By Tia Lynn Ivey
“But is it good enough?”
That was the core question hotly debated at the last Morgan County Board of Commissioners (BOC) meeting during a presentation on the county’s ambulance service. National EMS Director Huey Atkins and county officials argued two ambulances are enough to meet Morgan County’s emergency medical needs, citing that National EMS continually meets the “contractually-obligated” response time rate of 9 minutes and 59 seconds at least 90 percent of the time for Priority 1 and Priority 2 calls. Atkins presented a decade worth of response times average tabulated by National EMS alongside response time for surrounding communities. Local citizens pushed back, arguing that response time averages are skewed due the majority of calls coming from nearby Madison and pre-arranged hospital transfers, which receive far quicker response times than calls coming from further out in the county. Critics also noted calculated response time averages do not take into account the calls county ambulances cannot get to at all.
Atkins stressed his company’s dedication to serving the county but cautioned the audience to be “realistic” on just how well emergency medical service can function.
“This has been our mission for over 20 years, the mission of National EMS and its employees is to continue the legacy of providing pre-hospital care and transportation to our patients above and beyond the expectations of our communities, and I feel we have done that,” said Atkins. “With that said there has to be a realistic expectation of what EMS services are and what they are capable of doing.”
Atkins primarily defended Morgan County’s utilization of mutual aid, when out of county ambulances respond to medical emergencies, and National EMS regularly transporting non-emergency patients home or to other hospitals.
But critics were not so much opposed to the use of mutual aid and providing hospital transports in and of itself, but feared only two ambulances are spread too thin to handle non-emergency transports on top of emergency medical needs. For critics, the rate of mutual aid usage and the need to conduct non-emergency transports only bolstered the call for adding another ambulance in Morgan County. Among the critics in the crowd of over 30 people were Ellen Sims, Paula Sellers, and Beth Hallman Herring, all of whom witnessed extraordinary long wait times during severe medical emergencies and were serviced by Greene County ambulances because Morgan County’s ambulances were unable to respond. Ellen Sims’ mother, Donna Martin died last year after succumbing to complications from a wasp sting, and waited over 28 minutes for an out-of-county ambulance to arrive. Paula Sellers’ husband, Scott Sellers, suffered severe seizures in May outside the couple’s home in Buckhead, but neither of Morgan County’s ambulances could respond that day. Beth Hallman Herring, a nurse, sat with seven injured car crash victims on the side of Highway 83 for over 55 minutes before a Greene County ambulance arrived. All three women expressed dismay over how the ambulance service in Morgan County is evaluated and advocated for more transparency, and most importantly, another ambulance–no matter the cost. The addition of a third ambulance would cost the county $500,000 extra per year—a cost that would most likely be passed on to the taxpayers, according to County Manager Adam Mestres.
“Life is not about money. It’s about our loved ones, our health and the health of those we love,” said Sellers. “Health is more important than a small reduction in taxes.”
Atkins defended the two ambulances designated to serve Morgan County, despite acknowledging that the more rural parts of the county do experience longer response times.
“Morgan County is considered a rural county,” said Atkins. Atkins said someone once said to him that an ambulance coming from Madison could never get down to Buckhead or the lake in 8 minutes.
“And you know what, that’s right,” admitted Atkins. “Ambulances are no different than any other vehicle..they are not magic vehicles.”
County Manager Adam Mestres, too, admitted longer wait times happening despite the overall averages meeting the contractual standards.
“These are averages. We know there are longer wait times, people waiting 20 minutes, 30 minutes. No one is hiding it,” said Mestres. “There are other solutions that we can look at, that all have a cost to them, but the contracted time–the contractual obligation is being met.”
Mestres noted that 60 percent of emergency medical calls come from the City of Madison and those calls are usually answered very promptly, which then tempers the overall average response times despite calls from further out in the county potentially taking 15 minutes or more for an ambulance to arrive.
Atkins argued that response times are an archaic measure by which to judge the quality of an ambulance service.
“Depending on who you talk to, response times are going by the wayside,” said Atkins, who argued speediness can lead to increased risk and yield “no demonstrable benefit” to patients. “That was an early measurement people had to determine the accuracy and quality of an ambulance service but now more people are looking at patient outcomes.”
However, audience members were not pleased with this explanation.
“I think we all know the quicker you get service the more likely you are to live,” said David Moore, a Morgan County resident.
“Would any of you be okay with waiting 30 minutes for an ambulance if it were one of your loved ones?” Ellen Sims asked the BOC members. “What if it was your wife? What if it was your granddaughter? I don’t think you would be okay with it.”
Commissioner Ben Riden, Atkins, and Mestres emphasized that Morgan County’s response times are comparable with other surrounding communities, but critics do not believe it’s good enough. Sellers argued that just because it’s “the norm” for rural communities to have long wait times doesn’t mean that’s how it should be.
“Don’t we want to be out in front and be leaders on this?” she asked the BOC. “Don’t we want to be the player on the team that makes the difference?”
According to Sellers, who worked with the director of Morgan County Dispatch Amanda Proctor, in an 18-month period from January 1, 2018 to June 15, 2019, there were 3,729 emergency medical calls. According to Sellers, 714 of those calls were pre-arranged non-emergency transports by National EMS.
“That’s dollars in National’s bucket,” said Sellers. “I do not have a problem with a company making money as long as the citizens of Morgan County have coverage.”
The meetings took a heated turn when a few of public commenters, Michael Martin, Gary Savage, and Ellen Sims, took aim at the financial aspect of National EMS, being a private company subsidized by the county.
“Any time a medical service is privatized we are in dangerous territory,” said Sims, who urged the county to run ambulance service in-house or to form an independent oversight committee. “This is such an important service to our citizens, to our community, and to our taxpayers, and there’s no accountability.”
“If the county is going to get bids to paint stripes on the roads of Morgan County, I think all of you should be looking at getting bids on ambulance service,” said Michael Martin to applause.
Atkins fired back at the criticisms.
“I did not realize we had so many EMS experts living in this county,” said Atkins as the crowd groaned.
Atkins outlined the financial deal National EMS has with Morgan County. Atkins said National EMS in Morgan County operates on a $1 million per year budget. The company brings in $700,000 annually from fees charged to patients, which leaves a $300,000 shortfall. That is why Morgan County currently pays $289,000 plus fuel costs, according to Atkins. National EMS, bought by Priority One last year, has been Morgan County’s ambulance provider since 1988.
A visibly frustrated Atkins took aim at the Morgan County Citizen for printing citizens’ complaints about ambulance service and accused the paper of ignoring National EMS’ achievements.
“Before all these lies and misconceptions get printed in the paper, and I’m sure they will, let’s get our facts straight about what we are talking about,” said Atkins.
“This is something that really irritates me about our local paper,” said Atkins, who was displeased with the front page coverage of the ambulance controversy and inside coverage of National EMS earning a perfect score on an evaluation of the company.
But Atkins was most upset over a quote from Paula Sellers in which she stated “the right person just hasn’t died yet,” to argue that it would take a prominent community person to die before the BOC would spend the money to secure another ambulance.
“That one really struck close to home for me,” said Atkins. Atkins told his own tragic story of his father being shot and killed when he was just 17-years-old and the ambulance took over 30 minutes to arrive.
“It took me a long time to realize that it was a bullet that killed my father and not an ambulance that did or did not show up,” said Atkins. “And as far as the comment of Greene County thankfully came and helped Miss Martin, there are people living in Greene County that are thankful National came over to their county and helped them when their ambulances were busy. It happens in every county, everyday without fail in every community.”
The Morgan County Citizen reported last year how surrounding counties determine the number of ambulance needed to serve their communities in comparison to Morgan County. Morgan is one of the few counties in the region with only two ambulances.
Morgan County’s population is estimated to be 18,412 residents, spread out across 347.35 square miles. Morgan averages around 2,500 emergency ambulance calls per year. After examining ambulance service in Greene, Putnam, Oconee, Oglethorpe, Rockdale, and Hancock counties, Greene County bears the most similarity to Morgan County’s makeup. Greene County runs three 24/7 ambulances plus a private service handles hospital transfers. Greene County’s population is about 1,000 less than Morgan County’s, with 17,281 residents spread across 387.44 square miles. Greene County averages around 2,900 calls for ambulances per year since 2016, a reduction from previous years since Greene County EMS stopped handling non-emergency transfers between hospitals. However, Greene County’s service costs nearly three times as much as Morgan County’s ambulance service.
Atkins presented the BOC with several options to enhance emergency medical service in Morgan County with corresponding costs. The BOC promised to review the package, which included adding a third ambulance operating 24 hours a day, seven days a week, a daytime time ambulance that would operate five to seven days a week, 12 hours per day, or a “Quick Response Vehicle” with a paramedic on it to help cover emergencies when the ambulances are tied up.
“We will be reviewing these options,” said BOC Chairman Ron Milton.
Atkins stressed that National EMS would provide whatever the county is willing to pay for and praised his team for the work they do.
“I do believe that the people we have working in Morgan County are second to none and they do a great job in this community and I appreciate the work that they do,” said Atkins.