Ambulance alert

Stephen Williamson (pictured), president of EMSA, made a presentation before the Oklahoma City Council at its Aug. 16 meeting, and told the body that the city would be better served by sticking with the current ambulance service provider.

EMSA’s response comes about one month after Oklahoma City Fire Chief Keith Bryant made a presentation to the council recommending that the service be turned over to the fire department.

The issue is arising now because the city is approaching a so-called “window of opportunity” in which it can opt out of the EMSA trust, which it entered into in 1990. The eastern division of the trust includes Tulsa, while the western division includes Oklahoma City, as well as several surrounding suburbs.

Alhough the city didn’t initially subsidize EMSA, it eventually had to, resulting in the creation of the TotalCare program — funded by a $3.65 charge on the customer’s monthly utility bill. However, Bryant said that amount will not be able to fully fund the service within the next five years, requiring more customers’ money.

However, even if the city chooses to allow the fire department to take over, it may have a difficult time convincing everyone involved to do the same, which is a prerequisite to dissolving the trust. OKC and Tulsa, which is also considering the matter, each have four trustees on the EMSA governing board, and two other trustees come from both the eastern and western districts, respectively. Dissolving the trust must be first approved by each city’s governing body before being unanimously approved by the trustees.

If the proposal passes those hurdles, it must be approved by the governor before the trust is dissolved. Failure of dissolution and simply opting out means the trust could retain all of the assets serving the area, and could result in litigation.

Bryant and others have states the fire department and EMSA work off different dispatch systems, and the fire department is required to go to all EMSA calls. Eliminating the duplication could save $1 million, both Williamson and Bryant said.

However, at the council meeting, Williamson disputed other savings to the system the fire department said would result from its taking over ambulance services, and said there was a danger that it might end up costing more, increase response times and decrease quality of care.

After the presentation, Williamson was questioned by Ward 2 Councilman Ed Shadid.

One of those questions was how, by going with the fire department, it would not save money if Williamson and EMSA’s four officers’ salaries, totaling more than $750,000, and the 10.5-percent pretax profit margin by Paramedics Plus — a subsidiary of East Texas Medical Center in Tyler, Texas, that provides the physical ambulance service — were no longer part of the equation.

Williamson answered that the profit margin was because of the service’s ability to provide efficient, quality care, while the 10.5-percent profit margin is a cap on the maximum amount the company can make.

Shadid also questioned why EMSA was needed when the fire department was the first to arrive on scene in an overwhelming majority of the cases. He asked if the fire department — with a lower turnover rate — would not be more experienced in taking care of patients, and why EMSA’s computer-assisted dispatch system had not yet come online in Oklahoma City, despite being behind schedule.

Williamson said although the fire department is usually the first to arrive on scene, the fire paramedics do not have the experience of EMSA paramedics, who spend a longer amount of time with the patients, and that EMSA is waiting on the city’s Information Technology department to finish its work on the dispatch system.

Shadid then questioned how many times per week EMSA ran into situations where it did not have any ambulances left to dispatch.

“Would you dispute that it’s eight to 10 times a week?” Shadid asked.

“I wouldn’t not dispute it, but I would also say at the same time, they’re at 92 percent on their response times,” Williamson answered.

 “Let’s talk about that number, because it’s an important number. That’s part of their contract and that’s what’s presented to the public,” Shadid said. “But there are several instances where response times are excluded from that calculation, correct?”

Shadid asked whether there were instances during inclement weather where response times were not factored into the calculation that produced the percentage of times the minimal response time stipulated by the city was met.

 Williamson said there were, but that data from two to three different national weather agencies were used to justify the conditions, and that the decision of whether to not include the numbers came from his office.

 “You can’t hold anybody responsible for a response-time standard when there’s snow and ice on the road,” Williamson said.

“Except for the fire department, who finds a way to get there,” Shadid shot back.

“We do, too, but we don’t fine them for being late,” Williamson said. “It doesn’t automatically give them the go-ahead to shut down units.”

After more back-and-forth between Shadid and Williamson over EMSA’s definition of hourly call volume and whether there are incentives or disincentives used to keep response time rates at 90 percent, Williamson said Shadid was using the examples to make inferences that the company was allowing people to suffer in order to maintain its profit margin, calling them “ridiculous.”

 “There’s all sorts of ‘but’s in anything in business, but that doesn’t constitute direct parallels in behavior and I think that’s what you’re trying to do,” Williamson said.

 “How many times has Paramedics Plus been fined?” Shadid responded.

After a pause, Williamson answered, “We have it monthly; we can send it to you.”

Shadid asked for a rough estimate.

“I would rather … I’m not here to throw out numbers of everything that happens in an organization,” Williamson said. “I’d be happy to get that for you.”

Ward 4 Councilman Pete White asked if any other cities had gone to a similar model as the fire department was proposing. Williamson said Kansas City had, after pressure from its the firefighters union, but that the change has resulted in cost overruns, a decline in service quality, and upset citizens.

City Manager Jim Couch said the current system of fire and EMSA responding to all calls is redundant, but whether that redundancy is a bad thing has yet to be seen. The city’s financial position is such that an optimum balance between the financial side and operational side is the goal.

 “We’re in an enviable position of not being under huge financial pressures at this point in time,” Couch said. “We want to be good stewards and make sure we can provide the services as effective as possible. So we’re now, we’re looking at how to fine-tune that and … find that optimum peak point of financial efficiency balanced with operation efficiency.”

He said other municipalities have expressed satisfaction in the EMSA service, and if the city were to opt out of being a part of the EMSA trust, most would likely look to work with Oklahoma City to provide service.

A decision must be made by the council by Oct. 31. If the city opts out, it would take effect Nov. 1, 2013. Not taking action on the item would mean the agreement with EMSA would be renewed.

Clifton Adcock

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