The Decatur Daily, Ala.
Despite objections from the city’s ambulance service, Decatur Morgan Hospital will begin this week transporting non-emergency patients between its facilities during the coronavirus pandemic.
The City Council voted 3-0 Monday, with one abstention from Councilman Carlton McMasters, for the emergency exception that allows Decatur Morgan to temporarily handle transfers between any “Huntsville Hospital System owned facility” in Decatur or elsewhere during the pandemic. The Huntsville system includes Decatur Morgan Hospital’s main, Parkway and West campuses as well as other north Alabama facilities. Councilman Hunter Pepper was absent.
David Childers, president and owner of HealthCare Investment Group, which owns the city’s sole ambulance service, said allowing the hospital to transport patients would cut the revenue of First Response.
“Anytime consistent revenue is taken away, it’s going to hurt performance levels in other areas,” Childers said.
The council agreed to review the temporary resolution every 30 days until the pandemic is over.
Assistant City Attorney Chip Alexander said the hospitals and ambulance services are overwhelmed by COVID-19.
A city ambulance ordinance regulates patient transport and ambulance service operations, but hospital system officials didn’t want to wait for the ordinance amendment requirement that it be read twice before it could receive a vote. The ordinance generally prohibits any ambulance from operating in the city without first having been issued a certificate of public necessity and convenience, and states that violation can result in a $500 fine or 180 days in jail.
Alexander advised the council that it could approve the change as a resolution because it would only be temporary.
“Bed space and efficiency are at a premium (because of COVID-19),” Alexander said. “ICU and hospital beds are full. There’s still delays in getting people transferred.”
Decatur Morgan Hospital President Kelli Powers said the change would allow the hospital system to move a patient from a hospital in which all beds are full to one that has an empty bed. Alexander said it’s no different than transferring a patient from one floor to another.
Alexander said this is a way to solve the problem of First Response personnel waiting up to three hours at the hospitals for patients to get a bed.
“We want make sure (Childers) can focus on 911 calls and take the long waits out of the equation,” Powers said.
Alexander pointed out that First Response filed three complaints about the hospital with the Ambulance Regulatory Board about long wait times and then refused to meet with hospital and city officials about the problem.
Childers said he and other First Response officials didn’t have time to meet because of staffing issues caused by the virus, but in an email to the city he said he would only meet with hospital officials because the long waits were between two “private companies,” and the city shouldn’t be involved.
Councilman Billy Jackson said he would like to see a little cooperation from First Response and the hospital “because times are unusual.”
Alexander said the hospital system won’t need a certificate of public necessity and convenience that’s usually required of ambulance services, but it still has to have inter-facility transport and advanced life support licenses from the state.
He said a change to state law in April now allows hospitals to do inter-facility transfers. The change was included in an emergency order by the Alabama Department of Public Health. The hospital system cannot respond to 911 emergency calls or transfer patients to non-hospital facilities like dialysis or rehabilitation.
Alexander said the city looks at hospitals differently than it would a new ambulance service wanting to compete with First Response. Hospitals go through state approval and are established under hospital authorities.
“Until COVID is resolved, our position is this is a matter of life and death,” Alexander said. “If they can move their patients around faster, why not let them do this. This is a special exception that’s an emergency due to COVID.”
EMS Coordinator Ashley England, of Decatur Fire & Rescue, said the hospital system needs the advanced life support (ALS) license in case a patient’s condition worsens during a transfer. He pointed out First Response will still collect revenue for transfers to dialysis, rehabilitation and other facilities that aren’t in the Huntsville system, as well as for emergency calls.
Alexander said he doesn’t expect the change to cause First Response to leave the city as it has threatened to do in the past because the hospital system wouldn’t become a direct competitor.
Alexander said it will actually help First Response with its other non-emergency and emergency calls by ending its long waits at the hospitals.
Jackson said he had heard concerns that First Response would leave the city if the resolution passed.
Childers denied his business is planning to leave Decatur.
“David Childers has never said he is leaving the city,” Childers said. “We’ve fought for 12 years to be successful in Decatur, and we’re not going anywhere.”
Childers said the ALS license is proof that the hospital system would become a competitor with his ambulance service.
Childers said non-emergency transports are where his ambulance service makes its money so it can also handle emergency 911 calls, where reimbursement is often inconsistent and slow due to Medicare and patients who don’t have insurance and are unable to pay.
Childers did not know Tuesday how much allowing the hospital system to handle inter-system transfers will cost First Response.
Powers said her hospital doesn’t make money on the inter-system transports. She said the system usually pays First Response $90,000 a month for patient transfers but this move would reduce that expense to about $40,000 a month.
She said the three facilities in Decatur will have three ambulances. Two are coming from Marshall Medical Center in Marshall County, and HEMSI is loaning the system a third ambulance.
Noel Lovelace, director of development at Decatur Morgan Hospital, said the ambulances were 10-15 years old, “but very well maintained.”
Jackson asked why the council is just getting the request since the state law changed in April. Powers said she took over as hospital president in August and delays were particularly bad the week of Christmas so she started looking for solutions.
City Council President Jacob Ladner said allowing the hospital system to handle inter-facility transfers “will end the bottleneck that we’re seeing from COVID-19.”
Ladner said he’s gotten a number of complaints since he took office about patients’ long waits at dialysis and the ambulance service being stuck at the hospitals.
“All I care about is 911 calls,” Ladner said. “I don’t care about anyone making money.”
Councilman Kyle Pike said he supports the temporary change because “it comes down to public safety and I think it will help with response to 911 calls if you remove the wait at the hospital. They can get to 911 calls instead of waiting one, two or three hours in the hospital parking lot.”
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