A proposed overhaul of a city ordinance regulating ambulance services does not have a fan in First Response, Decatur’s sole ambulance company and thus the only entity that will be subject to the new ordinance’s mandates if adopted.
“At this point, we are just looking for some accountability,” Council President Paige Bibbee said last week. “Most of the time, to get accountability, you get into a person’s pocketbook and have a high enough fine that it gets someone’s attention.”
Absent a significant improvement in its response times, the proposed ordinance would definitely get into First Response’s pocketbook. It includes financial penalties ranging from $500 to $20,000. The proposed ordinance makes no change to the response times required since the current ordinance was adopted in 1998, but it provides enforcement tools missing for the last 21 years.
Both the current and proposed ordinances require the ambulance service to respond each quarter to 90% of in-city emergency calls within eight minutes, a requirement First Response frequently violates. The cumbersome eight-member EMS Committee has struggled to muster quorums, and it lacks any enforcement authority other than recommending to council the revocation of First Response’s certificate to operate.
Points and fines
The proposed ordinance would exact a $10,000 fine in the first quarter an ambulance provider fails to meet the 90% mark. If the provider again falls short in the next quarter, a $20,000 fine is imposed. Penalty points would also be assessed — 10 in the first quarter and 20 in the next — and accumulating 26 points over two years can result in revocation of the certificate to operate. The same penalties are assessed for failure to respond to 90% of calls in the police jurisdiction within 12 minutes, a requirement First Response rarely meets under the current ordinance.
Points and fines are assessed by an EMS coordinator appointed by the fire chief. They can be appealed to a newly created Ambulance Regulatory Board and the most severe can then be appealed to the City Council.
“We take issue with the amount of fees and also the point system,” said Harold Mooty III of Huntsville, First Response’s lawyer, at a City Council work session last week. “We’re talking about fines upwards of $20,000, which is astronomically higher than anything I’ve seen in the state of Alabama.”
Bibbee says the existing ordinance has been a failure, and that the penalties need to be severe enough to give First Response an incentive to make the necessary investments to reduce call-response times.
“We’re talking about people’s lives now. We’re not talking about a gravel contract,” she said. “We’re talking about living and dying, and that’s a very different discussion.”
Grande said the penalties, most of which are $1,000 or less and involve equipment or staffing violations, provide the EMS coordinator with needed leverage.
“If an ambulance service is using a 6-year-old vehicle that’s breaking down six or seven times a year, now I could take my new ordinance and say, ‘If you’re not going to repair it, we’re going to fine you to the point where you’re either going to get rid of it or repair it.’”
The ordinance also includes criminal penalties, including up to 180 days in jail, for infractions that generally involve giving false information to the city.
“No other market has a criminal provision like that,” Mooty said.
First Response argued at last week's work session that the eight-minute in-city response time should be relaxed to nine minutes. Mooty cited a national standard that adds a one-minute “turn-out time” to the eight-minute response time.
Councilman Chuck Ard said he has no interest in passing an ordinance that slows response times. He said he understands the need to incorporate turn-out time for firefighters who may need to change gear or vehicles depending on the nature of the call, but not as it applies to First Response.
“What is their turn-out? They’re sitting in an ambulance waiting,” he said. “They need to have enough ambulances, and in the right places. It’s all about them figuring out how to meet the standard to which they’re being held accountable, at the least cost. I don’t fault them for that, but I don’t fault the city for trying to set the standard.”
One change in the new ordinance designed to assist the ambulance service in meeting response times is elimination of its obligation to transport uninsured, non-emergency mental health patients. First Response has complained the distance to most available mental health facilities has tied up staff and ambulances, hurting overall response times.
Another change in the proposed ordinance, one requested by First Response, is it allows the ambulance service to operate its own non-emergency call line, rather than relying entirely on Morgan County 911.
Mooty spent much of the work session complaining that the proposed ordinance grants far too much authority to the fire chief. This is a conflict of interest, he said, because Chief Tony Grande has expressed some interest in the city running its own ambulance service. The idea has gone nowhere amid concerns about the significant upfront investment and a fear the city would get stuck with cost overruns.
“The proposed ordinance may be used by DFR (Decatur Fire & Rescue) as an attempt to push out First Response … and generate revenue stream. In other words, you abdicate the private property of a business to fund the creation of an ambulance system you couldn’t otherwise secure funding for,” Mooty said. “It sets it up for that type of abuse to happen.”
DFR 'running rogue'
Councilman Charles Kirby, a stalwart First Response defender, was more direct last week.
“Chief Grande’s got a department that’s running rogue. This issue isn’t about First Response. This issue is about a fire department that’s already made its intentions known: It wants those jobs. It’s all about job creation and protection,” Kirby said. “Chief Grande wants to generate a revenue stream. That’s extortion. I think we can prove violations that may include extortion and racketeering.”
Grande said he sees merit in a municipal ambulance service, “but that’s a tax burden on the people, and I understand that. Private services are doing this business all over. It doesn't matter if it's DFR or a private ambulance transporting patients, we just want people to be well taken care of, to get responses and transports in a timely manner.”
Kirby said response-time issues involve not just the ambulance service, but Morgan County 911, the Fire Department and hospital emergency rooms.
“The other three are the big bullies on the block, and the ambulance guy is the little weakling, and we know we can bully his a--,” Kirby said. “This council has no vision or courage. They don’t realize the bureaucrats are in control. It’s not about First Response; it’s about a rogue department.”
Kirby said the City Council's effort to pass a stronger ordinance is motivated by a desire to harm David Childers, who operates First Response.
"This is a consistent effort to drive a man out of business. That's the goal. And they're going to drive him out of business, there's no question in my mind," Kirby said.
One of Mooty’s complaints was that the proposed ordinance regulates the private ambulance provider, but not the Fire Department. His point, at least in part, was that if the Fire Department eventually transports patients, there would be no ordinance regulating it.
“I would rather see our Fire Department do transport over anybody else,” said Councilman Billy Jackson. “The fact of the matter is if we ever came to that point, then we would address that in a new ordinance.”
Assistant City Attorney Chip Alexander, who drafted the proposed ordinance, said it made no sense to apply an ambulance ordinance to the Fire Department.
“In my lifetime, DFR has never been a transport unit, which is why we don’t have regulations on them about how they transport patients,” Alexander said. “This applies to everybody in the city transporting patients.”
The proposed Ambulance Regulatory Board has three fewer members than the eight-member EMS Committee it would replace. Permanent members would be the fire chief, who would serve as chairman; the Decatur police chief; and the director of the Morgan County Emergency Management Agency. One member would be appointed by the mayor and one by the City Council, each with four-year terms and each required to have a background in emergency services.
First Response also objected to having to arrange for a $2 million performance bond required in the draft ordinance, which would be available to cover the city’s costs if the private ambulance service shut down before its five-year certificate to operate expired.
Alexander said the provision is necessary to provide the city with funds to pay for a temporary ambulance provider if the current one leaves of its own accord — as DEMSI did in 2014 — or has its certificate revoked.
“We’re not looking at this as a way to make money,” said Ard. “We’ve experienced this. If we’re doing this ordinance, why should we not protect the city?”