Private EMS owner accuses Ala. hospital of 'poaching staff'
First Response owner David Childers said Decatur Morgan Hospital is not part of the city's traditional ambulance service agreement, and accused the hospital of stealing his employees
By Bayne Hughes
The Decatur Daily, Ala.
DECATUR, Ala. — A battle over Decatur's ambulance coverage heated up this week, with the owner of First Response Ambulance seeking to reverse inroads Decatur Morgan Hospital has made into his 7-year-old monopoly. City officials countered by saying First Response's coverage is inadequate.
The city has long had a contentious relationship with First Response, but the latest dispute has its origins in a pandemic-related Feb. 1 City Council resolution. The resolution allows Decatur Morgan Hospital, a part of the Huntsville Hospital System, "temporarily and based on the critical situation at this time" to operate ambulances to transport patients to and from other facilities in the Huntsville Hospital System.
The resolution also is explicit that the hospital ambulances may not be dispatched by Morgan County 911 "except as required in the event of a mutual aid or mass casualty event."
Since then the hospital has built up a fleet of ambulances, purchasing several new advanced life support vehicles. Increasingly, Morgan County 911 and Decatur Fire & Rescue have redirected emergency and non-emergency calls to the hospital ambulances when First Response has been unable to handle calls quickly.
First Response owner David Childers told the City Council this week that the hospital's use of ambulances to end the patient backlog caused by COVID hospitalizations should have ended when Gov. Kay Ivey's state of emergency order ended June 30.
Childers is upset that the hospital ambulances are running emergency and non-emergency calls that are not authorized by the Feb. 1 resolution, and that it is doing so without first obtaining a certificate of public convenience and necessity (CPNC) from the city. Only First Response has a CPNC for ambulances.
"The (Feb. 1 City Council) resolution says (the hospital ambulances) can do interfacility transfers but nothing outside of that body or system," Childers said.
While the city's ambulance ordinance generally requires all ambulances to have a CPNC, 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."
First Response officials fought against the Feb. 1 resolution authorizing hospital ambulances at the time it was approved, and they continue 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.
Assistant City Attorney Chip Alexander and Fire Chief Tracy Thornton said the recent rise in the number of COVID-19 cases in the area shows the pandemic that prompted the Feb. 1 resolution isn't over.
According to the Alabama Department of Public Health, 159 Morgan County residents have tested positive for the coronavirus in the last week. The hospital had 11 COVID-19 patients Wednesday, far below the number it had in January and February but an increase from recent weeks when it had as few as zero. Historically, about 10% of those infected with the coronavirus have been hospitalized, usually after a two- to three-week lag time.
"I see we still have some issues with COVID," Thornton said.
Alexander said Childers' focus on the expiration of Ivey's state of emergency is misplaced because the Feb. 1 resolution is not tied to whether a state of emergency is in effect.
The resolution, Alexander pointed out, states that the hospital's authorization to run ambulances continues until the council votes otherwise or "until such time as the COVID crisis has fully resolved."
Thornton, EMS Coordinator Ashley England and Alexander also said at Monday's council work session that the hospital's ambulances are needed because First Response isn't providing the necessary coverage.
England and Thornton detailed a number of times in the last two months that First Response rolled or "zeroed out" calls, meaning it advised Morgan 911 it could not handle the call or that it could handle it only after a delay.
Morgan County 911 and England have frequently had to search for another ambulance service to cover for First Response after patients had to wait hours and even days to be transported, the city officials claimed.
Thornton said he received a complaint Tuesday that a patient had to wait more than a day for transport to receive dialysis. This forced England to finally call another ambulance service.
The lengthy delay caused problems for the dialysis clinic, Thornton said, because it required the facility to use new lines and medicine.
Mayor Tab Bowling said there are days when First Response cannot handle calls, requiring the city to reach out to a number of ambulance services, including Lifeguard, HEMSI and Decatur Morgan Hospital.
"Other ambulance services have grown so weary of getting calls to cover for First Response that they're turning us down," Bowling said.
Thornton said he has received only one official complaint against the hospital from First Response, but Childers said England refused to pass along to the City Council or investigate other complaints he has made against the hospital. Childers has frequently said the hospital's delays in discharging patients force First Response ambulances and crews to wait for patients, compromising their ability to respond to other calls.
Thornton, who is also chairman of the Ambulance Regulatory Board, said the ARB can't regulate anything other than ambulance services.
"If First Response is getting held up by the hospital, that's an issue between two businesses," Thornton said.
Childers has said he's struggling to keep enough ambulances in operation because of a shortage of personnel, an issue he said is causing problems nationally. He then accused the hospital system of "poaching" his employees and said this is why he's having trouble responding to calls. There have been days when he had only two or three ambulances available for emergency calls, Thornton and England said.
Councilman Billy Jackson said he has plenty of problems with Childers and First Response, but he queried whether the council's resolution authorizing hospital ambulances has caused the current problems. The resolution was aimed at relieving backups at the hospital as it sought to transfer patients to other facilities, a problem the Feb. 1 resolution solved, but Jackson said it could have contributed to the staffing shortage that Childers said is now hampering First Response's ability to respond to calls.
While Decatur Morgan Hospital CEO Kelli Powers told The Daily recently that her hospital is prepared to establish a full-scale ambulance service and likely will apply for a CPNC — moves requiring increased staffing — she told the City Council on Monday her facility is not poaching employees as Childers contends.
"We try hard not to (hire First Response employees) but some are PRNs who work as needed part-time, usually on their off days with First Response," Powers said. "Most of his full-time employees don't want to leave because they know he won't hire them back."
Thornton on Tuesday said this wouldn't be a controversy "if First Response would do their job."
"I wish (Childers) would just take care of his contract and do what they're supposed to do," Thornton said. "But time after time he's constantly shifting blame."
(c)2021 The Decatur Daily (Decatur, Ala.)