By D.L. BENNETT The Atlanta Journal-ConstitutionPublished on: 11/15/07
Fulton County's 14 cities will be forced to pay for ambulance services next year or see response times fall because county government will cut off about $10 million in subsidies.
The shift in costs will mean Atlanta may have to pay nearly $7 million and fledgling cities like Johns Creek and Milton more than $100,000 or risk endangering lives by letting emergency response times rise dramatically.
The cost that cities will take over June 30 represents money that none of the municipalities expected to have to spend in 2008.
The idea's not being warmly received even though city leaders concede the county isn't obligated to continue paying the subsidies. County commissioners compared the decision to Atlanta's move to stop holding county prisoners in the city jail â€” a move that saved Atlanta $10 million but cost Fulton a similar amount.
"I absolutely agree in a proper transition. This is the right thing to do in the long run," said Johns Creek Mayor Mike Bodker. "All I've been looking for is more time. They are in a position to give us a reasonable amount of time to take this over."
Under state law, counties are responsible for providing emergency medical service through regional councils. However, counties are only required to set up minimum service. In Fulton, that means a 12-minute response time.
Right now, Fulton pays about $10 million in supplements to its two ambulance companies â€” Rural Metro and Grady hospital. That extra money pays for more staff and more ambulances to buy down average response to 8 minutes.
Commissioners have decided to stop paying for enhanced service and let each city decide whether it will pay to keep response times low.
"If they are going to be a city, then they should be a city," said Commissioner Bill Edwards during a telephone interview this week. "All these operating agreements have propped these cities up. Now it's time for them to stand on their own."
In Atlanta, a four-minute delay could have dire results for trauma victims rushed to Grady Memorial Hospital or any other local hospital by the Grady ambulance service.Noah Reiter, director of EMS for Grady, said if response times increase by 4 minutes some patients who are saved today certainly would die.
"There is no substitute for rapid response," Reiter said.The county's payments to Grady make up about one-third of the revenues for the Grady ambulance service. Hospital officials said radical cutbacks in service would be needed without it."We can't make it up from the users," said Craig Tindall, interim CEO for Grady. "We would require additional funding."
Mayor Shirley Franklin said she was just learning about the issue and not sure what the city would do.
"I presume that Fulton County has made a decision that 12 minutes is sufficient," Franklin said. "Who am I to argue? That's their area of expertise."The net result could be a variety of response times across Fulton based on how much each city can afford. Some might elect to buy down response time to match the typically 5-minute-or-less time of first-responders, who are staffed in all the fire stations and outnumber ambulance crews. Sandy Springs Mayor Eva Galambos said the city will likely try to cut response times to below the current 8-minute county level. She said she had no idea yet what that might cost or how the city would pay for it.
"We are going to work to have the ambulances scattered throughout the community so they can get there as fast as a fire truck," Galambos said.
County commissioners weren't united on the plan to drop the subsidy. Commissioner Lynne Riley and Chairman John Eaves both wanted to give the cities at least a year to absorb the cost but were voted down.
"I wanted to do all I could to support the cities of Fulton County," said Eaves.
As the cities begin negotiations with the ambulance companies, another big question remains. What will Fulton do with the $10 million it saves? Some city leaders are already pushing for a tax break.