Under Georgia’s home rule for local government, cities can set tax rates, launch police forces, adopt zoning laws and contract for sanitation. But they have little say in who transports their residents to the hospital.
Two north metro cities are questioning that set-up, arguing they should be able to choose their own ambulance providers.
At stake are the governments’ ability to select emergency services that best suit them and possibly save residents and taxpayers millions of dollars in emergency care costs.
Johns Creek has refused to sign a contract with its only ambulance provider in protest and officials in Kennesaw want to know why the state forced them to switch from a local provider to one selected by a state-governed board.
“Not only does it frustrate me, but it is a matter of life and death,” Kennesaw City Councilwoman Cris Eaton Welsh said. “It’s being dictated to us from the state. We know best what needs to happen in our own boundaries.”
Ambulance service falls under the Georgia Department of Public Health, which has 10 regional EMS councils that administer local service and assign coverage areas. Council members are appointed by county governments and by health officials.
Region 3, which covers eight metro Atlanta counties, has 27 members, including county fire officials, medical professionals and representatives from three ambulance companies.
Both Rural Metro Ambulance, which serves Fulton County outside Atlanta, and Metro Atlanta Ambulance, which serves most of Cobb County, have representatives on the Region 3 EMS Council.
Which ambulance service is assigned to an area can make hundreds of dollars difference in patients’ bills.
Basic transport fees can range from $470 in Douglas County to the $1,600 Grady Hospital charges in Atlanta.
Gwinnett and Douglas counties operate their own ambulance service through their fire departments. But such an enterprise is beyond the financial means of most cities and is outside the interests of most counties.
Cobb County uses two companies for ambulance service. DeKalb County still operates its own ambulance service but outsources some coverage with Rural Metro Ambulance.
Johns Creek balked at its new contract with Rural Metro this month when city officials complained they were powerless to change providers. But it’s doubtful Rural Metro will lose Johns Creek’s business. By law, it is the only licensed provider in Fulton County, outside of Atlanta.
Johns Creek is petitioning the regional EMS board for other options.
Tony Anteau, division general manager for Rural Metro, said he is in talks with the city to craft a plan for improved response times. The city is exploring a deal in which it could use its two quick-response vehicles to transport patients for Rural Metro, then receive reimbursement from the company.
“We’re trying to get the best arrangement in terms of response times and cost for our citizens,” City Manager John Kachmar said.
Anteau said Rural Metro is doing all it can with the fees it receives to equip and staff the area. Officials in Roswell and Alpharetta have said the company provides quality, on-time service.
Rural Metro’s new contract with Roswell, Alpharetta, Mountain Park, Milton and Johns Creek calls for eliminating city subsidies totaling more than $1 million each year. In return, the company will increase rates for patients by about 40 percent.
Anteau also said that while the state system for ambulance coverage may not sit well with some cities, it makes sense.
“If you were to allow cities, on their own, to put transport units into the system, it would leave the unincorporated areas with no one wanting to service them,” he said. “They don’t have the volume.”
Meanwhile, Kennesaw officials are at odds with each other over their service.
Up until last July, the north Cobb city had defied a 1998 court order to comply with the Region 3 EMS plan assigning Metro Atlanta Ambulance Service to the area. Instead, the city’s 911 system dispatched calls to locally operated Georgia EMS Ambulance.
Things came to a head last spring when MAAS complained to the state that Georgia EMS was pirating its calls for service.
MAAS president and CEO Pete Quinones said the Region 3 Council, of which he is a member, assigns services based on economy, efficiency and the public welfare.
“There’s a broad spectrum of representation on the councils,” he said. “Seventy percent of [the membership] is appointed by the government and the rest are appointed by health directors of the different counties.”
But Kennesaw City Councilman Bruce Jenkins said that is no substitute for local control.
“We are not 70 miles down the road at the state Capitol,” he said. “We are here and we’re understanding what our people’s needs are.”
