DUNWOODY, Ga. — After reasserting standards for service six months ago, DeKalb County and Dunwoody remain plagued with emergency ambulance response times below contract requirements.
The issue comes to a head next month when county officials decide whether to switch providers when the current contract expires.
Last fall, Dunwoody signed a memorandum of understanding with DeKalb County stating that the county would station more ambulances in the city, including one at each fire station and a fourth ambulance that would remain in Dunwoody from 9 a.m.-5 p.m. on weekdays. The agreement stated that AMR, the county’s current EMS provider, issue monthly reports to log whether it met response times of 9 minutes or less for 90 percent of advanced life support calls and 15 minutes or less for 90 percent of basic life support calls.
Since the agreement went into effect at the end of October, AMR has failed to meet those time goals, according to data provided by DeKalb County to the City of Dunwoody. In fact, records show an upward trend in response times for life-threatening calls over the past four months in Dunwoody, and there has been no single month when AMR was compliant for both types of calls.
Dunwoody City Councilman Terry Nall has long advocated for better EMS services for Dunwoody, and he remains concerned about ambulance response times, even with improvement since last fall’s agreement with the county.
“DeKalb just isn’t capable of providing for this zone,” he said. “At what point does the state step in and say enough is enough?”
Nall backed his claim by pointing out substantial differences in the county’s agreement with Dunwoody last fall and its recent request for proposals for a new ambulance service provider. The new standards requested in the proposal set response times for life-threatening calls at 12 minutes and for non-life-threatening calls at 30 minutes for 90 percent of calls.
So far, the county has received bids from three providers: EMS Grady, PatientCare Logistics Solutions and AMR.
DeKalb began looking for other EMS providers after years of chronic, lagging ambulance response times. The situation came to a head in May 2018 when Dunwoody declared an EMS emergency with the Georgia Department of Public Health and Office of EMS and Trauma.
Dunwoody was the first city in the country to declare this type of emergency, Nall said. Response times were as high as 30 minutes in some cases, he said. In one instance, when Dunwoody police called for an ambulance that never arrived, officers were forced to transport a patient in their police car after a 40 minute wait time, Police Chief Billy Grogan said.
The proposal issued by DeKalb County for a new ambulance contract favors keeping AMR, Nall said, because there is only a 10-day transition time allotted for a new provider to implement their services.
“The county has an impossible 10-day transition period that favors only the incumbent, AMR,” Nall wrote in an email to City Council members.
Last summer, AMR lost its bid in South Fulton because of slow response times, and the new provider, EMS Grady, was given from May 29 to September 1 to implement its new system for the zone, whose population is close to 200,000. DeKalb County’s zone, which includes the entire county, is more than triple that size, according to census data estimates from July 2018.
However, instead of giving EMS Grady the agreed upon window, AMR pulled its services early, with AMR’s regional director Terence Ramotar providing a plan to pull about half its ambulances by June 30 and the rest by July 31, according to reports from the Atlanta Journal-Constitution.
“There’s nothing stopping them from doing the same in Dunwoody,” Nall said.
AMR was fined more than $1.5 million last May for non-compliant response times by DeKalb County. The county later settled the matter for $600,000, according to reports from the AJC last August. But, DeKalb has not collected on any fines for the last six-month period during AMR’s latest contract extension.
AMR can be fined $1,000 per occurrence for the “Contractor’s inability to follow the system status plan, when the Contractor cannot respond to calls,” terms of the extension state, but AMR has received no penalties since January.
Dunwoody is not the only city affected. No city in DeKalb County saw compliant response times in the first quarter of 2019 for either emergency or non-emergency calls, according to quarterly reports sent to Dunwoody from the county. Dunwoody saw the county’s lowest response times at 12 minutes 15 seconds or less for 90 percent of calls, still more than three minutes slower than the requirement.
All of DeKalb County, the state’s fourth most populous, is one zone for EMS services, Nall said. Fulton County, with a population about 50 percent greater, has five different zones.
One solution, Nall said, would be to create a separate zone north of I-285 that could include Dunwoody and some surrounding areas, even reaching into other counties. But rezoning for ambulance service would need to occur at the state level, or it could be initiated by the county with one or more providers, Nall said.
“[I-]285 acts like a river,” he said, which makes it difficult for ambulances south of I-285 to get where they need to go quickly in Dunwoody.
Since the memorandum of understanding with the county last fall, response times have improved from what they were before, even if they haven’t been compliant with the agreement, Police Chief Grogan said. He said he hasn’t seen or heard complaints as often as before, though response times are still not ideal.
Dunwoody Mayor Denis Shortal agreed.
He cited first responder times for life-threatening calls for 90 percent of calls at 8 minutes 57 seconds or less for the first quarter of 2019. He also cited average response times for life-threatening calls at 7 minutes 11 seconds for April, according to county data from AMR. By contrast, he said, in October of 2018, a month before the agreement with the county started, average response times for life-threatening calls were 9 minutes 51 seconds — a clear improvement, but still not compliant with terms in the agreement.
“We have made great, positive strides,” Shortal said. “I trust the best provider is selected.”
DeKalb County CEO Mike Thurmond will make the decision on the county’s next provider. Shortal said he trusts Thurmond to make the best decision possible.
Nall isn’t convinced.
The biggest determining factor for improved EMS services in Dunwoody, he said, remains the terms of the contract with the county.
In March, during a session with DeKalb County on its bidding process, Nall asked how bidders would serve Dunwoody differently, given its different qualifications.
The county responded:
“The (MOU) with Dunwoody is a separate legally binding agreement between the City of Dunwoody and DeKalb County. The RFP nor any contract that rises from the RFP will impact the existing MOU. The MOU is effective through October 30, 2019 and automatically renewed for successive annual terms.”
However, Nall said the county has not notified bidders that Dunwoody has different response time requirements. The proposal has no mention of Dunwoody or its memorandum of understanding in the entire document, except to show the city on the map of fire stations and territories.
At that same session, a DeKalb County official said that the county had no intention of offering a subsidy for the provider, meaning that if the provider needed additional equipment to meet Dunwoody’s MOU, they would not receive help from the county.
Nall said he still expects the county to adhere to the legally binding memorandum of understanding.
The mayor went further, saying response times could improve with a long-term contract in place and with greater incentives from the county.
It remains possible the state could determine that DeKalb requires multiple zones to resolve ambulance response time issues, but the mayor has his doubts, based on his last dealings with the committee overseeing Dunwoody’s complaint.
“They said they would entertain that, ‘maybe,’” Shortal said.
Every second matters for advanced life support calls, and if AMR, or a different future provider, remain non-compliant, then Dunwoody may have to look to the state to effect greater change.
AMR’s contract is on a six month extension that ends June 30, which also may be renewed for three months extensions as necessary. The EMS council ad hoc committee, who is investigating the DeKalb County EMS ambulance service deficiency, meets again on July 11 at Dunwoody City Hall.