Committee meeting of the Mobile City Council.

Today we are here with our committee members Samantha Ingram and Corey Penn, as well as other members of the council.

And the topic of this meeting today is on the proposal for a certificate of necessity and convenience for a proposed ambulance service to come into the city mobile.

Before we get started, just want to let everybody know we're going to try our best to keep this meeting to an hour.

Some of us have meetings already scheduled at two o'clock and we're already running behind.

Also, we will allow one speaker per, I guess, entity or side if you have it to speak.

We'll ask if you try to keep your comments brief and to the point.

I know we've already heard from some of you before.

There can be question and answer, however, um time set aside for for council members.

So as we get started, I'm going to ask our attorney if he will just provide for us the definition of the certificate of necessity for any ambulance or medical transport service.

That kind of gets us to the reason that we are here today to listen to the reasons to approve this proposal.

So Jonathan, if you will get started, and then we'll go down the list with Chief Glesson coming up after you.

Yes, Madam Vice President.

So pursuant to the municipal code.

Can you get closer to the microphone so we can pursuant to the municipal code?

Uh the purpose of the public hearing for a certificate of public convenience and necessity.

There are six factors to be looked at.

The first, whether or not the public convenience and necessity require the operation of such ambulance or ambulances, to whether the applicant will be able to provide ambulance service of such we're having trouble hearing you.

Can you bring bring it up closer to you?

There you go.

No, other one.

It's it's ready.

Can y'all hear me?

No.

Can you all hear in the back?

No.

Might have to hold any hand.

How about now?

Yeah.

Okay.

Okay, why don't you start over?

Yeah, absolutely.

Okay.

So pursuant to section 634 of the municipal code, the purpose of the public hearing uh for a public convenience and necessity.

Uh there are six factors.

One, whether or not the public convenience and necessity require the operation of such ambulance or ambulances.

Two, whether the applicant will be able to provide ambulance service of such permanence and quality as to best serve the public interest.

Three, the experience that the applicant has had in rendering ambulance service for the past experience of the applicant and satisfying judgments, if any, to claimants as a result of injuries received by reason of negligent operation of the ambulance.

Five, the financial ability of the applicant to respond to damages to property resulting from the negligent operation of an ambulance, and six, the character and condition of the ambulances and capabilities of ambulance attendant personnel to be used by the proposed ambulance business.

And uh Lana has just handed out some more information on the municipal code if you want to go back and check on that.

Chief Glisson is here.

We asked the chief to come and fill us in on several things, starting out with how we got here in the first place, give us some background on the need and their research going forward, um, and any other details that we need to know about what's happening in the city in regard to um ambulance uh support that we have and how you see us moving forward, Chief.

Good afternoon.

So to first answer the question while we're here, he just read the ordinance and while we the certificate of necessity had to be completed.

Um, and that's part of chapter six of the ordinance and uh section 631.

And um, so we provided everything with his application.

This should have been with the um the application that y'all have as well, uh our letter where we did all of the background checks and uh our review of their application, and we found everything to be truthful um with the application that they applied for.

Um currently with Newman's and Medebac, um, they are meeting our requirements for the city.

Um they are meeting the 90th percentile that response reliability that we require, and they have done so for the last six months.

Um that should have been information that y'all received.

Uh, we went back from December of 25 back through July of 25, and we show all of that information.

Um so some of these improvements have been because of uh enhanced communications between MFRD and the BLS providers, and also coordinating with local hospitals to relieve some of the wall time issues that we uh have effectively changed back in May.

Um additionally, another reason why I believe Arcadian is here is we have a letter um from Spring Hill Medical Hospital uh to um Chief Barber when he was chief of staff, and that was back in March of 18.

And then we talked to the um Arcadian came to us with wanting to apply for the certificate of necessity.

Uh, we went through our application process.

We actually had to redo that process to make sure that it aligned with what the city has in the ordinance.

So through back and forth, we got everything fixed and the new application, they filled that out.

We did the background on that, and then that's why we're here at this point today.

So before you just to reiterate, this all really got started with a letter from Spring Hill Hospital uh asking Chief Barber to consider a certificate for Acadian because they saw a need.

Yes, ma'am.

And it just kind of went from there.

Okay.

Yes, to the best of my knowledge, that is exactly how this happened.

Um so as of right now, um, like I said, our BLS transports for mobile fire rescue are being met.

So you know, there's no current operational failures that uh indicate any unmet needs for additional ambulance services for the BLS transport for the city of Mobile Fire Rescue.

And this was going back, what did you say?

Six months?

Yes, ma'am.

Six months.

And and how do you how do you measure that?

I know we've got the information, some was maybe under 90%, some was above 90%.

Correct.

So what we look at is their response reliability, the number of calls that they are given on a daily basis.

If they answer that call or if they are not able to answer that call, then that's how we create or calculate those uh percentages.

And they do that on a daily basis, and these are monthly calculations.

Um I know in the last seven months or six months, we've had a little over 7,000 BLS calls, and only a hundred of those in the last six months had not been answered by one of the BLS companies.

So that equates pretty closely to our overall percentage.

Some of them were called that were canceled, but there were about a hundred calls that we had to send our units.

And not to confuse the issue, but I guess I will.

Um, there is an RFP that has been talked about, possibly going out.

What does this have to do with the potential of an RFP?

So with the RFP, what we're looking at there um is to provide it a single provider to provide the BLS coverage to the City of Mobile Fire Rescue Department.

And it would be basic life support, yes, ma'am.

So that is currently we've been on hold trying to figure out some additional issues because the EMS system with the city of Mobile is so fragile.

We want to make sure that we're doing the right things at the beginning of this uh new contract um so that we don't have issues uh in the f in the in the future where something fails, and now we've got to try to redevelop um or get other companies back in here to uh to do this process.

Okay, any other questions for the chief?

Um councilman Penn.

Thank you, um Vice President Gregory.

Um Chief, um, you stated that currently the mobile fire rescue department based on our ordinance.

Um the BL response is being met, correct?

Yes, sir.

Our needs are being met at this time.

So with the RFP process, um, would that add more additional for a single person?

That means single um group or organization with our company, would they add more would that change the BL process?

Like the percentage.

So essentially they would still that one company would have to meet the 90th percentile to not void a contract, and that's what we're trying to figure out is what does that look like?

Um, but essentially that would only be for one company to handle all of the calls, and they would enter into that agreement um knowing that they had to meet that, or there would be a penalty.

And so currently, what how does it look, how it works right now?

So currently we operate strictly under the ordinance itself, and there's really not a a clause in there to have a penalty when that happens when they drop below a certain period of the reliability.

So we're trying to make sure that this ordinance gets addressed um along with the contract.

Okay, thank you, Chief.

Councilwoman Ingram.

Thank you, madam, vice president.

My question is for the RFP process, is there a requirement in terms of what um as it relates to the um certificate to apply for the RFP?

Is that part of the requirement process?

No.

To answer that question, uh so what we would have to do is part of the contract, they would be issued the certificate of necessity as part of a contract.

Okay.

Thank you.

Yes, ma'am.

All right.

Councilman Woods.

Thank you.

Um a couple questions, Chief.

Uh, just to kind of paint the picture of where we are.

Um, obviously, uh, if you have a certificate of a public convenience and necessity, um, and you know, it's awarded by the by the council, um, you have to you have to participate in BLS calls.

I mean, that's correct.

Um, and then uh, you know, that being said, uh also too, there is that transport aspect, and I'm I'm sure that as a as fire chief, you're not keeping up with where they are on transports, I guess.

Um kind of based on what we're seeing here with Spring Hill, it's saying that I guess not necessarily, you know, from a city side, we're we're meeting the we're we're getting what we need, or we're we're getting what's mandated out of them, and they're performing, I guess, it to anywhere from a 90 to a 95% rate for BLS.

But um, I guess the I guess this the I guess the source of this conversation is is I guess that our local medical centers are saying they need more, need more transports.

Um and but with that being said, uh, you know, kind of going out, kind of looking at the whole picture, because I really don't think you could look at this as a as a BLS as a transport um uh case by case.

Um in reality, they all kind of are intertwined and and working together.

What you're working towards, or in my understanding, right, what you're working towards is is solving um solving the responsibility of government of providing that public safety.

So we're we're trying to lock down and figure out the best way for for us to perform uh up to that 90, 95% level, if not better, on a BLS side, but meanwhile, pr uh possibly freeing up assets for for transports, which you know, domino effect back to the hospitals having wall time kind of kind of is that is that kind of the picture where you're trying to get to, I guess, or yeah.

So, like our focus is gonna be community members, right?

And we want to make sure that when they call 911, whether it be for ALS service or BLS service, that we're gonna have the resources to respond to our community members and make sure that we're answering that.

Now, with the ordinance and how it has this requirement for the certificate of necessity with the transports, um, anything that originates from inside the city to outside the city, they have to have a certificate of necessity.

And so this is where the hospital's claim with that, and I think it gets back to them having some resources available to them.

Gotcha.

And then um, my last question, or really two questions, um, whatever changes that you you implement.

Uh I know we've been kind of we we've laid over uh we've laid over this application.

I guess this would maybe the third or fourth time we've laid this over um and and been kind of working through, you've been working through this.

Um, I believe it kind of even started maybe with the previous administration.

Correct.

Um, so that being said, what what is kind of the outlook of where we're gonna start when when can we anticipate maybe something coming from um you guys in the administration to to kind of arrive on on agenda as far as an ordinance and any type of changes, and then um I'll ask my last question after that.

So I would say that you know between the holidays, the administration change that we've had to make some adjustments to the RFP piece, and uh we're trying to finalize that as we speak.

So we're hoping within a couple of weeks that we have that in place.

Gotcha.

And then on my last question, uh, to your knowledge, because uh based on how the the ordinance currently sits, uh there's really no one per se that you know every morning wakes up and looks at these certificates that are outstanding that we've always issued.

And then also too, it kind of appears based on my reading or understanding of the ordinance, there's really if if you have a certificate you pull out of the city, really you still got that certificate as long as you check a couple boxes, you can all the time hop back in.

So, with that being said, to your knowledge, and you know, because you've done the most research out of all this, uh, how many certificates do we have hanging out there?

I guess so.

To my knowledge, um, I believe we only have three because really um AMR or lifeguard would still have one currently.

Um Metabac and then Newman's is grandfathered in.

Um, however, like I said, when we look at this ordinance, there needs to be some issues that looked at that because right now there's a 10-year expiration on these ordinances or on the certificate.

So you have 10 years before that expires.

And so we've looked at some issues on how we need to address some of that.

Gotcha.

That answers everything.

Thank you.

All right.

Anyone else?

Mr.

Filman.

Thank you, Chief.

Um to your knowledge, have you heard from any other hospitals who have expressed any kind of interest, like Springhill did previously, saying they could um benefit from the transport services?

So I know that we've got some hospitals represented here today.

Um, but I know that uh we did reach out to the hospitals.

Um again, this is one of the things that I feel like we lack from the fire department side is the ability to track those number of transports.

So we don't know what that volume is for each hospital.

And that's some of the things that I feel like we need to have changed in the ordinance itself so that we can track that because we don't understand that load.

We understand what the load is on the BLS side, but there has been mixed reviews from the hospitals.

Some say that they have everything they need, where others say that they would like to see some additional resources possible.

But it is mixed, it's not councilman small.

Uh um, Madam Chair.

Uh, since we have the hospitals here present, is it possible we could hear from them?

Yeah, we will.

I wanted to go around the table first.

Um, Councilman Reynolds, do you want to?

I don't know.

You want to wait?

Okay.

We are going to allow for speakers, Chief Clisten.

Is that all you had?

Or yes, ma'am.

Unless y'all have other questions and if I need to come back out and answer something, just let me know.

All right.

Well, we'll go ahead and start with the speakers.

And since we do have some representatives here from the hospitals, if uh you all want to come to the podium, I recognize USA is here.

Anyone else?

No other hospitals.

Just one.

In the in the back, someone just raised a hand.

Mobile infirmary.

Mobile infirmary.

Okay.

Why don't we go ahead and start?

If you would just introduce yourself before you start.

Thank you.

Thank you.

Uh Danny Rickert, USA Health, uh, title of chief policy officer.

Um, from USA standpoint, as a level one trauma center, especially at university hospital, it is imperative for us to be able to keep our uh stay off of diversion.

Uh diversion occurs when we don't have any room in the hospital and we're unable to take any uh any transports.

Um, I think the uh council members had the point correct.

It is really about transport, not the BLS part of it.

Um, you know, we are rarely on diversion for some uh for some of the stroke or or things like that, but we are on diversion for is because we can't move people out of the hospital.

So we were on diversion, we are typically on diversion about a thousand hours uh over the last couple of years.

Uh so you add that up, and that uh that equates to probably somewhere range of about 2,000 patients that we are unable to see.

Now it's uh it's a complicated subject when we go into diversion, uh transport is a component of it.

So to the extent that there is more service available for transport, that is something that we would welcome.

Quick question when you say diversion, I think we probably know what it means, but if you would explain what the diversion is and what that actually means in your hospital.

What that means within the hospital is that we cannot take a we basically say to the uh to the ambulance services, whether it's mobile fire rescue newman's, whoever, that we are currently closed, you cannot bring a patient to our hospital because we have no room available for them either, because the emergency room is already full, uh, mostly because the emergency room is full and we've already got patients stacked up in the hallways and nowhere to put them into a bed.

What we need is the ability to transport our patients from the hospital from a bed when they're ready for discharge to their end um wherever their end place is going to be, whether that's a rehab facility or whether it's uh uh back home or whatever the case may be.

And so again, back to the point, it's not necessarily on the front end, it is the transport trying to make sure that we have access to enough transport to get them out of our hospital so we can stay off of diversion and so we can take in new patients.

So really that that hurts your bottom line as well, because you're not able to get the patients who need to go home or somewhere else out of the hospital, so you can bring the new patients in, which of course is uh a problem for those patients who need to come in and get care.

So it's just a that is absolutely true.

It's both the bottom line issue and also a you know just quality of care issue.

I mean, again, uh given the fact that we are the the level one trauma center and uh regional academic health center, there are services that only we can provide within this community.

We've got great services within the other hospitals, but there are certain things that they can't do that we can do.

And to the extent that we don't uh have the ability to accept a patient, then that is causing a quality of life issue for them, and they have to be transported out of this community.

I had an example just the other day where we were on diversion uh where a friend was uh from Chatham, appendicitis.

They were actually transferred to Sacred Heart because there was nowhere in the city of Mobile.

We were all on diversion at the same time.

That was about a week and a half ago.

Yeah, that's incredible.

Yep.

Okay.

Uh council members.

Councilman.

We're on diversion in that case as a result of not having transportation services.

Hard to say, councilman, whether that that may not be the only reason at that time.

I mean, the reason is is because we're full.

The reason why we're full is is uh a multifaceted issue, including transport.

Um who pays so it for these transports?

The university?

Uh typically the patient would.

And y'all are just like playing the bellhop.

Yeah, we're we're basically just a uh trying to uh be the traffic uh cop and trying to get them to the right place.

The idea of health care, and the reason why part of the reason why healthcare is so expensive is that you want to make sure that people are at the right place at the right time for the right type of care.

We don't need a patient sitting in the hospital uh that is just really sitting there waiting for a transport to get back home or to get to a rehab facility or to a nursing home, wherever the case may be.

We are very uh highly intensive, very high cost place to be just holding a patient.

Of course.

Are you does the university call and order the transport?

Typically, yes.

Okay, yeah.

Part social workers are are are working to discharge or discharge nurses.

Okay.

All right.

Councilman.

Oh, go ahead.

Councilman Small, go ahead.

Yeah, I can testify to what he stated.

I had a low one at USA last back in November.

Talking to you.

And uh pretty much um, I think it was after three o'clock.

They were one to go to transfer to Crown Nurse Home.

I couldn't get transferred because it wasn't no you know, vehicles available.

I guess it was after three o'clock and et cetera.

So I can testify to what you're saying.

Okay.

Councilman Penn.

Yes.

Um, so you um stated that um of course the hospital has to call for the transportation, right?

So is it a certain company that you call?

Like what's the process?

Because we have two companies right now.

Like what's the process of choosing who to call or how that works?

I personally don't have that level of information how they make that decision on who to call.

Uh, I just know that that, you know, whatever the ambulance services that are available in this community, those are the calls that are made until we get somebody.

Okay.

Thank you.

Councilman Woods.

Uh yes, thank you.

Um, just out of curiosity, is there uh obviously diversion, um, depending on, I guess, what the what the day looks like uh across the city, diversion can happen.

You can be on diversion for five minutes, you'd be on diversion for hours.

Um, traditionally, I guess at your your facilities, um, what's a typical diversion?

Is there is there a typical diversion?

Are we we looking at five hours, two hours, one hour, and then also uh frequency, I mean, maybe throughout the week is and then is there certain times of day that we tend to go on diversity?

Um good questions, councilman.

Uh, I don't have that again, that level of specificity on how often it occurs.

It's typically, I mean, it can happen upwards of once a week.

Uh, it really depends.

It is a it's a multifaceted issue.

I mean, there's a lot of things going on.

Uh, you know, it depends on you know, flu season.

I mean, you got a lot of people in for upper respiratory and flu, and so it's busier than it normally would be.

Uh, it could be that we've got uh patients in for longer length of stay and and are unable to get those out for whatever uh reason, whether that's transport or there's nowhere to place them, and that could cause it.

Uh, you know, it can be it, it is it is um uh kind of a moving target.

It can be for just as short of time as you said for an hour.

Uh it can be as long as hours, uh, depending on how quickly we can move them through the system.

So it's hard to really pin it down.

Uh, I could get you some further information to get back to you.

Uh unfortunately I don't have that level of detail.

Sure.

Okay.

Anybody else?

Thank you, Mr.

Rickard.

So basically on average, a thousand hours a year.

Approximately, yes.

So 2,000 patients.

So I mean, it would seem the more available transports you have, or the less stressed transports you have, you'd be able to turn more beds and have that people would have more access to care.

That is the we we average uh just under two uh two emergency vehicles to university hospital per hour.

Okay.

So that just kind of gives you an idea.

We're probably getting about 48 transports a day.

Yeah, so it seems into the into the emergency.

It's obviously case by case, and it's season by season, like you said, but at some point there's going to be diversion.

I mean, you're absolutely you can't prevent that.

But being able to get people in and out is a quality of care thing.

So the more access you have to the transport, it helps you, it helps infirmary, it helps it helps everybody, regardless if they need a level one trauma or not.

Correct.

And and obviously it helps the patient most because they're getting to the right place at the right at the right time which is the ultimate goal.

Right.

Okay.

Thank you.

Yes, sir.

Any anybody else?

Thank you, Mr.

Rickard, appreciate it.

And mobile infirmary representative in the back.

I'm Kelly Hicks.

I'm the director of emergency services for uh Mabel Infirmary.

I really had not intended on speaking, but from our point of view, we have the transport services that we need.

Um I've collaborated with our case management director and from an inpatient side on getting our patients out of the hospital.

They feel like our needs have been met by the services that we currently have.

Um transporting patients out of the emergency room.

I feel that we also have the services that we need.

Um, our patients rarely wait um an extended amount of time.

Occasionally they will if they have to go out of state or or an extended trip out of town, but usually we schedule those.

A lot of our inpatient discharges are scheduled for their transports, and so we find that we can set that expectation with the family and they understand when their loved ones should be leaving.

And so what we feel as an organization is that our needs are currently being met.

Okay.

Any any questions?

All right, great.

Thank you.

All righty.

Well, moving along then, uh, we have some representatives who were here today from Acadian, I know, and then also I believe the uh other uh ambulance services in town, Newman's medvach.

Well, since Acadian is uh requesting the certificate, why don't we have you guys come up or one speaker come up and go through the process why you're here, why we should approve this uh certificate for you all, and we'll just go from there.

Yes, madam chair, thank you.

And uh Mr.

Penn and Dr.

Ingham, thank you for the opportunity, other council members to be here.

Can y'all hear me okay?

Yeah, the the audio here is just not very good.

I'm sure you've noticed that.

Yeah, you had it on.

It's just that you got us get right into that microphone.

Try not to be technically challenged, but thank you.

Uh with the respect of what has been said today, we certainly honor and respect what Chief Liston said, and of course, the representatives from the other hospitals.

Our concern and what we feel why we're here today is what we understood was going on prior to our threat to come into the community.

We feel very strongly that the improvement is uh largely based on that, and the fact that uh it was no secret that we were trying to come into the community and the other services decide to try to get and get things right.

And I don't mean that in a disrespect to the other services at all.

I have a lot of respect for the other services, especially Newman's.

They've been doing this for a very long time.

But I would encourage you all to please look beyond the six months to see what was going on.

Our needs and understanding of the necessity was based on um information that we got from the fire department back then, which was about 40 to 45% of the BLS calls were not being met.

And I certainly respect what has been said today.

But again, I'll go back to the point of we feel that that current needs being met is because we have made known that we want it to come into the market.

So I just want to make sure that I'm being respectful with that information and uh and encourage you all to please look because what happens if we don't get a certificate, or what happens if that third certificate is not used.

Obviously, there's three certificates out there, so there is some type of need and necessity.

Um so is it a temporary approvement or not?

I I don't really know that, but I I personally question it for being that doing this for as long as that I have.

And again, I say that statement with all due respect.

Our service and what we're gonna bring to the community is gonna help with the gentleman that said from USA on three put throughput processes.

We dedicate resources.

We have a model that works both in the system of the hospitals to encourage throughput and to help make throughput efficient.

We also for the BLS response and getting out in the community and solving those issues as well.

It is a model that works very, very well.

Yes, another service was here and they left.

Sometimes it's not necessarily the market, it may be their model, it may be a certain ambulance services and the way they do business.

We have thrived in other markets where those types of services have pulled out, and the model works very, very well.

When you collaborate with the hospitals, you collaborate with the fire department, and you collaborate with the community.

And the other piece that I really want to talk about is the workforce development and what we're gonna bring to the table, not just the collaboration with all of the public services, including the hospitals, but the collaboration with the high schools, the collaboration with the vote schools because there is a national shortage of EMS personnel.

There's a national sort of health care personnel to begin with.

We feel that what we've done to aggressively pursue community involvement and workforce and development is going to help solve that problem.

Our position is not to come in and take from other people.

Our people, we want to start with our own core employees that we have because we're right next door in Jackson County, and then we're gonna work with very aggressively with the high schools and the vote schools.

We've already reached out to USA and we've already reached out to Coastal Community College, and we are going to help supplement their programs.

We're not here to take over their programs, we're here to supplement and put as many people in the seats as we can to solve this shortage problem.

I firmly believe that the hospital issues that do exist have something to do with a shortage of EMTs.

Acadian has chosen to attack that problem with training and workforce development, and that is what we're going to bring to the community.

And we feel that that is incredibly important to solve these issues to get these patients where they need to be in a very timely manner and not saturate the hospitals but actually unsaturate them because it's it's a coordinated move.

And the gentleman's right, it's not just about you know transporting the ambulances, but it's also making sure that you're coordinating with the hospitals and you're devoting those resources that they need at the proper times in order to anticipate those busy times so you have enough resources on the road.

I feel in closing, and and then madam chair, will we have an opportunity to come back and rebut if there's anything else that comes up that I haven't covered today?

If if one of the if any of the council members would like to have you come back to the podium, that's fine or ask you any other questions.

That's that's perfectly fine.

But for right now, we're just having you speak and then we can ask questions.

Yeah.

You know, Mobile City Fire took the opportunity to become CAS accredited.

I think CAS accreditation is very, very important.

It covers three of the six issues of what the ordinance brings up.

I would think that you would want your ambulance service that's out there CAS accredited as well.

And that is another thing that we bring to the table.

I've watched these council meetings over time and how progressive the city of Mobile and how much it's growing.

And we want to desperately be a part of that.

Uh, we think this is a uh a good decision uh for everybody.

We don't just run around to see where we can find a place to stick a flag.

We like to try to go to places that are a good fit for everybody.

Um, so we think um we're gonna make this decision a proud one for you all, and you're gonna back look back on it one day.

And thank you for your time to speak.

All right, thank you.

Uh council, any questions?

Mr.

Woods.

Um, thanks again for coming out of the day.

And uh I know that y'all have been closely following this, and uh uh hopefully uh hopefully here we'll we'll get this all sorted out so we don't make you keep coming down back back back.

Um because I I definitely hate that.

Um just a question I kind of have.

Um obviously mobile is a very unique model.

Uh when it or if you want to transport, then you gotta participate in BLS.

And um is there uh you know, I and I know that y'all y'all are contracted other places um to handle just BOS.

Uh is there is there anywhere that you're that you guys are that you work or that you that you participate in where you're or you're running BOS and um transports kind of at the same time.

Every area that we serve in the four states, we are a multi-service BLS and ALS and what you call CCT.

CCT is critical care transports, ventilators, many med pumps and stuff like that.

So, yes, sir, to answer your question, it's every area that we serve.

Gotcha.

Okay, thank you.

Thank you.

And I enjoyed coming down here, by the way.

Thanks.

Council, any other questions?

Anyone?

All right, great.

Um thank you, ma'am.

Thank you.

Let's see.

Do we have anybody here from uh Medivac or Newman's who would like to speak or any other services?

Good afternoon.

I'm Corey Hughes, I'm the owner of Medivac Ambulance Service.

Um actually, we're doing really well in O'Beal at this point.

If you remember about a year ago, I came to the council with a problem.

Basically, we had so much abuse in the system that it was taking over the system.

We had people running back and forth in the ambulance literally the entirety of the day.

I had one patient in that year that cost us over $650,000 in unreencooped ambulance bills, just going back and forth all day long.

I have worked with the city of Mobile, the fire department, and we have dramatically improved that process.

I can't say that abuse doesn't happen.

It certainly does, it happens everywhere, but we don't have people hijacking the ambulance for the length of the day.

That, along with adding resources, working together with Newman's, also a locally owned ambulance company, has brought us to where we are.

Our results are not temporary, they are not fleeting.

The letter that came from Spring Hill was from 2018.

That was the letter that helped us get into Mobile.

And it was bad then.

There were flying people from Spring Hill to USA because they couldn't get an ambulance.

I don't see Spring Hill here today.

We serve Spring Hill.

From whom?

Spring Hill.

But from whom?

He's not there anymore.

Yeah, I know, but but that's what precipitated okay.

Well, I can tell you that Spring Hill's needs are met.

I I you know they don't wait on ambulances.

We wait on Spring Hill a lot more than Spring Hill waits on us.

Um the reality of it is is it is a complicated issue.

All right.

The transports, the parts that we're having problems with, that's where our money actually comes from.

Why would we leave our money on the table?

It isn't the nine one calls, it's the transfers.

Obviously, they should be our priority.

That's where who pays us is the transfers.

So the reason that we have such problems is is because the 911 load can be at times so bad that it causes problems with the transfers.

That's fine.

But the problem is we'd add more ambulances if there were money to add ambulances.

We are not reimbursed directly by the hospitals generally.

We are on these 9-1 calls, not generally reimbursed by anybody.

If we spend three hours waiting on PD to get there for a dog bite, and then they cancel us, we eat that cost and we eat it every day.

Now, again, that's where we've been working with the City Mobile and the fire department to minimize those hours wasted.

And it's helped, it's helped immensely.

It's made it from where this is impossible to where this is merely difficult.

And we appreciate them.

And we work with our hospital partners to improve the wall time because again, if we can't get them out of the emergency room to run the next call, we can't come and get them off the floor.

And and it's one thing after another.

I wish it was as simple as it sounds like.

Oh, let's add another ambulance service.

That'll fix it.

It won't.

Because somebody's got to pay for this in the end.

And and that's the problem.

If there were another dime to put in this, I'd put it in.

And Acadian's not going to come here to lose money.

Simple as that.

We're not making money on this.

Every dollar that we make here goes back right here.

If they start becoming profitable here, it goes into the next operation.

It goes back to Baton Rouge, it goes forever.

Here, it stays here.

And no one's being flown from Spring Hill to USA ever.

It's not happening.

Now, are there still problems?

Sure, there are.

At two o'clock in the morning, it is really hard to get a paramedic to take somebody to Birmingham at the drop of a hat.

They're ought to quit over it.

It happens.

Happens every week.

More often than not, I have to do it myself.

Because I'm the only one that can't quit.

Now, USA's problems, I get it.

It's challenging.

And we've actually reached out to back Newman's.

Hey, we'll help you.

And that happened only a few weeks ago.

But USA has never previous to that called us to say, hey, we're backed up.

Come get this patient.

No, they've never.

Not one time.

They have a contract with Newman's, they use Newman's.

That's fine.

Newman's has been here a long time.

They're doing the best they can for them.

But again, it's a heavy load at times.

And while we're running these 9-1 calls and waiting for three hours, it's tough to put up another truck that we're not going to get paid for.

So yes, big company, lots of money.

I get it.

But this is the market as it is.

It's not simple.

It's not easy.

And there are no magic answers to it.

And adding an extra ambulance.

I think I read directly from Acadian's website to you the last time.

Adding more ambulance services does not equal adding more ambulances.

This is what can afford to be ran.

And that's all that can be afforded to be ran.

Newman's, I'm sorry, USA has their own ambulances.

A couple of years ago, this council allowed them to have their own ambulances.

If they were back that backed up, they could take people home themselves.

That's one of the extra complications of this market.

And there are lots of complications this market.

There are no other places that have ambulance services the way that this place has.

So I get it.

Nice simple answer.

Let's add another ambulance service.

Another big national ambulance service.

Great, fine, good.

It's not that simple.

It never will be.

Now for several years.

I don't know much more development you can do.

I don't know what else you can do.

But I can tell you we're giving you our best, and we're pretty damn proud to be here.

And if that's not enough, then you know, I don't really know what else I can do for you.

Uh council.

Any questions?

Uh yes, ma'am.

Um, kind of the uh thanks for coming down, Corey.

I know that you frequent uh frequently come down.

I don't want you to be a stranger.

Um, just uh uh it's mobile uh for you guys.

Mobile is the only city that you're operating.

We do mobile on the eastern shore.

Okay, that's all we'll ever do.

This is home, this is where we're gonna be.

And um, kind of the same question I asked uh uh over in the eastern shore.

Um, are you running BLS over there as well?

Are you running transport?

What's that kind of this is a weird thing?

What what we're talking about, this BLS split is not normal.

There is not a place that does this the way that we do.

We generally do transfers in Baldwin County.

That's almost exclusively what we do, and that is where the money is in this field.

That's what pays for everything else.

I'll be honest with you, we kind of use Baldwin County to help pay for mobile.

Um it's just that's where the money is.

Here we take part in this system, and and we're proud to do that.

And then um, I and again, uh kind of going into that vein.

Um, what is uh, you know, if you don't mind or if you feel what um uh collectibility on on BLS versus uh uh regular transports, I mean obviously it's a lot higher.

So a transfer we average about 500 per transport, and now well percentage-wise, I guess.

Are you collecting out of a out of a hundred percent of transports?

Are you collecting a transfer?

We generally collect about 70 percent of the time.

There's gonna be a few little misses somehow or another, these deductibles and these, you know, we've gotten into a weird place with Medicare and you know, there are a lot of health care issues that are involved.

Yeah, but generally speaking, we'll collect on transport on transfers.

And then what's your what's your BLS kind of look like?

Depends on how you want to split that apple.

Are we talking about how many times do we get dispatched versus how many times do we transport versus how many times do we collect?

Let's go in.

Let's go with uh how many times do you transport a BLS and uh and collect?

Okay, so we get canceled or have the patient refuse on more than half of all 911 calls.

So already from that point, we're really not gonna be paid.

Oh, we're as far as if you take the whole Apple, we're 20% that we're we're gonna collect.

It's a awful business.

I mean, as far as if you're just looking at money, uh, our accountant hates us.

I got you.

And then uh one more question for you.

Uh uh, you mentioned uh the out of state having to run folks to Birmingham at 2 a.m.

Uh that's that's more transport.

That and I guess what that looks like, and just tell me that that's uh that's hospital door to another facility outside of the city of Mobile.

You uh mobile to UAB.

That's that's a really normal example of it.

Um what's that look like on a typical week?

Are are you are you pulling an ambulance out of service that could be servicing BLS here to have to run up to depends on what time of the day it is and depends on a lot?

I mean, you know, we do everything we can at this moment.

I have a dedicated truck that I put up every night or every weeknight for it, and I put a dedicated truck up every day.

This has been a problem.

I've tried to deal with it.

And as long as these guys will work and not quit on me, then I'll keep doing it.

It pays for itself and mostly and and I'm happy to do it.

It's just a question of when can I not get the next paramedic?

Because this is complicated.

Again, we have mobile fire, we have mobile county, we have the hospital that hires directly paramedics.

Guess what?

They don't really want to work private service interfacility transports, they want to go do primary 911, which is most of what Acadian does.

It's not the same.

There is nothing quite like this.

Gotcha.

That's it for me.

Thank you.

I know I'm sorry.

It would take weeks to explain all this to y'all.

I know I'm talking too much.

Any other counsel questions?

Bug.

So it's tough business.

I'm sorry.

It's a tough business for you.

I understand that.

It's a tough business, yes.

So I mean, you're you're making your bread and butter, covering your bills, all that kind of stuff.

Transport.

That's where money is made in the ambulance world.

Right.

But it's still, you know, doing BLS is still a service that accompanies the industry, and it is kind of a it's part of your job, right?

I mean, it's part of your your business.

Depends on where you're at.

Some places that's all services do is transfers.

Some of them, Owen County US only does 911 calls.

Some places like Acadian and Jackson County, they do everything.

Gotcha.

And that's generally what works.

The issue is is it makes the most sense financially for your business to handle your transport calls and things like that.

But I'm sorry, I missed the question.

Transport is better, it's is easier.

I mean, financially, you're getting seven, you're collecting 70% on transport.

Financially speaking, transfers are what pays for all this.

And you're saying that's improved over the last six months.

More than just six months.

I mean, so when we started this in Mobile, when we got to Mobile, there were three services.

We were supposed to do a third, we did our third.

When AMR left very soon after, another big corporation, we started being asked to do half.

Then we started being asked to do more than half.

As things have improved as Newman's has been able to help us with more 9-1 calls, we've been able to do more transfers, which ultimately pays for all this and makes this more sustainable.

Right.

I I guess the only thing, and and uh and and well done.

I mean, if things seem to be on the up and up, I'm not I'm not trying to um you know criticize in any way.

I but I do feel if let's say USA, for example, um they wouldn't be here if they didn't see a need for better transport.

If they have their own service, why why are they here saying that you know they I don't know.

Uh I know that it's a little bit more complicated than just diversions for stuff you got to understand about diversions.

I get it, you gotta make a living, but at the end of the day, it's it's really about quality care.

It is, but it's a little more complicated than what was explained.

So, first off, even if as a hospital is on diversion, if someone calls 911, if you call 911 and you say take me to USA, and even though I know USA is on diversion and I know I'm not gonna get my ambulance back, I'm still gonna have to take you to USA.

And if I have to sit there for three and a half hours waiting on costing you money, then I am still gonna wait for three and a half hours.

So there is throughput issues, but the throughput issues are more complicated than just oh, they're on diversion.

First off, they're all on diversion all the time.

I mean, you know, but we're not building more hospitals because we can't actually afford to staff more hospitals.

We don't have enough nurses, we don't have enough structure, we don't at times have enough need.

Gotcha.

Appreciate it.

Any other questions from council?

Thank you, um, madam vice president.

I do want to follow up for my colleagues' question.

Corey, first of all, thank you for your service that you're doing on behalf of our citizens.

So thank you.

I want to follow up earlier.

You commented and you said that 911 can cause major issues in terms of transfers.

And so when we're talking about another service, and we know, and you've um stressed the you know how complicated this process is.

Are you do you not see or can you share um the impact that another uh service could have on that gap in terms of 911?

Are you saying that that's impossible?

Or you're saying that because it's complicated, it does have a it could potentially play a role.

So the revenue that pays for the 911 currently is what they would take from us.

So you would not actually increase the number of ambulances because the actual revenue to draw from is going to be the same.

Whether I do all the transfers and all the 911s, or whether I split them with Newman's, the amount of revenue that can be created that keeps ambulances on the road is ultimately the same.

Until you add revenue, there's no adding ambulances.

So then a follow-up question to that.

So you explain that the revenue will stay the same, but could the quality of care improve?

I have no way of really answering that.

I mean, can it improve sustainably?

I can tell you that my folks do a good job.

I can tell you that I watch them and I'm dedicated to the city.

Can I tell you that they can do a better job or can't do a better job?

No, they're they're a good quality ambulance service.

I once made a comment that if there was any ambulance service I would sell it to, it would be them.

But that isn't quite the same thing.

My folks are here for the city of Mobile.

Newman's is here for the city of Mobile.

That's all we can really tell you.

Okay.

Anyone else?

Thank you so much.

Appreciate you coming.

I'm sorry if I got a little too much.

That's fine.

Thank you.

Anyone else?

Any other ambulance services like to speak?

Are you different company?

Yes.

Oh, okay.

Y'all from Newman's, yes.

I'm Kenny Newman with Newman's Medical Services.

Uh I first off want to thank y'all for what y'all do for the city of Mobile, not only protecting its history, but also looking towards its future.

Uh, you know, I know most of y'all, some of the new ones may know me.

I don't really know y'all.

I grew up in uh District 2.

I went to Broad Street United Methodist at Broad and Elmira Street all my life until Hurricane Frederick destroyed it.

Our family has a history in Mobile.

My parents started this business in 1939, August 21st of 1939.

They started with two ambulances.

They've been doing this for all of their lives.

We have been doing this for all of our lives.

We've I had three brothers and myself that were on the fire departments in Mobile.

We two of them, one in Pritchard, one in Saryland, and two of us was in Mobile because the Mobile County personnel board decides where you're gonna go when you apply to be a fireman.

Uh, I put 33 years in for the city of Mobile.

My brother put 20 in before he passed away.

We have dedicated our lives to this city.

We have not come from any other area.

We have been here, born and raised, and we care about this city, just like y'all do.

We've uh we give out uh AEDs to schools and churches.

We go out and do CPR classes, we do everything we can to help provide a better service for this community for the city of Mobile.

We love the city of Mobile.

We're not just coming in because they're offering to start paying now.

We've been doing this for 36 years with under the fire department for free, doing the BLS runs that they make.

Uh, and we continue to do that.

We have had a few hiccups here or there where we've lost personnel uh during COVID and after COVID, we have lost a lot of personnel because people don't get into the business like they used to.

Affordable Care Act has caused a lot of reduction in services, not only for us, but for hospitals as far as what they pay for.

So they start doing it a different way.

Back when we first started or coming up, hospitals didn't go on diversion.

Hospitals didn't transfer their patients out.

They took care of them.

Then after all of this started, hospitals started closing down half the floors and putting doctors' offices in them.

Less beds, less patients can come in.

Therefore causes a blockage.

When ambulances bring them in, they don't have a bed to put them in.

So you have to sit, and as far as hospitals, USA owns Providence, uh women's and children's.

Yes, they do have their own ambulance service that they run within their cells.

They have their neonate trucks they run.

But all uh lately, they've not been running any of them.

We've been running them all for them.

Uh Providence, we've been on nine-hour uh bed delays before with our patients, where we have a crew sitting there to where I've gone out and had to buy them dinner and take to them so they could sit in that emergency room with that patient.

Did we make money?

No, we lost our butts.

Uh we do that quite a bit.

You know, back when things started getting bad, and Chief uh Glisten had come, he was chief of staff at the fire department, then came to us wanting to know why our percentage had gotten so low.

Well, I the communications between the fire department and us had stopped because they had a resine regime change that caused the person that was over the EMS side to not giving us the information we needed.

We had some uh things among that was internal.

Once it was brought to my attention, we changed it immediately.

Within 24 hours, it was changed and back up to the percentage that it should have been.

Uh, Chief Glisson asked me, said, How will we guarantee that that will never happen again?

Well, I can't guarantee that it'll never happen again, but I'll give you my word that we will do the best we can to make sure it never happens again.

Just like you can't guarantee by bringing another company that does good across the state line is gonna guarantee that it's gonna not ever happen because it does.

It happens in other areas they're in.

Uh, we've been here, we're dedicated to the city of Mobile.

We were born and raised in the city of Mobile.

We've provided uh for 86 years ambulance service in the city of Mobile.

We will continue to do that.

Our family is committed to this city.

We have a history here, we have a future here.

We're not just gonna want to say, take a chance on us, let us come in now.

No, we've been here all our life providing for y'all taking care of the citizens of mobile, and we want to continue to do that.

And I thank you for your time.

Okay.

Council, questions?

Anyone?

Councilman Lynz?

Um, I'll go ahead with the same question, Mr.

Noon.

Uh looking at uh kind of obviously transports, we've heard today, transports, collectibilities uh uh, I mean, is you know, 70, 20 is basically kind of what what uh Corey was talking about.

Um, is that is that probably the same roundabouts um collectively that you guys have probably varies a little bit.

Uh it depends on he does his own billing.

We have a billing service that does ours.

Uh we do uh you know a lot of our stuff in-house before it's ever sent to them.

So all the groundwork is done.

Our reports that go to the state, we're at 100% uh with their uh compatibility of what they require.

Uh we do everything we can back when they first started the services.

You put you had a driver with a stretcher in the back.

You got people on the scene to help you load and go.

Uh it's moved in the 70s, they started having EMS, which was uh the EMTs and paramedics.

Before then, in the 40s, we were the first to put oxygen on trucks in the state.

We were the first to have first aid trained personnel in our ambulances.

Uh and like I said, in the 70s it changed.

We've been a paramedic service since the uh late 70s.

Uh we provide both BLS and ALS.

We uh have state-of-the-art equipment.

We put everything we can into this stuff to make sure that it's done the way it should be.

Uh, as far as are there hiccups where all the hospitals go on bed delay?

Yes.

Is adding more trucks gonna do that?

No, because most of the hospitals' bed delay is the hospitals don't have enough rooms to put patients.

So then they start looking to transfer them out.

USA, we'd average probably 10 transports a day out of the city of Mobile for them between Providence, Women's and Children's, and uh USA Health.

Several of those go to Birmingham.

Well, if you take an ambulance and you send it to Birmingham with a patient, you're looking at a probably a eight-hour turnaround really probably 12 hours because you've got an hour or so to get the patient loaded up and then you transport, you've got an hour or so to unload and then you transport back.

That truck has been gone for the entire shift.

It can't be that I can put them on another call while they're on that call because that's 12 hours.

The same goes when we go to uh Jackson, Mississippi.

We go to Meridian, Mississippi, we go to Atlanta, we go to Dothan, we go to Sacred Heart in Pensacola to uh Oshners in New Orleans, we go uh, you know, Gov Port.

We're transporting all the time for them.

And so then they're saying, oh, well, we don't have uh transport trucks to transport.

Well, you only have a certain number, and you've got to have ones for emergencies.

If a patient is laying in the ditch, in my opinion, it's much better to take care of that patient in that ditch and get him to a hospital than it is to worry about that hospital patient that's in there with doctors and nurses taking care of them to get them moved over to another facility because they can't take care of that patient any longer.

Uh, and that's where we are here on the BLS for the fire department.

The fire department does the same thing.

We're here to get that patient there.

Is it costly?

Yes, it's costly.

Do we profit off of it?

Not a lot.

Most of our profits, as Corey said, come from transports from hospital to hospital or whatever.

You know, we're dealing with Medicare, we're dealing with Blue Cross Blue Shield.

All of that changed with uh Affordable Care Act.

They stopped coming service.

In fact, there's a lot of services now that you may think, oh, I've got insurance.

Well, it doesn't cover ambulance service.

You didn't read the fine print.

You should have.

Uh, and I recommend that all of y'all do that because just because you have insurance doesn't mean it's going to pay for the ambulance service.

So you need to know that.

Gotcha.

Thank you.

Any other questions?

I'm going to have to leave.

I have another meeting upstairs.

So I'm going to ask President Small if he will take over.

I know there were some other questions that you all have.

And um, if you will just go ahead and finish up, as you know, we laid this over for a week because we have the committee meeting today.

So it will appear on our agenda next week.

There is obviously a lot to consider here and think about as we go forward.

So again, it will appear next week.

What we do going on from here, I'm not sure of just yet, but uh I'm gonna ask President Small if he will continue on with the meeting and uh hopefully wrap it up fairly shortly.

Thank you.

Well, I apologize for having to leave.

That's okay.

Thank you.

Yeah, thank you so much, uh Mr.

Newman, for coming down on this afternoon.

We just have a question or two for you.

I understand that when Chief Glens have brought it to your attention, y'all got things better.

Um, this letter that's in front of us and dated March the 18th, 2025 from the um current, I mean, from then at that time, the president CEO of Spring Hill Medical.

Do you, and I know you cannot speak for him, but why do you think that he wrote this letter and have you heard anything from Spring Hill Memorial Hospital of any issues that they have had?

They have a lot of issues, uh, but we don't do their business.

They don't contract with us to do their transports.

Now we have offered and gone in there and done their uh ALS transports where they have uh stroke protocols or whatever to pick up their patients and take to USA or mobile infirmary.

We've offered to do that because we don't like for anybody to suffer.

But their biggest problem is why they couldn't get services is because the way they want they want you to come in and transport their patients for free when they should be out being uh payer of last resort, say, where the payer of the last resort is when we come in and move your this patient for you and we bill for 90 days to the insurance or to the patient for that patient to pay us, and if they don't pay, then we turn back to the hospital and say, okay, you have to pay us at this Medicare rate, which is a lower rate uh than what it would have been, and they don't pay.

They will refuse to work with any of the ambulance services, and they've been that way all along, and that's why they don't have services that are willing.

Now, Corey's doing it for them now, but we have not uh dealt with them for six, seven years because of that.

Okay.

So it's their administration problem that they need to straighten it out.

Okay.

You know, the council members.

Uh uh Ingram.

Mr.

President, um, thank you.

Kenny, first of all, thank you for your 86 years of service here, Mobile.

We appreciate what you do for our citizens.

I do want to ask you regarding you mentioned the fact that you know you're having issues, shortage issues.

And so when you think about the um territory that you have to cover and how the needs and things have changed, do you have uh some type of recruitment plan or training?

We recruit daily.

We take applications daily.

We work with all the schools, Fordists, we work with Coastal, we work with USA, we're even working with the fire college where we pay for these students to go through and take these EMT courses uh all the way up through paramedic.

We're paying for these people to go through these courses and do it.

The problem is not that there's not an availability for them to go, there's not resources for them to go.

The problem is there's not people willing to get into that since COVID.

It's very few.

Okay.

Thank you.

And other council members.

Okay.

All right.

Thank you so much, Mr.

Thank y'all, and y'all have a great day.

All right.

All right.

Anybody else have anything else to say?

All right.

If not, uh this committee, uh, Mr.

Reynolds.

We're gonna allow Acadian.

If somebody's the applicant, I mean, it's it's typical that way.

Yeah, go ahead.

Go ahead.

Thank you.

Uh I'll be very, very brief.

Um when we come into a community, we invest in the community as well.

We're not a nationwide company, we're a coastal company, we're an employee-owned company.

Understand what Corey and Kenny are saying.

I I get it.

Uh, I get it wholeheartedly.

Um, we believe what we bring to the table are more efficiencies in communication and in billing to solve a lot of those problems.

Our NIMSA program, we have 14 sites throughout four states.

We tend on bringing us training site here, not to compete with USA, not to compete with coastal and all the other places, but to go out and actively recruit and provide as little barriers as possible, both environmentally and financially, in order to solve this shortage problem.

And um, that's it.

Thank you for your time.

I don't want to go back and forth, and I appreciate it.

Okay.

Uh Mr.

Uh hello, one second, USA.

Uh gonna hear from uh Grays then USA.

I can't point.

I just wanted to say that uh we appreciate everyone being here today for this.

Uh, I know that everyone feels this is extremely important.

I will tell you that Chief Glisten has done tremendous work and trying to get the facts for us.

I will tell you to read it, weigh it, uh trust it but verify it.

Uh I believe that what we want in our city is response when needed.

Uh, while at the same time, we also want to support our local ambulance services as much as possible because uh I'm sure the hospitals will love to have as many ambulance services possible, but we also know what that entails for those businesses that are existing today.

Um, and we don't want that either.

Uh I'm not telling you to go one way or the other with this, but I am asking you all to to weigh it carefully and um know that the interest of the city is what Chief Clisten has put together.

Thank you.

I got a question.

Yes, the ISO rating that we have.

Does it require us to have our ambulances only require only respond to ALS or a majority of them respond to ALS or so many set aside so that we can respond to ALS?

How does the ISO rating affect our response?

I'm gonna let Chief Glisten answer that question.

Um and can I tack on to that too?

That was the same thought I had on uh not only what he said, but also too there is can you can you explain the criteria for a BLS component of ISA?

So ISO does not even look at the medical side.

ISO is strictly for the fire protection for the city of Mobile and the service that we provide in the fire department is only looked at from fire protection side, so it does not even look at the medical piece.

Okay, I the uh our ambulances that we currently fund and employ folks to use.

How often, if you can say, are we in a position where we don't have someone to respond?

Before we talked with the BLS companies back in May and got this situation figured out, there were times that we would get what we call critical mass index and our CMI.

We generally, when we have less than five on-duty ALS ambulances in the city, we go to our critical mass index.

So there were times that there would be, you know, one or two covering the entire city, but that was also due to hospital delays.

So that was when we looked at how we adjusted our wall time policy and we implemented that to where it would reduce down to 30 minutes, and then we could put that patient in triage, or we would come up with other means to get our units back in service.

I'm I'll make sure you use terms that are in my head, wall time and all this other stuff.

If the city of Mobile responded to a call and they transported them to the hospital and the hospital is on diversion for whatever reason, is there an out?

You're saying there's an out for 30 minutes that city of Mobile is only going to wait 30 minutes and then they're gonna use some extraordinary power to triage or something else.

Well, what we'll do is if that patient is triageable, we can mean that they're vitally stable, we can take them straight to triage, you know.

We're our paramedics are going to make that decision, even if that means that we have to remove an IV, but if that patient's stable, um, we've worked with the hospitals, all of the hospitals are on board with that, and I would say that we've reduced our wall times from I would say easily 50 to 60 percent since instituting this new policy, and that was working with and communicating and making sure that our policies were understood by the hospitals.

But since all of that has taken place, there has not been one day that we have had you know, critical mass index where we've gotten below our required number of ALS uh ambulances in the city.

Um we've this has affected all of that, and it's in the best interest of our uh citizens, and we've been able to uh institute that very well.

Do our ambulances respond on BLS calls at all?

If there is not a unit available, and since in the last six months, out of 7,000 plus calls, there's only been a hundred calls that we have actually had to respond as our paramedics to a BLS call.

Only a hundred.

Okay.

Um I think that's it.

I don't want to make just one comment that it appears to me that there is this discussion really is bigger than just a single certificate for public necessity.

That there seems to be some structural problems that we need to come to terms with as a city to make sure that the quality care is there, that we got staying power amongst these businesses that can come around because right now everybody's competing for the transport business.

You let somebody else in, they're gonna take a piece of the transport business, and then you know, you you just everybody's gonna take it on the chin for BLS, but the city of Mobile is currently spending millions of dollars for EMS services, correct?

Correct, best in the business, yes, sir.

We're spending already millions of dollars on that currently as taxpayers or citizens, and and it sounds to me like there's a request or desire amongst some to spend additional money for EMS services to support the BLS calls that are being made by these businesses who are frankly taking it on the chin because they can't get reimbursement at the rate that um they need to to be successful.

All of those things, I don't think one application for public necessity resolving this.

I mean, I just don't see it as being the case.

I think I think there's some structural things that we need to meet with hospitals, we need to meet with the providers, need to come to terms with it as a city, finances, all of that to figure out what's gonna work long term for us that um is gonna provide a higher level service than what we have today, where there's there's more certainty.

If somebody's gonna come in the city of Mobile and do business within the city of Mobile for ambulance services, there's more certainty on their part where they feel comfortable going out and buying five new brand new uh ambulances, or you know, hiring 10 or 12 or 15 more PMSs and paying for their training and all of that stuff.

Um, but that right now there's too much uncertainty, in my opinion, with the way we're operating, that it the model is not working.

It doesn't work.

So I think we need to have additional conversations about that's all that one thing I would add to that is patient um community education, right?

Why are we using the 911 system?

Are we using it for the right reasons?

And that that is another starting point that I feel like we need to work is as a city and as a whole with the hospitals of why are we using the 911 system?

Because right now it's for everything from needing a taxi ride across town.

Yeah, so so I do have this question about hospitals.

If if I have a broken leg, okay, and I go and I get a cast, and then I go to that hospital and I go to the front desk or whoever and say, Hey, I need an ambulance transport from here to my house.

I mean, whereas an Uber in that situation could resolve that issue.

But if I make that request or demand, is are they duty bound?

The hospital, the healthcare industry has a whole duty bound to make sure an ambulance is dispatched to transport me with my cast on my leg.

I think they have more leeway because the doctors um they have a necessity form that they have to fill out.

And if it's not medically necessity, then they don't have to have that.

On the other part of 911, if anybody calls 911, we're gonna show up and do our job.

But if they say I want to go to the hospital and there's no complaints whatsoever, we as 911 providers have to take them regardless, even if we know that this is not legit.

We our only option is to transport that patient.

We can't tell them that no, we're not gonna transport you because you just need to go to urgent care.

We're gonna have to transport that patient because they called 911.

That is part of the education.

But I'm saying in a in a hospital setting, if somebody doesn't have the medical necessities not been met, but that patient with the broken leg, me, my broken leg.

If I say I want an ambulance here, is there is there a duty for them to call an ambulance or do or does the hospital?

I do not believe so.

We're not calling you anybody.

Would you there's no duty, but you does have it.

Okay.

I'll let it just request first.

They have to meet medical necessity or the email that's gonna tell us no, they don't need medical necessity.

Okay, and then what we do is we offer them a taxi and Uber some other way.

Um, a bus, you know, how else can we get you home?

Do you have a family member?

So we we put a lot of resources into trying to find them another way home.

But no, if if they don't meet the medical necessity, then we can call them, but they're gonna say, well, they don't meet the need.

And so then how high is that bar?

The medical necessity bar?

Is that a high bar?

You want to speak to the medical necessity bar?

Officially speaking, yes, it's a fairly high bar.

Yeah.

Uh some hospitals do it wonderfully.

Google infirmary does it wonderfully.

Some hospitals do not.

I'm not gonna go into details on that.

Okay, it does happen.

It's not an everyday thing, it's not one of the problems.

Okay, thank you.

The net medical necessity, if they fill it out right and the doctor says it is medically necessary, we can bill for that run to the insurance.

If it's not, we cannot.

We lose money from the get-go on that.

There's no you can't bill it, you can build family or whoever, but they're probably not gonna pay.

Yeah, but the insurance is not, even if they have insurance doesn't cover it, it's not gonna pay if it was not medically necessary.

Perfect.

Thank you all.

Do you have something?

Thank you.

Just uh just real quick.

I don't I just wanted to say we uh as a health system, we very much appreciate all the ambulance services as you're saying, Councilman.

This is a very complicated subject that is not just about transport and it's not just it's about social issues and financing and and uh can we build a bigger hospital and can we have enough nurses to to staff that hospital?

I did want to clarify one thing.

USA hospital or USA Health does have some transport vehicles in particular, very specialized.

One is our NICU transport, because we're the only level three NICU in this community, and so our NICU nurses go out on our transport to transport very sick babies from other hospitals.

The ambulance services appreciate that because we've got that level of expertise.

The second thing that we do is that when we started our freestanding uh emergency department, we do have two transport vehicles that only transport internal to our facilities from the FED back to the hospital or from one hospital to another, and we do not charge for that.

If that if that uh vehicle is not available, and then we call an ambulance to do it, they have the capability of charging for it, but we do not charge for that service.

Okay.

I I got one other for you, Danny.

Oh, sorry, thanks.

We heard today that transports from the University of South Alabama to the University of Alabama Birmingham or somewhere in Birmingham are routine, as the hospital here in Mobile and UAV or whoever the other hospitals are, thought about some cooperative arrangement and cost sharing for that transport from one to the other or handling billing and repayment directly, anything like that, if it's that routine.

Yeah, great question that gets into the you know the whole medical economics and how we finance health care in the state of Alabama, whether it's Medicaid, Medicare, Blue Cross Bushill, what those reimbursement rates are.

Absolutely, we transport patients out of even as high level as USA may be, we can't do all the things that UAB does or Osher may do or whatever the the services may be.

Yeah, we transport patients outside of children's and women's hospital and from uh U.S.

uh university hospital to UAB and to Oshner and to children's of Alabama all the time and there is a cost for those ambulance services to do that.

Thank you.

Mr.

Woods I have one more question for you too I'm sorry.

We're just gonna keep you up here all day.

That's okay.

Uh I'm gonna get Nick when uh you know Nick was supposed to be here he he went to Font Gummary instead.

Listen to the governor state of the state yes um just out of curiosity and and just off the top of your head um uh I've seen uh I've seen an EQ um uh transport um obviously that's uh that's semi-schedulable if that's a if that's a real word um semi um uh you know the the standalone I mean are are you looking at uh the inner the inner transports I guess are you looking at because I'm just trying to kind of grasp the picture in in totality um is that is the standalones is that more of a scheduled thing um or do you have uh you have ambulance crews sitting there on standby at all given times we have them uh standing by but but no different from the ambulance services I mean we have limitations on staffing yeah and so how often they're available or are they available 24-7 no sir okay they are not so they're on really your your inner transports really aren't covering I mean I've covered they're covering I'm sure they're covering the vast majority so you're not pulling from a private transport um but you know we don't have that capability when on we are not authorized to do private transport like I cannot under the current you can't send out to a nursing I can't take our transport our vehicle and send them to ball healthcare uh because that's not within our system we only have the capability to transport within our system yeah and that would be per our per the city ordinance that is correct per the city ordinance and then um but kind of just going back to that inner transport um how often are you between facilities I mean is it y'all are covering the vast majority between facilities um correct okay to the to the best of our ability assuming we've got staffing both we have two transport vehicles assuming both of them are running we are transporting between Providence and University hospital the freestanding FED uh as well as children's and women's hospital gotcha thank you that's it for me and other council members all right all right this is then our meeting oh sir thank y'all for being here I mean it was good sir