By Harold Brubaker
The Philadelphia Inquirer
UPLAND, Pa. 鈥� Crozer Health has started using emergency ambulances that are supposed to provide EMS services to at least seven Delaware County towns to shuttle nonemergency patients between hospitals and long-term care facilities after an outside transfers vendor quit Friday, saying it hadn鈥檛 been paid.
The decision by Keystone Quality Transport, based in Springfield, is the fallout from the Jan. 11 bankruptcy filing by Crozer鈥檚 for-profit owner, Prospect Medical Holdings. The bankruptcy has thrown into question the future of Crozer, which is losing $160 million a year, a bankruptcy attorney said last week.
And that鈥檚 without paying vendors such as Keystone, which says Crozer owed it $267,000 from before the bankruptcy claim. A court order last week allowed Crozer to pay vendors that provide essential services, but Keystone was not put on the list of such critical vendors, Todd Strine, the company鈥檚 chief financial officer, said Tuesday.
The loss of Keystone adds pressure to emergency service operations in Delaware County that are already strained by staff and ambulance shortages, and rising 911 call volume. Crozer is the largest EMS provider in Delaware County, covering 60% of the county, including some of its most densely populated communities.
Public safety officials have already started planning how they will prop up emergency services if Crozer closes or abandons EMS, such as training firefighters to be EMTs who can provide emergency care until an ambulance arrives. But they worry that short-term solutions aren鈥檛 enough.
鈥淎s this continues and this crisis expands, some lives could be lost that could possibly have been saved,鈥� said Brian Boyce, Upper Darby鈥檚 fire chief.
Prospect鈥檚 bankruptcy followed years of turmoil at Crozer, which Los Angeles-based Prospect acquired in 2016 and has reduced substantially its services by closing two hospitals and implementing several rounds of job cuts. Crozer remains an important healthcare provider in an area of Delaware County with a high level of poverty and few other nearby options for care.
Keystone backs out of transfers contract
Before pulling out, Keystone transported about 120 Crozer patients a week in ambulances or wheelchair vans. Typically, these are patients who need to move between Taylor Hospital and Crozer-Keystone Medical Center or from the hospital to a nursing home.
Crozer CEO Tony Esposito confirmed in an email that the company started using its EMS vehicles for nonemergency transport after Keystone鈥檚 departure. He said Crozer had offered to pay Keystone. Strine said payment was expected Friday but never arrived.
Delaware County鈥檚 regional EMS director Pat O鈥機onnell, through a spokesperson, declined to discuss Crozer鈥檚 move and how it was impacting residents. County spokesperson Ryan Herlinger did not respond to an email or a voice message asking about the emergency medical services Crozer is supposed to provide.
Crozer has EMS contracts for Aston Township , Chester , Marcus Hook , Norwood , Ridley Township , Springfield Township , and Upper Darby Township .
Strained emergency services in Delaware County
Crozer鈥檚 EMS operators have already been struggling with staffing shortages and ongoing maintenance problems with an aging fleet of ambulances. Many of the vehicles have more than 200,000 miles, and are routinely off the road for repairs, said Kate Denney, union president for the Crozer-Chester Paramedic Association.
Earlier this week, operators used $500 worth of Wawa gift cards to fuel up the fleet because Prospect didn鈥檛 pay the fuel card bill, she said. Denney, a paramedic, didn鈥檛 know where the Wawa gift cards came from.
Reassigning ambulances to cover nonemergency transfers means fewer vehicles available to respond to emergencies, which puts pressure on neighboring EMS fleets, Denney said.
Pennsylvania law requires ambulance services to respond wherever they are called 鈥� even if it is outside their coverage area 鈥� if closer ambulances are busy.
A spokesperson for Main Line Health, which also operates EMS in Delaware County, said the system has 鈥渉ad a couple of calls in areas where there may have been a gap in EMS coverage, but there has not been any surge in services required from us so far.鈥�
Local fire chiefs say they are worried that Keystone鈥檚 departure will mean even longer waits for ambulances in an emergency.
Upper Darby, home of Crozer鈥檚 shuttered Delaware County Memorial Hospital, has relied on Crozer for emergency services for decades. Services began to decline after Prospect took over, said Boyce, the fire chief.
鈥淭he whole health system and EMS system is in disarray, and it has been basically since Prospect took over,鈥� Boyce said.
Ambulance turnaround times 鈥� the time it takes to respond to a call, drop off a patient at the hospital, and return to service 鈥� have increased since Delaware County Memorial Hospital closed, he said.
Ambulances in Upper Darby used to have a turnaround time of about 40-45 minutes, Boyce said. Now, ambulances must take patients to Crozer-Chester Medical Center, which is farther away and increasingly crowded. Turnaround times are often over an hour.
Adding to the strain: Call volume in Upper Darby is up, partly due to a rise in drug overdoses. Boyce said that he worries about safety as Crozer鈥檚 EMS takes on transfers dropped by Keystone.
EMS backup plans as Crozer declines
Upper Darby and Chester, a low-income community that relies heavily on Crozer for emergency and basic health services, are making contingency plans for if Crozer is no longer able to support emergency services.
Upper Darby is conducting a fire and EMS study that will evaluate emergency needs and other models for EMS, aside from contracting with Crozer.
鈥淐rozer is in such dire financial shape that it would be irresponsible if we didn鈥檛 look at what we would do if that failed,鈥� Boyce said.
The city of Chester, which is bankrupt and in state receivership, started looking at alternatives for emergency services in 2023, when Prospect first hinted they may cut back ambulance services, said John-Paul Shirley, Chester鈥檚 fire commissioner.
Almost all of the city鈥檚 60 firefighters are now trained as EMTs, and fire trucks are equipped with medical supplies, so that fire teams can provide immediate care until an ambulance arrives. Upper Darby鈥檚 firefighters are also certified as EMTs.
But for trauma patients, there鈥檚 no substitute for getting to the hospital as soon as possible. The so-called 鈥済olden hour鈥� 鈥� the first 60 minutes after a traumatic injury 鈥� is critical for severely injured patients. After that time, damage to the heart, brain, lungs, and other central organs can be much more difficult to repair.
鈥淭here is nothing trauma-wise that EMS can fix. Trauma patients need an operating room, they need a surgeon,鈥� Shirley said. 鈥淲e can prolong it, but the longer delays they have in getting to a surgeon, it鈥檚 not going to be a good outcome.鈥�
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