Lewis County Board of Commissioners Hears Proposals Regarding Ambulance Service

With the current extension to the contract with Maury Regional to provide Ambulance Service for Lewis County expiring on August 31, 2023, Lewis County government recently publicly requested proposals to provide ambulance service for our community, with Maury Regional and First Call each submitting a proposal. The request is to establish an exclusive contract for a term of three to five years with a qualified ambulance service to proved Advanced Life Support (ALS) and Basic Life Support (BLS) ambulance response for 911 Emergency Calls in Lewis County.

All Ambulance Service Providers who choose to participate must provide a fully integrated, high performance EMS delivery system that provides ambulance response, pre-hospital care, transportation to medical facilities, and related services such as billing, within Lewis County.

During a special called meeting on Monday May 22, 2023, the Lewis County Board of Commissioners heard in-person proposal presentations from both First Call and Maury Regional. All commissioners were present with the exception of Larry Pigg.

County Attorney Jack Heath advised the commission to address, on the record, the competency of both’s services, the ability to respond, response times, and the education, training and experience of the employees, and whether the employees are familiar with the area that they will serve.

Brian Peery sat in for Mayor Jonah Keltner as he was out of town. Commissioner Peery advised Maury Regional to step outside of the courtroom while First Call made their presentation. Representative Scott Yates began by saying, “I know our cost is more than Maury’s. The proposal outlines our capabilities and we believe, justifies this cost.” First Call is part of a larger ambulance company, Priority Ambulance, based in Knoxville, Tennessee, with the closest service being in Franklin County. “We’d be honored to serve this community as we’ve been in Middle Tennessee since 2004,” Yates stated. “We have worked very well with your current provider, Maury Regional and have nothing negative to say about them.”

First Call informed that they transport the client to the nearest appropriate facility. However, they do take into account the long-term care needs of the patient as well as the wishes of their family. When asked if they had looked at real estate in the area, Yates responded, “The highest priority is on the people. We would look for a center near an ambulatory care. We do not have and have not negotiated any property in the area. We’d prefer not to be locked into a long-term location at first due to us not knowing the best, most appropriate location for our services.”

Commissioner Peery asked, “who would be responsible for paying for and building of a facility?” “The county,” said Yates, “is responsible for the property, and that cost is built into our proposal.” Regarding the question of dispatch, it was stated that our dispatch center would contact their location in Nashville to dispatch an ambulance immediately with GPS assistance. He added, “We think it’s very important to have two ambulances running at all times. There should never be a time when you are without an ambulance in Lewis County. We do have mutual aid agreements with surrounding counties.” Concerns raised from the audience were that of location. A Newburg Road resident asked, “are your ambulances accessible down dirt roads?” to which Yates replied, “We do have 4 wheel drive ambulances, and we have selected the fleet that is best built for this terrain and are confident in our choice.”

First Call completed their presentation and stepped outside the court room. Michael Dunavant, who stepped into his role as Director of EMS in 2022, gave a power point presentation of Maury Regional’s proposal. “Maury Regional,” Dunavant began, “exists because of a 1949 state law that states rural communities must have access to 24 hour emergency services. We currently have eight full-time Advanced Emergency Technicians, eight full-time Paramedics, two Advance Life Support units per 24 hour day, and have been fully staffed since November 2022.” Regarding their communications, “We have been designated by the state as a Regional Medical Communications Center, have eight dispatchers who are rotating 12-hour shifts, all staff are Emergency Medical Dispatcher certified, and like First Call, Lewis County 911 transfers call to their own dispatch for EMS to respond.” A power point shown, informs of 24/7 coverage, staffed with paramedics and AEMTs with approximately 2,500 responses per year with an estimated 1,460 transports. Also provided is blood draws for Lewis County jail to prevent transport to Maury Regional Medical Center at no cost.

Commissioner Caleb Feichtinger addressed Dunavant, “The quote we have in front of us is almost 400% more than what we’ve been paying,” to which he replied, “We have been working at a significant loss for some time now. We are having that conversation with Hickman and the other counties as well. This is sort of a “catch-up” from those losses and is an attempt to get closer to a break-even. Ambulances have gone up over 100%.” “Another question,” said Feichtinger, “So, we would buy the facility, put that on Maury Regional property, and then you all would take ownership of that?” Committee Chair Kyle Bobo added, “It is my understanding that your current facility is condemned. Our concern with building another facility is that is will be let go again.” The most current quote for a 6 bedroom facility as requested by Maury Regional is $209,000. Maury Regional also presented a quote for the cost of an ambulance which was $276,913. However, that quote was from October of 2022, and costs for such have gone up.

The rough draft estimates are as follows:

Total Subsidy:

Maury Regional - $1,519,547.00

First Call - $2,601,476.00

There is no additional capital funding requested from First Call.

Capital funding requested by Maury Regional totals $927,764 and includes:

$237,500 for a new EMS Housing Station, $122,593 for New Bays to house EMS units, $276,913 for a new ambulance at 30 months (required), and $290,758 for a new ambulance at 60 months (also required and includes 5% inflation).

Total estimated cost over 5 years:

Maury Regional - $2,447,311

First Call - $2,601,476

Bobo and Feichtinger moved to reject both bids at this time to negotiate each proposal further. All were in favor with the exception of Ragsdale who voted no. “My concern,” said Ragsdale, “was that the bids that were proposed would become higher if we rejected them.”