Ala. hospital ambulance service avoids response time failure fine
Decatur Morgan Hospital Ambulance Service won an appeal but will still have points on record for possible revocation of license
By Bayne Hughes
The Decatur Daily
DECATUR, Ala. — Decatur Morgan Hospital Ambulance Service won't have to pay a $5,000 fine, but some City Council members warned they don't want a repeat of its response-time failure in the future.
After hospital CEO Kelli Powers blamed end-of-the-year staff shortages, the City Council voted unanimously Monday to uphold the ambulance service's appeal of the fine that was imposed for its failure to meet the city's response-time requirement in the police jurisdiction for the fourth quarter of 2022.
However, the council majority opted to follow the city ordinance and let a five-point penalty remain in place for the response-time violation. Accumulating 26 points within two years would lead to a requirement that the EMS coordinator recommends revocation of an ambulance service's license to operate, a decision that ultimately is up to the City Council.
Councilman Carlton McMasters said the council "showed them a little bit of grace" in the same way that it did for First Response Ambulance Service when that company appealed penalties in July 2020.
"We needed to be consistent between the two cases," McMasters said.
McMasters then added that he's not sure a council vote "would be unanimous on an appeal next time," so it's important that the ambulance service meet response-time requirements going forward.
Councilman Kyle Pike said he agrees that it's important to hold Decatur Morgan Hospital to the same standards as it did with First Response.
Councilman Billy Jackson said he's "willing to give them (Decatur Morgan Hospital) latitude" in this case.
"We don't need to necessarily change the ordinance but this should not turn into something subjective where we can give latitude or not give latitude," Jackson said. "I think it needs to be defined. It needs to be written, and we should not allow discretion. Either you adhere to the guidelines or you don't."
Councilman President Jacob Ladner said he knows there are nuances to responding to calls but if no valid explanation is given for a failure to meet response times, "I would probably uphold the fines."
Ladner said his inclination is to follow the ordinance in the future.
"If it says if you don't do X and you get fined Y, that's what we do," Ladner said. "But we set a very clear precedent by upholding the First Response appeal.
"... If we're going to have an ordinance and it has times that need to be met with financial penalties, we need to either change the ordinance or enforce the penalty."
Councilman Hunter Pepper made a motion to uphold the appeal and remove both the penalty and points, but Assistant City Attorney Chip Alexander advised the council that the ordinance doesn't allow for an appeal of a points penalty.
"So, we're basically making a motion to knowingly violate our own ordinance?" Jackson said.
However, Alexander pointed out that the council did remove penalty points on a July 2020 appeal by First Response, which closed its operations in March 2022.
Pepper's motion failed without a second, and he was critical of the council majority after the meeting. He called the practice of setting response-time requirements "the most absurd thing I've ever heard of."
An EMT until recently in Jefferson County, Pepper criticized his fellow councilmen for not removing the points penalty.
"I understand the need for certain standards and regulations because we want our citizens to receive the best of care," Pepper said. "I don't want to say they're wrong but none of them have even been in those shoes before. They don't know what it's like to have to respond to an emergency and prepare yourself for what you're about to see.
"They don't know what it's like to have to speed across town with lights and sirens blaring while hoping nobody moves in the wrong direction so you hit them and it ends up being your fault."
Pepper said "It's atrocious" that the other councilmen think they're giving the hospital a break while saying they would likely reject any appeals on future violations.
"I hope they're never in their shoes," Pepper said.
Pike said Pepper is "unequivocally wrong" in his stance that the city shouldn't have response-time requirements with penalties. He pointed out that Powers said in the meeting that the hospital wants regulations in place.
"We've got to have some standard to hold them to," Pike said. "Our job is to make sure we're providing a proper response to our citizens in responding to public safety."
The city ordinance requires the ambulance service to respond to at least 90% of its calls in the police jurisdiction, a 1 1/2 mile area outside the city limits, within 13 minutes.
Emergency Medical Services Coordinator Chris Phillips said the hospital responded within 13 minutes to 85% of the calls in the PJ during the October-December time period. He said the ambulance service had 87 calls, with its responses to 18 not meeting the time requirement.
Five of the delayed responses were not counted against the hospital, so the ambulance service missed its fractal response times by four calls, Phillips said.
He said the police jurisdiction usually has a low call volume but the last three months of 2022 were unusually high.
Phillips said the ordinance doesn't give him any discretion on response times so he has to issue penalties after an ordinance violation. The Ambulance Regulatory Board then voted at its April meeting to impose the fine and points penalties.
Powers blamed the fourth-quarter failure on the ambulance service's staffing shortages at the time but said they've made improvements by taking steps such as offering more money and incentives to attract employees.
"We really feel if we had the staff, we would have met the requirements," Powers told the council.
Carrie Wynn, of the ambulance service, said the hospital is also offering incentives to employees to cover critical shifts.
"We saw a lot of issues happen during the evening shift, which is our peak volume time," Wynn said.
Powers said they are now running 12 ambulances and they have two new trucks on order.
Jackson suggested the ambulance service shouldn't miss its required response times now that it is fully staffed.
But Powers said there's more to meeting response times than just staffing. She said there are other factors like answering out-of-area aid calls and delays at hospitals.
City Attorney Herman Marks said the ambulance service can seek a waiver on a call so it doesn't count against it if there's a legitimate reason an ambulance could not reach a scene on time.
Powers on Wednesday said she is happy with the council's decision and she believes the hospital will have a better relationship with the city than previous ambulance services did.
"The goals of the city and (the) ambulance service are aligned," Powers said. "We want what's best for the citizens of the police jurisdiction. I think we're going to be able to work together because we both want good service. I'm not in it for the money. I'm doing it to help people."
Powers said she wants Decatur Morgan Hospital Ambulance Service to be held to the ordinance's standards, and she "just wants to be held to the same standard as the others (First Response)." She also said she hopes the city will take into consideration that sometimes things happen that make it difficult to meet response-time requirements.