Right off the bat I’m going to confess, the title is
salacious shocking. But it is doing it’s job as a good title should and drags you in to read the story and understand the issues.
In July 2010 Granville County, North Carolina handed over the EMS services to Granville Health System (GHS), a non-profit community medical provider.
It appears the Granville Health System medical care is delivered by Granville Health, Inc. an IRS tax-exempt organization. People get this charity/tax exempt thing wrong all the time. While they may be non-profit it doesn’t mean they can’t make a profit. It just means they don’t pay tax on the profit they make. Non-profit is their tax status, not the way the organization is run. It’s a business.
Recently, ABC-11 ran a whistleblower story about the current state of the Granville EMS system. An insider, Captain Mike D’Haene of Granville EMS, expressed significant displeasure about the current state of the Granville EMS system and alluded to the fact it could jeopardize quality patient care.
D’Haene expressed concern over the level of services citizens in his county were receiving. “It’s not a good situation. I think the taxpayers need to be pretty upset about how their money is being spent.” – Source
One of the issues raised in the story was about a child having a seizure and a Vance County EMS crew had to come to help. However what the story did not say was that the child seizure call was cancelled by the mother and the paramedics were told not to respond.
You can listen to the full call below. The call had been edited by me to remove the callers full name, address, and telephone number. At the end of the call you can hear 911 told to cancel the call because the child seemed to be doing fine and her mother was taking her home from daycare.
The allegations D’Haene made in the ABC11 report were certainly alarming and concerning. And the ABC11 story determined that while D’Haene claimed a large number of days some EMS stations were not available, Granville Health System is said to have provided documentation showing EMS stations were unavailable for 39 full days, about half of what D’Haene claimed.
GHS provided me with the document below that showed staffing levels in February, 2014. It is allegedly the same document shown quickly in the ABC11 piece.
GHS also shared the Granville EMS, February 2014 Metrics
Chute Time: (Out the Door) 0:01:25 (Std. Dev. 0:01:40) Comparative Rural Group 0:01:48 (Std. Dev. 0:02:52)
Lights and Sirens Response Time: 0:10:19 (Std. Dev. 0:06:04) Comparative Rural Group 0:09:36 (Std. Dev. 0:06:13)
There can be disputes and argument over how many days an EMS station was closed and the actual number doesn’t really matter. In the end what does matter is if residents are getting the level of care they expect and contracted for.
Of course it would be nice to see them get the same level of exceptional care that we do in Wake County but if Granville County was still running EMS it would probably require big tax hikes to achieve that goal. It is doubtful Granville residents would opt for that considering many moved to beautiful Granville County for the low taxes.
What Trusted Local First Responders Say in Granville County
I made the trip up to Oxford where I spoke separately with fire and law enforcement members. I assured them I would not quote them for the story so they could feel free to speak openly.
Neither of those organizations works for GHS so they have nothing to gain by not sharing their honest opinions.
Members of the first responder community felt the services offered by Granville EMS were as good as they’ve always been. They uniformly and independently said as members of Granville County and public safety employees they felt safe with the current EMS system.
I did not hear a single word of concern by members of this community and they appeared to agree that while the Granville EMS system offers services today, they are neither better nor worse than those offered in years past.
Members I spoke with also brought up a very valid point. They said one of the attractive qualities of Granville County is their low tax rates. That’s true.
But it seems the battle between low tax rates and high levels of service is an impossible contest. If people are moving into Granville County expecting the same level of services we get in Wake County, they will most likely be disappointed. You can’t have Wake County levels of service and Granville County low tax rates.
Here is What Neighboring EMS Departments Say
I spoke with people from Durham, Vance, Franklin, and Person County EMS departments to see if those counties had to pickup the slack for Granville.
The concern was if a lack of response from Granville EMS was causing burden to be pushed off onto neighboring counties and their taxpayers. Only Durham County mentioned there had been some times when they had to position units at the Durham-Granville line to be ready to respond if needed in Granville. From their description those times seemed infrequent.
Wake County data showed between December 2013 and February 2014 there were six mutual aid response calls where a Wake EMS crew was requested and all of those episodes were for EMS to support fire departments for a structure fire, none for medical care.
The surprise was the challenges brought out in the ABC11 piece were said to not be unusual for any of their own counties, except Wake and Franklin County.
They uniformly said their own budget restrictions and limitations left them understaffed and shorthanded at times and it was not unusual for only one EMS crew to be available to cover a wide area as other crews were tied up and unavailable.
One agency said sometimes crews were just tied up “hugging the wall” waiting for a busy emergency department to accept their last patient they transported or even just waiting for mental health beds to open so they could hand over the patient for treatment.
These other counties did not seem to be as far ahead as Wake County EMS in being able to change the way they provide services to residents. Wake EMS has the APP solution that is allowing paramedics here to not get stuck as often with “hugging the wall” with patients and divert some patients from having to go to the emergency department altogether.
In Vance County the local EMS system said they wound up dealing with growing demand and shrinking resources by developing close alliances with for-profit ambulance services to pick up the slack for routine patient transfers. Maybe that’s something Granville should consider.
And at times Granville EMS has responded over in Vance to help them out.
Other counties face the same or worse challenges as Granville. One high-level source said, “Places like Johnston and Harnett counties regularly have to deal with the same issues like Granville does all the time. This isn’t really anything unusual.”
Wake EMS is the Exception
So the odd outcome from this story is if anyone takes the services of Wake EMS for granted, you should not. It certainly seems we undervalue and under-appreciate what Wake EMS does for us.
Frankly, looking outside of our borders to other counties and the realities of the EMS delivery system there, will give you appreciation for what we do have. The perception of four minute response times in most nearby counties is just not a reality with staffing issues, equipment restrictions, or crews just tied up.
Another local up and coming EMS shinning star system that is branching out is Franklin County. Over there they say they have not had to close any EMS stations due to staffing or equipment concerns. Although some say more EMS stations in Franklin are needed.
They are even growing their services to include the new state-of-the-art mobile integrated healthcare like Wake County. This will move more help and assistance to Franklin County residents and help people avoid the expensive emergency room when possible.
But before we get all in a frenzy comparing Granville County to Wake County, lets look back at the path Wake County took to reach the point it is at today using research by Mike Legeros.
Up until 1965 emergency ambulance service in Wake County was provided by funeral homes. Beacon Ambulance Service took over for the funeral homes and received a subsidy from the county for providing ambulance service in Raleigh and areas in the County the local funeral homes were not servicing.
In 1978 the now Wake EMS system ran an average of 20 calls a day. It wasn’t till 1983 that ambulance crews could speak to doctors over the radio from any location.
In 1988 Wake EMS had seven ambulances, less than What Granville County has today. In 2000 there were 14 EMS units.
Today they are about 46 Wake EMS/Paramedic units that can respond, not counting District Chief vehicles.
And I’ve been at Wake EMS on days when they’ve had vehicles out of service due to mechanical issues.
People Say Mike D’Haene is a Good Man
I spoke with some people who personally know Mike D’Haene who leaked his story to ABC11. Those that did know him all said he is a fine man and a talented paramedic. They say his intentions were to draw awareness to perceived problems to help the citizens of Granville County.
What is puzzling about the ABC11 piece is D’Haene must have known there were going to be repercussions after releasing internal documents and letting the camera crew film inside the GHS EMS vehicle and station, if that was his call alone.
I firmly believe D’Haene has witnessed a change in the services delivered in Granville County. And he probably feels he has exposed a broken system, at his own risk. I was told the day after the story appeared D’Haene was terminated.
Others I’ve spoken with in Granville County expressed similar opinions and even said to me that it was not uncommon to have just one EMS squad available at times to cover a significant part of Granville County. And that some ambulances have been taken out of service and replaced with SUV response vehicles like the one we saw D’Haene driving in the news story.
But the answer to this situation is not as straight-forward as you would hope. Granville EMS spends a lot of time with non-emergency routine patient transports. If there was an additional for-profit ambulance system in the county they could handle these. But till there is not so routine transfers from nursing homes and prisons in the County will be handled by Granville EMS. Those transfers tie up equipment and paramedics.
But don’t forget, EMS departments in the United States are primarily regulated under the Department of Transportation as transport units and not medical care providers. So transport they do.
Additionally, people in Durham County said it was not uncommon to see a Granville EMS unit transporting a patient over there for treatment. An out of county transfer takes an ambulance out of service as well.
Granville is not a big county with 45+ ambulances. It seems quite possible that resources could be stretched past the breaking point with an unexpected combination of a paramedic out, a routine transfer, and an out of county transfer. It logically seems there could be times when only one ambulance is available to respond.
Granville County Just Handed the Hospital the EMS Division
One criticism raised by some during my research was over the original deal for the transfer of the County EMS system to GHS. They expressed concern GHS got a great deal when they took over the EMS system.
Now I don’t know about the quality of the deal but because of documents released to me by Granville County I now have a better understanding of the transfer.
There are two important parts of this agreement. The first is the transfer did cost Granville County money. Not only did the County transfer the EMS system to GHS but they also gave GHS a graduated subsidy as well. This subsidy ends in fiscal year 2014-2015.
According to Granville County, the subsidy is the only direct financial support from the County for EMS Services. And as shown, that ends in the next fiscal year. So from that point forward EMS services will not cost the County any money and earns revenue from fees paid for EMS services rendered. This provides a slightly different context moving forward for D’Haene’s statement, “I think the taxpayers need to be pretty upset about how their money is being spent.”
Who Pays for Granville Health System
According to the Granville County annual budget “The Board of County Commissioners owns and operates a 62-bed hospital known as the Granville Medical Center. A nine member Board of Trustees appointed by the County Commissioners supervises the operations of the hospital. Two County Commissioners also sit on the Board as ex-officio members.
The General Fund contribution to the hospital supports the care of indigent patients, liability insurance, EMS services and certain capital needs. Fees and other revenue support the ongoing operations of the hospital. Approved funding for fiscal year 2013-2014 is $214,495 to offset the indigent care cost, $600,000 for EMS Services, $50,000 in property insurance, and $132,873 for capital expenditures. Debt service includes principal of $356,029 and interest of $411,678. The debt service is funded by a transfer from the Health System at 100%.” – Source
According to the County budget the taxpayers do contribute a lot of money towards the services rendered. Check out that line for debt service.
But Here is the Critical Question
It seems the bottom line here is not if services being delivered are different, but are they better or worse. The 2010 transfer document between the County and GHS contains a clause which makes it appear the County was concerned about continuing the level of care residents received when the County ran the EMS services.
“9.2 Level of Services. GHS shall at all times provide EMS services in Granville County in such a manner that the overall coverage and level of services provided to the County as a whole shall be equal to or greater than the level of services provided as June 30, 2010 by the County. Nothing herein shall be read to prevent GHS from changing station locations, from changing staffing levels in any area, or from making any other management decision that may adversely impact services provided in one area while augmenting services provided elsewhere.”
That is a tough question to quantitatively answer. Take response times as an example. Even if current Granville EMS squads took longer to respond now, is the outcome at least the same or better than it was in 2010? I’m not sure and nobody I spoke to on any side of this position could provide any measurement to make that determination.
Only the County can determine if they are satisfied or not with the services delivered. And after repeated requests to answer that question, they have not specifically said they are happy. They’ve also not said they are unhappy. Basically they pretty much dodged it.
What Granville County Manager Mike Felts did say was, “Granville Health System EMS and Hospital staff are dedicated professionals who contribute to the overall health and well-being of Granville County citizens and our surrounding areas. Granville County Government supports and appreciates the contribution Granville Health System provides to the community and to the citizens of the County.”
Scott Thomas from GHS also shared the following, “You are correct, the contract between the County and Granville Health System does not require an increase in coverage. The contract also states GHS can change station or staffing levels in any area, or make any other management decisions that may change services provided in one area while augmenting services provided elsewhere depending on the needs of the community.
However, even though there is no contractual requirement to expand EMS services, Granville Health System is committed to increasing coverage, which we have and continue to do into 2014. An example would be two EMS stations that before 2010 had not been open more than 4 days a week:
2009: EMS Station 7 Oak Hill and 6 Wilton – Open 4 days per week
2014: EMS Station 7 Oak Hill and 6 Wilton – Open 7 days per week
At no time since Granville EMS has transitioned over to Granville Health System has service levels decreased below the 2010 County’s benchmark levels. Coverage has only increased.
We had shared this information with ABC 11 news, however, for reasons not known to us they chose not to use it.”
Is Granville County a Good Place to Die Because of EMS?
The story started with a question, “Is Granville County a Good Place to Die Because of EMS?”
After spending days on this story and talking to a lot of people, what I can offer you is my outside opinion.
I think Granville County is an area under transition from a small rural North Carolina community that used to be essentially all alone out there to a growing county with new residents and new expectations. It sure seems like a good place to live.
The people who work very hard for Granville EMS seem to be caring individuals who take their jobs and patient care very seriously. I’ve not heard one word from anyone who was unhappy with the care they received from any Granville EMS paramedic or the hospital emergency department.
Rural communities are just not going to have fast response times and the struggles some perceive Granville EMS to have are not unique to Granville County. Far from it.
If Granville County is not happy with the services Granville EMS is providing then the 2010 agreement give the County a clause to back out of the deal. That’s an issue for local citizens and their government to discuss and contemplate.
If Granville County citizens want Wake EMS response and services then just increase taxes to pay for it.
I understand the unhappiness expressed by some but I’ve certainly not seen any evidence to support any systemic degradation of EMS life-saving services to Granville County residents. And people should also be comforted that there are mutual aid agreements with surrounding counties if needed.