Since Sept. 1, following the abrupt closure of Johnston Ambulance Service, convalescent transports in Sampson County have been in flux. County officials are seeking to return to a more steady service.
The issue was broached during a Thursday meeting, held as part of an ongoing planning session by the Sampson Board of Commissioners on the county’s various programs, departments and services. Sampson County Emergency Management director Ronald Bass and county attorney Joel Starling provided a recap of the situation and options going forward.
JAS abruptly ceased providing services under their franchise with Sampson as of Sept. 1, giving 24 hours’ notice of their closing. Temporary contracts were inked with five separate agencies to offer transports to local patients. The sudden cessation of services constituted an emergency situation under the county’s franchise ordinance, and memoranda of agreement were drafted for temporary contract services by other providers. In addition, Emergency Management officials worked with volunteer rescue organizations to provide convalescent services in the interim.
“We had these companies come in and do transports for us and volunteers stepped up and did quite a bit of those,” said Bass.
JAS was the largest privately-held ambulance service in North Carolina. After more than 40 years in business, during which it served 17 counties in eastern and central North Carolina, the business was suddenly shut down. That meant locations in a dozen counties were closed down — one on Warsaw Road in Clinton among them — ambulances taken off the road and approximately 400 full- and part-time employees laid off.
Under its franchise, JAS provided between 300-350 non-emergency transports per month in Sampson, including taking patients to and from the hospital and nursing home facilities, inter-hospital transports and transporting patients to doctors’ appointments or dialysis.
JAS could also provide backup emergency transportation if necessary, however JAS typically was utilized in that capacity less than two dozen times per year.
From Sept. 1 through Dec. 31, there were 1,103 transports completed by five temporary contractors to offer advanced and basic life support, including Cape Fear Valley Health System’s Lifelink (364); Pender EMS (260); Bladen EMS (164); and LifeStar out of Winston-Salem (168). North State out of Garner was signed to a temporary contract but performed on a limited basis. Local volunteer squads also conducted 144 transports.
“We had people bow out because it wasn’t feasible for them to maintain a presence here because there wasn’t a large enough call volume to support all five of them,” Starling explained. “Over time, they have moved out of the county. Pender is no longer able to help us out with it and Bladen will not be available after the end of February.”
If that call volume stayed steady, Bass noted, the project call volume would be 3,312 annually, or 276 a month.
There were just four convalescent transports conducted by Sampson County EMS through the end of 2016 compared to 36 in January 2017 alone.
There are two options, Bass explained, the first being to franchise with a private company for convalescent service. There is no cost to the county, and no revenue generated.
The second option would be for the county to conduct convalescent transports. To meet the projected call volume, that would require 12 EMTs, including six paramedic level and six basic. A 13th employee would be needed to schedule the transports. The total cost would be close to $780,000, including benefits. The program would generate additional funding, that amount of which would depend on the transport volume and fee charged.
Bass noted that Harnett, Pender and Bladen each provide their own convalescent services. Harnett officials said they responded to over 8,400 calls in 2016 utilizing three ambulances, generating $200,000. Cost per call was about $125, while $147 was collected. Bass said Wayne County also went to convalescent services, but it took six years to finally turn a profit.
Bass ultimately recommended that the franchise contracts be modified somewhat, incorporating the EMS operations chief and the Sampson County training officer into the wording of the agreements. Bass said that would assist in keeping communication open and addressing any issues with hospital officials and the general public. He called it a “quality management” issue.
The convalescent transport ordinance, originally adopted in 2000, was amended in 2005. The proposal would be another amendment, Starling said.
“We want to go forward with the notice to get people to file an application, so by the time we get the franchise amended we can immediately do the evaluation,” county manager Ed Causey said.
Starling said the two positions — EMS operations chief and training officer — could be nominated provisionally at the board’s March meeting, and then a public hearing could be held at a later date. There is no deadline for the hearing, but within 30 days of the hearing, an applicant would have to be told yes or no.
“Pender and Bladen have indicated they are not in a position to do this long term,” said Starling. We have three potential outfits that are potentially interested in entering into a formal franchise with us. It doesn’t have to be exclusive to one company.”
“I would be hesitant to have just one,” Bass added. “I would want to have a backup.”
Starling said it is an unusual RFP (request for proposals) in that there is no price point. Assistant county manager Susan Holder pointed out that it would have to be cost-effective for a company to come in and conduct convalescent transports. Bass noted that he already had one company in mind.
The board subsequently gave its blessing to move forward, directing staff to put out an RFP for convalescent transports.
Following the JAS announcement, Sampson Regional Medical Center officials said the hospital’s patients have depended on JAS for medical transport. Bass said it has been an ordeal since the beginning of September.
“Johnston Ambulance Service did a great job,” Bass remarked. “We really didn’t have convalescents to worry about, but when they ceased operations, we were in a completely different ballgame.”
