By Kendal Groner
Concerns regarding the county’s ambulance service have been expressed and discussed by both Town of Erwin and Unicoi County officials over the past several months amidst numerous complaints of long wait times, insufficient staffing and too few ambulances.
After the Town of Erwin was unable to garner enough support to create its own ambulance service, the task of addressing the issue fell into the hands of the county, prompting officials to explore the idea of creating a municipally-owned service or accepting a bid from a contracted provider.
However, after the county put out a request for proposals for ambulance service providers to bid on, the only response came from MedicOne, the county’s current service provider that is awarded a $132,000 yearly subsidy and has been accused of incurring several contract violations.
“We put out requests for proposals that were due today, and we sent them out to several companies,” said Unicoi County Mayor Greg Lynch during the June 20 meeting. “The only ones who responded were MedicOne.”
Abingdon Ambulance Service, American Medical Response, Lifeguard Ambulance Service, Shoals Ambulance and Bristol Ambulance EMS were a few of the companies that received the RFPs, prompting several Unicoi County commissioners to ask why only one bid was received.
“This is the same thing that happened last time,” Lynch said. “We had folks that were interested, but when it came down to crunch time, they didn’t bid.”
MedicOne submitted two proposals, with the first proposal requiring a $225,000 yearly subsidy, or a monthly rate of $18,750. In the first proposal, MedicOne agrees to provide two 24-hour advanced life support (ALS) ambulances and one 12-hour basic life support (BLS) ambulance for seven days a week.
In the second proposal, MedicOne is requesting an annual subsidy of $350,000 a year, or a monthly rate of $29,166.67. In the second proposal, they agree to provide two 24-hour ALS ambulances and one 24-hour BLS ambulance seven days a week.
“That’s an extra $125,000 for an additional 12 hours a day,” Lynch pointed out.
Also during the meeting, Unicoi County Commissioner and Ambulance Committee Chairman Jason Harris asked if the county provided MedicOne with a station would the price come down. Jimmy Erwin, MedicOne operations manager in Unicoi County, said the cost could come down if the county provided them with a station. MedicOne currently pays $1,500 a month to lease its current building off of Exit 36.
It is stipulated in the RFP that the service must be stationed one-and-a-half miles from the Harris Hollow exit and Unicoi County Commissioner John Mosley asked if MedicOne was awarded the contract if they would be in the same location
“I don’t see why we wouldn’t be,” Erwin said about staying in the same location.
MedicOne currently has a total of 26 employees including Erwin, with five full-time paramedics, seven full-time advanced EMTs, nine part-time paramedics, and four part-time EMTs.
“They are keeping the shifts covered,” Erwin said. “One of the things that drew some more part-timers in the last little bit was increasing the salaries. MedicOne is competitive at the high end of the area now.”
Currently, full-time paramedics make $14 an hour for 24-hour shifts and advanced EMTs make $12.50 an hour for 24-hour shifts – rates that Erwin said were at or above surrounding counties.
When asked how often a third truck is required, Erwin said it depends on the day and call volume. He said they currently have five trucks in the county, as soon as one is certified by the state inspector.
“A lot of times there’s confusion about how many trucks we have, but we always have two trucks,” Erwin said. “That’s not to say that we can’t get three, four or five calls at a time though.”
Unicoi County Commissioner Loren Thomas inquired about consequences for contract violations in the request for proposal.
“The attorney was concerned if there was a lot of language in there, it would deter bids,” said Unicoi County Commission Chairwoman Marie Rice. “Especially in a rural area, you can’t penalize a provider for response times.”
“I don’t see in this RFP any penalty clauses,” Lynch said. “That’s not to say that if we go through with this, that we couldn’t negotiate.”
Thomas asked about instances where there aren’t enough ambulances available and questioned how much more it could cost to have three ALS ambulances instead of using a BLS as the third truck, which is primarily just utilized for transports.
“If you’re going to have to just pay an extra dollar and a half an hour to have the paramedic … it’s not a huge cost increase to go with the ALS instead of the BLS,” Thomas asked. “Why not have an ALS available as the third truck in case, for instance, the first two trucks are on calls and say a heart attack call comes in.”
Erwin said he was unable to answer what the exact cost difference would be and also stated that the training for the advanced EMTs prepares them to handle most calls, with only a “small portion” requiring paramedics.
When Thomas asked Erwin how many scheduled transports they average per day, he was told that only one or two scheduled transports are made per week, but discharges that require transports can come with only an hour or two notice.
Mosley asked if Erwin had an estimate of how many transports were made to Johnson City or Washington County.
“We do transport out and we’ll even transport sometimes, if we have the extra truck, we’ll transport one from there to Greene County or Carter County if no one else can get it and they’re Unicoi County residents,” Erwin said.
Despite Erwin’s statements about the additional ambulance and increased staffing, Unicoi County Commissioner Gene Wilson was still adamant that the county should steer clear of entering into another agreement with MedicOne.
“My recommendation, the way MedicOne has treated Unicoi County, is the county needs to go on their own,” Wilson said. “As much trouble as we’ve had, it’s time for the county to wake up and do something. I voted for them when they first came here and I regret it.”
Lynch pointed out that the county still had the option of starting its own ambulance service and added that Jim Reeves, CEO of MedicOne, promised him a “smooth transition.”
“We’re just putting out a feeler just to see how much it would cost,” said Lynch.
Mosley said since Erwin became director last year he believes issues with MedicOne have been improving.
“We’ve had our biggest complaints in the last three years,” Wilson said.
Erwin said the majority of the complaints have centered around personnel issues, which he said was a regional issue that MedicOne has been able to overcome by increasing pay.
“The citizens thought that we could withhold money from these people for not performing as they should and the bottom line was, it was either black or white, you either have them or you don’t,” Lynch said. “If we had gotten rid of them we would have been in a mess.”
Lynch said his recommendation was to sit down with MedicOne and establish ramifications for contract violations.
“The biggest thing to me is the taxpayers are paying for a service that they weren’t getting,” Harris said. “So I think they should’ve been fined something for not providing.”
Thomas described MedicOne’s service as “smooth” the first four years, which he attributed to the building and utilities they were provided, along with the $180,000 subsidy as opposed to the current $132,000 subsidy.
“That’s when it started going downhill,” Thomas said. “On top of that, there was a paramedic shortage and in the contract we didn’t have penalties.”
Unicoi County Commissioner Glenn White said he would rather pay $225,000 for a contracted service such as MedicOne, as opposed to the estimated $1.4 million he believes it could cost for the county to start their own service.
“You’re not going to get better service unless you pay more,” White said. “You get what you pay for. To me, since they’re here and if we can get back to what we were doing with them in the first contract, it’s going to save the county a tremendous amount of money.”
Johnny Day, who is running as an Independent candidate for county mayor in the August election, mentioned that yearly operational costs for a county-run ambulance service could be higher than anticipated. Day referenced the approximately $350,000 budget gap that was projected by the Town of Erwin when they were exploring the possibility of creating their own service.
“It’s much easier to work with a contractor and hold their feet to the fire, but it needs to be in the contract,” Day said. “Once you birth that baby and buy all that equipment and set yourself up, the taxpayers are going to eat us alive if we screw this up.”
While Day was concerned about the costs of the county starting its own service, Harris pointed out that the county can still potentially access the $440,000 Community Development Block Grant that was awarded to the Town of Erwin, along with money from the sale of Unicoi County Memorial Hospital to Mountain States Health Alliance, in addition to funds from the Hospital Foundation to start a new service.
“To me, if we were ever going to start our own service … now is the time to do it,” Harris said.
Thomas said his issue with MedicOne over the last four years has been the “weak” contract and said that in moving forward they need to make sure they are able to “hold their feet to the fire” whenever a violation occurs.
“This ambulance issue is the most important thing, period, that we will deal with,” Thomas said. “We need to get it right.”
The committee concluded their meeting with an agreement to meet with MedicOne and discuss the ramifications of contract violations.