The recent history of ambulance services in Decatur has been ugly, and Decatur Morgan Hospital’s decision to seek approval to operate a service promises to benefit the city and its residents.
Decatur Emergency Medical Services Inc. had its share of problems when it held a monopoly on city ambulance services before 2012, and the headaches intensified when First Response received a certificate of public convenience and necessity in 2012. DEMSI and First Response tangled in and out of court, but their competition resulted in some of the fastest ambulance response times the city has ever had. Using GPS, Morgan County 911 dispatched the ambulance that was closest to a call, so the two services jockeyed to locate their vehicles in parts of the city where calls were most common.
The competition was healthy while it lasted, but there is a lesson in the fact that DEMSI abruptly shut its doors after two years of sharing the market. At least in that situation, unfettered competition was not sustainable.
The First Response monopoly that followed has never worked well. Conflict between First Response and the city has been nearly constant. Without competition, response times for the sole ambulance service quickly dropped as the firm chose higher profit margins over speed. The City Council’s passage of a strict ambulance ordinance in 2019 improved response times but generated even more conflict as the tense relationship between First Response and the city deteriorated into outright hostility.
One thing learned from First Response was that, even with a strict ordinance allowing for large fines and decertification, the city has limited enforcement power against an ambulance service with a monopoly. Severe sanctions for inadequate performance can backfire if the only service provider folds or decides the venture is not profitable.
As First Response owner David Childers has warned, there is little question that Decatur Morgan Hospital could push its competitor out of the market. Decatur Morgan is part of Huntsville Hospital System, which already operates ambulance services in Limestone, Colbert and Marshall counties. Just in preparation for seeking a CPNC, Decatur Morgan has already purchased six new ambulances, has another three older ones available and is rapidly hiring ambulance personnel.
There are significant downsides to allowing a monopoly to develop, even if the holder of that monopoly is a nonprofit hospital with lots of capital.
The city should work to keep both services healthy, which among other steps will mean making sure Decatur Morgan does not unfairly leverage its control over non-emergency transports to and from Huntsville Hospital System facilities.
If Decatur Morgan does become Decatur’s sole ambulance service, the city will need to monitor it carefully. Inadequate staffing or too few operational ambulances delay response times, and that can translate into deaths. While its financial pressures are likely to be less acute than those of First Response, it will have an incentive to keep costs as low as possible. The city’s role must be to ensure that its standards remain high.
Decatur Morgan Hospital has a long history of working well with city officials and of doing what’s needed to protect the health of city residents. Whether it coexists with First Response or eventually becomes the city’s sole ambulance provider, we look forward to a partnership between the hospital and city that benefits everyone.