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Public Notices

April 21, 2014

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County In Midst
Of Ambulance Turf War

Sun photo by Ken Little

Greene County EMS Director Robert Sayne discusses ambulance service operations.

Originally published: 2013-10-26 00:23:15
Last modified: 2013-10-26 00:29:49



The question of whether any ambulance service other than Greene County-Greeneville Emergency Medical Services will be allowed to operate in this county will remain unanswered until at least Jan. 9.

Greene County-Greeneville EMS has been providing both emergency and non-emergency ambulance service to the county since 1974.

The agency is a joint function of Greeneville and Greene County.

Life Care Ambulance Service, which is based in Cocke County, wants to offer non-emergency transportation in Greene County for services such as kidney dialysis treatment.

Strong opinions on the issue were voiced pro and con Thursday during a sometimes-heated meeting of the Greene County-Greeneville Emergency Medical Services Board.

The board tabled until the next meeting on Jan. 9 a decision on what rules apply to a resolution passed by the board in September.

That resolution designaed Greene County-Greeneville EMS as the only ambulance service allowed to operate in the county.


Robert Sayne, Greene County-Greeneville Emergency Medical Services director, is strongly opposed to permitting other ambulance services to answer non-emergency calls in the county.

Sayne said at the September board meeting that transporting patients by ambulance for non-emergency reasons, such as to and from kidney dialysis treatments, provides a revenue stream that supports the agency's emergency operations.

Greg Marion, former Hancock County mayor and EMS director, who is now director of business development for the privately-owned Life Care Ambulance Service, told board members that the company wants to work with Greene County-Greeneville EMS in a secondary capacity.

Marion said that the company presents no threat to revenues of the local EMS operation.


Kimberly Shelton, a Greene County resident whose father needs transportation for dialysis services, attended the meeting and told board members the family tried a Life Care ambulance based in Cocke County after having to wait hours for Greene County-Greeneville EMS on one recent occasion.

"These people are like family to me. They treat my dad like family," Shelton said.

"If Greene County cannot provide the service, we need somebody who can."

Nicole Hunter-Beatty, of Fresenious Medical Care in Greeneville, which offers dialysis services, also endorsed ambulance services provided by Life Care.

Greene County "has proven and shown us over and over they cannot handle transportation for these dialysis patients," Hunter-Beatty said.

"It's not the emergency services we are concerned with. It's the patients who cannot get to their treatment any other way."


County Commissioner Lloyd "Hoot" Bowers then asked Sayne if Greene County-Greeneville EMS had the resources to provide non-emergency services.

"Based on what these folks just said, Do we have the economic means or money to set aside a few non-emergency vehicles?"

Sayne said he understands the concerns of people such as Shelton.

He added that non-emergency services by the local EMS are possible if the county and the Town of Greeneville provide adequate funding.


"We have come to realize what the problem was," Sayne said.

He said it was caused by the Greene County 911 Dispatch policy of keeping one ambulance in reserve to respond to emergency calls.

"The logic was to keep one or two ambulances around in case of an emergency," Sayne said.

He went on to say that, after he spoke with 911 Director Jerry Bird, the issue has been resolved.

"In the past month there have been zero delays on any ambulance call in Greene County," Sayne said. "The next ambulance is dispatched on the first call. There are no delays."

Greene County-Greeneville EMS monitors how ambulances are dispatched in order to ensure availability of an ambulance in the event of an emergency call.

"We're not running out of ambulances like we were, and we're not having delays of two or three hours," Sayne said. "If we have delays, heads will roll."


Bird said that it has been the practice of Greene County 911 for at least 20 years to hold back one ambulance [from being dispatched for non-emergency reasons] for emergency calls.

"I still feel that is a good way to handle a business," Bird said.

Sayne and Bird are directors of two separate departments that receive funding from the county and the Town of Greeneville.

Sayne said that there are generally six EMS ambulances available to cover Greene County during the day.

If all ambulances are occupied on other calls and another call comes in, an EMS supervisor is notified, and part-time or full-time EMS personnel are called in to staff another ambulance, Sayne said.

If adding another ambulance can be accomplished without affecting taxpayers, "We're definitely going to do it," he said.


Greeneville Mayor W.T. Daniels said he isn't opposed to letting another ambulance service answer non-emergency calls "if we're not going to provide the service."

Chuck Whitfield, president and chief executive officer of Laughlin Memorial Hospital, suggested having Life Care Ambulance Service "on some type of second-call arrangement."


Sayne said that Life Care, which dispatches ambulances based in Cocke County and Morristown, did not consult with him before the company started answering calls in Greene County.

"They just came in and started transporting patients without anyone's permission," he said.

Marion denied that that is the case. Life Care has been operating in Cocke County since 2012, he said.

"It was OK when it was Cocke County EMS," Marion said.

He said other ambulance services, including Church Hill EMS in Hawkins County, also make non-emergency calls in Greene County.


Marion told board members that Life Care "will never go to those places that will harm your income."

He said Life Care has answered fewer than 200 total calls in Greene County.

"We want to do the things for the citizens of Greene County [that the local EMS] can't do," Marion said. "We don't want to harm your EMS. We want to make the calls they can't make."

He told board members that Life Care is willing "to make any contractual agreement you want" and occupy "second position" among EMS responders in Greene County.

"We want to be a friend, and everything we offer today, we will [formalize] in a contract," he said.


In October 2012, Nashville-based First Call purchased Allied EMS, another private ambulance provider in Newport and Morristown, and reached an agreement with Cocke County to provide 911 services.

First Call Ambulance Service was founded in 2004. It provides more than 250,000 patient transports annually and operates nearly 250 vehicles in 17 locations across Tennessee, Ohio, and Mississippi, according to the company.

Services affiliated with Medicare in Tennessee have the right "to state their provider," Marion said.

"Our fees under contract are as low as Medicare can allow," he said. "We kind of have a Walmart mentality."


Greene County Attorney Roger Woolsey said that, from the standpoint of Greene County government, EMS "is trying to operate a service and do it as effectively as possible."

A private service could "siphon off all these money calls," meaning non-emergency transportation calls for services such as dialysis, Woolsey said.

"A lot of counties are not happy with their contracted services. Some are happy with other contracted services," Woolsey said.

He said he has spoken with officials from other counties about the possibility of contracting emergency services to a private company.

Woolsey said he found "too many issues."

If the current owners of Life Care were to sell out, the company could decide "to go in a different direction," Woolsey said.

"I think the county has the absolute right to regulate ambulances [within the county]," said Woolsey stated.


Woolsey said that the board's alternatives include making Greene County-Greeneville EMS the exclusive provider of all ambulance services, putting another ambulance service in a "background position," or "contracting the whole thing out and getting out of the business."

The goal "at the end of the day is to provide the best services for our citizens at a price our citizens can afford," he added.

Daniel Wolcott, president and chief executive officer of Takoma Regional Hospital, said he supports local EMS services, but more statistical information is needed to support the assertion that Greene County-Greeneville EMS is providing quality service on both emergency and non-emergency calls.

Additional information will "give the community and providers confidence that we are doing well," Wolcott said.

"I think that, as a prudent governing body, we have that data {and] come back in the future with some more information," he said.


Woolsey said the issue is a "serious matter" and could quickly be resolved by voting to bar other ambulance services from working in Greene County.

But, he said, taking a "protectionism" stance may not be best for citizens.

"We need to explore all options," he said.

Woolsey asked Sayne to gather information about the number of calls made by Greene County-Greeneville EMS, and what the projected losses in revenue would be if other services are allowed to operate here.

Wolcott suggested Life Care "put a proposal together or series of proposals" to be reviewed Jan. 9.

"We can consider it or make a decision at that time," he said.

For more information and stories, see The Greeneville Sun.

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