Ambulance providers competing for Fulton County contract

American Medical Response and Grady EMS are bidding to provide ambulance service in the south part of Fulton County. AJC FILE PHOTO

American Medical Response and Grady EMS are bidding to provide ambulance service in the south part of Fulton County. AJC FILE PHOTO

Over 11 days last August, five people who called 911 in southern Fulton County ended up taking their own vehicles to the hospital when an ambulance was not available, and there was no indication of how long it would be before one was free.

In other instances, it took more than an hour before an ambulance showed up to help. And on several occasions last fall, the south Fulton ambulance provider, American Medical Response, held ambulance calls for more than 15 minutes before dispatching vehicles to the scene of an emergency.

VIDEO: Learn more about Atlanta's Grady Memorial Hospital with the AJC's "5 things to know" series.

Frustrated with what they deem dangerously long response times for emergency services, south Fulton leaders convinced the state Department of Public Health to open up the region for competitive bidding, hoping they could find a new company to provide this critical, potentially life-saving service for the area's nearly 200,000 residents.

It’s the first time in 18 years there has been any competition. Two companies — Grady EMS and the current provider, AMR — are vying for the contract. Because the carriers are paid by insurance companies and residents, the value of winning the service was not immediately available.

In other states, ambulance service contracts last five years with renewal options, or 10 years without, said Jay Fitch of Fitch and Associates, an emergency services consulting firm. But in Georgia, there is no consistent method for re-bidding service in an ambulance zone. Once a company wins ambulance service, it keeps it, until someone convinces the state that the bidding should be reopened.

Statewide, that happens only once or twice a year, on average, said Ernie Doss, the deputy director of the Office of EMS and Trauma for the state Department of Public Health. Some zones have had the same provider for more than 30 years, with no competition since the ambulance service was first awarded.

But this spring is different: in addition to the south Fulton bids, there are requests to open bidding in Richmond, Tift, Twiggs and Spalding counties. A similar request in Barrow County has been delayed.

“It seems like it’s more than normal,” Doss said.

‘We consider that unacceptable’

In south Fulton, response times have been an issue for more than five years, said Larry Few, the fire chief for the year-old city of South Fulton. In that city, response times average 23 minutes and 48 seconds.

“We consider that unacceptable,” Few said.

The state doesn't have response-time standards, but Doss said nationally, eight minutes is widely used. In Georgia, each jurisdiction can set their own response time requirements, and they can vary greatly depending on population density and the location of the ambulances in an area. In some cases, cities or counties pay additional subsidies to get better service. Now, Fulton County does not, and the cost of ambulance service is covered by insurance claims and patient bills for transport.

“The response time is just not where it needs to be,” said Robbie Rokovitz, the city manager in Chattahoochee Hills. “It’s a big deal. It’s a huge deal.”

In Chattahoochee Hills, it can take between 15 minutes to 45 minutes to get an ambulance, Rokovitz said.

There, and across south Fulton, emergency responders often respond much earlier from local fire stations. But state law prohibits them from transporting people if they aren’t the approved ambulance provider, Few said. He said the consortium of cities is looking into creating its own transport service, but that could be years in the making.

Terence Ramotar, AMR's regional director, defended the service, saying his company has worked to make improvements since 2016, when it took over the south Fulton area after buying the previous provider, Rural/Metro Corp.

Ramotar said the response time depends on where in the county calls are coming from, but that they can be 10 minutes or 12 minutes in East Point and College Park. Throughout south Fulton, he said, the average response time is 14 minutes.

AMR is taking steps to improve its response times, he said, including stationing ambulances at fire stations throughout the south part of the county and working toward agreements that could take some non-emergency calls to urgent care clinics instead of emergency rooms. Last year, Ramotar said, 45 percent of the south Fulton 911 calls were not true emergencies. He said by taking steps to change the system, including providing better medical care in the area, response times could be improved by virtue of reducing the number of calls.

Last year, he said, AMR lost $300,000 on south Fulton’s ambulance service. But the company — which is the largest private ambulance provider in the country — sees opportunities for improvement, both for its bottom line and for residents. Already, Ramotar said, response times have started to improve by three to five minutes, and he sees opportunities to reshape the system using “innovative solutions.”

“It’s unusual to open a zone that’s well on its way to progress,” Ramotar said.

Local leaders remain unconvinced, though, and in an April 23 letter, asked the state EMS Council award Grady EMS the service.

Doss said the council will make its decision based on efficiency, economics and public welfare. The proposals, which are not public, include proposed response times as well as information about employees and vehicles that would be made available.

“We have to be concerned at all times about the safety of our citizens,” said Robb Pitts, the Fulton County chairman. “Unfortunately, we won’t make the call.”

Fulton County is divided into five ambulance zones: Atlanta, Hapeville, the airport, and north and south Fulton. It’s only south Fulton that’s asked for a new provider. A recommendation between AMR and Grady will be made Thursday by the regional EMS council after bid presentations on Tuesday.