Alabama responders debate role of hospital ambulance service

Temporary authorization should end with COVID-19, Decatur First Response director says

Bayne Hughes and Eric Fleischauer
The Decatur Daily, Ala.

DECATUR, Ala. — First Response Ambulance Service wants the city to stop allowing Decatur Morgan Hospital ambulances to operate in the city, but the hospital's CEO on Friday said that the hospital may seek a city license to expand its ambulance operations due to concerns that First Response's service is inadequate.

"I want the citizens here to have the best ambulance service possible," hospital CEO Kelli Powers said. "Just think about it, when you call 911, you need to know that truck is on its way. I'm not sure that's happening today."

"We are going ahead with the full 911 service so we can help the city with this." (First Response Ambulance-Decatur)

She said the Huntsville Hospital System would have to approve it, as would the Decatur City Council, "but we are willing to" apply for the certificate of public necessity and convenience needed to establish permanent ambulance operations in the city.

The hospital began running ambulances after Feb. 1, when the City Council passed a COVID-related resolution authorizing Decatur Morgan Hospital "temporarily and based on the critical situation at this time" to transport patients to and from other Huntsville Hospital System facilities.

The resolution expressly states that the hospital's ambulances may not be dispatched by Morgan County 911 on emergency or non-emergency calls "except as required in the event of a mutual aid or mass casualty event," but they have begun taking 911 calls when First Response has no ambulances available.

Powers said she requested the transport authorization because during the pandemic First Response was unable to quickly transport patients out of the hospital, which meant there was no hospital space to admit new patients.

First Response fought against the resolution at the time and continues to oppose it because it reduces the number of non-emergency transports it handles. Transports tend to be more lucrative than emergency calls because many emergency calls involve uninsured patients.

At a City Council meeting last week, First Response director David Childers said the COVID-19 crisis that was the reason for allowing hospital ambulances to make transports has ended, noting that the Alabama state of emergency has expired. First Response had a monopoly on the city's ambulance service until Decatur Morgan Hospital began the transports.

"We would like to formally ask that this (Feb. 1 resolution) be rescinded so we can go back to business as normal, have our full staffing and continue to provide service for the city," Childers said.

Decatur officials, however, responded that the city is increasingly dependent upon hospital ambulances because First Response frequently has too few ambulances to respond to emergency and non-emergency calls.

Missed calls

Decatur Fire & Rescue Chief Tracy Thornton said First Response often misses multiple calls a day, forcing Morgan County 911 to call other ambulance services, including the hospital's, to respond to emergency calls.

Thornton said patients have had to wait several hours for a response to an ambulance call when First Response has too few units in operation.

EMS Coordinator Ashley England said First Response is having to "zero out" frequently, meaning it is unable to respond to a call. The company has been running two or three ambulances in a day when six or seven usually provide city coverage, England said.

"Between June 21 and June 29, they rolled 11 calls," England said, meaning 911 dispatched a different ambulance service because First Response was not able to respond. "That's a lot."

Thornton said First Response zeroed out 13 calls on June 26. He said other ambulance services picked up some of these calls or there were long waits for First Response to become available and respond.

Some of those "rolled calls" are going to Decatur Morgan Hospital's ambulances, according to Powers, who said she was contacted by city EMS personnel asking that the hospital accept calls when First Response fails to respond.

"What happens now is that if First Response can't respond, it rolls to Lifeguard (Ambulance, which serves much of Morgan County outside Decatur). If they can't respond it rolls to us," Powers said. "I don't think we can get out of that unless First Response steps up to the plate.

"We are going ahead with the full 911 service so we can help the city with this."

While the city's ambulance ordinance generally requires all ambulances to have a certificate of public necessity and convenience (CPNC), which only First Response has, it creates an exception for a "major emergency when the ambulances authorized to operate in the city by CPNC are either insufficient in number or inadequate for any other reason as determined by the ( Decatur Fire & Rescue) chief or EMS coordinator."

Powers said Decatur Morgan Hospital has four operational ambulances, all of them equipped as advanced life support units. Three of them are older units donated by other hospitals in the Huntsville Hospital System, but Decatur Morgan bought a new truck two to three weeks ago that is in service and accepting 911 calls not handled by First Response.

First Response had only two emergency ambulances in service on Thursday and two non-emergency vehicles in operation, Thornton said.

'Poaching our employees'

Childers said First Response is having a problem with Huntsville Hospital and other ambulance services "poaching our employees. It's very difficult for a private company to pay $20 an hour."

England said the employee problem is the only reason Childers has given for the high number of rolled calls.

Powers said Decatur Morgan Hospital has been hiring ambulance staff, "but I don't think we have very many First Response employees hired as of today. Now that doesn't mean they haven't applied."

Assistant City Attorney Chip Alexander said First Response could be penalized under the city ordinance for a rolled call by counting the call against the requirement that an ambulance must respond and reach the call scene of 90% of the emergency calls within eight minutes in the city limits and 12 minutes in the police jurisdiction.

However, enforcement of the response-time requirements is in limbo. Morgan County 911 is switching to a new system and that switch is into its third month of implementation. The new system is not yet tracking response times for First Response. Morgan 911 also doesn't track the number of rolled calls and there isn't a penalty under the ordinance when First Response says it can't respond to a call, England said.

Childers said he sent two complaints to the Alabama Department of Public Health's Office of EMS against Decatur Morgan Hospital for allegedly running emergency calls without the proper license. The Daily could not confirm the complaints were filed.

England said he's aware of one of the complaints, which the city dismissed as not valid. The hospitals' critical care truck was being repaired so it had to use an ambulance not certified for critical care to transport a patient to UAB Hospital.

"The truck had a special (critical care) crew that was sent by a physician," England said.

Thornton said First Response's second complaint came after the hospital ran a call in Decatur. Again, Fire Department officials didn't think it was valid because the hospital's ambulance was called in after a patient was held up too long waiting for an ambulance.

"They had to wait for hours," Thornton said.

Powers said complaints from Childers and First Response are not unusual.

"He's called the state on many occasions on us, and so far they've all been unsubstantiated," she said.

In the meantime, changes in the city ordinance that were recommended by the Ambulance Regulatory Board two months ago have not been presented to the City Council for consideration.

Some of the recommended changes include eliminating the required performance bond, increasing the amount of time an ambulance has to respond to emergency calls in the city and the police jurisdiction and a reduction in the fine amounts.

Alexander said he is working on making the recommended changes to the ordinance before he presents them to the council.

Council President Jacob Ladner said he hopes those recommendations will be presented at Monday's work session so the council can consider them on July 19.


(c)2021 The Decatur Daily (Decatur, Ala.)

McClatchy-Tribune News Service

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