Ala. agency fined $15K for not putting enough ambulances on the road

First Response received 53 penalties for not meeting the response guidelines for running the required number of trucks during operations every day


Bayne Hughes
The Decatur Daily, Ala.

First Response Ambulance Service has racked up $15,900 in city fines for not putting enough ambulances on the road since Jan. 14, but the company owner claims call volume and per-call revenue are too low for the company to meet the city's requirement.

City Emergency Medical Service Director Chris Phillips reported to the city Ambulance Regulatory Board on Tuesday that First Response received 53 penalties for not meeting the response guidelines for running the required number of trucks during operations every day.

Phillips has 14 days to notify an ambulance service of a penalty and each penalty carries a fine of $300. The penalty can't be appealed, but First Response has not paid a single one of the fines, Fire Chief Tracy Thornton said.

"He (First Response owner David Childers) hasn't had the correct number of trucks on the road a single day since the response plan went into effect," Thornton said.

Childers said his company doesn't need more ambulances on the road, and that it doesn't have the ambulances and personnel required by the city for emergency calls because most pay little or nothing at all due to low reimbursements from Medicare or insurance and the large percentage of indigent, uninsured patients.

"There's not enough call volume and money to support that number of trucks," Childers said.

The ARB approved a response plan in December that went into effect Jan. 14 as the city tries to manage two competing ambulance services.

The competition began officially in October when Decatur Morgan Hospital received its certificate to run an ambulance service. The hospital has been running an ambulance service with a temporary license since February 2021.

Thornton said First Response also isn't meeting the city's requirement of reaching the scene on 90% of its calls within nine minutes in the city and 13 minutes in the police jurisdiction.

"That shows me he doesn't have enough trucks on the road," the chief said.

Thornton accused First Response of keeping its ambulances at its Central Avenue Southwest office instead of staging them around the city. He said this is one of the reasons the hospital ran 338 calls in February and First Response ran only 189.

Staging would give First Response a chance to respond to more emergency calls because Morgan County 911 gives calls to the closest ambulance to the scene.

"He seems to be trying to play the system," Thornton said. "He admitted in the meeting he doesn't want to run 911 calls because they don't pay enough."

Childers said the problem is that Decatur Morgan Hospital controls the non-emergency transports that pay well while emergency calls don't pay enough to support his ambulance service.

Childers estimated the Decatur Morgan ambulance service now makes 99% of the non-emergency transports out of the hospital.

"The hospital controls anything and everything coming out of the hospital," Childers said.

He said his service brings in about $38,000 per month on dialysis calls, but that money is spent on payroll and other business expenses in the first two weeks of the month.

"If the money is not there, how do you put the trucks on the road?" Childers asked the ARB. "Where does the money come from to pay employees when the money isn't coming in? My people don't work for free.

"We are not going to manage two 24-hour trucks and one 12-hour ALS (emergency) truck. We don't have the funds to do that because we don't have the non-emergency calls."

Childers said his company runs two ambulances on Mondays, Wednesdays and Fridays and three on Tuesdays and Thursdays and he has no plans to increase those numbers.

"It becomes an issue when the city is trying to force me to put trucks out there that I can't pay for," Childers said.

In contrast, Tyler Stinson, Decatur Morgan Hospital Ambulance Service director, said his service is running five ambulances a day.

Thornton asked Childers if he makes money on emergency calls and how much he makes, but didn't get an answer.

Childers estimated First Response transports about 62% of patients when responding to calls, with up to 48% of the potential patients refusing transport.

Thornton said after the meeting that he thinks the percentage of patients refusing transport was exaggerated.

"It's more like 15%," Thornton said.

The ARB on Tuesday also approved a $2,000 fine and a five-point assessment against First Response for failure to execute a contract with Morgan County 911 by Jan. 1. Phillips said the company didn't sign its contract until Feb. 4, and he issued the notice of the fine and points penalty on Feb. 8.

Childers said he notified 911 on Dec. 31 that he wanted to make some changes to the contract but, after almost a month of no response, he signed the contract even though he's not happy with it.

"We didn't stop answering calls and transferring patients," Childers said. "We didn't lock the doors."

Thornton asked why he didn't pursue the contract changes in October or November.

"Everybody is aware of our issues in Decatur — our legal issues," Childers said. "We didn't recognize that there's a $2,000 fine for (not signing the contract on time). That's my fault."

Both ambulance services were notified March 1 that they are being fined $5,000 and five points each for failure to meet the city's required response times in the city during the fourth quarter of 2021.

First Response met the time requirement on 81% of its calls and the hospital met it on 85%, both below the 90% mark required by the city's ambulance ordinance.

They were also notified that they are being fined $5,000 and five points each for failure to meet the city's required response times on 90% of calls in the police jurisdiction during the fourth quarter of 2021. First Response arrived at the scene within 13 minutes on 80% of the calls while the hospital was at 78%.

Phillips said the hospital ambulance service appealed both fines, but there's been no response from First Response. — Lawsuit

First Response in December filed a federal lawsuit against the city and the hospital over the City Council allowing the hospital to run ambulances from February 2021 to October without a certificate of public necessity and convenience (CPNC).

Both defendants have filed motions to dismiss the complaint, arguing among other things that First Response's claims that it had a right to be the city's exclusive ambulance service were incorrect under both the city ordinance and state law.

First Response last month filed a brief arguing that the hospital's ambulance service constituted unlawful competition during the time it lacked a CPNC.

In recent months, First Response argued, "the city's Ambulance Review Board has repeatedly and falsely alleged that First Response has violated applicable ambulance regulations ... . For whatever reason, the city has decided to attempt to force First Response out of the market — only now, through competition with (the hospital), after allowing the (hospital) to capture the profitable business in the market illegally."

"The tea leaves don't need reading — the city wants First Response out — which is why First Response was compelled to file this case," the brief continued.

A magistrate with the U.S. District Court for the Northern District of Alabama on Tuesday gave the defendants until March 25 to respond to First Response.

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(c)2022 The Decatur Daily (Decatur, Ala.)

McClatchy-Tribune News Service

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