Expect longer wait for ambulance in Atlanta

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Funding cuts to delay emergency response
End of subsidy could slow ambulance service

By GAYLE WHITE
Atlanta Journal-Constitution
Published on: 06/23/08

Ambulances could be slower to respond to emergencies — from minor accidents to life-threatening strokes and heart attacks — across Atlanta and much of south Fulton County next week. The county's public subsidy for the service ends next Monday. Fulton officials say they expect response time to increase by only four minutes, but critics say it could be much more.

Despite months of warnings from physicians and hospital administrators that the cutbacks could endanger lives or cause permanent harm to some patients, little appears to be happening in much of the county to fill the gap.

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"I don't know why there's no sense of urgency," said Pamela Stephenson, chief executive officer of Grady Health System, which provides emergency ambulance service in central Fulton — basically the city of Atlanta. "We haven't gotten any indication that anyone's coming through."

Officials said that they haven't given up on finding some additional sources of income.

The Fulton County Commission voted in November to eliminate a $10 million supplement for emergency ambulance service. Towns in north Fulton are making up the shortfall for their areas, but in most of the rest of the county, emergency ambulance providers will be dependent on collections from patients, their insurance plans or Medicare and Medicaid.

Even with a $6.8 million share of the county supplement, last year, Grady came up short. Transportation of uninsured patients accounted for the lion's share of a shortfall of about $8.7 million. Collection averaged less than $11 per patient for the uninsured.

Rural/Metro Ambulance Service, which provides emergency response for the county area not served by Grady, will lose about $3 million in supplemental funds.

Fulton Emergency Services director Alfred "Rocky" Moore, whose controversial recommendation was the basis for the county commission's decision, said the change will let municipalities take responsibility for ambulance service while also saving the county money.

The six towns in north Fulton are signing their own contracts with Rural/Metro. The ambulance service is also near a final contract with College Park in South Fulton, said Nita Ham, market general manager for Rural/Metro. Negotiations continue with East Point, Union City, Fairburn, Palmetto and Chattahoochee Hill Country, she said.

In Atlanta, efforts to make up the difference seem stalled.

The city is facing a projected budget shortfall of $140 million, and seems unlikely to supplement ambulance costs for its residents. Mayor Shirley Franklin's budget included no money for ambulances. The City Council could amend the budget to provide a supplement, said Franklin spokeswoman Beverly Isom. But the council is already considering buyouts and budget cuts to avoid a tax increase.

Although paramedics with the various fire departments often treat patients at the scene of an emergency, they can't transport people.

Any slowdown in ambulance service will affect care, said Dr. Joe Wilson, a cardiologist who practices at St. Joseph's Hospital.

Physicians "can't undo what's been done" in medical damage caused by slow ambulance response, he said.

When someone collapses from sudden cardiac arrest, "even a difference of two or three minutes in response time can make a difference in resuscitation," said Dr. Arthur Kellermann, professor of emergency medicine at Emory University School of Medicine. "Every moment of delay reduces someone's chances of coming back."

A few minutes also can make a critical difference in asthma attacks, childbirth and severe bleeding, he said.

Earlier this year Georgia's Region III EMS Council, an advisory body for the state department of Human Resources in metro Atlanta, asked for a ruling from the state attorney general on whether Fulton County is legally obligated to pay for emergency ambulance service for the county's indigent patients.

Russ Willard, a spokesman for Georgia Attorney General Thurbert Baker, said Baker has been "in conversation" with the Department of Human Resources, but those talks, he said, are private because of attorney-client privilege.

Residents of south Fulton will continue to receive emergency ambulance service with response times equal to most jurisdictions in the state, said Kristofer Schleicher, a lawyer for Rural/Metro.

Grady will continue providing service "to the best of our ability," said Craig Tindall, Grady's interim chief operating officer, but he predicted "our service level will continue to degrade" as calls pile up.

As the situation worsens, workers are finding jobs elsewhere, worried that theirs at Grady will disappear. "The further this drags out, the more individuals we will continue to lose," Tindall said.

Grady's ambulance fleet is down from 39 to 35, and its work force is at 212 — well below the full staff of 255 — said James Bothwell, Grady's director of EMS and Trauma Services.

The funding squeeze will be felt by the Peachtree Road Race on July 4. Grady will provide some ambulances for the world's largest 10K race and will coordinate communication, but other ambulance services will play a bigger role than in the past.

Day-to-day emergency ambulance service will be harder to solve.

The Region 3 EMS Council has formed a committee to review the performance of Grady and Rural/Metro after July 1, said council president Pete Quinones. He is also president and CEO of MetroAtlanta Ambulance Service, which serves most of Cobb County.

Quinones said emergency ambulance fleets are finding it "close to impossible" to work without a subsidy.

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Comments

By Retired

Jun 26, 2008 8:41 PM | Link to this

Rocky Moore is still up to no good, right now he is doing everything in his power to sabatoge the cities from getting contracts settled with RMA and it refusing to not only help out if he can but is putting up roadblocks. I am not sure what his agenda is but he has one and the citizens of fulton county and their welfare are not included in it.

By john doe

Jun 24, 2008 9:28 PM | Link to this

Fulton county residents either don't care about EMS, or they are poorly educated. it will not be until a county or city official, or their family needs an ambulance that we will see any improvement in the current state laws.
as a medic in the south Fulton area, i see more effort and money put into paving roads that are all ready paved, take home cars for employees,and huge salaries for officials than i see any improvement or expansion in fire, police, and ems. this goes for all the cities and the unincorporated county; look at east point, they are going to lose 3 fire stations, can they afford an ambulance?? it's gross mismanagement by gov. officials. time for public education and tax payers to rid their cities and county of crooks.

By v racer

Jun 24, 2008 3:02 PM | Link to this

John Doe and others said it right. The same crowd that screws up everything, is doing it to hospital and ambulance service too. They mucked up the streets, the schools, their governments, Marta, and dozens of neighborhoods. And, their mayor wants our federal tax money to bail them out.

By ATL

Jun 24, 2008 9:42 AM | Link to this

Health care is not a City function in Georgia. It is a County function. The cities are not even authorized to provide health care services.

People will die because of the Fulton County Commission's decision. It is not hyperbole to say that the Fulton County Commissioners are going to have blood on their hands.

By Retired

Jun 23, 2008 9:29 PM | Link to this

To GET REAL,
There is NO law that anyone has to provide ambulance service to anyone, not sure how you interrupted the code you read, but you read it wrong, they could shut down every ambulance service in the state and no could do anything about it, just find your own ride to the hospital, that was how it was in the old day, say 40 years ago. To hold a city charter you must provide fire and police service and some other basic services, but EMS is not included. It is an option

By Retired

Jun 23, 2008 9:18 PM | Link to this

Well lets see now, Grady EMS was getting 6.8 million dollars in money from Fulton County Tax payers to provide ambulance service to residents of Atlanta, maybe Atlanta should pay the 6.8 million, after all they know what it would cost to convert the Fire Department over to a Fire/EMS. Try around 25 million per year extra (if and it is a BIG IF they could even get an ambulance license from the state, some old law about government competing with private industry for money, much cheaper to pay Grady EMS to do it, or better yet pay no one, there is no law that says that EMS coverage has to be provided to have a city charter, only Fire and police have that privilege. Everyone knows it is cheaper for cities and counties to pay a private service to provide ambulance coverage than to do it themselves, private services don't waste tax payer�s money the way government services do, and this is a cold hard fact. Any by the way response times are set by the Region 3 EMS council, not the services, if the response times are not met, the council has the option to open zoning for the region, if that happens, hold on to your hats boys, the fun will really start then, as it will open the entire region, not just Fulton County, but Clayton, Cobb, and every other county in the region, and any ambulance service that wants to can ask for a piece of the pie, it will be a bloodbath.

By ER Nurse

Jun 23, 2008 7:12 PM | Link to this

It started with the government mandate that all patients must be transported upon request. So those 80% of bogus calls cannot be refused. I work at Grady ER and see what comes in. "Sore toe", call an ambulance. "Got a cold", call an ambulance. "My baby daddy left me and I am so sad", call an ambulance. "My knee been bothering me for two years", call an mbulance. We cannot turn these non-emergent folks away either. And I do blame the US government policies for this. We cannot refuse service, so the whole emergency system, from EMS to the ER, gets bogged down with non-emergent problems, from folks who deem the service free. And it is free for them. They don't pay for it; they don't pay for their meds, either, and get angry because our out patient pharmacy is closed on the weekends. They get mad if we then don't provide them a way home.
"I came by ambulance, and I ain't got no way home". Oh, and "I am hungry too, so ya gotta feed me. And I didn't bring my shoes, so ya gotta give me some of those Grady footies." You cannot educate folks who don't want the education. The cradle to the grave mentality is such that these people think they are entitled to free care, free transport, free meds, free food, free clothing. And they get it all.......because we must provide the services. I don't have the answers to the problems. I just see them every night I work. And I love what I do, but I do get fed up with the "gimme gimme" attitudes. It would be great if EMS were allowed to do a screening exam and if deemed non-emergent, refuse service. But they aren't allowed. And people know it. There are some who get a free ride into town. They come in with some bogus complaint and hightail it out of the ER after being checked in. Fortunately, we don't have too many of those, but we do get them. And none of this unique to Grady or Fulton Cty. It is nationwide. I say again, it started with the government. Therein lies the problem. But, I fear, not the solution.

By john doe

Jun 23, 2008 7:07 PM | Link to this

on behalf of the ems community i would like to thank Fulton county for an uncertain future, for both the citizens, and the medics and emt's that have families to support. our recommendation is to boot rocky moore.

By Tim

Jun 23, 2008 6:00 PM | Link to this

Public education is the key. No one is educating the public on when to call 911. 911 is being used as a information service and free ride to the hospital.

By Ashamed

Jun 23, 2008 5:29 PM | Link to this

As a paramedic i can honestly tell you that 80% of these so called emergency medical calls are not emergencies and people just use ambulances as taxi cabs. The difference between and ambulance and a taxi cab is that you have to pay the taxi cab at time of servive.

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