October 15, 2015 - The Shelby County Commissioners approved the continuation of a contract with ACE EMS for 911 call response exclusivity on Monday, October 12, 2015 with a small caveat thrown in for the County Attorney to review the contract for possible revisions.
Representatives for ACE EMS, Dale Alexander and Jessie Griffith, provided statistics on their activity from September 1, 2014 to October 8, 2015. According to their report, during a 13-month time period they have provided 3,190 transports which are from a wide variety of locations; however, they could not at this time show how many of the calls were from 911 when Judge Harbison asked as the Sheriff's Department has that information.
"Most every call we get, unless it's a transfer, comes through Shelby County," said Griffith.
The report provided by ACE EMS shows they have transported 494 individuals from crash scenes alone. Judge Harbison confirmed the 911 calls for the City of Center also are run through the Shelby County 911 system and then transfered to the city. Jimmy Lout, Precinct 2 Commissioner, asked who decides when a helicopter is called to transport someone.
"That's the medic's decision, but we have a list of things, protocols, that will tell us what needs a helicopter and what don't. We don't necessarily go by that, but we go through and we see how bad the patient is," said Griffith. "There have been times that we've called the helicopter, Life Air Rescue and Flight For Life, they want us to call. If they get in the air and we turn them around, that's fine it's no charge to anybody, but if we get on scene and we need them it's better to have them 5 minutes away instead of 30 minutes away."
Lout inquired as to how much a helicopter transport costs. Griffith didn't know the exact figure; however, he said his wife had to be transported once and the cost was around $12,000. Lout asked why a man with a broken leg, which he understood to be a clean break and not through the skin, was flown from Huxley instead of taken by ambulance.
Agenda items receiving approval include:
Agenda items tabled:
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Griffith stated the roads from Huxley to Shreveport would have been too rough for the transport, and according to Griffith the man had requested a helicopter fly him. Griffith elaborated on the job of the medic to make such a decision as he stated he relies on people to make judgment calls, just like the county relies on the Sheriff and anyone else to make responsible decisions.
Roscoe McSwain, Commissioner Precinct 1, stated he wouldn't question the decision to call a helicopter because it isn't his job and he isn't trained to make such decisions.
"If you wanted an example, like this one that you're talking about, the guy has a broken leg they call the helicopter for the broken leg. If it's his femur, you have a major artery right there in your leg. If that artery ruptures, it doesn't necessarily have to come through the skin, that artery could rupture and you're gone in 5-6 minutes if that's not taken care of," said Alexander.
Alexander continued to explain a helicopter can cover a lot more ground in less time than the ambulance can, and that the concern is not cost, but what it takes to save a life.
Judge Harbison stated she has had reports ACE EMS has bypassed the local emergency room to take patients to other hospitals and it is her understanding the local emergency room is a state of the art facility. Alexander agreed the emergency room has a state of the art facility and addressed her concerns, "Maybe where that's coming from is that, unless you're in the back of that truck, you don't hear the patient may request say, 'my doctor's at such and such a facility,' you take them to that facility assuming they're able to make the ride, or you know sometimes it could be about definitive care, and that's going to be a medic's judgment."
Tammy Hanson, Nacogdoches Medical Center - Center Emergency Department Emergency Room Director, was present for the meeting and she stated she really doesn't have a perspective on how well 911 response has been, "It is the judgment call of [ACE EMS] whether they use a helicopter at scene, it is my judgment call in that ER whether I use a helicopter out of my ER. For my ER, we do have, it is a state of the art ER and so there are very few things that should bypass me. As far as multiple trauma, absolutely, if there is a need for definitive care those guys that are flying out of there, they didn't need to stop at me anyway, probably."
McSwain shared the commissioners have rumors and conjecture to go by "on the street" and he wanted to know the opinion of Hanson.
"We have a very good working relationship I'd say with ACE [EMS] as well as with Force [EMS]. Force EMS came in about [3 months ago] came into Nacogdoches and Center," said Hanson.
At this time, Force EMS is being used in addition to ACE EMS for transports from the ER. According to Hanson the ER is now able to have a patient transported out in 15 minutes after a transport has been requested and to whatever definitive care they may need, and she is satisfied.
"I think, it's my opinion, that the exclusive has worked good for Shelby County. For a long time we were against any kind of promotion of any kind of business through the county," stated McSwain.
He recalled when there were several ambulance services and it was difficult for just one to survive and ensure Shelby County had any kind of ambulance service.
Gary Rholes, County Attorney, stated to McSwain the county could contract with two ambulance services. Judge Harbison asked Rholes if he likes the current contract.
Rholes had a question over funding for the ambulance service, since a subsidy was provided in the past to keep it running, "If y'all get this exclusive, are you gonna be back up here again like last time in a month or two sayin', "y'all have to give us $15,000 a month, or we can't stay in business'?"
"At that time, we were operating on no facility here, they just opened. It takes time, I mean you're aware of like in a billing process it takes time especially in the medical field, it takes time to turn around and see the realization of what you've billed and what you're actually going to collect," said Alexander. "It was only temporary too. We started out in the very beginning and said, 'Well it's only temporary,' I think you did, I think you guys did six months for us and we appreciate that to the ends of the earth."
Rholes recollected a commissioner asking ACE EMS if the subsidy would be an ongoing necessity, and he wanted to know if agreeing to the contract once again would be a harbinger of the service returning for more financial assistance after having already received $180,000.
"No, we never, never wanted the subsidy to be an ongoing thing. We needed it to make sure we could do what the county needed and to fulfill that contract, well to do that at the time we needed help. As of right now, we don't need that help and in the future I don't see it coming back to us needing that help again, heaven forbid it happens again," said Alexander.
Several concerns were on Rholes mind as there are departments in the county with many needs and he felt the ambulance service was not confident they could meet their obligations without the subsidy from the county.
"We've got lots of needs is what I'm getting at, I mean we obviously need ambulance service and I think y'all have done a good job on that," said Rholes.
"Don't mistake us asking for that for saying, 'hey, we're not going to do this unless you give us this subsidy,' please don't ever mistake that," said Alexander.
Michael McKay, Force EMS Representative, addressed the court and stated although he is competition for ACE EMS, he would prefer to work with them, "Having a primary person be your go to is better than having two different people that you're going to call at two different times. I would like to be able to back them up, maybe have a mutual aid agreement with them if they do get in a bind. I don't want to pry and get in the way of helping a patient on the side of the street."
A motion carried to renew the contract for 30 days until the next Commissioners Court meeting to allow time for Rholes to examine the contract closely and see if there are any changes he wants made before finalizing the contract.
Rholes added he would like to see ACE EMS and Force EMS meet together and come up with some language for the contract which would allow everyone to work together.
A proclamation was approved by the commissioners recognizing "Kings Nursery" on its 100 year anniversary.
"It was such a nice celebration," said Judge Harbison. "I did not realize it but there's many, many fruit trees and flowers that were developed there, pollinated there and cultivated. So there's several special breeds that you can only get there at King's Nursery that go all over the United States."
The meeting was adjourned at 10:52am.
Fees collected per office for September:
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Deborah Riley, Tax Assessor/Collector office: Property Division - $74,398.41; Motor Vehicle Division - $37,307.90 for a total of $111,706.30 -
Jennifer Fountain, County Clerk: $33,897.96 -
Lori Oliver, District Clerk: $17,430.16 -
Maxie Eaves, Justice of the Peace Precinct 1: $8,922 -
Marla Denby, Justice of the Peace Precinct 2: $1,291.10 -
Margie Anderson, Justice of the Peace Precinct 3: $9,624 -
Jenny Hicks, Justice of the Peace Precinct 4: $2,373.40 -
Mike Crouch, Justice of the Peace Precinct 5: $2,866 -
Zach Warr, Constable Precinct 1: $360 -
Jamie Hagler, Constable Precinct 2: $180 -
Billy Hearnsberger, Constable Precinct 3: $90 -
Bryan Gray, Constable Precinct 4: $90 -
Stanley Burgay, Constable Precinct 5: $90
Grand total: $188,920.93
CDs generated $18.26 for a total book value of $60,040.96
Money Market generated $353.28 total market value of $1,719,569.02
Total investments as of September 9, 2015 $1,779,609.98
