Georgia Fire Chief Wants to Rework EMS Contract

He says the vague nature of the contract hinders his ability to make sure the ambulance service is living up to its agreement


 
 

Summer Moore, The Augusta Chronicle | | Tuesday, July 24, 2012


Richmond County Fire Chief Chris James said the vague nature of the city's contract with its ambulance service hinders his ability to make sure the company is living up to its agreement.

"There are key elements missing in the contract," James said about the city's contract with Gold Cross EMS. "I would like it to be reviewed and revised."

One of those missing elements is the number of ambulances Gold Cross makes available to the county. The $1.3 million contract does not state how many ambulances Gold Cross must keep in service in Augusta at all times.

Its contract with Augusta says the company is responsible for "providing sufficient ambulances ... to perform under this agreement."

Gold Cross clearly defines the number of ambulances it will provide in its contracts with Columbia County - five - and Jefferson County - four - and where the ambulances are stationed.

Rural Metro, the company that provided Augusta ambulance service before Gold Cross took over in 2004, was mandated in its contract to keep seven Advanced Life Support ambulances in service in Richmond County at all times. That contract was for $700,000.

Bo Pounds, the owner of Gold Cross, said it is a "performance contract," meaning as long as the company performs to the standards of the contract, they are compliant. He said he has at least 11 ALS ambulances on duty in Richmond County at all times.

James said because of how the contract is written, he cannot confirm that number.

"How do I verify that?" James said. "I don't know where they are. I don't know if they run out. There needs to be some oversight."

Another sticking point with the contract, James said, is that although it requires Gold Cross to place each call in a priority category of 1, 2 or 3, it does not define what each priority entails, such as a life-threatening situation or non-emergency. James said that would be the only way to determine whether the ambulance service is adequately getting to the scene on a timely basis. The priorities are defined in Columbia County's contract.

In the highest priority call, Priority 1, the contract states the ambulance must arrive on scene in eight minutes if it's within the city, 10 minutes in rural areas. In Priority 2, it has 10 minutes for urban areas, 12 minutes for rural areas; Priority 3 is 20 minutes regardless of area.

The contract has a tardiness penalty - $12 per minute late for Priority 1 calls; $6 for Priority 2; and $3 for Priority 3. But not contractually forcing Gold Cross to define the calls prevents accountability, James said.

Neither James nor City Administrator Fred Russell, who is contractually obligated to dock Gold Cross if necessary, have any recollection of Gold Cross being penalized.

Pounds said his dispatchers decide the priority of the call based on national standards.

"That's something that should be defined in the contract," James said. "I would think every call which the fire department sends out first-responders would be a Priority 1 call."

Gold Cross is required to send a report to James 15 business days after the end of each calendar month documenting every "request for 911 ambulance service," and what priority Gold Cross assigned it. Within that report, Gold Cross can request a response time exemption for tardiness. The request is reviewed by James and the medical program director, Dr. Phillip L. Coule with Medical College of Georgia Hospital, to determine whether the exemption will be granted.

Russell, who told an Augusta Chronicle reporter that the contract needs to be looked at again, said he could not remember ever seeing a report. The contract also states Gold Cross must send the city administrator quarterly financial reports. Russell said he did not know he was supposed to be receiving them.

Before James became chief in January, the EMS coordinator received the reports, Pounds said. Until he left to join Gold Cross in March, that person was Matt Paynter, who said in an e-mail that he did receive the reports monthly, and forwarded them to former fire Chief Howard Willis, and then to James when he became chief.

James said he had seen one from Paynter from Decem-ber when he was interim chief but didn't receive reports after that until he requested them from Gold Cross officials. He received reports for February through April in May. He said he has been unable to find any other previous reports.

A June incident highlights the concerns James said he has with Gold Cross' accountability.

On June 11, James received an e-mail from a firefighter to his battalion chief saying the fire department's ambulance, Rescue 1, had been called off a 911 call by Gold Cross for a 75-year-old woman having chest pains. Rescue 1 continued to the home anyway - a policy James instituted after firefighters complained Gold Cross had called them off, but who then discovered the Gold Cross ambulance had not arrived.

The firefighters started to treat the woman. Four minutes later, a Gold Cross ambulance arrived.

James tried to get more information from Gold Cross about the call, including the dispatch time, the priority given to the call and where the ambulance was responding from, but he has yet to get a response.

When reached about the incident, Pounds said the issue had been resolved.

"We dealt with that issue internally," Pounds said. "That dispatcher was disciplined."

He did not say how.

"We still responded to that call in eight minutes," Pounds said.

According to Augusta's 911 dispatch center, the call came into 911 at 7:22 p.m. Gold Cross didn't dispatch an ambulance until six minutes later at 7:28 p.m., according to the ambulance service's records.

Dominick Nutter, the director of Augusta's dispatch center, said typically it takes no longer than a minute for 911 to transfer a call to Gold Cross.

Paynter said the six-minute delay could have been caused by a few things, including an ambulance being dispatched, then a closer one becoming available, making it look like it was dispatched later.

BEFORE GOLD CROSS took over the county's ambulance service, emergency calls were dispatched by Augusta's 911 center, which dispatches Richmond County sheriff's deputies and the fire department. James said he would like to return to that, given that 911 sends out first-responders to calls. Currently, Gold Cross has its own dispatch center, which also dispatches calls to Columbia and Jefferson counties.

Pounds disagrees with James about letting 911 dispatch his ambulances.

"I'm much better at it," Pounds said. "We need to have control. They have enough trouble controlling what they're doing."

James said he is not trying to end Gold Cross' agreement with Augusta, or have the fire department take over the service. However, he said the contract has to be amended for him to do his job as the contract administrator.

"If someone dies or something happens because of the missing elements in this contract, that will come back on me," he said.



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