Is worst best for Decatur?
Decatur EMS poised to continue ambulance service monopoly in city
By Eric Fleischauer
Seven months after its panel concluded that Decatur EMS was the worst of six ambulance services seeking to do business in Decatur, the Emergency Medical Services Committee on Wednesday recommended that it remains the only option for Decatur residents.
Accepting the panel’s evaluation as accurate means the worst-available ambulance service is the only one allowed to provide transport within the city or its police jurisdiction.
Decatur Emergency Management Services Inc., the company that the EMS panel ranked last, has had a monopoly on ambulance services in Decatur since 1998. It’s operating without a contract.
Decatur EMS continues its monopoly through the city’s consistent denial of requests by other ambulance services to offer services in Decatur.
On Wednesday, the EMS Committee gave a thumbs-down to two such requests. Care Ambulance and Med-Call requested Certificates of Public Necessity and Convenience, a prerequisite to operating an ambulance service within the city.
The committee turned down both, not because of any expressed concerns about their ability to do the job.
The sole reason expressed by committee members was a desire to retain a single-provider system in Decatur.
Decatur EMS has a public necessity certificate from the city; no other company does, although many have sought one.
By default, that means Decatur residents have no option but Decatur EMS.
The panel made its ranking Nov. 24 after reviewing submissions from six ambulance services that responded to a city Request for Proposals. The process took almost two years.
Alabama law provides cities with the ability to enter into exclusive contracts with ambulance providers, but only after going through a competitive bidding process.
In 2004 — before Decatur started its process — the state attorney general concluded in a published opinion that an RFP was not a legal method of awarding an exclusive contract.
On Monday, the City Council will vote on whether to cancel the RFP. Cancellation is likely due to concerns over the legality of the process.
Assistant City Attorney Kelly Butler, primarily responsible for the drafting of the RFP, defends its legality. She said even though it is labeled a “Request for Proposals,” it meets all the requirements of the competitive bidding law and thus does not run afoul of the 2004 attorney general’s opinion.
Barnes Lovelace, lawyer for Decatur EMS, argues to the contrary. He said the attorney general’s opinion is squarely on point and that the RFP process was flawed from the beginning.
Whoever is correct, Lovelace seems to have won the debate. Numerous city officials and EMS Committee members — all refusing to speak on the record — said during the last few days that they are convinced that awarding a contract under the RFP process would be illegal.
Under Lovelace’s reading of the law, the city could start all over again with a competitive bidding procedure, rather than an RFP. He argues the city cannot, however, legally begin a competitive bidding procedure for an exclusive contract.
An exclusive contract to an ambulance other than Decatur EMS, he said, presupposes revocation of his client’s CPNC. He further argued that under Decatur’s CPNC ordinance his client has a vested right to its CPNC. The city cannot revoke Decatur EMS’s right to operate in Decatur without due process of law and a showing that it has somehow failed in its responsibilities, he said.
The ordinance does not, on its face, require such a procedure. The city can revoke a CPNC, according to the ordinance, simply by finding “the public convenience and necessity no longer warrant such operation.”
Why a monopoly?
Underlying the debate is a longstanding city policy that Decatur’s ambulance needs are served best with a government-protected monopoly.
The theory that the Decatur market cannot financially support multiple ambulance services, even though the five ambulance services (other than Decatur EMS) responding to the RFP have said it can.
The concern is that, in a free-market environment, ambulance services would cut costs, potentially endangering their patients.
Exacerbating this concern is that 911 calls tend to be the least lucrative for ambulance services because the patients do not always have insurance.
Officials fear that competing ambulances would service higher paying transports, leaving dangerous gaps in their
responsiveness to emergency calls.
Care Ambulance Director of Operations Dell Gamble said the city should deal with this concern by providing an exclusive contract for 911 calls. The terms of that contract would dictate response times, equipment requirements and other matters designed to ensure high-quality response to emergency calls.
“If you’re running 911 calls, you’re going to do the bulk of the work,” Gamble said. “That’s our goal.”
Councilman Gary Hammon has argued consistently that the free market works fine for ambulance services.
David Childers, president of Med-Call, agreed. Existing equipment permits 911 operators to locate any licensed ambulance through GPS monitors. The best system for the patient, he said, is to base dispatches entirely on location. The ambulance closest to an emergency is the one that gets dispatched, regardless of who owns it.
Some ambulance services may collapse under such a system, he said. The strongest — those with the most ambulances placed closest to anticipated need — will survive.
“They’re running the GPS system in Morgan County, and we’ve run into zero problems,” Childers said. “Response time has dropped.”
EMS Committee member Dr. Steve Hall, along with the other committee members, sees the one-provider system as inviolable.
“A single provider best serves this community,” he said. “I don’t want to compromise that philosophy.”
Mayor Don Kyle said he doesn’t much care which ambulance service provides care in Decatur, but the current debate is hurting everyone.
Decatur EMS’s franchise is under attack. Financially, Kyle said, that creates a disincentive for it to invest in 12-lead monitors or other improved equipment.
Similarly, he said, granting a CPNC to other ambulance services, with no assurance that they would receive an exclusive contract or even a contract to handle all 911 calls, would make it difficult for them to invest in a first-rate service.
“One way or another,” Kyle said, “we’ve got to put this matter to rest.”
Review pane’sl rankings
After interviewing six companies in November, a seven-member review committee overwhelmingly recommended Care Ambulance of Montgomery. NorthStar EMS was second, Rural/Metro third, Lifeguard fourth, Lifecare fifth and Decatur EMS, sixth.
The committee included three doctors familiar with medical transport, the police and fire chiefs and the city’s chief financial officer and assistant attorney.
Decatur City Hall
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