An application to operate a second ambulance service in Warren County – which appeared to be “fast-tracked” for approval after a state emergency regulation smoothed its path – now faces a court challenge.
TriStar Greenview Regional Hospital affiliate Southern Kentucky Ambulance Service filed a Certificate of Need application Sept. 26 on the heels of a Sept. 25 emergency administrative order issued by the Kentucky Cabinet for Health and Family Services.
That order contended that Warren County was facing a public health crisis, basing that conclusion on a report issued by Louisville’s Pegasus Institute think tank. That report contended that having only one ambulance provider – Med Center EMS – leaves the county underserved. Med Center Health officials have argued against that finding, saying in a full-page advertisement in the Daily News: “There is no public health crisis and there is no need for a second ambulance service in Warren County.”
Now, Med Center Health has taken its opposition a step further, filing a lawsuit Monday in Franklin County Circuit Court to stop the emergency regulation. The suit names the CHFS, Southern Kentucky Ambulance Service and Greenview as defendants.
The lawsuit calls into question the accuracy of the Pegasus report, saying it is “replete with errors.” The lawsuit requests that the court enter an injunction to enjoin the Health Services Administrative Hearings Branch from holding the “fast-tracked” nonsubstantive review hearing on the CON application of Southern Kentucky Ambulance Service.
Without the emergency regulation, Greenview’s path to approval of its Certificate of Need application would be much more difficult. It would need to make the case for a second ambulance service in the county. With the emergency regulation in place, the need for another service to compete with Med Center EMS is assumed.
With the stakes so high, Med Center Health Executive Vice President Wade Stone said he and Warren County Judge-Executive Mike Buchanon requested a meeting with CHFS Secretary Adam Meier to discuss their objections to the emergency regulation.
When Meier denied that request, Stone said Med Center Health took the extreme step of litigation.
“This was our last resort,” Stone said in a news release. “The Cabinet left us no choice when it refused our request to simply have a conversation. We had hoped that a ‘public health crisis’ would warrant a meeting. It certainly seemed reasonable to us.”
The action throws into doubt a plan laid out by Greenview in its CON application to have Southern Kentucky Ambulance Service operating by July.
The application lists Nov. 15 as the public notice date and Dec. 20 as the decision date for a ruling on the application.
If the CON is approved, the ambulance service would secure funding in February for what it projects to be a $724,200 investment. The timetable included with the application calls for a building to be constructed, bought or leased by June, when personnel are also expected to be employed and trained in time for a July opening.
The application projects that Southern Kentucky Ambulance Service would make 3,532 emergency runs and 1,533 non-emergency transports in its first year. Med Center EMS currently makes more than 23,000 runs annually.
Although the need for a second service is assumed under the emergency regulation, the Greenview application spells out its case in the application. According to language in the application, “There have been instances in which The Medical Center EMS has transported patients to The Medical Center against the request of the patient, the patient’s physician and/or the patient’s family.”
In the application, Greenview cites Kentucky Board of Emergency Services data suggesting that Med Center EMS routes a disproportionate number of patients to The Medical Center. Of the patients transported by Med Center EMS to one of the two Warren County hospitals, 21 percent are taken to Greenview, according to the KBEMS data.
The application claims that transporting patients to The Medical Center instead of Greenview can cause serious delays for patients, citing data showing that the median time spent in the emergency room before being seen by a health care professional was 47 minutes at The Medical Center and only seven minutes at Greenview.
In advertisements and in public statements, Med Center officials have made it clear they believe the justification for a second ambulance service is spurious.
Stone argues there is no need to change an arrangement that has worked well since 1980, when The Medical Center took over operation of the county ambulance service with no financial support from the city of Bowling Green or the county.
That arrangement has worked well, according to Buchanon. He points out that Med Center EMS has allowed the county to have an ambulance service without using any taxpayer dollars. Most of the state’s counties do have to rely on tax dollars to fund their ambulance services. Hardin County, for example, used $152,000 of taxpayer money to subsidize its ambulance service last year.
“I know of no public health crisis or pressing need that warrants another ambulance provider,” Buchanon said. “I just hope that this current action does not disrupt what we consider to be an ideal situation for county taxpayers. Warren County is proud of the EMS services that we provide through Med Center Health.”
In its ad, Med Center Health questions Greenview’s motivation for wanting to operate a competing ambulance service. It says a competitor that is owned by Hospital Corporation of America “wants more market share ... and sees adding an ambulance service as a way to get more patients into its emergency room and transferred to TriStar hospitals in Tennessee.”
Greenview CEO Mike Sherrod said his hospital is only looking to fill a need.
“The ambulance service we’re proposing will transfer patients to the closest, most appropriate ER and honor the request of the patient,” Sherrod said in an emailed statement. “This important service for our community will not be subsidized by taxpayer dollars and would provide care and transport for patients regardless of their ability to pay. We look forward to improving healthcare in Warren County by adding this long-needed medical service.”