Decatur Morgan Hospital has the permit required to operate a full-time ambulance service in the city following a verbal guarantee by CEO Kelli Powers that it's in the ambulance business “for the long haul.”
The City Council voted 3-1 Monday to approve the hospital’s certificate of public necessity and convenience. That means the city will have two competing ambulance services once the hospital has the necessary staff and ambulances.
First Response Ambulance Service has had a monopoly in Decatur since 2014, but city officials have pushed it for years to improve response times, passing a strict ambulance ordinance in 2019.
“We believe Decatur deserves better,” Powers said at Monday's council meeting. “Due to the increase in response times, dissatisfaction in the community and delayed transports, we believe approving our CPNC will solve these issues and give people the service we want for our community.”
First Response owner David Childers told the council that Decatur doesn’t need another ambulance service and that hospital officials and a few select city officials conspired against his company.
“We’ve been given a bad deal,” Childers said.
Council President Jacob Ladner asked Powers if the hospital is serious about starting and sustaining an ambulance service even if it isn’t always profitable.
“I want to make sure that in five years you don’t decide, ‘Hey, this doesn’t make sense financially so we don’t want to do 911 calls anymore,’” Ladner said.
Powers' reply was that their investment shows they plan to stay in the ambulance business and even possibly expand it in the future.
“We’re in it for the long haul,” Powers said. “We’ve spent over $3 million on this. This is something we’re not going to stop doing.”
Councilman Billy Jackson cast the only vote against the CPNC for the hospital. He said emergency calls aren’t profitable, and he pointed out that Powers’ verbal promise won’t actually stop the hospital from deciding in the future to stop running emergency calls. He said the city would be in trouble if First Response is no longer around and the hospital decided to stop responding to emergency calls.
“We don’t have a mechanism to guarantee they won’t stop running those emergency calls when it’s no longer profitable for their company,” Jackson said. “If they decide to stop, there’s nothing we can do.”
Jackson said he voted against First Response’s CPNC in 2012 when Decatur Emergency Medical Services Inc. was already operating in the city and now he opposes the hospital’s CPNC because he doesn’t think Decatur is big enough for two ambulance services.
Jackson said he felt having a second service “would be disruptive” of emergency call response in the city because of the call jumping — when one service answers another's call — and other issues caused by the competition.
While the city has an ambulance regulatory ordinance, Jackson said he is concerned that the state is the only regulatory authority over the hospital.
Councilmen Kyle Pike and Carlton McMasters said they believe Decatur is big enough for two ambulance services and that response times will improve.
“It’s good for the city to have multiple providers,” McMasters said. “This is about public safety, and I wouldn’t care if 10 ambulance services applied for a CPNC. That just adds to the city’s coverage and makes response times shorter.”
Pike said he didn’t hear anything from Childers that would keep the council from voting for the hospital’s CPNC.
Ladner said Powers’ answer was one of the reasons he voted to approve the hospital’s CPNC.
“It’s important to the city and for me to know that (the ambulance service) is a long-term investment,” Ladner said.
'They don't like me'
Powers said the hospital will save in transporting its own non-emergency patients. She estimated it pays a little more than $1 million a year to First Response to transport the hospital’s non-emergency patients.
“It’s also an efficiency thing,” Powers said. “Having your own ambulance service ... really helps get patients in and out. If we have somebody holding in the ER, a supervisor can come and take care of that patient so the truck can get right back on the road to do 911, non-emergency transports or whatever needs to be done.”
She said this is why a lot of hospitals in the Huntsville Hospital System now have ambulance services. Decatur Morgan Hospital is part of the Huntsville Hospital System that also includes the Parkway and West campuses in Decatur. Powers' hospital began running a limited ambulance service in February after the council approved a temporary resolution to allow the hospital to transport patients between system facilities to alleviate delays and overcrowding caused by the pandemic.
“We had patients in the hospitals but we couldn’t get them out so we could get these people to rehab or back home in a timely manner," she said.
Childers said during Monday's public hearing that city officials are conspiring with the hospital to make a second ambulance service necessary.
Childers showed clips from previous council and Ambulance Regulatory Board meetings of Assistant City Attorney Chip Alexander and Emergency Medical Services Director Ashley England making statements he thought showed they were biased against his service.
Childers said his clips showed that the previous City Council, which instituted the strict ambulance ordinance, “was given bad advice and misguided advice.”
However, Ladner and Alexander interrupted Childers several times to say the public hearing was about the hospital’s CPNC and not about any perceived slights against him and his company.
“I know they don’t like me,” Alexander said. “But we’re here to decide if Decatur Morgan Hospital can and should receive its CPNC. It’s a tired argument that (former fire chief) Tony Grande, (EMT Director) Ashley (England) and Chip ‘pick on me.’”
Childers showed a clip of Alexander stating that response times were “amazing” when First Response, which opened in Decatur in 2012, was competing against Decatur Emergency Medical Services Inc. DEMSI filed for bankruptcy in 2014, leaving First Response with a monopoly in the city.
However, Childers pointed out that First Response’s average response times were worse in 2012 when the company opened in Decatur, with most finishing under the required 90% average for a month.
Childers said First Response was making the 90% response time requirements in the last two years until the council’s Feb. 1 resolution on hospital transports.
He said the decision to allow the hospital to transport its own non-emergency patients hurt his company’s finances because of the loss of revenue from those transports.
Childers said in the past that ambulance services make their money on non-emergency transports but lose money on emergency calls because of the large number of indigent patients in the city.
He said First Response started losing employees in June, some of then going to work for the hospital, and that’s when he started having problems with the number of ambulances in operation. There were a number of times when First Response only had two or three available ambulances. There has been agreement that four to six are required to provide full coverage for the city.
Jackson said he is concerned that, in his opinion, the hospital has the ability to slow a competitors’ response times.
In an update on the hospital’s plans to start an ambulance service, EMS director Tyler Stinson said the hospital has 10 trucks plus two supervisor vehicles.
Two of the trucks are scheduled for remount and two more than will be remounted next. The other six are 2019 or newer. Two have fewer than 10,000 miles and two are scheduled for delivery.
England said First Response has only two ambulances that meet the city’s requirement that these vehicles have fewer than 200,000 miles on them. He said Childers promised when his CPNC was approved in October 2020 that he would buy at least two new vehicles during the past year but he hasn’t fulfilled that promise.
Stinson said the hospital ambulance service has 38 employees, including 20 fulltime and 18 part-time, with one critical care paramedic, eight advanced EMTs and 15 basic EMTs.
“We’re interviewing people two or three times a week so that staffing is going up,” Stinson said.
“Without the license, it’s hard to get people to come aboard,” Powers added. “Once we get the license, we feel like a lot more people will be willing to join us."
Stinson said shift supervisors will be a paramedic or someone who is training to be a paramedic. They will have quick response vehicles “so they can respond and help crews with critical calls or high acuity calls. They will also be able to provide some direct supervision for the crews and help when needed.”
If a crew is held up in the emergency room waiting on a bed, Stinson said a shift supervisor will be sent to take over while a patient waits for a room so the crew can respond to a call without delay.
Stinson said they plan to establish a quality oversight with internal reviews on a daily basis planned by shift supervisors and training officers. They will monitor response times on a daily basis and look at any consistent issue. A system management program will allow them to post ambulances throughout the city.
Quality reviews will also be done by a committee consisting of hospital personnel and Decatur Fire & Rescue and Morgan County 911 representatives, Stinson said.
Stinson said the home bases for the ambulance services will be at Decatur Morgan and the Parkway campus.
England said he plans to present a plan at Tuesday's ARB meeting on how to dispatch calls for two ambulance services. Stinson said the hospital’s ambulance service is in limited operations now and would likely begin full operations after that meeting.
Councilman Hunter Pepper abstained from the vote because he is attending Calhoun Community College to become an emergency medical technician.