For-profit EMS no longer subject to oversight in Athens and Oconee

A committee designed to provide oversight for the Athens-area ambulance service is no longer carrying out its responsibilities with members of the committee left wondering whether it still exists. This leaves National EMS, a for-profit company owned by a private equity fund, without public oversight in Clarke and Oconee Counties.

Background

The Athens / Oconee Emergency Medical Services (EMS) Oversight Committee was officially created in 2013 as a collaboration between EMS stakeholders in the Athens area, including Athens Regional Hospital (now Piedmont-Athens Regional), St. Mary’s Hospital and the Athens-Clarke and Oconee County governments. Each hospital maintained their own ambulance service in-house before 2009, but as a cost-saving measure, the hospitals hired National EMS to take over both services that year. 

This change increased the need for oversight to ensure that stakeholders would continue to get quality EMS, which is why the oversight committee was later created.

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Each county government agreed to pay $100,000 per year to the hospitals to help subsidize the cost of the EMS service. This agreement was formalized in a memorandum of understanding which describes the oversight committee and the respective obligations of all parties involved.

From 2013 to 2019, the oversight committee met quarterly, ostensibly to review National’s performance and report back to EMS stakeholders. At least, this is the way the committee functioned for the first few years. More recently, Dee Burkett, Executive Director of Patient Services at Piedmont-Athens Regional and chair of the oversight committee, admitted to ACC Commissioners during a work session in July 2019 that the oversight committee had not evaluated late ambulance responses comprehensively in four years.

In 2018, National EMS was bought by Priority Ambulance, a company which is in turn owned by Enhanced Healthcare Partners, a private equity fund.

Accusations of poor response times denied

Commissioner Patrick Davenport
Commissioner Patrick Davenport

Despite accusations of poor response times and other complaints from the public, including one from Commissioner Patrick Davenport, the oversight committee has maintained a positive view of National EMS. The oversight committee even released a statement of confidence in 2018 after receiving criticism from public safety advocates, saying that “National EMS provides a high level of service that is comparable to the publicly-owned EMS services in neighboring counties.”

An inactive and unresponsive committee

Brittany Horne, Vice President of Strategy and Ambulatory Services at St. Mary’s and a member of the oversight committee, said in the statement that “our committee is dedicated to ensuring our community has safe, cost-effective, high-quality EMS.” 

While Horne’s statement may have been true in 2018, it does not accurately describe the state of the committee today. APN can find no evidence that the oversight committee has met since October 2019, and some committee members are currently unaware of what’s happening with their committee. One even questioned if it still exists. 

Commissioner Jesse Houle
Commissioner Jesse Houle

ACC Fire Chief Jeff Scarbrough, a member of the committee, referred to it in the past tense and told APN that he did not know the reason why it had been so inactive recently. Commissioner Jesse Houle, another member, told APN that “I’ve reached out to various folks at Piedmont, including Dee Burkett. I’ve gotten nowhere. I’ve not even been able to get a meaningful conversation.”

Davenport, another member of the committee, told APN that he had also not received a response from the hospitals despite reaching out several times. 

Davenport even questioned whether the committee still existed. “That’s one of the questions we asked the attorney [ACC Attorney Judd Drake], does it [the committee] still exist? Apparently, it does,” he said, implying that the committee still exists in a legal sense, if in no other way.

Why the oversight committee stopped meeting

The EMS oversight committee stopped meeting shortly after Drake informed them in a six-page legal opinion, at Commissioner Tim Denson’s request, that their meetings were subject to the Georgia Open Meetings and Open Records Acts. These laws require government meetings to be open to the public and that minutes and other records be made available upon request.

Instead of allowing public meetings, the EMS oversight committee cancelled their final meeting of 2019. One scheduled in January and another in April 2020 were also cancelled. Burkett told APN in November 2020 that they had “deferred our meetings for the past several months.” Thus, it appears likely that the committee did not meet at all in 2020 or 2021, although the hospitals dispute this.

Commissioner Tim Denson
Commissioner Tim Denson

“It’s imperative that we have oversight,” Denson told APN. “One of their driving motivators, if not their primary motivator, is to make a profit. That can oftentimes not be consistent with providing a high-quality public service.”

After the Great Recession of 2008, private equity funds expanded rapidly into the healthcare field, including emergency healthcare services. This has often coincided with a decline in service quality and employee wages as the new owners attempt to extract profit. An investigation by the New York Times in 2016 found that “under private equity ownership, some ambulance response times worsened, heart monitors failed and companies slid into bankruptcy.”

Commissioners may redirect EMS funding

As long as the committee still exists on paper, both Athens-Clarke and Oconee Counties are obligated by the memorandum of understanding to continue paying $100,000 a year of taxpayer money to subsidize EMS service, even though the public has no assurance that the money is being well-spent. However, either county can pull out of the agreement, which otherwise renews yearly, by giving 180 days notice.

If the hospitals are found to be in violation of the agreement, then they would have only 60 days to get back in compliance or the agreement could be terminated.

“I believe that the hospital authorities are violating our agreement by not having oversight committee meetings at least quarterly,” said Denson. “We should call upon them to fulfill their obligations.”

If oversight is not restored, commissioners may soon reevaluate whether they wish to continue subsidizing National EMS or if instead they’d rather use the money in another way. For example, they could choose to divert the funding to the fire department, which is already an important part of EMS in Athens. In fact, the fire department currently answers over 7,000 medical 911 calls a year.

“I don’t understand how we are expected to give any amount of money in the future, if we don’t even have basic correspondence,” said Houle. “The lack of transparency is totally unacceptable.”

Moving away from for-profit EMS may be difficult

Public safety advocates have been pushing for a public EMS system in Athens for years, but it’s important to realize that the only leverage local governments have in this situation are the subsidies they provide. The ultimate responsibility for EMS does not fall on local government, but instead on the Georgia Department of Public Health through a regional EMS council (Athens falls in region 10).

If the Region 10 EMS Council decided that National EMS was no longer providing a quality service, they would put out a request for proposals for another provider. At that point, any qualified agency, whether they were a public or private entity, could respond and put themselves up for consideration. The local government would have no advantage in this process over a private company. 

More importantly, the ACC government is not currently qualified to provide emergency medical services, so they could not even apply.

Even so, it may be worthwhile to reach out to Chris Threlkeld, Regional Program Director for the Northeast Georgia Health District, if you have questions or concerns about EMS in Athens. You can reach him at (706) 583-2862 or use this form to contact the Northeast Georgia Health District.

The hospitals respond

Piedmont Athens Regional and St. Mary’s Hospitals have released a joint statement regarding the oversight committee which you can read here:

“Like many areas of life around the country and out of an abundance of caution, the EMS Oversight Committee has functioned virtually since early 2020 as a result of the COVID-19 pandemic. Nonetheless, the functions of the committee continue unabated. National EMS continues to share detailed information about call volumes, locations, response times, outliers and complaints for our review. Experts in emergency care from our two health systems, along with representatives from the two county governments, continue to look at each report in granular detail. Our review involves individual 911 calls with patient-specific information that we must protect under state and federal privacy laws, including HIPAA. Our experience is that National EMS is transparent and actively engaged in continually improving the training of their staff, upgrading their equipment, and refining their processes to provide the highest quality emergency medical services possible for our communities.”

This statement is either a lie, a likely violation of Georgia Open Meetings and Open Records Acts or both.

UPDATE (12/9/21): The ACC and Oconee County governments have confirmed that there have been no meeting announcements posted for the EMS oversight committee anytime during the last two years. Holly Stephenson, Oconee County Clerk, told APN that “The Athens and Oconee EMS oversight committee has not existed during the past two years.”

Further reading

APN has written a number of times on this topic:

For-Profit EMS: Putting Georgia at Risk? [Video with transcript, July 2019]

National EMS Misled Officials About School 911 Call [Flagpole article, December 2019]

ACC Attorney to EMS Oversight Committee: Open your meetings to the public [May 11, 2020]

National EMS definition of “response time” ignores patient perspective [February 15, 2021]

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