One persistent difficulty, which has been insufficiently addressed for many years by the current system, is the need for consistent and timely inter-facility patient transport. A frequent example of this is when Gritman Medical Center needs to transfer a patient to Sacred Heart Medical Center in Spokane, WA for a procedure that may not be available in Moscow’s own hospital.
Moscow Ambulance has been unable to fill this need in a timely fashion. Nurses at Gritman were directed to “please exhaust all other options for transfer… within a reasonable amount of time.” They were told to consider transport by air, and to contact Lewiston, AMR, and Kootenai ambulance services before requesting service from Moscow’s own ambulance company. 
Former Fire Chief, Ed Button further demonstrated this in a meeting with the city council. He said, “[The department] has been criticized for not being able to transfer care to a facility in Spokane.” He says, “We do not have a paramedic available at that particular time of day or night. We do not do it on a consistent basis.” 
Here’s an example of how badly things can go when a hospital does not have access to patient transport services: On March 9th, 2009, Merrill Conitz’s wife watched him die while waiting for an ambulance to transport him from Gritman to a hospital with a higher level of care. The ambulance never came.