Ricky Howell, director of Oxford Emergency Medical Service, and two relatives were no longer employed by the service as of Wednesday.
“Yes they have been let go,” wrote Marty Carter, the Oxford EMS chairman, Thursday in a text message. “This is not the first time we have let folks go. We cut six full-time positions a few months ago. We are reorganizing to make the agency financially viable.”
Multiple attempts to reach Howell by phone Thursday were unsuccessful; calls went almost immediately to voicemail, and his voicemail inbox was full in the morning and afternoon. The service also had employed Howell’s daughter and his ex-wife, who both worked in administrative positions.
The terminations followed the City Council’s appointment of four new board members to the five-person Oxford EMS board Tuesday, after a weeks-long series of resignations that left the board with Carter as its sole member. The new members — James Slick, Leon McCall, Trina Clark and Molly Denson — replaced former chairman Greg Skinner, Randy Beshears, Patrick Miller and Shannon Stephens.
A City Council member said Tuesday that the board members had been chosen for their backgrounds; Slick and McCall are former Oxford EMS employees, and Clark said she’s a chiropractor with a history of revitalizing failing medical practices. Clark said the new board had been tasked with making the service solvent again.
Oxford EMS has frequently approached the City Council for emergency funding in the form of high-dollar appropriations from the city’s coffers; the council recently shot down a request for $300,000 per year paid out in monthly installments, and another request for $50,000 at least through the end of January. Those denied requests were the end of frequent cash injections into the service, stretching back over the last few years, not including money set aside in the city budget each year.
Last month, employees of the service said Oxford EMS had withheld money from paychecks to pay health insurance premiums and retirement contributions, but repeatedly failed to make those contributions, leaving employees without insurance for themselves and their children for with several stretches.
High-stakes, high dollar industry
The changes at Oxford EMS will affect one small service in an industry with several kinds of providers — public, non-profit and commercial — who all depend on expensive equipment and on the complicated medical billing practices of insurance companies, Medicare and Medicaid in order to provide life-saving care.
Randy Childs, an assistant fire chief with the Jacksonville Fire Department — which runs the city’s ambulance service — on Thursday explained in general some of the challenges that ambulance services face in maintaining solvency.
“You have to balance the price of the vehicles, price of supplies, the price of the equipment we put on them, and fuel costs,” Childs said, listing just a few of the concerns EMS leaders must manage.
Paramedics have to be trained not only in saving lives, but in documenting how they go about doing it. Medicaid and Medicare have certain tiers of payout they’ll provide for treatment, Childs explained, based on how advanced the care is.
“It’s based on procedures, like if we have to give drugs, put someone on a monitor, if we have to give oxygen; all those procedures have to be well-documented,” he said.
Improperly documenting care could mean losing out on some of the payment, money that the service won’t have to put back into its payroll, maintenance and other overhead costs.
Equipment is expensive, he pointed out; heart monitors are $35,000 each. Stretchers aren’t just wood and canvas — they’re heavy-duty machinery, with a price tag to match.
“Just to have the equipment on the ambulance is an enormous cost,” Childs said. “Then you’ve got billing, insurances ...”
Finally, some people aren’t insured, and some can’t afford to pay the costs associated with ambulance care and transport. Jacksonville’s ambulance service works with a billing company to handle collecting payment, and the city works with its residents to make payment plans, Childs said, but sometimes it doesn’t work out. Some accounts become write-offs, money that will never be collected.
Jacksonville’s ambulance service — its Dire Department — works with the City Council and other city departments to manage administration. Finance is handled by the Finance Department; the city puts ambulance service in its budget, Childs said.
“It’s definitely a monthly issue we have to evaluate,” Childs said.