Knox County Commissioners are wary of ambulance recommendation

Allie Feinberg and Tyler Whetstone, Knoxville News Sentinel
Updated ·5 min read

Knox County Commissioners didn't hide their skepticism and concern in a meeting Nov. 2 about whether the county's ambulance provider is the best choice to continue providing emergency medical services to residents.

AMR has been under sharp criticism from residents and Knoxville police and firefighters for extremely long delays in getting an ambulance and EMTs to injured and sick people who call for help. KPD police spokesman Scott Erland even told Knox News last month, "The harsh truth is that, in the current state of ambulance services in Knox County, there’s no guarantee an ambulance will show up quickly or at all."

Commissioners will give the proposed AMR contract an up-or-down vote later in November, and their Nov. 2 meeting was the first time they were able to talk to each other about the recommendation from a committee that American Medical Response, commonly called AMR, is the best choice.

Chairwoman Terry Hill and Commissioners Courtney Durrett, Kim Frazier, Larsen Jay, Rhonda Lee and John Schoonmaker pushed AMR and a representative from the selection committee about how they made the recommendation, the high stakes of their choice and AMR's response time.

Selection process

Some commissioners felt the committee did not include enough input from stakeholders in the city. Durrett, whose district lies entirely within city limits, wanted the Knoxville Fire Department to be consulted, but the department wasn't.

Durrett said that KFD firefighters often are the first to respond to a call, and they're the ones who administer immediate life-saving care. Then they have to wait for an ambulance to show up to take the injured or sick person to a hospital, preventing them from quickly responding to other urgent calls and putting them in a position to provide care under less than ideal circumstances.

"I have received complaints from KFD employees," Durrett said. "The problem is transport. (Are we) making sure that they're looped in?"

Frazier, Lee and Commissioner Gina Oster all said that hospitals needed to be consulted, as well. County Mayor Glenn Jacobs put the bulk of the blame for delays on hospitals and the government regulations they operate under in an opinion piece he wrote for Knox News in late September.

"I feel like we have a responsibility as a commission to address long (wait times) with hospital executives," Frazier said.

AMR's problems with response time

It's no secret that AMR has had a problem with its ambulances' response time. It's a problem across the country. In the proposed contract, the company would be penalized if a vehicle takes longer than 20 minutes for 90% of calls in the county, including Farragut. Commissioners think that's too long. In the city, the contract calls for a response within 10 minutes for 90% of the calls.

"Respectfully, I am not comfortable with the response time of 20 minutes," said Frazier, who represents the county at-large. "Twenty minutes is hard for me to stomach."

Schoonmaker, whose district includes Farragut and parts of Southwest Knox County, agreed.

There's no plan for an AMR extension if commission needs more time

If the commission gives the proposed AMR contract the thumbs down, the assessment process starts all over.

And there isn't much time to act. AMR's contract expires Jan. 31, and the company confirmed it has not been approached about an extension if the county has to start the process over.

The fallback option would be to extend AMR's contract, but the committee and AMR confirmed there haven't been discussions about doing so. If commissioners decided not to stick with AMR, they'd have to figure out a plan for ambulance service for the county while the process starts over.

"This has been kind of a hurried process where everything has to be done because we're up against this deadline," Schoonmaker said. "We're stuck because we've got to make a legislative decision to go forward but we probably haven't had enough time to make any great decisions."

Four companies applied to serve as Knox County's ambulance provider. Priority Ambulance, which is based in Knox County, finished second behind AMR in the committee’s ranking system.

The county does not have its own ambulances so it relies on private firms like AMR or Priority.

How were the ambulance companies scored?

A committee of medical experts scored each company on four segments: administration, operations, quality management and cost. The total possible score was 5,000. This is how they finished:

  • AMR: 4,761

  • Priority: 4,124

  • Falck: 4,060

  • AmeriPro: 3,655

History suggests ambulance vote could be an ordeal

In a heated ambulance contract debate in 2002, two Knox County Commission committees voted against awarding the contract to AMR, which won the rebidding process over Rural Metro, according to Knox News archives. Rural Metro held the contract the previous 17 years.

Weeks later, County Executive Tommy Schumpert removed a final vote on the contract minutes before the commission could take it up after Rural Metro filed a complaint with the county about how the process was handled.

Schumpert originally supported AMR but later changed his mind, supporting Rural Metro instead. Months later, the commission approved a contract with Rural Metro. In the interim, Rural Metro's original contract had to be extended so the county could continue receiving ambulance services.

How did we get here?

The county’s ambulance service has been hit with a perfect storm of crippling issues that has sapped its effectiveness to respond to emergency calls.

Many of these problems aren’t unique to East Tennessee, or to AMR. They're happening across the country as ambulance providers become the first option for residents who lack health insurance or a ride. Understaffed emergency medical service systems and hospitals add to the problem.

A firm hired by Knox County to review the situation, Fitch & Associates, conducted a process that consisted of interviews with system participants (law enforcement, fire agencies and hospital systems among them) and a multiyear data request to create baseline information and a review of the current EMS system.

Fitch said the expiring contract is "financially nonviable." A Fitch representative told commissioners Oct. 16 the county likely will have to subsidize any contract by paying $1.9 million to $3 million each year. AMR’s proposed two subsidy options range from $2 million to $2.8 million, with a 3% annual increase built in.

Allie Feinberg reports on politics for Knox News. Email her at allie.feinberg@knoxnews.com and follow her on X, formerly known as Twitter, @alliefeinberg.

Tyler Whetstone is an investigative reporter focused on accountability journalism. Connect with Tyler by emailing him at tyler.whetstone@knoxnews.com. Follow him on Twitter @tyler_whetstone.

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This article originally appeared on Knoxville News Sentinel: Commissioners push back on ambulance wait times, recommendation process