Crozer Health pulls emergency ambulances into hospital service, leaving towns short on service

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’t been paid.

The decision by Keystone Quality Transport, based in Springfield, is fallout from the Jan. 11 bankruptcy filing by Crozer’s 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’s 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’s 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’t enough.

“As this continues and this crisis expands, some lives could be lost that could possibly have been saved,” said Brian Boyce, Upper Darby’s fire chief.

Prospect’s 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 health-care provider in an area of Delaware County with a high level of poverty and few other nearby options for care.

» READ MORE: Crozer Health since Prospect acquired it in 2016: A timeline

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’s departure. He said Crozer had offered to pay Keystone.

Delaware County’s regional EMS director Pat O’Connell, through a spokesperson, declined to discuss Crozer’s 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.

Crozer’s 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’t pay the fuel card bill, she said. Denney, a paramedic, didn’t know where the Wawa gift cards came from.

Reassigning ambulances to cover non-emergency 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 — even if it is outside their coverage area — if closer ambulances are busy.

A spokesperson for Main Line Health, which also operates EMS in Delaware County, said the system has “had 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.”

Local fire chiefs say they are worried that Keystone’s departure will mean even longer waits for ambulances in an emergency.

Upper Darby, home of Crozer’s 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.

“The whole health system and EMS system is in disarray, and it has been basically since Prospect took over,” Boyce said.

Ambulance turnaround times — the time it takes to respond to a call, drop off a patient at the hospital, and return to service — 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’s EMS takes on transfers dropped by Keystone.

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.

“Crozer is in such dire financial shape that it would be irresponsible if we didn’t look at what we would do if that failed,” 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’s fire commissioner.

Almost all of the city’s 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’s firefighters are also certified as EMTs.

But for trauma patients, there’s no substitute to getting to the hospital as soon as possible. The so-called “golden hour” — the first 60 minutes after a traumatic injury — 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.

“There is nothing trauma-wise that EMS can fix. Trauma patients need an operating room, they need a surgeon,” Shirley said. “We can prolong it, but the longer delays they have in getting to a surgeon, it’s not going to be a good outcome.”

Editor’s note: This story has been updated with comment from the Crozer-Chester Paramedic Association and Main Line Health.