NEWPORT, Tenn.—County officials decided to reevaluate their contract with First Call Ambulance after a Tuesday meeting of the Public Safety Committee, in which members met with medical executives and emergency responders to discuss the conditions responsible for poor ambulance response times and coverage gaps. Unreliable ambulance service has led to confusion, uncertainty, and at least one death when an ambulance that was promised never arrived.
The Chancery Court meeting of 27 people was one in a series of discussions around the ongoing arrangement with First Call Ambulance, the ambulance service with an exclusive contract to service the county. With that contract coming up for renewal in June, the committee is taking a hard look at the exclusivity clause, a stipulation in the contract preventing Cocke County from hiring another company to pick up the slack.
In January of last year a Cosby family lost a loved one to cardiac arrest. The family was told First Call was on the way; however, they received another call saying Gatlinburg EMS was dispatched. In fact, no one came, and that person died.
At the time, all four ambulances available to the county were on other calls.
Response times under the current arrangement are unacceptable, said Forrest Clevenger, Vice Chair of the Public Safety Committee. Clevenger said a previous Newport Medical Center executive emailed him a range of data showing high response times.
“I understand we’ve got an exclusivity contract that won’t allow someone else to come in. I’m wondering how we are going to be able to work then, where that’s not going to be a problem,” he said. “I don’t want someone sitting here at the dialysis office waiting two and three hours for transport because the service we have doesn’t have an ambulance. I don’t want someone waiting to be transported out of your hospital for emergency or non-emergency for several hours because we can’t get another truck from somewhere, another county, or this county. I’m wondering if we get our attorneys to look at that exclusivity clause, uh, have some sort of a lenience that it goes out the window after an hour, two hours, whatever, that if they can’t produce someone in the next couple hours to make this call, we can go on down the list.”
Clevenger said there have been ambulance services in previous years that have offered to pick up the slack and take nonemergency transports, but were rejected on the basis of the exclusivity clause of the county contract with First Call.
“That’s money. I understand that. I mean, that’s bread and butter, but it’s also people’s lives,” Clevenger said. “It’s also a great discomfort and disservice to citizens if they’re having to sit four hours. You’ve got a person on dialysis that’s having to wait in a lobby for four hours, before they can get a ride back? That’s unacceptable.”
The committee heard suggestions for putting new measures in the contract that would hold the company accountable in the future, such as fines when the service does not meet expectations within a certain time.
The current terms of the contract do not work, said Scott Williams, CEO of Newport Medical Center.
“The contract you’ve got right now, the best ambulance service in the country would fail,” Williams said. “It just won’t work.”
He said it is not the job of the county to decide on the number of ambulances or EMTs on retainer, but simply to state the county’s needs in terms of response times and quality of outcomes, and that by contract the ambulance service is charged to provide it. He said the committee needs to adjust its contract terms to clearly state the county’s needs and that it should include measures to be taken if those needs are not met. He also told the committee to get ready to meet the added cost of a bolstered contract.
“Consider funding it, because you get what you pay for,” he said. “This is life or death.”
Williams said the county should reassess its priorities. He said the county spends more on the dog pound than its ambulance service, although his claim could not be independently verified at the time of publication.
“The ambulance has trouble when they’re tied up on calls and we don’t have anybody to take that person to Chattanooga, or to Knoxville, or to Johnson City,” he said. “I would implore you that in the contract that there’s things put in the contract, that those resources are available that we can transport patients to that higher level of care, and save lives.”
Williams said the ambulance team, with only two trucks in the county, faces the inherent challenge of being called around the county, containing about 800 miles of road, while also being tasked with longer transports to higher level care centers.
“This is the one public service that you need, and you need in a hurry when you really need it, because minutes matter to a stroke patient, to a cardiac patient,” Williams said. “That response time is what’s so, so very important.”
After more discussion between Williams and Clevenger around the logistics of using such a small number of ambulances, Clevenger said the county had been threatened with litigation after expressing a need to hire on extra help to bridge the largest gaps in coverage.
“What I’ve heard from one place, which will remain anonymous, is that they were having to wait three to four hours, and when they threatened to call another ambulance service, they were told by First Call that they will be turned in to the state, there’ll be a lawsuit, and threatened,” Clevenger said. “That kind of bugs me, I’ll be honest with you. We’ve got a person, one of our citizens, that just went through dialysis, who’s sitting on a hard chair in a waiting room for four hours, trying to catch a ride, and then when they’re told that we’re going to have to get somebody else, um, out of threat of losing whatever moneys that ride is going to provide, they’re going to threaten with a damn lawsuit. Get this person home. You know, get them home. Don’t threaten to sue them. You know, that right there shows me where your heart’s at, you know? Get—Get in your car, go over there, and you transport. Don’t threaten to sue this man, or this person. That is just unacceptable.”
Williams presented leaders with sample contracts in use by other states and counties, many of which contain the provisions for which Clevenger is asking.
“You all are charged with the hard task of, ‘Where’s the balance between the money, and the lives?’” Williams said. “I don’t envy you.”
Clevenger said First Call should not take all the blame. He said the county must take responsibility for its role in accepting a contract on terms that max out the company’s half of the agreement to provide, keeping First Call medical personnel busy, yet unable to meet the full needs of the county.
“The contract’s bad right now, in my opinion, but we didn’t do that,” Clevenger said. “We have the opportunity to fix that, correct that for the county, and that’s something that we really need to take seriously.”
The discussion later turned to the specific terms of the exclusivity clause, or “non-compete clause” as people began referring to it during the conversation. Mayor Crystal Ottinger attempted to clarify whether the clause still allowed individuals to source their own ambulance services, besides First Call, and trying to ascertain that the main point of the clause was that only 911 operators are restricted from asking another company to transport patients.
At that point, newly-elected Chairwoman Gayla Blazer invited the public to clarify any misconceptions or misreadings of the contract. Her gaze moved to a man in the back.
“Is that correct? You’re here,” she said, gesturing to First Call President and CEO Scott Yates, who appeared unprepared to be called upon. She asked again. “Is what I just said correct, or not correct?”
Yates stood up at his place in the back of the room, introduced himself, and from there spent three minutes agreeing with the consensus that there is a need for stretcher vans in the county. Then, for the next two minutes he addressed the terms of the exclusivity clause, stressing that Priority Ambulance is the largest service provider in the state, having acquired First Call, and saying First Call follows state regulations and protocol.
He responded to a previously expressed desire by the committee to find another provider, by emphasizing the company’s ability to pay fees and meet state regulations, suggesting the county’s options are limited.
“All ambulance services operate under state rules, right, and every ambulance service has to be licensed in an area within the state. That sometimes, that could be a city, sometimes it’s—and most of it is the county, and uh, in order for an ambulance to provide service to citizens in a county, the c—the service has to be licensed in the county, so it’s a bit of a—it’s not as much, sometimes, First Call is not saying, ‘Hey, nobody else come in.’ Uh, it’s the state regulates this. We pay a lot of fees to the state, for—by ambulance, and for our county license for Cocke County, and all the counties that we serve, so there’s some issues there … I can tell you, for First Call – and we’re part of the Priority family of—family of companies – so we’re all over the state, you know, look, I can’t think of any circumstance ever, where we’ve said, “Hey, we can’t do this but you can, and a patient needs it, please provide the service, whether that’s a transport from a hospital to another hospital, or from a—from a nursing home to a dialysis clinic. You know, sometimes they have to, you know, make sure that we’ve got—we’re following the state protocols and there’s good communication. But, uh, we get asked all the time to do things where we’re not licensed to, but you know what I do? I call the MS Chief in the county, and I say, ‘Hey, we’ve got this request, uh, is this OK for us to come in?’ and just about every time, they say, ‘No no, we’ve got it covered. There must have been some miscommunication.’ Say, ‘Fine, call us back if you need us. We’ll be happy to help out, if we’ve got resources.’ That happens all throughout the state, First Call, and pretty much everyone in this organization. So I just want to make sure you understand, kind of, some of those protocols.”
His remarks were met with silence.
“Thank you so much,” Blazer finally said with a laugh. “Who was next?”
There will be another meeting of the Public Safety Committee at the Chancery Courtroom in the Annex on Monday, Feb. 28, at 6 p.m.
This story appeared in The Newport Plain Talk.