FULTON COUNTY, Ga. — Emergency-response services in Fulton County are in a state of crisis, in large part because county officials have abdicated their responsibility to provide ambulance care and an effective 911 system to county residents.
Recent reports about the county’s 911 call center — including one commissioned by the county itself — show the place to be in complete chaos, plagued by high turnover, poor morale and inadequate performance. And the county’s refusal to address the ambulance service issue is forcing cities to cut deals on their own with ambulance companies. In cities unable to finance such deals, there is a very real fear that the level of service could drop to dangerous levels.
The county should quickly convene a summit conference pulling together ambulance providers, hospitals and others connected to the full range of emergency medical services inside the county. It also must restore confidence in the troubled EMS and 911 services and start now building a unified, countywide approach to saving lives.
To do that, however, Fulton County would first have to change the attitude and political culture that have infected its emergency medical services. And that seems unlikely.
A year ago — for the worst of reasons — the commission decided to stop subsidizing ambulance services in the county. That unwise move has extended the time it takes EMS crews to respond to victims of heart attacks, strokes and other deadly and debilitating medical conditions in much of the county, almost certainly leading to unnecessary deaths.
The recommendation to cut off the $10 million in subsidies ostensibly came from Alfred “Rocky” Moore, who at the time was director of Fulton’s Emergency Management Agency. As a political appointee with a law enforcement background, Moore knew little or nothing about emergency medical services.
Without the subsidies, EMS companies have had to absorb the cost of providing emergency care for uninsured or poor patients. That forces them to cut back on services, most often by putting fewer crews in the field. And in emergency medicine, slower response times mean more death and disability.
In recommending that the subsidy be dropped, Moore was merely carrying water for county commissioners who had politics, not public safety, on their minds. Some commission members were angry at residents of north Fulton who had voted to form new cities and lower the amount of taxes they pay directly to county government. The subsidy withdrawal was intended to force those cities to negotiate and pay for their own contracts with EMS providers.
Fortunately for residents of the northern part of the county, the cities did just that. But Atlanta, already facing a budget deficit, did not. Nor have south Fulton’s municipalities, forcing EMS providers there to make up the difference on their own.
In Atlanta, a city that routinely hosts large conventions and attracts millions of tourists each year, the cost of providing ambulance services is being absorbed by Grady Memorial Hospital’s EMS department. To keep response times from deteriorating, Grady has had to raise charges to insured patients, a cost-shifting that raises the price for everyone.
Atlanta’s fire department has also tried to ease the crisis by sending emergency medical technicians to the scene quickly to provide basic life support until Grady’s ambulances get there. But the fire department faces a funding crisis of its own and should not be forced to do a job that is primarily the responsibility of county government.
Fulton County began providing the subsidies 10 years ago, at the same time demanding that its private ambulance contractors meet the eight-minute response time set by the American Heart Association, the American Stroke Association and other health groups. Those high standards allowed Grady to double the survival rate of heart attack patients brought in by ambulance over the last two years. But retreating from those standards — potentially stretching response times to 12 or 15 minutes — didn’t seem to worry Moore or the County Commission then. It still doesn’t.
Moore was also in charge of the county’s 911 call center, which in four years wrote up 1,100 infractions by employees for sleeping on the job or being tardy or absent from work or for other failings that jeopardized public safety. Yet rather than severely disciplining the deadbeats, managers covered for them by doubling up on the shifts of hard-working employees, causing horrendous morale problems and staff turnover that continues today.
The 911 call center became the focus of attention over the summer after a dispatcher — one of those cited regularly for poor performance — sent ambulance crews to a wrong address, contributing to the death of a Johns Creek woman who had called 911 for help.
An outside consulting firm, hired after news reports of the botched 911 call, recommended recently that the 911 center be completely overhauled. It issued a scathing 81-page report on how dysfunctional the call center has become, and Moore has been removed.
As a result of the crisis, the more affluent northern Fulton cities have chosen to largely abandon the county’s troubled 911 call center to start their own. Emergency communications centers are being set up in Johns Creek and Sandy Springs, and by this time next year they will be receiving more than half of the revenue generated in the county from 911 fees added to telephone bills.
With its revenue sliced dramatically, the county needs to ask itself how large its own revamped 911 center will be and who it will serve. There’s also a serious danger of confusion and inefficiency with multiple emergency communications centers operating in the same county.
That and related issues can be addressed only in a summit among representatives of city and county emergency service departments — 911, police, fire and rescue — county commissioners, mayors and city council members, EMS contractors, hospital ER departments, state EMS officials and consumer representatives. Those officials should be locked in a room until a plan emerges that better coordinates these vital services in the state’s largest county.
But of course, that would take leadership, and leadership is almost nonexistent right now in the county. The commission, for example, seems interested only in fixing its own 911 call center and refuses to accept responsibility for its role in jeopardizing ambulance response times.
To ensure the safety of Fulton’s residents and visitors alike, somebody at the county must look at the bigger picture.
Mike King, for the editorial board (mking@ajc.com)
JUST THE FACTS
FULTON’S TROUBLED 911 SERVICE
* High volume of calls: The Fulton County 911 call center fielded nearly 78,000 calls last year and helped send ambulances from the two major EMS providers, Grady Health System and Rural/Metro Ambulance Co., to locations all over the county.
Here’s how calls to providers broke down in 2007 for total calls and average daily calls:
Rural/Metro: 37,564 total, or 102.9 daily calls.
Grady: 39,072 total, or 107 daily calls.
Private services: 684 total, or 1.9 daily calls.
* High turnover of staff: Consultants determined that low morale at the county’s emergency communications center was severely impacted by the constant turnover of workers. On average, most large urban 911 centers have a retention rate of 85 percent. Here’s Fulton’s 911 staffing since the first of this year.
Authorized staffing: 109
Highest staffing this year: 75
Staff who left this year: 20
Retention rate: 73 percent
In the past three years, rehiring for the county 911 center has not kept pace with departures.
2006: 27 separations, 5 hires
2007: 14 separations, 6 hires
2008*: 20 separations, 8 hires
Note: 2008 figures are through Aug. 31
Source: Emergency Services Consulting Inc. report to Fulton County Commission, November 2008
