DeKalb County may prove the test case in a move that could shake up Georgia's system for assigning ambulance service.
The state's regional EMS Council that covers metro Atlanta will decide next month whether to consider taking control of the county's ambulance service from the Fire Department and open the county's coverage up to private bidders. The contract could be worth millions.
And while the county argues to keep the service it began 40 years ago, some cities are arguing that control should be even more local, at the municipal level. Officials in Johns Creek and Kennesaw have called for more say on who transports their residents to the hospital and how much they pay for the ride.
As the clarion call for new cities has taken root over the past eight years, so has the call for greater local control of services, particularly those involving life and death. One of the first things north Fulton's new cities did when they incorporated was establish police and fire departments.
But none of them can operate an ambulance service. They can't even hire one.
That's because the Georgia Department of Public Health assigns ambulance service primarily to counties through its 10 regional EMS councils.
Theoretically, a regional EMS council could recommend to the state that a city be awarded a zone. Such arrangements are in place in Hapeville, Morrow and Forest Park, where the fire departments are the zone providers for ambulance service.
Region III EMS includes the eight-county metro area. Its 28-member council is composed primarily of county emergency responders, such as firefighters, appointed by the eight counties. Members also include doctors, several private citizens, three city fire officials and four ambulance company executives.
The last time the Region III EMS Council opened up a metro Atlanta coverage area for competitive bid was Cobb County in 1999. The zone was assigned two ambulance services in 2001.
But that may change soon.
DeKalb Fire is being challenged over terms of a contract it issued last year seeking a private company to help it run the ambulance service. Rural/Metro Ambulance, which currently serves in that role, says the county's new terms are unreasonable and possibly illegal.
Tony Anteau, division general manager for Rural/Metro, says the new contract requires the ambulance company to buy close to $1.5 million in equipment for the Fire Department and pay about another million for dispatch service and monitoring.
Anteau told a special committee of the Region III EMS Council this week the terms are unfair and would allow the county to profit from its state-awarded franchise.
DeKalb County Fire officials said they cannot speak specifically about the contract because it has not been awarded, but they did say they are committed to ensuring that residents receive the best emergency care available.
The full Region III Council is expected to consider the complaint next month.
Meanwhile, two north metro cities are questioning the state's practice of awarding ambulance franchises by county.
"What comes to mind to me is the word 'monopoly,' " Kennesaw City Councilman Bruce Jenkins said. "We don't have a systematic approach to the bidding process. It should be done every year."
Up until last year, Kennesaw had defied a 1998 court order to comply with the Region III EMS plan assigning American Medical Response to cover that area of Cobb County. Instead, the city's 911 system dispatched calls to locally operated Georgia EMS Ambulance. The practice continued when Metro Atlanta Ambulance Service took over the territory in 2001.
Although the city complied with the court order last July, some officials are still sore about it and want service opened up to competition more regularly.
Jenkins said he doubts he can get a majority of the City Council to file a protest with the Region III Council, and he doesn't hear a lot of noise coming from other cities.
"There hasn't been any thunder, and there may not be enough spark here until after the fall election," he said.
That's not true in Johns Creek. The City Council is unanimous in seeking alternatives to its current arrangement with Rural/Metro as Fulton County's sole provider outside of Atlanta. City leaders say they are disturbed they are powerless to hold Rural/Metro accountable for its record in response times.
Johns Creek is part of a coalition of north Fulton cities that have paid the company $132,000 each for the past four years as a means of "buying" response times down to 8 minutes. But while the company has hit the mark regularly in Roswell and Alpharetta, that has not been the case in Milton or Johns Creek.
Rural/Metro has proposed ending the subsidies in exchange for relaxing the response times to 12 minutes. In return, the company would provide additional equipment and ambulances while raising customer rates by 40 percent. Roswell, Alpharetta and Milton have agreed to the proposal.
Johns Creek had been pursuing an arrangement where the city could use some of its own personnel to transport patients as "subcontractors" for the company in certain cases. Rural/Metro would reimburse the city $50 an hour for the service.
But now, Johns Creek city leaders say they want the state to tell them what recourse they have in the matter.
Mayor Mike Bodker said he doesn't think $50 is a fair compensation for the added demand on firefighters, liability issues and the wear and tear on city vehicles.
"We're asking the EMS Council to review our concerns about the service delivery we've been receiving," Bodker said. "We're just asking them to take whatever action is appropriate."
Whether this means opening the area to competitive bid, the mayor did not know.
"It's really out of our hands," he said.