Great questions! Please follow up during the interviews. I am also curious about your experiences of traveling to Naluwan via various transportation methods. Are there different senses of place when you travel by car, by train, by foot?
“Under a 1986 federal law titled the Emergency Medical Treatment and Labor Act (EMTALA), hospitals are required to treat people who come to the ED presenting with an emergency medical condition, defined as a condition that, without treatment, will likely lead to serious impairment or death. … EMTALA is one of the largest federal mandates to provide services to have gone unfunded (Friedman 2011); costs instead fall on states and local health care systems.” 481
“In bringing ethnographic attention to hot spotting as a technique of governance, we find that it provides lifesaving humanitarian interventions while operating within the racialized structures of violence that produce continual life crises. The institutional rationality of hotspotting and the encounters of care that it produces illustrate the often-contradictory role of medicine in the lives of poor people: both caring and coercive, it intertwines care and violence.” 475; “we conclude by suggesting that economic investment and return are becoming a reigning logic in the governance of poverty, generating hot spots as sites of interest for both policing and health care and decentering normative assessments of deviance, illness, and social problems” 476; “Neoliberal social assistance, as it is practiced in the health care safety net, is conceptualized as an “investment “in the population, as a strategic and targeted deployment of basic resources, one that promises to generate a return on investment for the state or health system in the form of cost savings.“ 485
The authors examine the practice of “hot spotting,” a form of surveillance and intervention through which health care systems in the US intensively direct health and social services towards high-cost patients. Health care hot spotting is seen as a way to improve population health while also reducing financial expenditures on healthcare for impoverished people. The authors argue that argue that ultimately hot spotting targets zones of racialized urban poverty—the same neighborhoods and individuals that have long been targeted by the police. These practices produce “a convergence of caring and punitive strategies of governance” (474). The boundaries between the spaces of healthcare and policing have shifted as a “financialized logic of governance has come to dominate both health and criminal justice” (474).
1. Under private equity ownership, some ambulance response times worsened, heart monitors failed and companies slid into bankruptcy, according to a Times examination of thousands of pages of internal documents and government records, as well as interviews with dozens of former employees. In at least two cases, lawsuits contend, poor service led to patient deaths.
2. “Private equity has, in this case, threatened public safety,” said Richard Thomas, the mayor of Mount Vernon, N.Y, which relied on TransCare. “It’s not the way to treat the public.”
3. Do the Write Thing “didn’t sit well with the firefighters,” said Nico Latini, who has worked at Rural/Metro for a decade. “We operate under a high level of integrity and we do the right thing every day — with an R, not a W.”
The main point of the article is that private ambulance and fire department agencies have questionable policies and business practices that hurt not only patients but also their employees. It's supported with anecdotal evidence following several agencies that have filed for bankruptcy, going over incidents of lateness, understaffing, lack of supplies, and aggressive billing or lawsuits to get payments from patients.
Private equity firms like "Warburg Pincus, Kohlberg Kravis Roberts & Company" that invest in emergency medical services.
TransCare EMS, an EMS provider owned by the firm Patriarch Partners that served East coast states, filed for bankruptcy; had trouble paying its employees and was losing contracts with counties.
Rural/Metro, another privately owned EMS/fire provider known for lateness, suing patients, and had deteriorating patient care, and was losing contracts with counties in several states.
The article addresses the public health inequities caused by for-profit ambulance agencies, which can put low-income families in a worse situation when they bill outrageously and/or sue their patients after sometimes providing sub-par or negligent treatment. Also shows the poor examples of emergency response when first responders are delayed due to understaffing or don't have the drugs/ equipment to adequately treat patients ("hospital shopping" done by desparate ambulance agencies).
"Today, people interact with private equity when they dial 911, pay their mortgage, play a round of golf or turn on the kitchen tap for a glass of water."
"Supervisors regularly paid for supplies out of their own pockets and hoped for reimbursement, emails show. Some workers said the ambulances carried expired medications. Others went “E.R. shopping.” "
There were many personal interviews along with overall analysis of the system through history of the industry and related companies. He combined both personal subjective experience and objective events to strengthen his arguement.