Recapping: Decatur ambulance debate
By Eric Fleischauer
Understanding the city’s dealings with prospective ambulance services is like untangling a ball of yarn after a cat spent a week with it.
To begin, the status quo: Decatur EMS is the only company licensed to provide services within the city.
In recent years, it has maintained that monopoly because the City Council, at the recommendation of the city Emergency Management Services Committee, denied licenses (called Certificates of Public Necessity and Convenience) to all would-be competitors.
Almost two years ago, the EMS Committee began requesting proposals from ambulance services, including Decatur EMS, that wanted to operate in Decatur.
The Request for Proposals did not specify whether the winner would have a monopoly on ambulance services, although the city’s longstanding support of a monopoly suggested that would be the end result.
Committee member Dr. Dale Trammell said the committee’s expectation was that the process would be a method of leveraging Decatur EMS toward a higher standard of care.
Six companies submitted proposals. A panel ordained by the EMS Committee, but composed of different members, evaluated the six and placed Decatur EMS at the bottom of the list.
Trammell said the committee was surprised that so many ambulance providers submitted proposals, and even more surprised that Decatur EMS finished last.
After the evaluation, it was tough to see how bottom-ranked Decatur EMS could retain its position if the Request for Proposal process played out.
Trammell and other committee members said they suspect that Decatur EMS did not take the application process seriously. Stated differently, they said, it is a better service than its proposal indicated.
Decatur EMS’s lawyer, Barney Lovelace, argued the Request for Proposal process violated state competitive bid laws.
He pointed to a 2004 state Attorney General’s opinion that concluded a Request for Proposals in Montgomery County was not a valid way to award a monopoly to an ambulance service.
That’s when the EMS Committee’s lawyer, assistant city attorney Kelly Butler, tried to abort the Request for Proposals process that the committee had itself initiated.
Why? One reason is that Decatur EMS’s low ranking would effectively knock it out of the running, a result committee members see as drastic.
A lousy proposal does not equate to a lousy ambulance service, and most members speak highly of Decatur EMS’s performance over the last nine years.
Another reason is the EMS Committee members feared they had spent two years on a process that the city could not use legally to award a monopoly to anyone, and they deem a monopoly as essential to quality ambulance care in Decatur.
Trammell and other EMS Committee members are reluctant to bash the Request for Proposal process, in part because it consumed tremendous city and private resources.
Also, the process told the committee that it could elevate standards.
Decatur EMS members are unanimous that they want an ambulance monopoly in place.
A monopoly, they argue, makes it easier for the city to monitor compliance with safety standards.
Also, a monopoly ensures the anointed ambulance service’s financial stability.
As Trammell put it, any one of the six providers — operating as a monopoly — is preferable to a multiple-provider system.
Two weeks ago, the EMS Committee signaled its continued adherence to a monopoly policy when two ambulance services — including the one that ranked first in the evaluation — asked the committee to license them for ambulance services in the city.
The EMS Committee recommended that the City Council turn down both applications. Decatur already has an ambulance provider, they said, and we don’t need or want another one.
On Monday the City Council, long deferential to EMS Committee recommendations, revolted. Even though the EMS Committee started the Request for Proposals process, City Council rejected its attorney’s recommendation to abort the process.
Councilman Ronny Russell led the charge. He said Friday, “My vote was more of a protest vote. We have a city attorney with one opinion, an assistant city attorney with another opinion and Decatur EMS’s attorney with another. I’m sick of it.”
So what comes next?
The odds are that City Council will end the Decatur EMS monopoly sometime next month and grant a license to one or more competitors.
As Russell put it, “I’d have a hard time voting against the ambulance service that ranked highest” in the EMS Committee’s evaluation.
What happens after that is more difficult to gauge.
The default, if the city licenses multiple ambulance services, is that the city would dispatch 911 calls to the ambulance located nearest the point at which an ambulance is needed as determined by the global positioning system.
Another option — although it has received little discussion — would be for the city to award an exclusive contract for 911 calls.
Under this scenario a single ambulance service would have sole responsibility for handling 911 calls, and other ambulance services would compete for non-emergency transports.
EMS Committee members say this option has problems.
“Most ambulance services lose money on their 911 calls,” said EMS Committee Chairman Dr. Larry Sullivan.
“They make it up on transports.”
Nonetheless, Sullivan said, he sees an exclusive contract on 911 calls as a close second to a one-provider system in terms of providing quality service to Decatur residents.
Unlike transports, 911 calls often involve patients without insurance.
Competitors who think
they have discovered a gold mine in Decatur, Trammell said, may find themselves belly-up after a diet of emergency calls.
If Decatur residents woke up one morning to a bankrupt ambulance service, a memorandum of understanding between Decatur and Huntsville Emergency Medical Services Inc. would go into effect.
HEMSI would handle all 911 calls until the city arrived at a permanent solution.
Russell said he increasingly sees merit in an exclusive 911 contract with a single ambulance provider, but he wants to make sure the provider could remain solvent under such a system.
Either way, it appears the Request for Proposal process will die a natural death.
Legal issues abound and, as Russell put it, “we’d like to figure this out without going to court.”
The members of the Decatur Emergency Medical Services Committee:
Dr. Larry Sullivan, chairman.
Dr. Dale Trammell.
Decatur Fire Chief Charles Johnson.
Decatur Police Chief Kenneth Collier.
Dr. Bernice Swain.
Morgan County Emergency Management
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