An ambulance leaves Grady Hospital. Critics say Georgia’s system of selecting ambulance providers needs a major overhaul, pointing to concerns such as rampant conflicts, lax oversight, and vague rules on vetting that can put Georgians’ lives at risk at the most critical hour. 
Photo: JOHN SPINK/JSPINK@AJC.COM
Photo: JOHN SPINK/JSPINK@AJC.COM

EMS in Georgia due for overhaul

Members of councils that recommend ambulance providers would be required to sign disclosures and comply with public meeting laws.

As controversies have erupted across the state over how ambulance providers are selected, a committee of top EMS officials is working to rewrite the rules.

The committee’s draft proposal, due out next week, is expected to call for a conflict-of-interest policy covering every member of the state’s 10 Emergency Medical Services councils. Members would be required to disclose the company they work for and if they own stock in an EMS company or a private ambulance provider. The proposal also is expected to call for limiting the number of representatives from any one organization, so that they aren’t able to steer decisions.

In addition, the proposal would require the councils to comply with the state’s open records and open meetings laws. Members also would have to undergo specific training on open meetings laws, said Courtney Terwilliger, the Emanuel County EMS director who is leading the committee’s effort.

“There could be some light at the end of the tunnel to improve the EMS profession in Georgia,’’ he said. “For some of us, I think we have some ability to improve what we do.

“It’s an extraordinarily interesting time,’’ he said.

Courtney Terwilliger is leading a state advisory committee that is rewriting rules governing EMS in Georgia. The committee’s proposal is expected to be reviewed by the Georgia Department of Public Health this summer.

The move to introduce new regulations 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 Department of Public Health about ambulance service. At issue have been questions about whether DPH rules ensure a fair and transparent selection process that operates in the public’s best interest.

In June, an Atlanta Journal-Constitution investigation 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 standards on the care required and lax oversight on how emergency transport services are vetted.

The opaqueness can shield ambulance providers from criticism that help arrives too slowly or that patients don’t receive care they need. Often, the public has no way of knowing about such problems until a tragedy occurs.

DPH told the AJC this summer that it was working on a revision of the rules but didn’t release any details.

As the rule-setting process unfolds, Terwilliger said, there will be multiple opportunities for the public to weigh in on the new proposal over the next several months. There also will be a public hearing to draw feedback on the proposed rules later this year, he said.

His group, which has been meeting since November, is expected to unveil its final proposal to Georgia Department of Public Health officials on Tuesday. It likely will undergo several revisions over the next several months, but the department is expected to adopt new rules before the year’s end.

“We would love to have it done before the legislative session,’’ Terwilliger said.

Fiery debate

Still, the upcoming legislative session appears sure to ignite debate about how to improve emergency medical services in Georgia.

A group formed last year to push for changes, the Georgia Ambulance Transparency Project, has said it plans a renewed push for legislation that would require ambulance providers to meet certain safety standards and register with the state ethics commission.

Julianne Thompson is the spokeswoman for the Georgia Ambulance Transparency Project. The group was formed last year to push for changes in rules that govern the selection of ambulance providers in Georgia.

One of its proposals that drew the most controversy called for removing some ambulance providers from the councils. Because providers take part in the selection process, they can improperly influence the award of lucrative service contracts, said Julianne Thompson, spokeswoman for the Georgia Ambulance Transparency Project.

“Now, that may not be illegal, but it’s plainly unethical,“ Thompson said. “Someone with a possible financial stake shouldn’t be directing taxpayer resources.’’

That, and some of the project’s other initiatives, will get push-back from the industry, though.

Chad Black, chairman of the Georgia Emergency Medical Services Association, said that ambulance executives often can provide a layer of expertise during discussions about service that otherwise might be lacking.

Chad Black is the chairman of the Georgia EMS Association, which represents EMS providers and educators. He is also EMS director of Habersham County.

“We have to have EMS people on the councils to know what’s going on in the industry,’’ Black said.

The draft proposal by Terwilliger’s group does not recommend removing ambulance providers from the councils.

But he and other EMS officials acknowledge that changes to the state’s rules to require conflict-of-interest policies are long overdue.

Terwilliger said accusations about such conflicts have been surfacing “sporadically” for decades.

“I’m a little frustrated that the department has not been aggressive about fixing it in years past,’’ he said. “But at least I feel right now that we are addressing it.”

Among the other changes the committee will likely push for is a standardized set of bylaws that would be included in the governance rules of each of council. The committee also wants to create a new role of parliamentarian on each council. That person’s job would be to keep order on the council, ensure that state open meetings laws are being followed, and quickly identify conflicts and report them to the state.

There also would be a flowchart delineating the process by which councils consider accepting bids from ambulance providers that are seeking exclusive contracts to provide services to a geographical region of the state. There would also be a detailed process for when someone requests a change in the region or zone. Last year, the city of Dunwoody asked to have its own zone because it was unhappy with service provided through DeKalb County.

Terwilliger said his committee has included top officials from DPH who have been giving feedback on the draft proposal during its development.

“As we come up with things that we think should be done, we’ve been running them by the (DPH) general counsel so that we make sure when we get it done, that it will be appropriate,” he said.

Push for transparency

Additional efforts are also in the works to provide the public with greater detail about the quality of EMS services.

Top DPH officials have been meeting with leaders of the Georgia Ambulance Transparency Project to discuss how to create a searchable database where the public could find out if ambulance providers are lagging their peers in responding to emergency situations, said Sam Rafal, a former EMT and member of the project.

“We’re currently talking about the data and what can and cannot be released,’’ said Rafal, who also leads When Every Second Counts, an advocacy group in Athens-Clarke County that is pushing for greater accountability in EMS services.

Rafal is among those who also want the state to set standards on acceptable response times for all EMS operators.

But DPH told the AJC this summer that it was was “not feasible.”

Response time standards, it said, must be left up to local communities, which can consider such circumstances as population density, traffic, geography and accessibility to medical facilities.

Black, the chairman of the Georgia EMS Association and the EMS director for Habersham County, agreed with that assessment.

“We’d love to be able to have average response times that everyone can go by, but it’s not realistic because every community is different,” Black said.

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