DeKalb County could soon take a big step in privatizing a long-held government service, hoping to save lives as well as tax dollars.
County commissioners are expected to approve a contract --- three years in the making and riddled with controversy --- for American Medical Response to provide countywide ambulance service.
Once done, that should free advanced-life support (ALS) paramedics now stationed on county-run ambulances to ride on fire engines at 24 of DeKalb's 26 fire stations.
That doubles the number of stations with the higher level of service --- at a price expected to save taxpayers hundreds of thousands of dollars in personnel and maintenance costs.
AMR, meanwhile, will provide mostly basic life support transport with some ambulances outfitted for advanced care. Patients, not taxpayers, are expected to pay $8.5 million yearly in transport, mileage and other fees for those services.
"We are ready to go, because it will be a pretty significant amount of money saved and it will make us the premier first-response for advanced care countywide," said Fire Chief Edward O'Brien.
Commissioners first said they wanted to move to the private service model that has worked well in Cobb and Fulton counties in 2010. CEO Burrell Ellis responded by awarding an "emergency" yearlong contract to Rural/Metro Corp., to allow for time to research and solicit bids.
DeKalb has since extended that contract on a month-to-month basis, running 12 of its own ambulance service with 14 Rural/Metro ambulances. No taxpayer money funded the private ambulances, since the firm charged patients $750-$825 per trip.
Technical problems and rumors of cronyism, though, delayed the effort to outsource the service.
The first red flag appeared shortly after Ellis gave Rural/Metro the no-bid deal, when it was revealed his former campaign manager, Kevin Ross, represented the company.
At the time, Ellis said the choice was a coincidence. But Rural/Metro was one of six firms identified by name in search warrants served in January at the homes and offices of Ellis and Ross, looking for possible corruption. That investigation remains under a court seal.
That sped up the review process that put AMR as the top selection among four bidders, including Rural/Metro.
Rural/Metro responded by filing a complaint with a state regional EMS Council, asking it to take over the selection because DeKalb's request was unreasonable. Among its complaints were the county's requirement for the winning firm to pay $620,000 a year to reimburse taxpayers for dispatching service and to spend about $1.4 million for new heart monitors on county firetrucks.
Rural/Metro withdrew that complaint just before this month's council meeting. Members of the council, run by the state Department of Public Health, voted only to monitor DeKalb's privatization effort.
That cleared the way for the commission to review the recommended contract and better understand projected savings.
Already, the fire department has shed 200 positions --- down to about 620 full-time firefighters --- as part of outsourcing, O'Brien said.
The department expects to save about $80,000 every month on diesel fuel costs alone when it no longer runs the ambulances. Still uncertain is how much the county --- and taxpayers --- will save from no longer having to buy and maintain ambulances or how much it will be able to cut spending on medical and equipment supplies that the vendor will provide. Early estimates call for saving at least $30,000 monthly in those expenses.
"We can't see our way clear yet to how this is going to be because it's been such a confusing process," said Commissioner Elaine Boyer, who pushed for the privatization effort. "But I think once we get through this confusion, we'll see it as a very positive result for everyone."
AMR has told the county it can have 18 ambulances running within 30 days of contract approval. It will eventually run 26-28 ambulances to meet the requirement of responding to 90 percent of calls within nine minutes. Commissioners expect to vote on the contract later this summer.