Commissioners push forward with for-profit EMS contract

For County Commissioner Mike Fryar, the issue is very simple: He wants the closest ambulance to pick him up in the event of an emergency.

“I’m like my friend Mr. [Al] Whitesides down there,” Fryar said, pointing down the dais. “I’m getting a little age on me.”

A 22-page report sparked an approximately two hour discussion during a Board of Commissioners meeting on April 17 about the merits of allowing a for-profit EMS system to operate in Buncombe County. Medical Emergency Ambulance, Inc., also called MEDIC, is seeking a franchise that would allow it to respond to incidents outside its current service area, which encompasses the city of Asheville. After a lengthy debate, Commissioners voted 4-3 to have staff draft a contract between the county and MEDIC for future review by the board. Commissioners Brownie Newman, Jasmine Beach-Ferrara and Ellen Frost voted against the move.

MEDIC owner Kermit Tolley said the limitations on the company can tie the hands of 911 dispatchers in Buncombe County — especially when one of MEDIC’s ambulances is closer to the scene of an emergency incident than another ambulance. “We’re not asking to go camp out in anybody’s fire district,” he said. “We don’t want to do that, nobody can afford to do that.” But, especially with recent concern about opioids in Buncombe County, Tolley says he sees value in adding options.

While the company is limited to operating in city limits, MEDIC’s station on Long Shoals Road is located in the county. This means that if an accident happens right outside the station, Tolley said the company can’t technically respond to that incident without the franchise from the county. “That’s ridiculous,” he said.

Tolley said the franchise agreement would allow MEDIC to operate outside the city as backup to EMS services in the county. “All we’re asking for is when an ambulance is out of its area … somebody has to respond to that call,” Tolley told commissioners. “Otherwise it could come from a much greater distance.”

From December to April, Tolley said, MEDIC has responded to 347 calls. “That should tell you the service is needed. Otherwise, we wouldn’t have been sent.” In a followup conversation with Xpress on April 19, Tolley said that total had increased to 360, including calls related to the multiple-victim shooting on the night of April 18 in Asheville.

In light of the report, however, several commissioners were concerned about the impact the franchise would have on fire departments that already dispatch EMS in the county. Newman pointed to a specific passage in the report to illustrate this point.

For example, the report says that if an outside company started responding to about half the calls that the Fairview Fire Department billed in 2017, the station would lose about $131,000 of income.

“If this were to happen, Fairview would most likely need to cut its second ambulance and terminate staff,” the report says. “This change wouldn’t provide any more of a service than is in place now.”

Fairview, like many departments in Buncombe County, receives less money than it bills — only pulling in about $262,000 of the $392,000 that it billed in 2017. The report said the county could mitigate the loss of revenue by allowing Fairview to increase its tax rate by one cent.

“This increase in the tax would allow for more resources, though not needed in that area, but may result in a reduction in response times,” the report says.

Newman said that the question from the beginning was never about the qualifications of MEDIC, which he said is a good company.

“I think the question is whether embedding an expanded for-profit entity within the existing public and nonprofit fire district system makes the system better or somehow undermines it,” he said.

Buncombe County currently has a mixture of public and nonprofit entities that help meet its EMS needs. Newman said he was initially on the fence about this issue, but the report convinced him that this is something the county should be cautious about considering.

“Unless we’re really clear that we’re willing to raise the tax rates in the fire districts to make [fire departments] whole from any diversion of revenue that results from [allowing this franchise],” Newman said, “then this would hurt the existing services out there.”