If someone is badly injured or experiencing tremendous pain, it is an emergency and most people’s first instinct is to immediately call 911.
After all, there is nothing more gratifying than the sound of an ambulance siren when a person is in desperate need of help.
But ever since the beginning of 2014, most Augustans don’t realize that there is currently no ambulance company obligated to respond to such emergency calls.
On Dec. 31, 2013, Augusta-Richmond County’s contract with Gold Cross EMS officially expired.
The Augusta Commission was scheduled to approve a renewal of Gold Cross’ contract on Dec. 17, but Augusta Commissioner Bill Lockett told his colleagues during that meeting that he needed more time to review the renegotiated contract before voting to approve it.
Without any other meeting scheduled in December to consider Gold Cross’ contract, that left Augusta without any agreement in place.
Technically, Gold Cross is currently under no contractual obligation to handle any emergency calls in Richmond County.
Fortunately for Augustans, Gold Cross isn’t about to leave Richmond County vulnerable.
“Our contract with Augusta-Richmond County ended on Dec. 31,” said Matt Paynter, director of operations for Gold Cross EMS. “Now, we have verbally agreed to provide the service on a month-to-month basis and we are going to do it.
“We would never just walk off and leave the county empty-handed. And we have invested millions of dollars in Richmond County and we are not going to just walk away from that either. But from a legal aspect, yeah, we could because there is no contract in place.”
Paynter is confident a contract will be finalized by the Augusta Commission’s first meeting of the year on Jan. 7.
“Both sides have agreed on the final terms of the contract that we feel are good for each of us,” Paynter said. “So the contract is ready to be signed, it just needs the commission’s approval.”
One of the reasons the contract’s deadline was passed was because Augusta didn’t provide Gold Cross the revised contract until Dec. 7, Paynter said.
“We have been waiting for the contract since June or July and they got it to us on Dec. 7,” he said. “Of course, we looked at it and went over it with our attorneys, so we had it for about a week and gave it back to them. But I have no idea why it took them so long to get it to us.”
Paynter suspects the delay had something to do with the East Central Georgia (Region VI) EMS Council’s decision in November to designate the city of Augusta to be the EMS zone provider for Richmond County.
“The council’s decision was to grant the zone to Augusta,” Paynter said. “The fire department has an EMS license. You have to have an EMS license to apply for a zone, so they actually granted it to the fire department. Now, the fire department only has two ambulances, so they obviously couldn’t handle the volume Richmond County has. But the council’s decision does put the legal responsibility on the city. And I guess, from their viewpoint, the city could go contract with whomever they want.”
For more than a year, Augusta Fire Chief Chris James has voiced some concerns that Gold Cross’ previous contract with the city was not specific enough and that Augusta should have more of a voice about how its EMS service is provided.
“The contract was very vague,” James said. “The way the contract was set up, there was no checks and balances.”
James explained that under the city’s previous contract with Gold Cross, he was given the role of “contract administrator,” which meant he was to ensure that Gold Cross was complying with the terms in the contract.
“The old contract said the contract administrator is responsible for the day-to-day operations of the contract. If the contract administrator is not keeping up with what is going on, then the contract administrator is liable for not assuring that the proper services is being provided to the citizens,” James said. “But, as the contract administrator, if I wanted to know their specific run times for the ambulances, I had to go to them to get that information.
“There was no independent way of telling what Gold Cross’ run times were. It was kind of like them getting to write their own report card.”
Also, the manner in which Gold Cross and Augusta have both been designated a “co-zone provider” in Richmond County since 2006 was uncommon, James said.
Of the 159 counties in Georgia, James said only a handful of counties do not have the local government as the zone provider.
“I think when the city has the zone, then the citizens have a say or some input through their governing body on how their ambulance service works,” James said. “Because, if the city has the zone, the city can set standards of care and better define the amount of service that they get.”
While the regional council voted to designate the city of Augusta to be EMS zone provider for Richmond County in November, that may not be the end of the story.
The Georgia Department of Public Health will have the final say on who will be Richmond County’s zone provider.
“We asked for a hearing and there has been a hearing set on Jan. 13 in Atlanta,” Paynter said, explaining that Gold Cross plans to appeal the council’s recommendation. “The zoning rule that was voted on back in November actually hasn’t been finalized. What happens is, when the EMS council makes a recommendation to the state, the state can either have a hearing on it or they can just sign it in and add it into the zoning plan. The state has elected to have a hearing.”
Gold Cross wants the council’s decision to be overturned because the company feels it has done an outstanding job as the zone provider for Richmond County.
“We want to stay the zone provider because we have been the zone provider since 2006 and we’ve always done a good job,” he said, adding that Gold Cross has been in Richmond County since 1997. “We haven’t had any response issues. So for us, it was kind of like, ‘Why would you change the zone provider?’”
Members of the council have even told Gold Cross that the company does an excellent job in Richmond County, Paynter said, but yet the members voted 10-8 in November to designate the city of Augusta as the EMS zone provider.
“For us, it kind of feels like it is a slap in the face,” Paynter admitted. “We’ve done what we’re supposed to do, but they still want our name taken out of the zone.”
By removing Gold Cross as the zone provider, Richmond County could fall victim to inconsistent EMS service, Paynter said.
“The part that we fear, and I hate to compare us to Aiken County, but Aiken County has had some recent issues with their EMS system,” Paynter said. “They are splintered over there. They have at least three different services that are running calls in the county. So, if you call 911, you don’t know who is going to show up.”
Such an agreement can open the county up to several different problems with each company having varying standards, he said.
“With each service provider, they have different equipment on their trucks and different personnel,” Paynter said. “There is no consistency and we are afraid that that is what will happen in Richmond County.”
Like many aspects in Augusta, Paynter is also concerned that the regional council’s decision could cause EMS service in Richmond County to become “political.”
“Now, it has the potential of being political because Augusta could allow two or three services in Richmond County and that would make inconsistencies in the service that is responding,” he said.
Ironically, the EMS zoning laws that were written back in the 1970s were specifically created to take the politics out of emergency services, Paynter said.
“What was happening back in the 1970s, there were tons of ambulance services in the same area and a call would go out on the scanner and they would race each other to the scene,” Paynter said. “Of course, they were driving around in hearses back then, so we have come a long way since then.”
But the state of Georgia decided to develop the zone provider to dissolve the competitive aspect of EMS service.
“What the state did was, for public welfare, economy and efficiency, which are the three things that they look at for zoning, the Department of Public Health decided, ‘We are going to have a designated zone provider and we are going to look at this from a medical aspect, not a political aspect,’” Paynter said. “So, they kind of took it out of the hands of the local government to decide.”
But Augusta Fire Chief Chris James insists that his motivation to make sure that Gold Cross was abiding by its contract was in no way political.
“My bottom line is to provide quality service to the citizens. That’s it,” James said. “The case is, I thought there were issues with the contract that were not being met and they know that they were not being met. They don’t want that to be talked about.”
Specifically, James said the fire department noticed that not all the ambulances being sent on calls by Gold Cross in Richmond County were Advanced Life Support units.
“We knew, based on the fact that the fire department was riding on calls with the Gold Cross, that not all of their units were Advanced Life Support, even though the contract stated that all of the units responding would be Advanced Life Support,” James said. “So, there was a conflict between what the contract was saying and what was actually being done.”
But Paynter insists Gold Cross’ service in Richmond County has been outstanding.
“We have been compliant with our response times every month since 2006,” he said.
The company also works hard to ensure there are enough fully equipped ambulances on the street to maintain their response times, Paynter said.
“During the day, we run 12 units, which are staggered at different times,” he said. “We also have about five or six non-emergency trucks that are basically set up for our private business, but we do sometimes pull those to do 911 calls if we need to. And we go down to nine trucks at night in Richmond County.”
In Richmond County, Gold Cross’ contract states that it must respond to life-threatening emergencies within the urban area in less than eight minutes. In non-life-threatening emergencies, the response time is 10 minutes.
“Now, the county is split into urban and rural areas. And anything south of Willis Foreman/Brown Road is rural,” Paynter said. “Everything else is urban. So, in the rural area, for life-threatening emergencies, it is 10 minutes and for non-life-threatening emergencies in the rural area it is 12 minutes.”
With that level of service, Paynter doesn’t understand why Augusta is interested in becoming the zone provider.
“Why would they want it?” he asked. “If someone else is going to do it and does a good job, why would they want it? I could see it if people were waiting 45 minutes for an ambulance. In that case, somebody has got to step in and do something. But that’s not the case here. So we are a little puzzled about all that.”
So, it begs the question: who wanted the zone change?
“The only thing I can think of is the fire chief because his service applied for it,” Paynter said.
James said that is “absolutely not true.”
“We received an e-mail from the regional council, letting us know that the zone was open,” James said, referring to an e-mail he received in October from Ernie Doss, the program director for the EMS Region VI.
James said he forwarded the message to then-City Administrator Fred Russell.
“Mr. Russell in turn said, ‘Apply,’” James said. “It wasn’t Chief James who said to apply for the zone provider. It was not me. In fact, I never applied. I forwarded the e-mail to the law department and the law department in turn said they had already been instructed to do it. So it didn’t come from me.”
But Paynter believes the county doesn’t realize the enormous responsibility it is taking on if it is designated the zone provider for the county.
“I don’t know that the county realizes the impact that it is going to make on them if we are not here to do the service. Now, they are on the hook,” he said. “Where before we were on the hook to do it legally, but now it is theirs. So, if we just decided we don’t want to play anymore, it’s their puppy. I don’t know why they would want that.”
When Paynter explained that aspect of the zoning change to some of the commissioners, they were shocked, he said.
“When we talked to some of the commissioners they were like, ‘What? Now we are legally obligated to do what?’” Paynter said. “It has really put the county on the hook for potentially millions more than what they are spending today.”
Paynter finds it interesting that when James applied for the fire chief job in 2012, his strategic plan suggested he would increase the number of paramedics within the fire department so the department would be able to transport patients.
“Obviously, when he applied for the job, his long-term plan for the fire department was to do EMS transport. He put it in writing,” Paynter said of James. “So I think somewhere along the line, he still wants to do that. He says that he is not interested in doing that. That is what he has told me and he has told us a couple of times. But I don’t know why he would put that in his plans for the fire department if it wasn’t something he was going to do.
“I think that is one reason the zoning thing occurred. So that it gave him the ability later on to say, ‘Hey, I’m going to do this now and I’ve already got the zone.’”
James again insists that accusation is “absolutely false.”
“No. Chief James is not trying to take over the ambulance service,” he said. “We do not want to take over the service because we only have two ambulances and that is obviously not enough to provide the service to Richmond County.”
The only times the fire department’s ambulances are used is when Gold Cross goes to “system status zero,” which means there are no Gold Cross ambulances available, James said.
“Those ambulances are used as backup when Gold Cross doesn’t have enough ambulances to respond,” James said. “But Gold Cross took a strategic plan that I wrote as a candidate for this job and are now trying to say, ‘See, he is trying to take it over.’ That’s not the case. And, anyway, that’s not my decision. That’s the decision of the governing body.”
If anyone in the city is considering taking over the EMS service with the belief that it will be a “money maker” down the line, Paynter says he or she is sorely mistaken.
“For some reason, people think that they are going to make money off of this or it is going to help their budget, but it’s not. It’s going to suck them dry,” Paynter said. “We don’t make our money off of 911. We make much money when we pick Grandma up at GRU and take her to the nursing home. We get paid for that every time. Where our 911 collection percentage is less than 30 percent.”
That’s the reality of EMS service and no one knows that better in Richmond County than Gold Cross, Paytner said.
“You have to know your industry that you’re working in,” he said. “I was a firefighter for a number of years. I still am. But I wouldn’t pretend to think that I could go run a fire service. There are certain things that you need to have administratively to be able to run it.
“Well, we feel like we are the professionals in EMS. This is what we’ve done for a living. This is the career that we’ve chosen. And we feel like we are good at it. We know how to bill. We know what can be reimbursed and what can’t. We know how to keep trucks on the streets. We know the day-to-day operations. We feel like that is our expertise.”
If the county was forced to take over EMS service in Richmond County, Paytner said the costs would be exorbitant.
“Even if you are charging insurance and Medicare and Medicaid, the first three or four months a service starts up, you don’t get any money in,” Paynter said. “It takes that long to get any cash flow coming back in. Plus, they would have to purchase all the ambulances. The capital expense is huge.”
No matter what the Department of Public Health decides this month about the zone provider, Paynter said Gold Cross is committed to providing service to Richmond County for many years to come.
“We are not going anywhere in Richmond County,” Paynter said. “Our intent is to stay here. We’ve got a contract that everybody has agreed to. We are hoping that will go through with no real issues because we are a fairly large employer here. I’ve got about 270 employees in our three counties of Richmond, Columbia and Jefferson counties, so obviously, we want the contract to be there because that makes a lot of job security with those folks. So we are here to stay in Richmond County.”
From his perspective, James welcomes Gold Cross’ service in Richmond County and he hopes the new contract that is expected to be approved next week will clearly outline Augusta’s service needs.
“I’m not against Gold Cross. It doesn’t bother me who the ambulance company is. That’s the truth,” James said. “Augusta just needs a good contract in place with good standards. That’s my only concern.”