But there was talk in the e-mail that we would be reimbursed at $160 an hour," Piker said.
Erwin refused to comment Friday and referred a reporter to a DHH spokesman.
"We have no evidence that Steve Erwin sent an e-mail," said Kristen Meyer, a DHH spokeswoman. "But Steve did say that when he rounded up ambulances to respond to the storm, he did it by calling each ambulance provider on the phone."
Piker and other alliance members said they received the e-mail. However, Piker and alliance members were not able to provide The Advocate with a copy of the e-mail.
Within a week or so after Katrina struck, Gary Peters, president of the alliance and owner of Northeast Louisiana Ambulance Co. in Winnsboro, said the state Bureau of Emergency Medical Services asked the alliance to continue working.
"They said, 'Stay down here. We'll get you paid,' " Peters said. "We stayed. We were sent to Mississippi, Beaumont (Texas), Lake Charles, Plaquemines Parish, Chalmette to name a few. We were sent all over the place."
"Because of the urgent situation during and after the storm, no one had time to worry about billing the state. Now we have time," Piker said.
"At first, the state told us to go to FEMA for reimbursement," Piker said. "We did go to FEMA and their response was, 'The state owes you the money; we don't.' "
When FEMA refused to pay the alliance directly, the state decided to bill FEMA on behalf of the alliance.
State officials began meeting with the alliance as early as January to figure out what was needed to prove their claim to FEMA.
There was a lot of "wrangling over the format of the paperwork and what information was needed" to prove the local companies worked during the storm, said Jeff Reynolds, administrator for the Division of Fiscal Management at DHH.
"It's been a huge bureaucratic process that's taken too long," Reynolds said.
As the ambulance companies submit their paperwork, DHH must approve it. Once DHH completes its review, the documentation is sent to the state's Inspector General's Office, the Health and Hospital Group at FEMA, and finally to the state's Office of Emergency Preparedness. All four offices must approve the claims, Reynolds said.
Reynolds said he is sympathetic to the ambulance companies.
"When the storms rolled through, the local ambulance services showed up first. Then there were requests submitted to FEMA that additional ambulances were needed," Reynolds said.
"These out-of-state ambulances showed up with FEMA contracts in hand promising to pay them $160 an hour," Reynolds said. "I've heard those ambulance providers have been paid. Now the in-state guys are going through this process with us to get paid."
Reynolds said that from the documentation he's received, he believes the alliance should be paid by the state "because it was the state Office of Public Health, Emergency Medical Services who requested that those guys come down and were directing those guys where to go, and who to pick up and where to take them."
Sharon Robinson, the state's inspector general, agreed that the alliance's efforts to get paid has been "immersed in bureaucracy."
She said her office is doing a "100 percent inspection" of each claim submitted by the alliance.
"We want to be sure that further down the road when FEMA's auditors come in to audit records ... they don't find that something was done wrong and ask for their money back," Robinson said. "We are trying to catch things on the front end."
Robinson also said the state has no choice but to bill FEMA rather than pay the claims itself.
She said others like pharmacists and some hospitals that provided medicines and care during the storm are in the same position as the alliance.
"It's just been bad," Robinson said. "All I can say is we're working as hard as we can."
"My gravest concern with these ambulance providers is that by not being paid and with another hurricane season just moments away, will they even be capable of helping if another disaster should occur without this capital," Robinson said.
A FEMA spokesman said Friday she didn't know how many out-of-state ambulance companies were paid by FEMA for work during the first weeks after the storm.
"I just don't know the answer to that," said Debbie Wing, a FEMA spokesman.
She did say that if the state deployed the ambulances during the early days of the storm, "then the state is responsible for paying them."
Wing also said the state could seek reimbursement from FEMA. "I don't think we've received their claims yet," Wing said. "We can't do anything until we get those. We don't know whether they'll be approved until we review them."
For now, alliance members say they're frustrated.
"We were at the Superdome evacuating people," Peters said. "When the floods came, we drove to the edge of the water and picked up people. There were so many times we were up to our necks in water. We saw things that we'd never seen before. We rescued thousands of people.
"We were home-state guys taking care of our own people," Peters added. "Yet they will pay the out-of-state providers and not us. It's a real slap in the face."
Piker, the alliance legal adviser, said some companies may disregard his advice on responding to the next storm.