Members of the Carter County Commission voted 20-2 Monday night to release an additional $100,000 in funding for the Carter County Emergency and Rescue Squad following a report by the EMS Task Force recommending increased funding for the agency.
Carter County Commissioner Dr. Robert Acuff, who served as chairman of the Task Force briefly addressed the Commission when the Task Force presented the report.
“We’ve learned a lot, to say the least,” Acuff said regarding the work done by the Task Force.
Acuff then turned the podium over to Task Force member Dwain Rowe, who is the director of the Wings Air Rescue program, to present the group’s findings. Rowe discussed the history of the Carter County EMS and how the field of emergency medical care has changed over the decades.
“Back in 1980 you could get by with an EMT on a truck,” Rowe said, adding now state and federal regulations require the trucks to be staffed with paramedics, which is a higher degree of training than an EMT.
In 1980, staffing costs were $12,000 per year salary for an EMT while the cost of an ambulance was around $38,000, Rowe said. In 2015-16, staffing comes in the form of a paramedic with an annual salary of around $36,000. An ambulance truck costs around $174,000 now, but stocking it to comply with state and federal mandates increases that cost to around $250,000.
In recent years, some current and former members of the County Commission have voiced opposition to Carter County EMS turning patients over to collections or seeking court judgements against them due to unpaid medical bills. That subject was also addressed by the Task Force as they looked over the agency’s finances and the regulations they must operate under.
“There is a federal law that says they must pursue all bills,” Rowe said, adding the agency cannot “just decide” to let bills go.
Commissioner Charles VonCannon questioned why so much debt was written off and Rowe replied it was the nature of the world of healthcare and medical debts.
“You can’t get blood from a turnip. This problem is not unique to Carter County,” Rowe said, adding other EMS agencies and medical professions face the same issue. “Carter County EMS does no better and no worse than any other EMS or other healthcare entity like a hospital or doctor’s office when it comes to collecting debt.”
Medicare and Medicaid have set standards for what they will pay when it comes to EMS services or transports, Rowe said, adding that many private insurers have adopted those same standards.
However, those payments to the agency for services rendered seldom cover the actual cost incurred by the agency, Rowe said.
“Over 90 percent of patients covered by insurance will be left with a balance,” Rowe said.
VonCannon was joined by fellow Commissioner Ray Lyons in inquiring about the salary of Carter County Emergency Rescue Squad Director Terry Arnold’s salary as well as the salary of his Associate Director Anthony Roberts.
Lyons asked if the Task Force considered cutting administrative salaries to save costs.
Acuff responded to Lyons by saying a national salary study for EMS director positions showed that the salaries for both Arnold and Roberts were within the median range based on similar positions across the nation.
VonCannon said he had done his own research checking the salaries of EMS directors in the majority of the counties in Tennessee and said based on his research, Arnold was paid more than $100,000 per year which was the highest of any EMS director in the state.
Acuff and Rowe both deferred that question to a Carter County EMS representative, who said for the past two years Arnold has declined receiving a raise. The representative, who handles accounting and bookkeeping for the agency, said Arnold’s salary is actually $87,000 — not over $100,000 — and explained numbers on a tax form may show higher due to Arnold being compensated for unused vacation time he had accrued but had not been able to use.
While some members of the Commission pressed the salary issue, other thought Arnold’s salary was not the heart of the issue.
“His salary has got nothing to do with paramedics going out and saving someone’s life,” Commissioner John Lewis said. “This Commission needs to get real.”
Commissioner Danny Ward noted the service which Carter County EMS provides to the community and it’s residents.
“You get what you pay for in life,” Ward said of Arnold’s salary. “Mr. Arnold has been on the job for a number of years, he’s not an intern. If you stay in a job for that many year’s you’re obviously good at it.”
Acuff concluded the report to the Commission by addressing some of the costs to operate the agency that people don’t typically think of when they consider how expensive it is run an EMS service.
“There are a lot of hidden costs that I don’t think members of this Commission appreciate,” Acuff said.
Among those costs he listed replacing out-of-date medications and supplies as well the costs of complying with federal and state mandates regarding training, equipment and what supplies and medications are stocked on a truck. The cost of prescription medications has risen exponentially over the years, Acuff said, adding that anyone who has had to purchase medicine for themselves or a loved one can attest to the increases.
“Healthcare is an expensive proposition,” Acuff said. “ObamaCare, the Affordable Care Act, was put in place to reduce costs but we have yet to see any reductions.”
Following the presentation, Commissioner Sonja Culler made a motion to release the additional $100,000 funding that had been put into reserves during the budget process to Carter County EMS. The motion was seconded by Commissioner Mike Hill.
During discussion on the motion, Commissioner L.C. Tester shared an experience with Carter County EMS he had recently after being involved in a motor vehicle crash. Tester said he suffered two broken bones in his arm but thankfully his 8-year-old granddaughter who was with him only suffered bruises from her seatbelt. He commended the professionalism of the EMS employees as they not only worked to treat his injury but also to calm his granddaughter who was extremely upset following the crash.
“You don’t understand what they do until you need them,” Tester said.
When the matter came to a vote, the Commissioners voted 20-2 to release the additional funding that had previously been set aside during the budget process. Commissioners Willie Campbell, Acuff, Nancy Brown, Hill, Al Meehan, Brad Johnson, Ronnie Trivett, VonCannon, Isaiah Grindstaff, Tester, Ward, Ross Garland, Bobbie Gouge-Dietz, Randall Jenkins, Lewis, Larry “Doc” Miller, Culler, Lyons, Scott Simerly, and Kelly Collins all voted in favor of releasing the additional funds. Commissioners Buford Peters and Robert Carroll opposed releasing the funds. Commissioners Timothy Holdren and Cody McQueen were absent from the meeting.
In other business, members of the Commission voted 15-5 to approve a resolution creating a “reasonable fee schedule” for the copying or duplication of public records. The resolution also left the discretion in charging fees up to the individual office holders.
County Attorney Josh Hardin explained the process was already in place and had been used for several years however the fee schedule had never been formally adopted.
“This isn’t something new,” Hardin said. “This is kind of a housekeeping matter in my opinion.”
Some commissioners voiced support for the resolution while others opposed it.
“This is a bad resolution,” Lewis said. “We shouldn’t charge the people no kind of fees for these records.”
The resolution ultimately passed on a vote of 15-5 with Ward, Lewis, Brown, Miller and VonCannon opposing its adoption.