1998-06-11 Special Meeting
NEW HANOVER COUNTY BOARD OF COMMISSIONERSBOOK 26
WORK SESSION, JUNE 11, 1998PAGE 534
ASSEMBLY
The New Hanover County Board of Commissioners held a Work Session on Thursday, June
11, 1998, at 7:30 a.m. in Room 501 of the New Hanover County Administration Building, 320
Chestnut Street, Wilmington, North Carolina.
Members present were: Commissioner Buzz Birzenieks; Commissioner Ted Davis, Jr.;
Commissioner Charles R. Howell; Vice-Chairman Robert G. Greer; Chairman William A. Caster;
County Manager, Allen O’Neal; County Attorney, Wanda M. Copley; and Clerk to the Board, Lucie
F. Harrell.
Chairman Caster called the meeting to order and welcomed Mr. Bill Atkinson, President/CEO
of New Hanover Regional Medical Center and other persons in attendance. He stated the purpose
of the meeting was to discuss the transfer of Emergency Medical Services (EMS) to New Hanover
Regional Medical Center.
Ms. Anne Patterson, Vice-President of New Hanover Regional Medical Center, presented the
following chronology of events:
In February, 1997, the New Hanover County Board of Commissioners requested the Medical
Center to consider transferring EMS to the hospital. Through March and April, a thorough
evaluation of the implications of such a transfer was performed, and this information was presented
to the Medical Center Board of Trustees in April. In May, the Board of Trustees voted to contribute
$2,000,000 to fund the deficit operation of the County EMS.
In March 1998, the Medical Center received a request from the Board of County
Commissioners to continue the $2,000,000 subsidy for EMS. This request resulted in additional
discussion of whether the Medical Center would be willing to assume the County EMS during the
current year.
After a thorough evaluation of assuming the operation of the County EMS, the transfer was
recommended to the New Hanover Regional Medical Center Board of Trustees. In April, the Board
of Trustees voted to accept the operation of EMS services. Since that time, the Medical Center staff
has been working with County staff to bring about the transition, on or before July 1, 1998.
Ms. Patterson explained that emergency medical services include a broader focus than
traditional emergency medical services. This service encompasses local traditional EMS services
currently provided by the County, non-emergency transports, critical care transports, first responder,
air transport, water transport, 911 dispatch, rescue and extrication, and information from VitaLink,
plus a quality component to make sure these services continue to improve. There are five categories
of services required of EMS offices by State Statues:
Category 1: Basic level of traditional emergency services
Category 2: Non-urgent transport
Category 3: Critical Care transport/VitaLink
Category 4: Air Ambulance
Category 5: Water Rescue/Transport
Director of Emergency Management, Dan Summers, asked whether water services included
just water search and rescue, or water recovery and water extrication services. Ms. Patterson
responded that she was not sure but thought it could include both.
Discussion was held on the plan for the Medical Center to incorporate Emergency Medical
Dispatch into the 911 Center. Ms. Patterson explained that in order to incorporate EMS dispatch,
the following sequence of events would have to occur:
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The call is placed and enters the 911 dispatch center.
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The 911 Center will determine the level of the emergency.
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If the call is an emergency, an EMS transport occurs
NEW HANOVER COUNTY BOARD OF COMMISSIONERSBOOK 26
WORK SESSION, JUNE 11, 1998PAGE 535
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If a move to another hospital is needed, the VitaLink service is initiated.
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If the call is determined to be a non-emergency transport, such a carrying a patient to a
nursing home or rehabilitation center, this transport service is provided by Medical
Transportation Specialists.
Mr. John Hubbard, a partner of MTS, questioned whether 911 was currently giving medical
instructions over the phone.
Ms. Patterson responded the 911 Center is the key to saving time in responding to
emergencies. Brunswick County has implemented priority medical dispatch, whereas, New Hanover
County has not. This type of service has been activated in most major counties in North Carolina,
and it has become a computerized dispatch in Forsyth, Guilford and Wake Counties. Our computer
system has this capability and it should be considered. This type of dispatch matches the service to
the need by not sending a high-speed ambulance response unless it is actually needed.
Mr. Hubbard asked if VitaLink was dispatched when an emergency occurred in Columbus
County and a transport was needed at the Medical Center.
Ms. Patterson responded that Columbus County has a Critical Care Response capability with
its own emergency vehicle for transport. However, Brunswick County does not have Category 3
Critical Care Response capability. The vehicles used for this level of response are extremely
expensive.
Ms. Patterson continued her presentation saying it is becoming more prevalent elsewhere in
the state to have hospitals be responsible for providing EMS services. In some areas, private
hospitals are assuming this responsibility and in other areas the service crosses county lines. Craven
and Lenoir Counties have some unique relationships, and in Charlotte there is a private component
that handles the bulk of non-emergency transport.
A chart was presented on growth in the numbers and levels of nursing home beds/care. There
has been a significant amount of growth in service and activity in the skilled nursing level, indicating
a potential growth in the need for non-emergency transport. With an increase in the number of
elderly residents, there is a potential for growth in non-emergency transport.
Mr. Hubbard questioned the location of the Medical Center’s radiation oncology services and
the need to transport hospital patients to this facility.
Ms. Patterson responded the Medical Center has maintained a long standing relationship with
MTS. The Medical Center is currently building an oncology center that will provide radiation therapy
enabling patients to be treated on campus.
Mr. Hubbard asked how many patients would be transported to the radiation center per day.
Ms. Patterson responded approximately 3,000 trips per year. She advised that MTS was used
on a routine basis for these transports.
President/CEO Bill Atkinson pointed out the goal was not to take 911 equipment and use it
to transport a hospital patient to the radiology center after hours. It is important to understand the
relationship of providing EMS Services in the least costly way and at the same time accomplish the
mission of emergency response throughout the area.
Ms. Patterson concluded her presentation by emphasizing the importance of NHRMC being
granted Categories 1-5, and she requested the Board of County Commissioners to adopt a franchise
including the categories. She also requested the Board to support the additional positions for the 911
Center as recommended in the proposed FY 1998-99 budget.
NEW HANOVER COUNTY BOARD OF COMMISSIONERSBOOK 26
WORK SESSION, JUNE 11, 1998PAGE 536
Commissioner Birzenieks asked if the NHRMC Administrative Staff had taken time to sit
down with Mr. Hubbard to discuss how the hospital and MTS could work together.
Ms. Patterson replied that three meetings had been held, including one just two days ago to
review a second draft of the proposal. It appears that both parties agree on the wording in the
contract, but MTS wants to wait until a decision is made about the franchise before making any
commitments.
Director of Emergency Management, Dan Summers, requested clarification and direction on
how the water rescue component would be coordinated. He noted that every water rescue event in
New Hanover County was a coordinated effort among agencies that have boats available. Sometimes
boats are provided by Marine Fisheries, the Sheriff’s Department, Coast Guard, or the Ogden Rescue
Squad. With the growing number of tourists and the need for more water rescue, coordination is
needed among the agencies to provide this service. The New Hanover County Emergency
Management Department currently has no forces, but is charged with coordinating water rescue
efforts as well as being responsible for land search. The Commissioners were requested to envision
Emergency Management’s role in the coordination of water rescue.
President Atkinson advised that formal discussions are being held with area rescue squads and
volunteer groups to develop a coordinated effort in all aspects of EMS, including water rescue. The
role of the Coast Guard is to find persons who are missing on the water, but there is no conventional
medical component. Medical services are administered by the personnel on duty at any given time.
Chairman Caster requested Mr. Hubbard to comment on his concerns about the transfer of
the County EMS to NHRMC.
Mr. Hubbard said he continues to have concerns about Category 2 (a non-emergency service)
being included in the NHRMC franchise. Based on recent discussion in meetings, it appears the role
of MTS will decrease. No assurance has been provided by the hospital that MTS will be used to
transport patients from NHRMC to nursing home facilities. Also, it would be an extraordinary event
to award a franchise to an entity that is not now prepared to offer EMS services when MTS can
provide non-emergency services. It appears that money is an issue and the hospital sees an
opportunity to enhance their revenues. Dr. Atkinson told the Commissioners at a previous meeting
that he needed the non-emergency service to offset the cost of emergency service. This means there
is no long-term future for MTS. No one has listed the benefits to New Hanover County taxpayers if
the transfer occurs. MTS has continued to benefit the taxpayers by keeping costs down, and it is felt
the hospital will not be able to provide the non-emergency services at a cheaper cost. A franchise is
not needed to pick up a patient at NHRMC and transport that person to a nursing home or another
hospital.
In closing, Mr. Hubbard stated he would like to be included in the new system because the
establishment of a well functioning emergency component and a private non-emergency component
would compliment each other.
Discussion ensued on whether NHRMC was prepared to provide non-emergency services.
President Atkinson advised that New Hanover County currently has 10 vehicles of which 6 are
staffed. The Board of County Commissioners has approved 14 additional positions. It is not the goal
of the hospital to provide non-emergency service tomorrow; however, a system should be developed
that will meet future needs for the next 10 to 20 years. He spoke on continued growth of the Medical
Center with acquisition of other facilities, and he stated there is a great opportunity for Mr. Hubbard’s
business to be enhanced by the hospital assuming the EMS operation. Emphasis was placed on the
fact that NHRMC has a moral and legal obligation to do everything it can for its patients, which
includes all areas of medical transport.
Mr. Hubbard said that MTS had not been reluctant to work with the hospital and the company
has the same moral and legal obligation to its patients. He noted that he was convinced that NHRMC
and MTS could work together to create an excellent system. However, two providers of non-
emergency transport services are not needed in New Hanover County.
NEW HANOVER COUNTY BOARD OF COMMISSIONERSBOOK 26
WORK SESSION, JUNE 11, 1998PAGE 537
Dr. Atkinson stated that the services of MTS will be used after July 1, 1998.
ADJOURNMENT
Chairman Caster expressed appreciation to everyone for attending the meeting, and advised
that the Board of County Commissioners will be voting on this issue next Monday.
The meeting was adjourned at 10:20 a.m.
Respectfully submitted,
Lucie F. Harrell
Clerk to the Board