Eric Fleischauer
The Decatur Daily, Ala.
In a process shrouded in secrecy, city officials are reviewing how to revamp Decatur’s oversight of ambulance services.
The latest effort, outlined in a draft ordinance and contract obtained by The Decatur Daily, would dramatically increase the city’s enforcement tools in dealing with First Response ambulance. The company, which has had a monopoly on ambulance transport in the city since 2014, frequently has failed to meet response times mandated by city ordinance.
The existing ordinance requires ambulance services to have a response time of eight minutes or less on 90 percent of its in-city calls and 12 minutes or less on 90 percent of its calls in the police jurisdiction. In 2017, according to data compiled by Morgan County 911 and Decatur Fire and Rescue, First Response met the eight-minute mark on 88 percent of its in-city calls. It met the 12-minute mark on 83 percent of the calls in the police jurisdiction, which is an area generally extending 1½ miles beyond the city’s border.
In the first half of this year, First Response failed to meet the requirements of the code for in-city calls in two of six months. It failed to meet the city code for police jurisdiction response times in each of the first six months of the year.
City Council President Paige Bibbee has pushed for a new approach. Her conclusion that the existing ordinance is a failure has been met with public agreement from City Council members, Decatur Morgan Hospital officials, the Fire Department, First Response and the EMS Committee that is charged with enforcing the ordinance.
“We are diligently working on it,” Bibbee said. “I have been screaming and yelling about it. We have to have a higher standard in the city of Decatur now, and it’s going to be up to us as a City Council to maintain that with an ambulance provider.”
Bibbee in January asked the city’s Legal Department to prepare a draft ordinance that would be tied to a contract. The idea is the contract, which could be amended more easily than an ordinance, would include the enforcement mechanisms lacking in the existing ordinance.
Assistant City Attorney Chip Alexander drafted the proposed ordinance and contract with input from Decatur Fire and Rescue and others. He provided the draft to officials in sealed envelopes, only after they signed confidentiality agreements. The city’s Legal Department refused to release the draft to The Daily after the newspaper filed a public records request.
“It doesn’t appear that the work Chip did is going to move forward,” Mayor Tab Bowling said. “It’s been shredded. So now the issue is what we can do to try to motivate the council to help us get that service provider. That’s the work to be done.”
Bibbee said the draft ordinance and contract were an important first step in tackling the issue of improved ambulance services, but she doesn’t think they work.
“I’m not satisfied with that contract,” Bibbee said. “There are four other council members, so maybe that contract will pass. But I’m not going to vote for it.”
Alexander said that, after talking with council members and emergency medical service officials, he drafted the ordinance and contract to meet five goals:
- To update and streamline the current ordinance, “because the one we have is wordy and outdated.”
- To eliminate the lengthy delays in enforcement, which he said have made it almost impossible to implement corrective action against First Response.
The existing ordinance details an elaborate and time-consuming enforcement procedure when an ambulance provider fails to meet required response times or numerous other requirements. Only the City Council can enforce the ordinance against First Response, and it can’t do so without a recommendation from the EMS Committee and after multiple hearings.
- To give the EMS Committee the authority to resolve issues without council involvement.
- To create disciplinary actions short of suspension or revocation of the license to operate in the city.
“When you get to the council you can suspend or revoke their license or you can do nothing” under the existing ordinance, Alexander said. “And when you’ve only got one provider, the council is going to be reticent to go and cancel them.”
- To provide heightened protections for the ambulance provider’s monopoly status, which includes more protection for the lucrative non-emergency transports. Officials see these protections as a critical component in getting ambulance companies to compete for the contract, and for maintaining the financial stability of the ambulance provider that is awarded a monopoly.
“These are what we tried to accomplish when we started looking into a contract,” Alexander said. “I think this is what the contract and ordinance do. … Legally, I think this would function.”
--
Draft contract
The draft ordinance and contract take a vastly different approach to ambulance oversight than the existing ordinance, although they continue many of its requirements — including the response-time mandates.
The draft ordinance replaces the EMS Committee with a nine-member Ambulance Regulatory Board. The board would include the chiefs of Decatur Fire and Rescue and the Police Department, the medical directors of Decatur Fire and Rescue and Decatur Morgan Hospital, and the EMS director of Calhoun Community College. It also would include one member appointed by the mayor and three appointed by the City Council.
The increased number of appointed members appears to be an attempt to make it easier to obtain a quorum, which has been a constant problem for an EMS Committee consisting almost entirely of ex officio members whose membership comes by virtue of holding leadership positions in the EMS field.
The draft ordinance also includes a laundry list of violations that subject offenders to a $500 fine and up to 180 days in jail. Many of the provisions penalize competing ambulance providers who attempt to infringe on the licensee’s monopoly.
The draft contract Alexander prepared focuses on monetary penalties, a departure from the existing ordinance’s complete reliance on suspension or revocation. It also streamlines enforcement procedures.
The EMS coordinator, who must be a paramedic at Decatur Fire and Rescue, has far more authority under the draft contract than under the existing ordinance. The EMS coordinator would make the final determination on whether the ambulance service has violated the terms of the contract, and the ambulance service would have no right of appeal unless financial penalties exceed $10,000.
Significant financial penalties would be imposed if the ambulance company fails to meet a response time of eight minutes or less on 90 percent of its in-city calls and 12 minutes or less on 90 percent of its calls in the police jurisdiction. For example, First Response was at 88 percent in the first quarter of 2017 on in-city calls. That performance would result in an $11,000 penalty under the draft contract. The same quarter, First Response was at 83 percent on calls in the police jurisdiction. The company would have been slapped with a $25,000 fine for that result.
In addition to the monetary fines, the draft contract would assign points to some violations. The points would remain in place for two years, and the accumulation of 25 points allows the city to cancel the agreement and find another ambulance provider.
The same 83 percent response time that would have resulted in a $25,000 fine for First Response in the first quarter of 2017 would also have earned it 15 points. The company’s performance in the police jurisdiction in the first two quarters of this year would have resulted in fines of $50,000 and 30 points under the draft contract, enough to allow cancellation of its license. If an advanced life support ambulance breaks down, the provider would be assessed a $500 fine and five points.
If the provider’s response times are better than 90 percent over a quarter, it could subtract points and deduct from any monetary fines.
Because Bibbee said she signed a confidentiality agreement as a condition of receiving the draft ordinance and contract, she declined to specify why she opposes it.
City Attorney Herman Marks said the secrecy is necessary.
“There are options being reviewed, but we’re not in a position to narrow those down,” Marks said. “It’s not that there isn’t anything happening.”
Alexander said the confidentiality was necessary because the draft contract and ordinance were work product, effectively legal advice to the council. He said in the unlikely case the contract ultimately is used, public knowledge of its contents could cause unfair results for those companies competing for a contract with the city.
“I can’t breach that confidentiality agreement because it would be a legal issue, and I’m not going to jail for something I signed,” Bibbee said. “The contract doesn’t have a lot of what I expected to be in it. As far as my vote, it is dead. What I’m looking for is something that fits a little bit better than that contract did for me.”
Bibbee was similarly tight-lipped about other options for improving ambulance services, although she said she is pursuing them.
“We have options out there, we just need more details before we go public with it,” Bibbee said. “If I said it, and it turned out my numbers were totally off, then I’d have a problem.”
Alexander said he’s only heard of one other option.
“The one that keeps coming up is there’s discussion of having Decatur Fire and Rescue take it over … and that has not progressed to anything in writing,” Alexander said.
In the meantime, the city has few tools available to improve ambulance services.
“I think Decatur Fire and Rescue is a potential solution, as are other things,” Bibbee said. “I don’t care who it is; we have to have something to hold whoever is doing the ambulance service for the city of Decatur to a higher standard.”
———
©2018 The Decatur Daily (Decatur, Ala.)
Visit The Decatur Daily (Decatur, Ala.) at www.decaturdaily.com