ATLANTA -- Ambulances could be slower to respond to emergencies --- from minor accidents to life-threatening strokes and heart attacks --- across Atlanta and much of south Fulton County next week. The county's public subsidy for the service ends next Monday. Fulton officials say they expect response time to increase by only four minutes, but critics say it could be much more.
Despite months of warnings from physicians and hospital administrators that the cutbacks could endanger lives or cause permanent harm to some patients, little appears to be happening in much of the county to fill the gap.
"I don't know why there's no sense of urgency," said Pamela Stephenson, chief executive officer of Grady Health System, which provides emergency ambulance service in central Fulton --- basically the city of Atlanta. "We haven't gotten any indication that anyone's coming through."
Officials said that they haven't given up on finding some additional sources of income.
The Fulton County Commission voted in November to eliminate a $10 million supplement for emergency ambulance service. Towns in north Fulton are making up the shortfall for their areas, but in most of the rest of the county, emergency ambulance providers will be dependent on collections from patients, their insurance plans or Medicare and Medicaid.
Even with a $6.8 million share of the county supplement, last year, Grady came up short. Transportation of uninsured patients accounted for the lion's share of a shortfall of about $8.7 million. Collection averaged less than $11 per patient for the uninsured.
Rural/Metro Ambulance Service, which provides emergency response for the county area not served by Grady, will lose about $3 million in supplemental funds.
Fulton Emergency Services director Alfred "Rocky" Moore, whose controversial recommendation was the basis for the county commission's decision, said the change will let municipalities take responsibility for ambulance service while also saving the county money.
The six towns in north Fulton are signing their own contracts with Rural/Metro. The ambulance service is also near a final contract with College Park in South Fulton, said Nita Ham, market general manager for Rural/Metro. Negotiations continue with East Point, Union City, Fairburn, Palmetto and Chattahoochee Hill Country, she said.
In Atlanta, efforts to make up the difference seem stalled.
The city is facing a projected budget shortfall of $140 million, and seems unlikely to supplement ambulance costs for its residents. Mayor Shirley Franklin's budget included no money for ambulances. The City Council could amend the budget to provide a supplement, said Franklin spokeswoman Beverly Isom. But the council is already considering buyouts and budget cuts to avoid a tax increase.
Although paramedics with the various fire departments often treat patients at the scene of an emergency, they can't transport people.
Any slowdown in ambulance service will affect care, said Dr. Joe Wilson, a cardiologist who practices at St. Joseph's Hospital.
Physicians "can't undo what's been done" in medical damage caused by slow ambulance response, he said.
When someone collapses from sudden cardiac arrest, "even a difference of two or three minutes in response time can make a difference in resuscitation," said Dr. Arthur Kellermann, professor of emergency medicine at Emory University School of Medicine. "Every moment of delay reduces someone's chances of coming back."
A few minutes also can make a critical difference in asthma attacks, childbirth and severe bleeding, he said.
Earlier this year Georgia's Region III EMS Council, an advisory body for the state department of Human Resources in metro Atlanta, asked for a ruling from the state attorney general on whether Fulton County is legally obligated to pay for emergency ambulance service for the county's indigent patients.
Russ Willard, a spokesman for Georgia Attorney General Thurbert Baker, said Baker has been "in conversation" with the Department of Human Resources, but those talks, he said, are private because of attorney-client privilege.
Residents of south Fulton will continue to receive emergency ambulance service with response times equal to most jurisdictions in the state, said Kristofer Schleicher, a lawyer for Rural/Metro.
Grady will continue providing service "to the best of our ability," said Craig Tindall, Grady's interim chief operating officer, but he predicted "our service level will continue to degrade" as calls pile up.
As the situation worsens, workers are finding jobs elsewhere, worried that theirs at Grady will disappear. "The further this drags out, the more individuals we will continue to lose," Tindall said.
Grady's ambulance fleet is down from 39 to 35, and its work force is at 212 --- well below the full staff of 255 --- said James Bothwell, Grady's director of EMS and Trauma Services.
The funding squeeze will be felt by the Peachtree Road Race on July 4. Grady will provide some ambulances for the world's largest 10K race and will coordinate communication, but other ambulance services will play a bigger role than in the past.
Day-to-day emergency ambulance service will be harder to solve.
The Region 3 EMS Council has formed a committee to review the performance of Grady and Rural/Metro after July 1, said council president Pete Quinones. He is also president and CEO of Metro Atlanta Ambulance Service, which serves most of Cobb County.
Quinones said emergency ambulance fleets are finding it "close to impossible" to work without a subsidy.
PROVIDING EMERGENCY SERVICE
Grady Emergency Medical Service, which covers Atlanta, transported 66,919 patients in 2007 at an average cost of $322 per patient.