By Kendal Groner
On Thursday, Feb. 15, Town of Erwin, Town of Unicoi and Unicoi County officials gathered in a work session to discuss plans to create a countywide ambulance service due to dissatisfaction with the county’s ambulance service provided by MedicOne.
The Town of Erwin has been receiving ambulance services through an agreement with Unicoi County, who holds the contract with MedicOne. Inadequate staffing, long wait times and simply not enough ambulances have become a common occurrence since the county contracted with MedicOne for their services, according to local officials.
The county’s four-year contract with MedicOne took effect in April of 2015, and includes a $132,000 subsidy. In an attempt to address some of the issues with the service, MedicOne hired Jimmy Erwin, MedicOne’s Operations Manager in February of 2017.
“There’s really not been that much of an issue everyday, but when multiple calls come in, such as two emergency calls, there’s a small wait time,” Erwin said. “There are occasions that arise, and there will be two or three emergency calls within five minutes.”
Erwin said that while there is nothing in the contract specifically about wait times, they are required to have two ambulances running 24 hours a day, and an additional ambulance for times of peak call volume.
“The wording in the contract was weak,” Erwin added.
The biggest issue impacting the quality of the services is the lack of personnel, according to Erwin. However, he did say MedicOne has managed to attract one full-time and one part-time employee with a $5,000 sign on bonus, which he says has tremendously helped the staffing after those individuals went through training the first week of February.
Still, county and city leaders feel the service isn’t meeting the needs of the area, and with the help of $440,000 from Community Development Block Grant funds to purchase ambulances, the Town of Erwin is spearheading the task of creating its own service.
During the meeting last week, one option was discussed at length, which would create an interlocal agreement among the Town of Erwin, Unicoi County, and the Town of Unicoi to create the ambulance service.
Under that option, the projected costs for the creation of the ambulance services would be $1,233,802.56, with projected revenues of $885,120. With the projected budget gap of $348,682.56, the Town of Erwin would contribute an additional $115,000 in matching funds, bringing that deficit to $463,683.
After the anticipated $250,000 for the sale of Unicoi County Memorial Hospital to Mountain States Health Alliance in 2013, the remaining $213,683 would be split among all three municipalities based on population.
Based on this plan Unicoi County would be responsible for $138,253, the Town of Erwin would be responsible for $47,651, and the Town of Unicoi would be responsible for $27,779.
“I think this would be a great deal for the county … but I think this is a county problem to be honest with you,” said Unicoi County Commissioner Gene Wilson. “We do need to work together on this.”
The second option, would not include the additional $115,000 matching funds from the Town of Erwin, and after subtracting the $250,000 for the sale of the hospital from the $348,683 budget gap, there would be $98,683 remaining.
Of that, Unicoi County would pay $63,848, the Town of Erwin would pay $22,006, and the Town of Unicoi would pay $12,829.
Town of Erwin Mayor Doris Hensley said she believed that after the first year, the service would be self-supporting. The employees would work 12-hour, as opposed to 24-hour shifts, eradicating the need for additional costs for overnight housing.
She also said she didn’t foresee an issue with attracting employees and mentioned they would be offering competitive pay for the industry. Currently, 17 cents from every dollar a MedicOne employee makes goes to pay for MedicOne’s insurance, according to Hensley.
“They’re only making a little bit over minimum wage, and they’re going to go where the money is,” Hensley said.
The proposed salary for the director of the service would be $50,000, and the seven paramedics would average $18 an hour. Full time AEMTS (advanced emergency medical technician) would average $16 an hour, and part time AEMTS would average $13 an hour.
Town of Erwin Aldermen Mark Lafever mentioned that the shortage of paramedics and emergency medical technicians was not a salary issue, but a reflection of an industry shortage of trained personnel. He also expressed concerns that the projected $885,120 in revenue, could take longer than expected to come in.
“All three governments have done well the past two years to come up with a good fund balance,” Lafever said. “We finally have our head above water, and we’re about to put ourselves in a situation where we are going to have to pull big dollars out of that to cover these expenses, or raise taxes.”
If the new ambulance service were to be created, the Community Development Block Grant would provide funding for two advanced life support ambulances, and two basic life support (BLS) ambulances would be purchased outside of the grant, unless a scope change request was submitted.
Two ALS ambulances would run 24 hours a day, with the third BLS ambulance being run during times of peak call volume. The fourth would serve as a backup.
Unicoi County Commissioner Loren Thomas raised concerns that running the ambulances 24 hours a day, all year could lead to mechanical issues, like MedicOne has been having.
“Three days this week we have had three ambulances running because of the call volume,” Jimmy Erwin said. “We had an issue with one ambulance recently, and it’s in the shop now because it had a fuel line break.”
Town of Erwin City Recorder Glenn Rosneoff said that according to the grant, the ambulances must remain the responsibility and property of the Town of Erwin, but they can be used countywide.
“We need to remember that we have a half a million dollar grant,” Hensley said. “You don’t get that everyday.”
Unicoi County Mayor Greg Lynch said that if you look at a zone breakdown, 70 percent of ambulance calls are for the Town of Erwin, 15 percent are in Unicoi County, and the rest originate from the Town of Unicoi.
“But that includes all of the nursing homes, the hospital calls, and I think the bottom line is, when you roll to a nursing home, you are going to get paid,” Lynch said.
Hensley said that according to her figures, 75 percent of all calls are paid, and each of those paid calls brings in $320. She also mentioned lost revenue from the over 100 ambulance calls Washington County has picked up since July 1 of last year because Unicoi County did not have enough ambulances available.
Thomas questioned whether there was anyway to fix the issue with MedicOne, and Lynch said that essentially the county’s hands were tied because of the way the contract was written.
“We’ve tried, and we’ve had meeting after meeting and nothing changed,” said Unicoi County Commissioner Jason Harris. “It changes for awhile, and then it goes back to the same thing. I think the only thing we can do is move forward and move on. It’ll cost the Town of Erwin, the county and the Town of Unicoi a little money, but you can’t put money on a life.”
Unicoi County Commissioner Kenneth Garland voiced his support for option one to create the new ambulance service, but only if the county paid the $213,683 remaining balance.
“Let the county be responsible … I mean we dropped the ball on this,” said Thomas. “Would we be better off to put it out to bid and let other ambulance services bid on it? If it costs us more then so be it.”
Unicoi Volunteer Fire Department Chief Robert Adams mentioned that anytime he has seen the county contract out for ambulance services it has been inefficient. He also stated that while some officials might be concerned about potential tax increases down the road, emergency services are imperative to have.
“Right now is the time for this county to come together and start an ambulance service, and we need to get quality people to do the job,” Adams said. “We’ve had countless days where we’ve had one ambulance in this county. It’s time to step up and do something to protect the people of this county … they deserve more.”
The Unicoi County Commission will discuss the ambulance issue during their next meeting on Monday, Feb. 26, at 6 p.m. at the Unicoi County Courthouse.