“Ultimately, the buck stops with the CEO.”
In past years, the former state legislator, state Labor Commissioner and superintendent of DeKalb schools has been credited with bringing accountability and transparency to governmental bureaucracies that have needed it most. Now, state and local officials are anxious to see whether Thurmond – and DeKalb County — can deliver on a pledge to improve ambulance services to the 13 cities within the county’s 271 square miles.
In some cases, DeKalb has been forced to act. A regional subcommittee that acts on behalf of the Georgia Department of Public Health intervened last month to hold the county accountable, issuing detailed recommendations.
So far, Thurmond has adopted key recommendations that the county put more ambulances in fire stations to improve response times in the northern portions of the county, which include Dunwoody, Chamblee, Doraville and Brookhaven. Average response times in those cities over the last 12-month period exceeded the county’s nine-minute goal, in some cases by several minutes, data show.
This month, DeKalb also signed a memorandum of understanding with the city of Dunwoody, where complaints of slow response times have been the loudest. DeKalb committed to nine-minute response times for ambulance services on critical calls, as part of the agreement.
Since trying to address the problems, Thurmond has won new allies among his former critics.
Early this year, Dunwoody Mayor Denis Shortal was among those on the council who petitioned the state for permission for the city to run its own ambulance program.
Now Shortal said he believes that Thurmond – and DeKalb — can put together a solution.
“I have faith in Michael Thurmond and he has faith in me,’’ Shortal said. “We looked each other in the eye, and we’re going to make this work.”
A pledge for prompt response
Thurmond has repeatedly said that he is serious about his commitment to address problems with the ambulance service, provided by American Medical Response under a contract with the county.
"The protection of the safety, health and welfare of the citizens of DeKalb is my highest priority,'' the CEO told the AJC last month.
Even before a new contract is signed to replace the one that expires on Dec. 31, Thurmond has agreed to place nearly a half-dozen transports in various locations of the county, DeKalb officials wrote in response to questions from The Atlanta Journal-Constitution.
In some cases, like in the southeastern town of Stonecrest, the additional units will be operated by DeKalb County Fire Rescue, officials said.
Data show that Stonecrest has experienced average response times below the county’s nine-minute goal. In a recent 12-month period, Stonecrest had average response times of 13 minutes, 22 seconds on 90% of calls for a total of 7,443 incidents.
In Brookhaven, the city plans to refurbish an old service station to provide office space and space for staging of ambulances. In a recent 12-month period, Brookhaven’s average response time was 11 minutes, 26 seconds on 90% of calls, based on a total of 4,662 incidents, data show.
In Dunwoody, DeKalb said that to enable ambulances to arrive faster, it stationed three additional ones at fire stations. The new agreement, effective one year, says a fourth ambulance will be provided “during peak times to meet the needs required by increased daytime population in the Perimeter Center area.”
Dunwoody ambulances also will be equipped for advanced life support. That means the transports will carry a paramedic and equipment to provide adequate care to critical patients. Dunwoody officials have demanded that the ambulances be equipped with personnel and equipment that can handle life-threat situations.
Dunwoody leaders also have demanded that DeKalb provide monthly reports on response times. In the most recent 12-month period, Dunwoody saw average response times of 10 minutes, 52 seconds on 90% of calls, based on 4,264 incidents.
Councilman Terry Nall said he was pleased with the agreement with DeKalb. But he is taking a wait-and-see approach to determine if the improvements take hold over the long-term. In three years, the county has made efforts to improve service “but the initiatives were not sustained by the county and were not sufficient for the medical calls volume we experience in Dunwoody,’’ Nall said.
The county has a track record of “pulling back and not solving the ambulance problem on a sustained basis,” Nall said.
The Department of Public Health also is keeping watch on DeKalb. It has the power to permit Dunwoody to establish its own ambulance services if it is not satisfied with DeKalb’s progress.
DPH wants a progress report on Feb. 14. It also has asked DeKalb to report to a subcommittee of the EMS Region 3 Council on Feb. 7, DPH spokeswoman Nancy Nydam wrote in response to questions from the AJC.
Guaranteed response times
Key to Thurmond’s success will be his county’s ability to draw up a new contract when the current one expires and select a provider that can follow through.
Earlier this year, Thurmond won allies among city leaders after he acknowledged that there were problems with the existing contract and that an overhaul was in order.
The county tried to enforce response times and other contract requirements by imposing fines on its ambulance provider, but complaints continued. AMR has blamed traffic congestion and wait times at hospitals for slow responses.
Other parts of the country also have struggled with using fines to improve ambulance service.
One example has been the city of San Diego.
San Diego has a contract with American Medical Response for ambulance services across its 325 square-mile territory, and, like DeKalb, it tried to hold the company accountable with fines for late arrivals.
When that didn’t work, it changed the terms of the contract, said Christopher L. Olsen, fiscal and policy analyst for the city’s Office of the Independent Budget Analyst. The lesson: A fine-based contract didn’t incentivize the contractor to improve its response to 911 calls.
“It was up to the company to staff according to their own calculations in terms of their best guess of how to avoid getting fined for response time non-compliance,’’ Olsen said.
The city’s modified contract now allows San Diego fire officials to direct minimum staffing levels for ambulance services, Olsen said. As a result, response times have improved.
“It’s more collaborative and less punitive,’’ Olsen said. “It also allowed the city to have more data than it did before to know exactly how the contractor was deploying resources.’’ The city expects to replace its modified contract with a new one by 2020, he said.
DeKalb officials are now talking about a contract that could include some of the same elements that are working in San Diego.
AMR has already responded to requests from DeKalb for additional resources, such as staffing and service enhancement, to improve response, said Terence Ramotar, AMR’s regional director.
“AMR has committed to exhaustive efforts to provide enhancements to the EMS system in DeKalb County,” he wrote in response to questions from the AJC.
In DeKalb, officials are working with a consultant to hammer out the new contract, which is due out next year.
"We're going to have a contract that, I think, will address the needs of all DeKalb County, unlike the one that's in place now,'' Thurmond told the AJC.
Proposal to improve ambulance services in DeKalb County
A subcommittee of the state’s Region 3 EMS Council issued a report detailing a series of recommendations for DeKalb County. These are among the suggestions:
- Place 24-hour static units in Dunwoody fire stations 12 and 18. In addition, the county must make and verify shift changes at stations 12, 18 and 21.
- Look at some type of solution to help with the fragmentation of call times between dispatchers and 911 call takers.
- DeKalb Fire does not have a mutual aid agreement with EMS providers in other jurisdictions and must establish one. The agreement will allow the county to seek help when units are not immediately available to respond to calls.
- Provide a list of all calls from all parties with response of over nine minutes.
- Provide a report that will be reviewed on Feb. 7 by a subcommittee of the EMS Council Region 3. The report should include the following: minimum number of ambulances being operated within the established zone; hours of operation, staffing and level of care; map demonstrating the primary response area for the units for each operational period, or the proximity matrix used to have units available throughout the designated zone; breakdown of average percentage of responses for each unit for 911 and non-911 responses for calls responded inside and outside DeKalb; 911 EMS demand analysis for the designated zone and subset for each municipality within the zone broken into hour of the day and day of the week format for each month.
(Source: Summative fact sheet of recommendations to the Region III EMS Council from the ad hoc committee, Nov. 8, 2018)