Ambulance Victoria hit in coffers by patient billing ban

An indefinite ban on paramedics taking billing details from patients is significantly affecting the financial sustainability of the troubled Ambulance Victoria service, an internal Health Department document has warned.

The frank assessment of the impact of protracted industrial action by paramedics over pay and conditions, such as excessive overtime, is contained in a briefing note written by former Ambulance Victoria chief executive Jane Miller in April.

Paramedics are increasingly under the pump.Credit: Luis Enrique Ascui

Miller abruptly resigned on August 20 after 98 per cent of Victorian Ambulance Union members passed a vote of no-confidence in Ambulance Victoria’s executive last month.

“Protected industrial action is significantly impacting Ambulance Victoria’s financial sustainability by causing revenue loss due to decreased billing and unfunded mitigations,” Miller wrote to an executive director at the Health Department.

“Financial impacts are being closely tracked and monitored.”

The document, released to the opposition under freedom-of-information laws, says as of April 8, there were 50 active industrial actions, with the risks of each being monitored.

Victorian Ambulance Union secretary Danny Hill.Credit: Luis Enrique Ascui

“Given the dynamic nature of AV’s environment, continuous monitoring and evaluation are imperative to track the trajectory of risk ratings over time,” the document says.

Financial notes titled “revenue and income from transactions” show transport fees are Ambulance Victoria’s largest non-government source of revenue, bringing in $219 million last year.

Victorian Ambulance Union secretary Danny Hill said paramedics wouldn’t put the public at risk and therefore had to be innovative with the industrial action they took.

He said the ban on paramedics taking billing details from patients added to the administrative burden for Ambulance Victoria because they had to track down the information.

Andrew Crisp was appointed Ambulance Victoria’s interim chief executive last week.Credit: Getty Images

“We try to frustrate, disrupt, cause administrative burden to Ambulance Victoria to try to advance our claims. People still get billed it just takes them longer to do it,” he said.

Paramedics are fed up with hours of overtime, ambulance ramping at hospitals, a dispatch system they say wrongly classifies minor incidents as code-one “lights and sirens” emergencies, and internal turmoil.

The revelations came on another day of tumult for Victoria’s health system with an inquiry launched into an ambulance crew being sent to treat a cardiac patient in a Maroondah Hospital corridor and the new interim head of Ambulance Victoria admitting he is taking seven weeks’ leave just days after his appointment.

Andrew Crisp – appointed the agency’s interim chief executive last week – defended his decision to take a pre-booked seven-week holiday from Thursday hiking through mountains in Corsica, saying Ambulance Victoria would not “live or die by Andrew Crisp being around”.

“I think the Victorian community broadly – based on my experience – will see me as a safe pair of hands,” said Crisp, the former emergency management commissioner.

“I think they will also see that’s an organisation of more than 8000 people with some great leaders that will continue to lead based on the expectations I’ll be setting up for them in the time that I’m away.”

He will return to work on October 23.

Crisp said Ambulance Victoria management was meeting union representatives every day, indicating that the pay and conditions dispute, which has dragged on for eight months, was getting closer to resolution.

Maroondah Hospital where an ambulance crew was sent to treat a cardiac patient in a corridor.Credit: Eddie Jim

He said he would work with hospitals and unions to address issues in the system, including improving ambulance response times.

“With response times, there is a number of issues around that, whether it’s ramping of hospitals, whether it’s call-taking and dispatch. There’s a systems-wide issue that we’ve actually got to look at, right from primary health through to what’s actually happening in the hospitals themselves.”

Crisp said he thought the Maroondah Hospital incident “seemed unusual”, but highlighted the incredible work of paramedics. “This incident will be reviewed. I have learnt over many years not to jump to conclusions.”

Hill said an ambulance crew had taken a patient with heart arrhythmia to Maroondah Hospital but no beds were available.

“The staff at the hospital declined to start treatment of the patient on the ambulance stretcher,” Hill said. “The patient actually started to deteriorate, their blood pressure dropped and their heart rate increased.”

Hill said the ambulance crew tried to get assistance from the hospital, but when that wasn’t provided they called Mobile Intensive Care Ambulance (MICA) paramedics to treat the patient in the hospital.

“In a major metropolitan hospital this is not something we see,” Hill said.

Health Minister Mary-Anne Thomas said the incident was “unacceptable” and she had ordered Ambulance Victoria and Eastern Health, the operators of the hospital, to investigate.

Opposition health spokeswoman Georgie Crozier said the government’s inability to manage frontline agencies was impacting the delivery of vital health services across the state.

“Under Labor, the chaos engulfing Ambulance Victoria continues to grow.”

An Eastern Health spokesperson said that at times its emergency departments experienced significant pressures due to an increased volume of higher-acuity cases that could limit bed availability.

“Despite the health system being under a great deal of pressure, we constantly strive to work with Ambulance Victoria to deliver the best care for our community,” the spokesperson said.

The public was encouraged to access alternative healthcare options, such as a local GP or Priority Primary Care Centres, for non-urgent or non-life-threatening conditions.

An Ambulance Victoria spokesperson said the agency continued to “negotiate in good faith with employee representatives towards a mutually beneficial enterprise agreement”.

The spokesman also said it was known that Crisp had pre-booked leave when appointed to the role. “Executive director of specialist operations Anthony Carlyon is an experienced paramedic and executive who will be acting CEO during this period. This will not impact enterprise negotiations,” they said.

A Victorian government spokesperson said paramedics played a critical role in keeping people healthy and safe.

“Since coming to government, we have invested an additional $2 billion into our ambulance services, more than doubling the on-road paramedic workforce to what is now the largest in Australia,” they said.

“We expect Ambulance Victoria and the Victorian Ambulance Union to continue to negotiate in good faith and reach a resolution as soon as possible.”

Start the day with a summary of the day’s most important and interesting stories, analysis and insights. Sign up for our Morning Edition newsletter.