To the Residents of rural Taylor County:
Next week, on April 23rd, your Taylor County Commissioners Court will decide on proposals relating to who will provide Emergency Medical Services (EMS) throughout the county outside the Abilene city limits. Their choices are between American Medical Response (AMR), a Colorado based company that has the EMS contract in Abilene, and Taylor County EMS (TCEMS), a community-based 501(C) non-profit organization that has provided EMS to the county for the last 34 years (12 years full-time and 22 years as a volunteer service).
We are asking for your support by contacting the members of the Taylor County Commissioners Court and telling them to retain TCEMS’ excellent service. AMR has a poor and unreliable recent history with other localities which also comes with damaging, long-term financial ramifications.
AMR has a history of long response times, getting a contract and then asking for sizable adjustments, not fulfilling contractual requirements, and backing out of services. Many localities have used AMR and have decided to not retain them, including the hometown of their headquarters in Colorado Springs and surrounding cities. In the attached articles, you will discover recent instances where AMR underperformed in their contracts. AMR often requests more money when unable to deliver on their obligations. The locality either pays AMR more for inferior service, establishes their own service from scratch, which is incredibly expensive, go through the bidding process again, or simply doesn’t have coverage. AMR’s nefarious actions place the locality into a difficult dilemma and the locality’s options are all unpleasant. In one case, AMR’s final contracted amount was over SEVEN times the original amount (see Falls County, TX article in attachment).
MetroCare/AMR abruptly terminated county EMS responses twelve years ago. This action prompted the Commissioners Court, some of whom are still on the Court, to ask the volunteer service, South Taylor EMS (STEMS), to cover the entire county. STEMS stepped up and transitioned into a full-time service, TCEMS, to fill the need and serve the community. Why would we give MetroCare an opportunity to do it again? This history and AMR’s recent troubles demonstrates the need to stay with TCEMS.
Attached is detailed information regarding the history of AMR/MetroCare, locally in Texas, and around the nation. Also attached is information on the dedicated performance of TCEMS. We humbly request you petition the Taylor County Commissioners Court to retain the excellent and professional service that TCEMS delivers. Let’s not relinquish this vitally important service to the untrustworthy performance of AMR for what appears to be a short-term financial gain. Why replace a system that already provides excellent EMS and community support that, in the long run, will be cheaper than AMR and keeps tax dollars in Taylor County? Cheaper isn’t always better!
Please contact the following court members and tell them you want to keep TCEMS as YOUR county EMS provider!
County Judge Phil Crowley Commissioner
phil.crowley@taylorcounty.texas.gov
Randy Williams, Pct. 1
Ph: (325) 665-0775
randy.williams@taylorcounty.texas.gov
Commissioner Kyle Kendrick, Pct. 2
kyle.kendrick@taylorcounty.texas.gov
Commissioner Brad Birchum, Pct. 3
Ph: (325) 386-8171
brad.birchum@taylorcounty.texas.gov
Commissioner Chuck Statler, Pct. 4
Ph: (325) 669-6266
chuck.statler@taylorcounty.texas.gov
Additional Information Relating to Taylor County EMS Proposal Agencies
Background of EMS Providers
AMR owns MetroCare, the EMS provider in Abilene. A little background on AMR. They are based in south Denver, Colorado and are a subsidiary of Global Medical Response (GMR), who also owns the main local aeromedical evacuation service provider, Air Evac Lifeteam. If AMR receives the contract for county EMS, GMR would essentially have a monopoly on all EMS, ground and flight based, in the entire county; much like Hendrick Medical Center currently has a monopoly on hospital services in the area.
TCEMS, formerly South Taylor EMS (STEMS), started as a volunteer service to cover areas of the county not serviced by full-time services 34 years ago. Twelve years ago, MetroCare abruptly dropped EMS in the county to focus on the city. STEMS then transitioned to TCEMS providing full-time EMS. Since then, TCEMS has been providing EMS throughout the entire county, screening patients and providing assistance in the city and county during COVID, and providing medical standby for your local volunteer fire departments during incidents, including the 13,000 acre Mesquite Heat fire in May 2022. TCEMS supports community activities like sporting events including numerous football games, rodeos, and other events as requested. TCEMS members volunteer countless hours at the first aid station during the West Texas Fair & Rodeo, preparing and delivering meals during the holidays, providing community education, training with local volunteer fire departments, and taking part in community events like Trunk or Treat. TCEMS actions prove their commitment to supporting the communities they serve on all levels, without focusing on profits for shareholders.
History of EMS in Taylor County
MetroCare inherited EMS responsibilities from Rural/Metro Ambulance in 2004 for the area in the county along I-20 in Tye, along Hwy 277 in the View/Caps/Elm Valley areas, and in the Potosi area with STEMS and Merkel EMS handling much of the remaining parts of the county. In September 2011, MetroCare abruptly informed the county officials that they were refocusing their efforts on the city and would no longer provide EMS in the county starting in 60 days. See https://www.ems1.com/ems-management/articles/texas-county-close-to-deal-with-rural-ambulance-team-g7xnO6yZzyiA1V8T/
With AMR not providing EMS outside the city, the Commissioner’s Court, three of which are still County Commissioners, asked the volunteer organization STEMS to take over EMS. STEMS received funding to transition from an all-volunteer agency to a full-time EMS service and TCEMS was formed. Since then, TCEMS has dedicated itself to the service of the Taylor County communities.
AMR Recent History in Texas and Around the Nation
AMR has a demonstrated history across the nation of not fulfilling their EMS contractual obligations. These lapses manifest as large response times, using resources allocated for one mission to support more lucrative missions, requesting large funding adjustments after contract award, and abruptly pulling out of contracts.
AMR could not meet contractual requirements literally in their own back yard. This article, https://www.csindy.com/news/ambulance-provider-has-until-dec-31-to-improve-response-times-or-possibly-lose-contract/article_9f64a6c4-43ef-11ed-88b9-b3bd9ce8bf0c.html details how AMR racked up millions of dollars in fines in Colorado Springs and surround communities, right down the road from their headquarters. They blamed the pandemic for their lapses but according to this subsequent article, https://krdo.com/news/2023/02/01/colorado-springs-to-stay-with-ambulance-provider-after-it-breaks-contract/, AMR got the contract in April 2020, right as the pandemic hit, and maintained acceptable response times until December 2021. Their response times troubles started in December 2021, after the bulk of the pandemic was over. In an April 2022 a letter to the city, AMR’s regional director declared the pandemic “an unanticipated circumstance not caused by AMR” that “made AMR’s performance under the agreement virtually impossible…”. They exonerated themselves by asserting “there is no default under the agreement and any alleged failures of performance are excused.” (see first article). But their metrics were within contract parameters during the height of the pandemic. Their performance fell as the pandemic waned. After being put on a cure period, basically a probationary period, from mid to late 2022 AMR improved but was still unable to meet their requirements. In the short term, Colorado Springs decided to continue using AMR but only because their full-time fire department stepped in and filled the gap including using fire department assets to transport patients. As of mid-March 2024, Colorado Spring is considering standing back up their own EMS and their neighbor, Manitou Springs, made with switch in February 2023 (https://www.koaa.com/news/covering-colorado/colorado-springs-fire-considering-switch-from-amr-to-city-run-ambulance-service). If they have problems providing EMS in their own back yard, how much will they care about Taylor County.
Another example is encapsulated in the late 2023 situation in Hinds County, MS where AMR provides EMS to the city of Jackson and Hinds County, much like what would happen in Abilene and Taylor County. AMR has consistently not met contractual response time requirements and that has led to poor patient care and outcomes. According to these reports (Part 1 - https://www.wlbt.com/2023/09/27/i-could-have-had-him-little-bit-longer-3oys-finds-amr-fails-meet-response-time-mandates-hinds-co-contract/ and Part 2 - https://www.wlbt.com/2023/09/28/whos-supposed-keep-up-with-this-analysis-shows-amr-defaulted-hinds-co-contract-months-ago/ - the video reports are informative also), AMR met response times requirements only 50% of the time when the contracted metric was 85%. This is even after excluding calls from being counted for things like weather, traffic/road obstructions, and too many ambulances out. One Jackson councilwoman went so far as to say “if we are not at 85%, which the contract requires, we need to cancel the contract” (see video report). In neighboring Clinton, MS, serviced under the same AMR contract, when asked about a 46% response time rate the mayor “had no idea about that” but was “satisfied” with AMR services. He was comfortable with the status quo because many in their full-time fire department are trained as EMTs and fill the response time gap (see video report). The city of Jackson is now in the process of selecting another EMS provider. Taylor County residents are served by volunteer fire departments, not full-time departments, who cannot always make it to calls or do not have medically qualified members. Taylor County residents rely on TCEMS. This MUST be a cautionary tale for Taylor County.
In late 2020, the Emergency Medical Services Authority (EMSA) of Oklahoma, the agency that provides EMS to a large portion of Oklahoma including Tulsa, Oklahoma City, and other cities in Oklahoma, voted to almost immediately terminate their contract with AMR (EMSA Board Votes to Terminate Contract with AMR - EMSA (emsaonline.com) - https://emsaonline.com/news/emsa-board-votes-to-terminate-contract-with-amr/). In September EMSA presented AMR with a default letter for breach of contract. Some of the details in the default letter: failure to comply with response time requirements, failure to pay amounts due to EMS and honor gain sharing provisions totaling over $16 million, failure to ensure workforce licensing requirements, and failure to provide EMSA with documentation for billing. A week later, AMR unilaterally walked away from their contract because of the letter and planned on ending EMS January 31, 2021. In late October EMSA decided it was better to take out a loan and set up their own services, to start covering EMS a month later, rather than continue with AMR. This is like the situation Taylor County was in 12 years ago with MetroCare and is a forewarning of what could happen again.
This article from November 2022 (Falls County could lose ambulance service (kwtx.com) - https://www.kwtx.com/2022/11/16/falls-county-could-lose-ambulance-service/) details how AMR asked for a 163% increase in their agreed upon price. In a follow on article dated May 2023 (Falls County ESD tax increase to keep ambulance services passes (kwtx.com) - https://www.kwtx.com/2023/05/07/falls-county-esd-tax-increase-keep-ambulance-services-passes/), the Emergency Services District President said “they very surprised with AMR increased the price of their services for the rural county” with an decrease in services; two ambulances originally provided versus only one for the whole county now. In the end, the new one-year contract was over seven times the originally contracted cost with “no assurance it won’t go up next year.”. To cover the cost, officials stated they would need to double what the average taxpayer pays for EMS services.
This article from January 2024 (Sacred Cross to return as emergency ambulance service for Breckenridge, Stephens County - Breckenridge Texan - https://breckenridgetexan.com/2023/01/04/sacred-cross-to-return-as-emergency-ambulance-service-for-breckenridge-stephens-county/) details the situation in nearby Stephens county. AMR rescinded their bid when the agreed upon amount ($300,000 per year) would not cover their expenses. They wanted the parties serviced by the contract to pay $1 million a year – over three times their initial agreement.
This article from November 2023 (Knox County leaders discuss proposed AMR contract, including changes to support EMS system | wbir.com - https://www.wbir.com/article/news/local/knox-county-discusses-changes-to-amr-contract/51-625556c5-dd51-4f1a-bfc5-f7d4db0fcc8f) details how AMR had long response times and did not meet their contractual obligations. AMR was requesting an adjustment for their services after the contract was awarded. One commissioner expressed concerns about the financial stability of GMR, AMR’s parent company, and how that could affect their service.
Often AMR uses a shortage of paramedics as cover for their lack of compliance. There are three levels of certification on ambulances, basic emergency medical technicians (EMT-B), advanced EMT (AEMT) and paramedics. AEMT and paramedics are qualified in advanced life support (ALS) techniques. Some jurisdictions require AMR to have two paramedics on an ambulance. AMR often counters that if they could use a mix of paramedics and EMT-Bs it would solve many problems. They even try to get localities to use “Basic Trucks”, ambulances staffed by two EMT-Bs, to cover calls that need only basic skills. This article (https://www.ems1.com/american-medical-response/articles/displeased-with-amrs-response-times-calif-county-turns-down-contract-renewal-2oSxGOPvWuSgVp7Q/) talks about AMR using basic trucks when advanced life support (ALS) ambulances, ambulances staffed with at least one ALS provider, are required. Oftentimes a call will devolve to a point where ALS skills are needed, and an EMT-B crew would have to call for assistance. TCEMS’ staff is mostly ALS qualified individuals, nearly 80%, with two more Advanced EMTs finishing their paramedic training in the next few months.
To illustrate the responsiveness of TCEMS over AMR, take for example a recent call. One afternoon, the primary and backup TCEMS crews were already on two separate 911 calls when a third 911 call came out. TCEMS leadership decided that based on where their crews were, the severity of the third call, and in accordance with established mutual aid agreements, they needed help from AMR. An AMR crew was dispatched to the third call. The AMR crew responded to the third call but due to the nature of the call and circumstances beyond the crew’s control, they were delayed getting access to the patient. While they were on scene at the third call, a fourth, critical care call dropped less than 5 miles (7 minutes) away from the third call. At that point, the primary TCEMS crew was just arriving at the hospital, and even with a quick turnaround at the hospital, it would be at least 35 minutes before they could get to the critical call location. TCEMS and AMR local leadership talked and agreed that the AMR crew should go to the critical call since there were already two ALS First Responder agencies already on scene and still no access to the patient, but AMR had to consult with their upper management in Dallas. Confusion between local AMR dispatch, local AMR management, Dallas AMR management, and the on-scene AMR crew led to the AMR crew not redirecting to the critical call, even though they knew about the significant but unavoidable delays on the third call. When the TCEMS crew realized the AMR crew was still waiting to get to the patient on the lower priority call and had not yet redirected to the more critical call, TCEMS took the initiative to respond to the critical call. This demonstrates the agility of TCEMS as a small, but effective, EMS agency to triage situations locally and make instantaneous operational decisions that can be executed without “corporate approval” for improved patient outcomes.
Historically AMR does not generate much from 911 EMS calls. The majority of their profits come from non-emergency transfers to other facilities, such as patients at Hendrick needing to be taken across town or to the Metroplex. Their real interest is getting their foot in the door in an area. That is why their initial bids are low and then they often request large adjustments, because they need the adjustments to make up for losses taken on EMS calls.
A few years ago, AMR had the EMS contract in Coleman County. According to Coleman officials, AMR would often take the ambulance covering EMS calls and send it on a more lucrative transfer call. That left Coleman County with longer response times or even completely without EMS support until the ambulance got back. Coleman County decided against using AMR again.
Many communities are at the mercy of AMR to either pay their fees or risk losing services, just as the case was for our neighbors in Stephens County. Paying their large fee adjustments is often preferable to county leadership in the short term rather than paying the upfront and overhead costs of standing up and managing a county EMS. This does not have to be the case in Taylor County. The infrastructure developed by STEMS/TCEMS over 34 years is in place and is working well. If TCEMS is not kept as the local provider, all their infrastructure is gone and the county will be at the mercy, like so many other localities, of AMR or another service or pay for all those upfront costs to stand up EMS again. This does not have to happen.
AMR has demonstrated their main priority is profits. They do not provide any substantial community support without reimbursement. TCEMS provides an all-volunteer first aid station during the West Texas Fair & Rodeo and other venues. AMR’s history demonstrates they likely will not donate the services TCEMS covers for free. This shows AMR’s real priorities despite what they may put in a press release.
Lastly, we want our tax dollars to stay in the county and with a service that is integrally involved, often on agency member’s personal time, with the community. If AMR is awarded the contract, those local tax dollars will flow out of Taylor County.
AMR’s real interest is using this contract as a way of expanding their presence in the Big Country area to leverage contracts in surrounding counties. They don’t have an interest in serving Taylor County residents. It is all about how they can expand their profits. If AMR gets this contract, there is no going back to a local service. Taylor County, and eventually other localities, will perpetually be at the mercy of AMR. Let’s learn from other communities’ examples, and our own history, and not let Taylor County fall victim to AMR/MetroCare.
Other news articles:
San Bernardino County, California - https://www.ems1.com/american-ambulance-association/after-more-than-40-years-amr-out-as-ambulance-provider-in-calif-county and https://news.yahoo.com/san-bernardino-county-cuts-ties-101827019.html
Main Line Health in Philadelphia - https://noah-news.com/us/en/business/2023/11/22/american-medical-response-announces-layoffs-amid-contract-change-in-philadelphia
Santa Barbara County, California - https://www.independent.com/2023/09/19/santa-barbara-county-fire-beats-out-amr-for-countywide-ambulance-service-contract/
Biloxi, Gulfport, and Harrison County, Mississippi; They set up a commission to investigate AMR after 50 years of service- https://www.supertalk.fm/harrison-county-moving-away-from-american-medical-response-for-ambulance-services/ and https://www.wlox.com/2023/09/22/harrison-county-appoints-unique-committee-investigate-amr-consider-other-ems-services/