Decision on ambulance service delayed
Jeff Davis police jurors have postponed making a decision on whether to allow Med Express ambulance service to operate in the parish. The police jurors want additional time to review data on response times, daily patient transport numbers and the financial documents of the applicant.
Acadian Ambulance has been operating exclusively in the parish for the last 45 years. Now Med Express President Mark Majors has presented an application for his company to operate locally. Majors said in addition to adding two ground units to the parish, Med Express would locate offices in Jennings, Welsh and Elton. The Jennings office would be located on the southern side of the city and would also service the Lake Arthur area.
“If we are able to operate here, Jeff Davis will see an immediate improvement in access to care and response times,” Majors said.
The approval of the permit was postponed Feb. 13 so a police jury committee could make sure the Med Express applications met all of the requirements according to the parish’s code of ordinances. That committee includes Police Jury President Donald Woods, police jurors Steve Eastman, John Marceaux, Bill Wild and police juror Marcus Peterson, who is also an employee for Acadian Ambulance. Marceaux was unable to attend the committee’s Wednesday meeting.
During that meeting, Police Jury Attorney David Bruchhaus asked Majors to explain several issues that came to light after reviewing the parish’s ambulance ordinance.
Accreditation
One of the concerns expressed was that the company is not currently accredited by the Commission on Accreditation of Ambulance Services (CAAS).
“The ordinance asks for proof of CAAS accreditation or a demonstrated commitment to working towards that accreditation,” Bruchhaus said.
Majors said his company is currently in the process of obtaining the accreditation in order to meet the requirement, however, he expressed his concern about the necessity of such a certification in the industry.
“It’s no small reason that there are currently only two ambulance services in the state that are accredited by CAAS,” Majors said. “Ordinances with CAAS requirements are anticompetitive and limit the options that a jurisdiction has for ambulance services.”
He said Med Express purchased CAAS templates several years ago that are utilized today in many of their systems and processes.
“From an industry perspective, CAAS has not evolved with the dynamics of health care,” Majors said. “(CAAS) could be doing a better job at addressing issues like performance, such as response times, as well as emerging issues in health care. CAAS does not demand performance. A certificate does nothing when people are waiting 45 minutes for service.”
Establish home office address
Another concern that was discussed was the requirement to provide an address for the home offices. Majors asked the police jury for a provisional permit, however, Bruchhaus said the ordinance requires a permanent location to be provided in the application before approval can be made.
Majors agreed to get a letter of intent stating the address from the landlords of the properties the company intends to use if the application is approved and they are allowed to operate in the parish.
911 compatibility
Jurors asked whether or not Med Express’ communication systems would be compatible with the parish’s current 911 system. Majors assured the committee that the systems would sync up and that any costs associated with the technology would be taken on by Med Express. He promised to include a memorandum with the application stating such.
Public necessity
The parish’s ambulance ordinance requires that there must be a public need for a second service to operate here.
“The police jury, under ordinance, is required to make sure public convenience and necessity is there,” said Bruchhaus. “Is there enough need in the parish for another ambulance service?”
Majors said he believes that from both a business perspective and the consumer’s standpoint, operating here would be beneficial to both parties.
“This is a sustainable structure,” Majors said. “In all of the markets that we share currently, we see a significant decrease in response times. Suddenly the best interest of the patient is the best interest of both companies.”
He said his company would work with Acadian to be sure each patient gets the quickest response possible.
“We often roll calls to each other and work together,” he said. “The market pressures us to do very good work and to work together.”
He also said the savings for both individual and institutional consumers would decrease significantly if Med Express were allowed to operate here.
“The savings at an institutional level are quite significant and can dramatically increase a hospital or other facility’s bottom line” Majors said. “Altering the types of transportation for nonemergency patients drastically reduces costs for all patients.”
Performance of applicant
A final consideration discussed was the past performance of the applicant, as well as the company’s financial solvency, which are also included in the ordinance as a requirement.
Majors had told police jury members when originally presenting the application that Med Express had previously operated in the parish but left as a result of a buyout by another company. However, Majors explained Wednesday that while his company had secured a 90-day occupational permit to operate in Lake Arthur, that permit was at the time denied by the police jury.
“We never operated here because we never obtained a permit,” Majors said. “I was wrong about that.”
Additionally, Bruchhaus brought up the fact that the company in the past had filed for Chapter 11 bankruptcy and owed the Internal Revenue Service (IRS) $2 million dollars.
“When Hurricane Katrina hit, for 20 months we tried to continue providing services, but we ended up having several hundreds of thousands of dollars in payroll taxes,” Majors said. “We kept fighting it, but after five years the penalties and the interest continued to grow so we filed for bankruptcy.”
Majors explained that the bankruptcy was discharged over two years ago and that over the last four years, the company has been on a payment plan to address the debt. He said currently the company only has $380,000 left to pay of the $2 million owed to the IRS.
“Our company is in good shape,” he said. “Our debt equity, borrowing capacity and debt ratios are all very healthy.”
On the same night the decision was originally postponed in Jeff Davis, the Acadia Parish Police Jury voted down approval for a permit from MedExpress 4-3 with one abstention and approved the opportunity for Acadian Ambulance to present how they will improve services to the parish. Majors said he is currently trying to appeal this decision.
On the other hand, Vernon Parish Police Jury approved a non-exclusive permit to work in the parish Feb. 20, stating that the decision was their solution to reports of long response times in rural areas from Acadian Ambulance, the primary provider in the parish.
Acadian Ambulance’s response
Acadian Ambulance Service Regional Vice President Mike Burney said he stands by the company’s belief in a single-service system.
“Adding a second ambulance service does not reduce response times but adds confusion to the parish’s 911 system,” Burney said. “Without knowing where everybody is, the response times will increase, not decrease.”
Burney cited an example where having two companies in the same parish caused confusion.
“Med Express opened a station in Vernon Parish,” he told the jurors. “We had a call at the Walmart in Leesville and an Acadian unit pulled up and saw that Med Express was there, so they left and didn’t transport. It turns out the Med Express employees were just there shopping, and had no idea about the call. This will only cause more confusion.”
Burney also told committee members that the parish doesn’t have enough patients here to warrant another service.
“More ambulance services does not mean there will be more patients. On average we only transport a total around 11 patients per day in Jeff Davis, which includes both emergency and nonemergency patients,” he said.
Bruchhaus asked Burney to provide the committee with more specific data on patient loads in the parish. Peterson asked Burney to present one month of data that breaks down how many are transported in the parish by emergency and non-emergency patients.
One ambulance service willing to be held accountable is better than adding another service, Burney said.
“No one has ever called Acadian Ambulance to complain about response times,” Burney said.
However, committee member Eastman said he has personally received complaints about 18-plusminute response times for emergency patients in the Welsh area, despite the fact that a service station for Acadian is located there.
“Why does it take 18 minutes to get there if there is a substation in Welsh? We have really got to start looking at these response times,” Eastman said.
Burney said that due to low patient loads, there is not always a unit stationed in Welsh, so they have to drive in from Jennings. He said they are currently working to resolve this problem.
“With only 11 patients transported per day, another ambulance company operating here would face the same problems,” he said. “Another service is not needed here and we can work with you to provide the best possible service here.”
Time to hold ambulance companies accountable
Air Evac Program Director Corey Miller also approached the police jury earlier this month saying his company would work with Med Express to provide air and ground ambulance services here. Miller told committee members Wednesday that he has documented incidents where a patient’s care was negatively affected.
“I have documented incidents from multiple families where (Acadian) refused to give us the patient, causing a delay in care,” Miller said. “In Elton on Sunday, Acadian flew an aircraft in from Lafayette instead of us when we were sitting there in Kinder. Y’all need to be holding them accountable. At the end of the day it is about the people.”
Adding a second ambulance service in the parish would also allow residents more choices for services.
“If you have two companies now fighting over 11 patients a day the service will improve and the requests will be prioritized,” said Miller. “The public is going to have a choice regardless of rotation if they request a certain ambulance.”
Miller recommended that members of the committee meet on a quarterly basis to assess performance and hold any ambulance company operating in the parish accountable.
“Somebody needs to be held accountable for these response times and performance,” Miller said. “It is time we do the right thing for the people.”
Ultimately, the committee decided to defer the decision to allow Med Express to operate in the parish so that members could review the data on patient loads and response times requested, confirm Med Express’ bankruptcy status, as well as make a decision with the full committee present, since Marceaux was not to present at the meeting on Wednesday.