The Pflugerville City Council has authorized contract negotiations with Acadian Ambulance Services to provide emergency medical services for the city and its extraterritorial jurisdiction.
The motion to negotiate a temporary contract comes two weeks after city officials voted on a first reading to establish a franchise requirement to provide emergency medical services within city limits. The motion passed on a 5-1 vote, with Council Member Ceasar Ruiz voting against.
The contract would begin Jan. 1 and includes a base term of two years with an option to renew up to three subsequent years. If approved, the city would terminate its EMS services with the Fire Department.
When researching Acadian, Ruiz said he found criticism of its billing program.
“I talked to firefighters and paramedics all over Texas who have had dealings with the organization and I have not found one entity that has said anything good about you,” Ruiz said. “My biggest deal isn’t the average citizen — it’s the people who are economically disadvantaged.”
Troy Mayer, Acadian’s regional vice president, said there are different ways that companies handle their billing processes.
“Some people do get turned over to collections who are resistant, some people qualify for the compassionate care program, some individuals are financially able to pay for those services but choose not to have insurance and will go through the extreme of not paying us for those services directly served,” Mayer said. “And so yes, naturally some people will end up in collections, but if they make the effort to reach out to our billing department, we will work with them to make certain it is not something that is forced down their throats.”
Acadian was founded in Louisiana in 1971 and operates primarily in Louisiana and Texas, including Bastrop, Live Oak and Bexar counties, according to its website.
The negotiations with Acadian come after city officials sought options after the tax-supported emergency services district for the area announced a funding shortfall that would prompt the cancellation of ambulance services without a subsidy from the city.
Unlike the city of Austin, where the Fire Department is funded from city coffers, Pflugerville’s fire service comes from a separate taxing entity. ESD No. 2 funds the Pflugerville Fire Department, which currently is struggling to also provide emergency medical response.
The City Council, by voting to contract out those services, could thwart an attempt to get voters to fund an overlay district, another independent taxing entity, to offer emergency medical services.
In an assessment this year by a third party consultant, Acadian said it could outperform the ESD for less cost.
Acadian’s proposal stated that it can meet the requested eight-minute response time, does not require a subsidy and will provide four dedicated ambulance units to Pflugerville.
“They were distinguished by their compassionate billing protocols and policies, availability and the depth of resources in Central Texas,” said Trey Fletcher, the city’s deputy city manager.
Mayer said the company is 80% employee owned.
“It is contingent upon employees that they provide exceptional service,” Mayer said in a presentation to the council. “Our team goes through a vigorous amount of training.”
Mayer said at least one of the four ambulances dedicated to Pflugerville would be equipped and staffed at the critical care transport level.
Depending on the type of vehicle and level of care provided, Acadian would charge patients $868 to $2,763 per trip, according to city documents. Acadian also charges $26.49 per mile, and rates for its emergency medical technicians would be $35.85 to $83 an hour.
Mayor Pro Tem Omar Peña said he was concerned about billing and response problems that have been reported about Acadian’s services in Bastrop County.
The Bastrop Advertiser, which like the Pflag is part of the USA Today Network, first reported in February 2020 that Acadian had reported the highest number of response-time violations since Bastrop County began monitoring the company eight months earlier. The worst response time occurred on Jan. 8, 2020, when an ambulance responding to a call in the city of Bastrop took 47 minutes to arrive. As per the contract, Acadian is required to ensure its ambulances are arriving to life-threatening emergencies, or Priority 1 calls, within 10 minutes in Bastrop.
“We are still the 911 provider for the county, as they renewed in May of this year,” Mayer said. “I was the one that signed the Bastrop County contract, and that news article was misleading because we have improved drastically since then.”
During public comment, residents spoke against the city commissioning a private ambulance service.
“My concern is that the decision may be financially motivated instead of care motivated,” Jim McDonald said. “I ask you to find another alternative besides privatizing our medical emergency services and advanced life support.”
Said Chris Wolff, a firefighter for the Pflugerville Fire Department: “I absolutely believe the for-profit EMS people care just as much as I do, but the difference is none of the administrators of these companies are going to stand up here and tell you they can provide the same EMS service that the citizens are getting from the Pflugerville Fire Department. … At the end of the day, that’s what it comes down to.”
Ronald Cunningham, who lives outside Pflugerville’s city limits but within its extraterritorial jurisdiction, said he was not pleased that the council took away the opportunity to vote for the creation of ESD No. 17, the overlay district that would have created a new taxing entity for emergency medical services.
“You made a choice for me that wasn’t in alignment with what I would have chosen for myself and my family,” Cunningham said. “I’m concerned about the predatory billing practices of for-profit ambulance services. There is a dollar sign for every call, and that dollar sign shouldn’t be at the risk of my family, the level of care or the people of this city.”
ESD No. 2 response
The Board of Commissioners for ESD No. 2 sent a letter to the council on Oct. 11 expressing its concerns.
“For-profit EMS will identify the minimum level of service needed to be profitable and will accept significant lapses in response times,” the letter said. “ESD No. 2 has concerns about the potential reduction in the level of care provided to the citizens of Pflugerville if a contract is awarded to one of the private for-profit ambulance services.”
In Bastrop and Milam counties, the letter states, “ambulance response times were 47 to 55 minutes in some cases.”
After the Pflugerville council voted to negotiate a final contract with Acadian and approved the franchise ordinance on second reading, ESD No. 2 Board President Mike Bessner said he was unhappy with the council members.
“The council took some very disheartening steps to fundamentally change how Pflugerville residents will receive emergency services should they need them,” Bessner said. “The council has to understand that response times will suffer based on information and history from other areas.”
Bessner said the decision will cause problems for ESD No. 2 as the first response to an emergency could potentially hurt a future response.
“I have sent four correspondence to the council with information and questions about needing to meet, and I have received no response to those letters to date,” Bessner said. “It is clear that a play for power has clouded the truth of what will best serve Pflugerville residents.”
Long battle between city, ESD No. 2
ESD No. 2 provided both fire and EMS services but created a separate district to handle ambulance calls, citing a lack of funding. ESD No. 17 was formed in May to provide ambulance services and overlays the portions of ESD No. 2 that are in the Austin, Manor and Taylor extraterritorial jurisdictions.
But the city of Pflugerville voted in February to not take part in the creation of ESD No. 17 , saying it wanted to explore other options.
The Pflugerville Fire Department reported in 2020 it would run out of its financial reserves by fiscal year 2023-24. Over the past year, officials said, the department has seen its call volume nearly double, and said it cannot maintain the increased need in EMS calls due to funding shortfalls.
“Projections show that ESD No. 2 will not have enough resources to continue providing enhanced emergency services, including advanced life support and ambulance transport at its current levels,” the Fire Department said in a news release Sept. 29, 2020.
That month, the Pflugerville Professional Firefighters Association launched a petition for the creation of ESD No. 17, which received nearly 5,000 signatures. Voters approved the new district in May.
In August, ESD No. 17 called for an election Nov. 2 to annex the city and its extraterritorial jurisdiction. In response, the city filed suit against ESD No. 17, saying it was disrupting its authority. If voters approved the proposition, $.045 cents per $100 of valuation on property taxes would go towards the new district.
“This is an unfortunate attempt to circumvent the Pflugerville City Council’s authority as elected officials to represent Pflugerville residents and provide EMS services,” city officials said in a news release at the time.
On Aug. 12, Travis County District Court Judge Jan Soifer denied the city’s request for a temporary restraining order.
In September, Travis County District Judge Jessica Mangrum dismissed the city’s case against ESD No. 17, with the court not ruling on the temporary injunction requested by the city.
Two ballot items will appear on Travis County’s Nov. 2 election ballot, with one for Pflugerville residents to vote on whether to expand ESD 17 into the city, and another for ETJ voters to decide on a potential expansion into Pflugerville’s ETJ.
“If voters approve the propositions then they will become a part of ESD No. 17,” Bessner said. “If this occurs, the city’s contract with Acadian would not be needed.”
Early voting for the Nov. 2 election began on Monday.