Ambulances from various services are lined up at Grady Hospital in May. Critics say Georgia’s system of selecting ambulance providers needs a major overhaul. 
Photo: JOHN SPINK/JSPINK@AJC.COM
Photo: JOHN SPINK/JSPINK@AJC.COM

Georgia on the verge of first reforms in years of EMS rules

Georgians would get better information on the time it takes an ambulance to arrive on the scene of an emergency, as a result of a proposal aimed at improving the quality of emergency medical services in Georgia.

Set for adoption by Dec. 9, the proposal demands that regional EMS councils adhere to the state open meetings law and that council members disclose potential conflicts of interest.

Supported by EMS leaders from various corners of the state as well as by transparency advocates, the move would shed light on decisions that have kept the public mostly in the dark about ambulance service.

“There is a big need for change in how emergency medical services in our state is handled,” Henry Argo, fire chief of the city of Palmetto in south Fulton County, told the Atlanta Journal-Constitution. “This could substantially help overhaul EMS in Georgia.”

The proposal, representing the state’s first efforts in years to revamp EMS rules, is the result of widespread criticism of gaps in state oversight and a spate of political skirmishes rocking the various regional councils, which make recommendations to the Georgia Department of Public Health about ambulance service.

In June, an Atlanta Journal-Constitution examination found that the state fails in its duty to ensure the quality and reliability of Georgia’s emergency medical services system. Many of the problems, the AJC found, stem from vague state rules for determining who is selected to provide emergency transport services and how they are vetted, leaving the system vulnerable to political pressure and conflicts of interest.

Critics also said the lack of independent information on how ambulances are serving their communities undermines public confidence. The opaqueness can shield ambulance providers from criticism that help arrives too slowly or that patients don’t receive the care they need.

Often, the public has no way of knowing about such problems until a tragedy strikes.

Under the proposed revision of state rules, standards would be developed to require members of state’s 10 regional EMS advisory councils to disclose their employment status and if they have a financial stake in an EMS company or a private ambulance provider.

The proposal’s intent is to weed out potential conflicts of interest among ambulance executives who sit on those councils.

Some EMS leaders say the changes are necessary but are just a start. Some want the state to enforce ambulance performance standards.

Chiefs of fire departments from south and north Fulton counties have banded together to push for reforms that would allow them to have input in the hiring of ambulance providers.

Current state law, they say, makes them powerless to hold ambulance providers accountable and address complaints of slow response times and inadequate medical care. That’s because the chiefs don’t have a seat on the advisory councils.

Chris Coons, the fire chief for Johns Creek in Fulton County, wants local governments to have input in decisions over ambulance services.
Photo: Handout photo

“No one understands the needs of a specific community and the challenges within that same community as the local fire chief,’’ Chris Coons, fire chief for the city of Johns Creek, wrote to the state last month. “I feel very adamantly that local officials should have some say as to who the ambulance provider is and the level of service that is to be provided.”

Robert Edgar, fire chief for the city of Milton, expressed a similar sentiment in a recent letter to the state.

“Decisions for the north Fulton zone … should not be made by council members who work in Gwinnett, Clayton County, Marietta or Atlanta,” Edgar wrote. “Department members from the zone in question should be included in the process.”

Other critics are demanding that key elements from an early draft of the proposal be restored to the final draft. An early version would have limited the number of representatives from any one organization on a regional council. The intent was to prevent ambulance executives from having too much influence and steering business their way.

“It’s unclear to us or to the victims why this vital provision, which would limit the potential for abuse of the system, was removed in the latest draft,’’ Julianne Thompson, spokeswoman for the Georgia Ambulance Transparency Project, said in a public address to state officials last week.

“We strongly encourage its inclusion in the final rule,” said Thompson, who told state officials her group is advocating on behalf of families of patients who have died as a result of delays and inadequate medical care from ambulance providers.

DPH Commissioner Dr. Kathleen E. Toomey is expected to issue a final decision on the rule revision by early December. Toomey can adopt the current version, make changes or take no action.

Call for legislative action

Top EMS officials from all corners of the state have been working for months to hammer out the proposal, which was unveiled last week in a public hearing.

The hearing drew fire chiefs from the cities of Roswell, south Fulton and Chattahoochee Hills, as well as representative from private ambulance companies American Medical Response and Community Ambulance, records show.

State EMS leaders, including Director David Newton, “have spent many hours going back and forth on drafts of this rule over many months,’’ said Kristin Miller, general counsel for DPH.

“They are a long time coming,” she said.

Courtney Terwilliger led a state advisory committee that drafted rules governing EMS in Georgia. 
Photo: Handout photo

State lawmakers also will likely be asked to weigh in with revisions to state law to improve oversight, said Courtney Terwilliger, who chaired the statewide EMS committee that drafted the rule revision.

For example, the General Assembly may be urged to grant the state the authority to approve the individual bylaws of each regional council. That change would direct the state to play a more active role in providing administrative guidance to the councils.

“If it’s in law, they will pay more attention to it,’’ Terwilliger said.

Some EMS leaders want even broader changes. They say that the state’s EMS office, one of many under DPH, is often neglected and isn’t adequately funded to provide oversight.

It’s time for lawmakers to revisit that framework by requiring that ambulance providers meet standards on response times, adequate staffing and equipment, say the fire chiefs of the cities of south Fulton, Fairburn, Union City, Palmetto, Chattahoochee Hills, College Park, East Point and Hapeville.

“A law and a system that may have met needs many years ago is not meeting the needs of today,’’ said Argo, the Palmetto fire chief. “Georgia needs an overhaul.”

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