Bayne Hughes
The Decatur Daily, Ala.
Decatur City Council President Paige Bibbee is ready for the Ambulance Regulatory Board to begin enforcing the new ordinance regulating the city’s only ambulance company, even if it provokes a lawsuit.
The ARB held its second meeting Tuesday since the ordinance went into effect Sept. 1, but it has yet to assess any points or fines.
Under the new ordinance, First Response ambulance service could receive points for violations that could result in loss of its certificate to operate in the city and fines ranging from $500 to $20,000.
“We want to be fair to First Response, and I expect the ARB will begin enforcing the ordinance at its next meeting,” Bibbee said. “I’m ready to begin implementing the fines and points (under the ordinance) because I think First Response wants us to penalize them so they can sue us.”
Fire Chief Tony Grande, the ARB chairman, said Friday the board needed its initial two meetings to get organized and familiar with the enforcement procedures in the new ordinance. The plan is to provide the data and information in one meeting and then give the board members a month to study it before they have to make enforcement decisions.
“I expect in the next meeting or two there will be a point on the agenda in which we discuss points and violations,” Grande said.
David Childers, First Response director of operations, said the city shouldn’t be in a hurry to begin enforcement. He said the new ordinance has a lot of problems, like how response times should be averaged and a provision involving advanced life support medications and supplies that a state official says violates state law.
Childers continues to say his company has been unable to obtain a $2 million performance bond, which the ordinance required it to have “prior to commencing operations.”
“Every council member has a right to his or her own opinion,” Childers said. “However, we have told the council there are a lot of strong legal problems with the ordinance.”
One of the reasons for the new ordinance is the city has been unable to enforce its response time requirements.
First Response has had difficulty for years in achieving requirements that it respond to 90% of its calls in an average of eight minutes or less in the city and 12 minutes or less in the police jurisdiction.
Childers has maintained this requirement is more strict than national standards, but city officials insist they won’t change it.
There was debate between First Response and ARB members at Tuesday’s meeting on whether city and police jurisdiction response times should be added together and whether First Response made its requirement for the third quarter of 2019.
Averaging city and PJ calls together, First Response reported it was in compliance at 90.13% for the quarter.
The ordinance, however, is explicit that separate penalties apply for in-city response time violations and PJ response time violations.
Penalties for violations
The ARB asked 911 and First Response officials to begin reporting their response rates for both the city and the PJ separately.
Childers said Friday that his service was granted one exemption for a call that did not meet the response time requirements.
Morgan County 911’s numbers show First Response had an 87% response rate for 995 calls within city limits for the third quarter. Police jurisdiction percentages were incomplete for the quarter.
Under the new ordinance, this in-city violation should have resulted in a penalty of $10,000 and 10 points. If First Response fails to meet the eight-minute response time on 90% of its in-city calls next quarter, the ordinance calls for it to be fined $20,000 and 20 points. Penalties in the same amounts apply if First Response fails to respond to 90% of PJ calls within 12 minutes. Financial penalties are to be assessed by the EMS coordinator, but if over $500 can be appealed to the ARB and if over $1,000 can be appealed to the City Council.
If 26 or more points are accumulated over a two-year period, the ordinance requires the EMS coordinator to recommend that First Response’s license to operate be revoked.
Childers said he is taking some steps to improve response times, including working with Decatur Morgan Hospital on improving wait times and working with Morgan County 911 on its policies. He said he is considering another office in the city, but he isn’t at the point of adding another vehicle.
“Buying another vehicle is based on whether the market will support the additional capital outlay,” Childers said.
Medication replacement
Childers said an example of the ordinance’s problems is found in a recent letter from the state to the city on advanced life support supplies.
The Decatur Daily obtained a copy last week of an Aug. 27 letter from Jamie Gray, compliance coordinator for the Alabama Office of Emergency Medical Services, to Mayor Tab Bowling. The letter warns the city that a provision in the new ordinance involving advanced life support supplies violates state law.
The ordinance says the provider (First Response) must “replace all medications (except Schedule II narcotics), fluids and supplies used by (Decatur Fire & Rescue) for each patient … . Items not replaced on scene will be recovered by the EMS Coordinator.”
Violation of this rule results in a one-point penalty.
Gray says this portion of the new ambulance ordinance is an “unacceptable practice” and a violation of state law.
“Any medications or supplies that are improperly obtained from another licensed provider service may be considered a theft of property; and, the provider service, as well as the individual, will be subject to immediate disciplinary action, up to and including license revocation,” she wrote.
Assistant City Attorney Chip Alexander and Grande said they don’t agree with the state but they will follow the state’s directions.
Alexander told the ARB that Decatur Fire & Rescue provides medications and supplies and then the ambulance service reimburses the city before it completes transport.
“We don’t have a bill so we were asking for reimbursement off of the truck,” Alexander said. “It (the practice) was more designed to ensure the integrity of the medications that was having to come from a pharmacist.”
He said First Response’s medications and supplies come “from a pharmacist and ours comes from a pharmacist, and what we were doing made sense, but they said it was a violation to directly transfer the medicine and supplies.”
Grande said he and Bowling spoke with Gray about this issue. The supplies under scrutiny are IV bags and anything that comes through a pharmacy or has a medical director’s license attached to it. The Fire Department and the ambulance service operate under different medical directors so they can’t share items, the chief said.
Battalion Chief Ashley England, the city’s new EMS coordinator, said other cities were handling the advanced life support items in the same way as Decatur.
Grande said he told his crews to stop exchanging advanced life support items.
“We are tracking what we use so we can submit for reimbursement of our costs, but we’ve got to change the ordinance to allow us to do that,” Grande said.
The ARB voted to recommend to the City Council that it amend the ordinance so that it doesn’t allow the transfer of the items.
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©2019 The Decatur Daily (Decatur, Ala.)