Fire chief lays out plan to replace EMSA; city officials believe public should be part of any discussion to change EMS provider

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If the city of Tulsa ever chooses to opt out of its agreement with EMSA, Wednesday’s City Council meeting may well be remembered as the moment the longtime partners began to drift apart.

It was a bruising day for the public trust, which has been the city’s emergency medical services provider since 1978. Not only did Tulsa city councilors reject a requested rate hike, they did so in no small part because they don’t trust the way the organization is run.

And now a majority of city councilors have joined Mayor G.T. Bynum in saying the process for selecting an ambulance provider  — historically a decision made solely by the mayor  — needs to include public input.

“I am convinced that our community has lost faith in the leadership of the administration of EMSA as it stands today. There is no question about that,” City Councilor Blake Ewing said Wednesday night before voting against the proposed rate hike.

He added that while there could be some unpleasant consequences to not approving the rate hike, “I am coming to the conclusion that it is also not a pleasant option to continue to validate and reinforce the actions of EMSA’s leadership.”

Ewing made clear after the meeting that he has no fix in mind for the city’s ambulance service but stressed that the pros and cons of the existing system and possible alternatives need to be discussed openly.

Ewing, like each of the councilors interviewed by The Frontier, has made it clear that he has no qualms with the clinical care EMSA provides.

“I am not presupposing a solution, but I am advocating hard that we consider all this,” he said.

Councilor Ben Kimbro, one of the six “no” votes on the price hike, praised the clinical staff that provides ambulance services for EMSA. But there was another factor he had to consider when making his decision.

“I will not ask voters, taxpayers, to divorce themselves of the fact that there is an administrative problem at the authority that has for more than 30 years been directly in, dipped a toe in, standing next to, very near a lot of bad decision-making that taxpayers don’t deserve to have,” Kimbro said after Wednesday’s meeting.

He added: “In my universe, as a businessman, if I have an executive who is consistently making bad choices or is not stewarding company resources properly, they have got to go. We can’t possibly consider waiting 30 years for that.”

Ewing and Kimbro were two of eight city councilors who told The Frontier this week that they agree with the mayor’s position that the public should have input in the selection of an ambulance service provider. The others were Karen Gilbert, Connie Dodson, Anna America, David Patrick, Vanessa Hall-Harper and Phil Lakin. Councilor Jeanne Cue was unavailable for comment.

“Absolutely — to investigate if nothing else,” Hall-Harper said. “Absolutely. We have to. Transparency is the way to do it.”

Lakin, who sits on the EMSA board, said any discussion of the city’s ambulance service needs to ultimately be focused on facts.

“I would like that,” Lakin said of the public input. “But let’s use real, quantifiable data to make our decision.”

EMSA officials asked for the $400 rate increase for transports in part to help cover the estimated $2.4 million in legal fees the authority expects to rack up defending itself against a federal civil lawsuit. The lawsuit alleges EMSA and its executive director, Steve Williamson, were part of a multi-million dollar kickback scheme.

In making the request for the rate increase, EMSA officials insisted that they expect to prevail in court and that the price hike would affect only 20 percent of customers  — those not signed up for EMSACare.

The authority’s pitch also came with a few words of caution: failure to approve a rate hike this year would necessitate a larger rate hike next year, and should the city choose not to approve a rate increase in the next three years, it could be found in violation of its trust agreement for not properly funding the program and lose its ambulance service.

Still, councilors weren’t swayed. The vote was 6-2. Councilors Lakin and Patrick voted for the rate increase. Cue was not present for the vote.

Jan Slater, EMSA Board of Trustees chairwoman, said in an email Friday that the EMSA board appreciates the careful review councilors gave to the matter but that it was disappointed the rate hike was not approved.

“The board is now exploring cost-cutting areas that will minimize impact on patients and quality of care,” she said.

Bynum, who was not at Wednesday’s council meeting, told The Frontier earlier this year that he wants the public to have a say in the selection of an ambulance provider.

“My interest in discussing it is, I think anything that has such a life-and-death impact on Tulsans and incurs such a cost for Tulsans ought to be something that Tulsans are more informed on then they have been allowed to be in the past,” Bynum said. “So I think that is a discussion we ought to have in more of a public forum … than has been allowed to occur in the past.”

Fire Chief’s Plan

Every five years the city is given a one-month window in which it can opt out of the EMSA agreement. And every five years since at least 1996, the Tulsa Fire Department has made  — or attempted to make  — a pitch to the mayor to take over the ambulance service. The next chance for the city to opt out of EMSA is October 2021.

Fire Chief Ray Driskell’s plan is simple: cut out EMSA and have the city contract directly with an ambulance provider.

It is being done in other cities, including Arlington, Texas, and Colorado Springs, Colo. Both cities contract with American Medical Response, the same company EMSA contracts with to provide ambulance service in Tulsa.

Under Driskell’s plan, the city, not EMSA, would oversee the ambulance provider’s performance. And the city, not EMSA, would handle billing.

“The thing that makes it so easy is, we don’t change anything,” Driskell said.

Driskell says he’s not necessarily advocating that the city change ambulance systems, but like the mayor, he believes it is something that should at least be discussed publicly. And it hasn’t been.

Bynum, speaking earlier this year, said one of the main questions he hears from citizens is why both the Fire Department and EMSA show up at medical emergencies

“The reality is it isn’t efficient, but it is effective,” Bynum said of the EMSA model. “Our cardiac survival rates are among the best in the country, and I chalk that up to the collaboration between the two (Fire Department and EMSA), the quick response — that basically, you have a race to the scene between these two agencies, and that better serves the person who is in distress.

“So all of that is a discussion that we ought to have and that the citizens ought to be more informed on rather than it continuing to be something that is chatted about behind closed doors in the Mayor’s Office, and then a decision made without any sort of public acknowledgement or discussion.”

Bynum said he doesn’t know whether Driskell’s plan or the EMSA model would be best for the city because he hasn’t discussed the plan with the chief and, like other Tulsans, only hears EMSA make its case publicly when responding to a crisis or a scandal.

“I think we need to get removed from those types of anecdotal situations and have more of an all-encompassing look at the service and who the best provider might be,” the mayor said.

Bynum said he does know this much about choosing a service model — it would not be an easy decision.

“There are pros and cons,” he said. “It is not a stark, easily determined issue. There are pluses and minuses on both sides, but I think all that ought to be aired out.”

Talk of the Fire Department taking over the city’s ambulance service isn’t new. And EMSA officials are certainly aware of it. In a City Council committee meeting, held prior to Wednesday’s regular council meeting, EMSA’S Slater addressed the idea head-on.

“In the past, the decision has been made not to go that route,” she said. “We still think the wisest decision (is) not to go that route.”

Slater reminded councilors that a 2016 study commissioned by then-Mayor Dewey Bartlett recommends the city maintain its existing arrangement with EMSA.

“And in fact encouraged the Fire Department to look at some of our efficiencies to adopt,” Slater said.

The report compares EMSA’s performance to fire departments in other cities that provide both emergency medical services and fire protection, Slater said.

“And in no case have they come close to the efficiencies that EMSA has achieved in providing medical service,” she said. “In fact, many times the costs for providing emergency medical services was up to 50 percent greater.”

A Little History

Driskell’s plan might not change day-to-day ambulance service operations, but if implemented, it would end a relationship that has been in place four decades.

For much of Tulsa’s history, residents relied on a hodgepodge of private companies  — including several funeral homes  — for their ambulance services. But by the late 1960s, Central Ambulance Co. had bought out most of its competitors and become the city’s leading emergency medical services provider.

It was Bynum’s grandfather, Robert LaFortune, who was mayor in 1977 when the Emergency Medical Services Authority was established to oversee and improve ambulance service. The next year, EMSA took over the city’s ambulance service from Central Ambulance.

It’s been a good ride. Over the last four decades, EMSA has grown into the state’s largest emergency medical services provider. Fifteen cities, including Tulsa and Oklahoma City, rely on the authority for their ambulance service.

But the organization has had its down times, including two recent incidents that have fueled city councilors’ concerns about the administrative side of the operation.

The most recent incident was a civil lawsuit filed earlier this year by federal prosecutors in Texas alleging that EMSA and Williamson were part of a lucrative kickback scheme.

According to the lawsuit, filed in the eastern district of Texas, Paramedics Plus LLC — the same ambulance provider that once contracted with EMSA to provide service in Tulsa — was part of a kickback scheme to obtain ambulance contracts awarded by Williamson and EMSA.

The lawsuit alleges that a fund overseen by East Texas Medical Center Regional Health Services Inc., and Paramedics Plus was used to pay more than $20 million in kickbacks, including at least $50,000 that benefited Williamson.

In addressing the lawsuit Friday, Slater said it was important for EMSA’s customers to understand that “none of our patients, insurers of health care or city government partners received inaccurate billing nor were subject to any unlawful activity.”

“Additionally, none of the money that EMSA received was mismanaged and no individual has been personally enriched,” she added. “In fact, profit cap revenue went to reduce EMSA expenses and reduced costs to our patients and community partners. The trustees believe that the profit cap does not violate the False Claims Act or Anti-Kickback Statute and therefore is not unlawful. 

Another reason city councilors are concerned about the performance of EMSA’s top brass is a 2013 audit by the state Auditor and Inspector’s Office that notes “abusive expenditure patterns” by the agency and takes aim at Williamson for his spending.

According to the audit, Williamson was reimbursed for spa goods and services, lifetime Sirius Satellite Radio subscriptions and an American Airlines Admirals’ Club membership.

The audit also questions other expenditures by the agency, including $35,190 spent on floral services and office beautification, $4,504 on a retirement party, and $1,300 for “casino style entertainment” at a Christmas party.

The report, which also recommends improvements to EMSA’s billing system, did not find any violations of state law.

Lakin said the EMSA board has made major changes to how the organization is run since the auditor’s report was released.

“We took most of the recommendations from our state Auditor’s Office, from (the city’s) Management Review Office and just from natural, standard best corporate practices and we applied those to the management and administration of EMSA,” Lakin said. “We made the financial information down to the very smallest of all expenses publicly available online so that anybody and everybody could see how EMSA’s dollars were being spent.”

Driskell said he believes that if the city ever had direct control over its ambulance service, those types of incidents would be less likely to happen.

“You would have oversight with the mayor, the City Council, the city attorney, all of these people,” the fire chief said. “So, to me, there is less likely a chance something like that could occur.”

Driskell also believes his plan just might provide additional revenue for the city.

“That group over there (EMSA) isn’t doing it for free, so there has to be some revenue there,” he said. “When I talk to other fire departments that do the ambulance service, there is significant revenue to be gained.”

Under the fire chief’s plan, the city would retain the EMSA medical board that oversees operations, as well as Dr. Jeffrey Goodloe, who oversees the board. And Driskell made clear he is not interested in using firefighters to replace the paramedics and EMTs provided by the private ambulance service that contracts with EMSA.

“The last thing I want to do is put firefighters in ambulances,” Driskell said. “It’s too expensive. I can’t afford it.”

Driskell acknowledged that he doesn’t have every answer regarding how his plan would work. He believes, for example, that the city might be able to handle billing. If not, he said, the city could hire a private company to do that work.

“Today we don’t have that option,” Driskell said.