Letter To The Editor: EMS Takeover Leaves Many Unanswered Questions

By: D. Banks Wallace
Johnston County EMS Advisory Committee Member

After reading the article entitled, “County Commissioners Forcing Four Oaks EMS, 50-210 EMS Out of Business”, I felt it my duty to the citizens of this great county to add perspective to this topic.  Not only am I a lifelong resident of Johnston County, it has been my life goal to give back to a community that has given so much to citizens like me.  In addition, I began my career in emergency services almost two decades ago by volunteering for one of the two rescue squads, as we used to call them, that is being taken over.  As my volunteer service developed and grew into a career, I felt it important to continue to serve the citizens of our county through volunteer work.  These are some of the few reasons I chose to serve as a voice to the citizens as a Citizen Representative on the Emergency Medical Services (EMS) Advisory Committee.

The EMS Advisory Committee is tasked with and is responsible for “advising the emergency services director and board of commissioners on matters…which will maintain and improve the quality of emergency medical services for the residents of the county.” [Johnston County Ordinance – Chapter 10 – Sec. 10-13(a)]  As a committee member who understands that while our recommendations are only that, and that the board of commissioners has the final decision on all recommendations, I believe that each member takes seriously the gravity of the decisions we make as a committee.  This is, of course, with the end goal of improving the quality of life for our visitors and citizens who receive emergency medical care from our EMS System.  While the Johnston County EMS system encompasses Johnston County Emergency Services Division of EMS, Four Oaks EMS, and 50/210 EMS, with the latter two being contracted with the county to provide EMS coverage, it hasn’t always been this way.

Almost two decades ago when I began volunteering in EMS, most EMS coverage provided to Johnston County residents was provided through agencies just like Four Oaks EMS and 50/210 EMS.  Over the years, the Johnston County EMS system, which at one point had no transport units (Ambulances) and simply provided management oversight and Paramedic quick response vehicles (QRV’s), has grown into a county EMS system with merely independent departments remaining.  If you look at history, all the EMS agencies that were absorbed by the county were taken over for only two reasons: mismanagement, or at the request of the EMS Chief and/or Board of the EMS Agency.  Neither of those reasons are the case with Four Oaks or 50/210 EMS.

At our EMS Advisory Committee meeting on January 7, 2020, one of the last items mentioned was by Chairman Joe Austin.  He stated, “at the April 2020 EMS Advisory Board meeting, the board needs to discuss and decide if they are going to recommend to the commissioners to continue the contracts for Four Oaks and 50/210 EMS.”  Since our April 2020 meeting was cancelled due to COVID-19, although other county meetings were being held via phone and video conference, I made it a point to bring some resolve during our June 23, 2020 advisory meeting.  It was important to me, after speaking with Chief April Matthews and Chief Ricky Denning, that I act in the interest of what I felt their wishes for the future to be, along with the wishes of their respective boards, and what was best for the citizens that each of their departments serves.

Just before a motion was made to the close the June 23rd meeting when prompted for any other comments before the motion, I stated that I believe we should discuss the future of Four Oaks EMS and 50/210 EMS as it pertains to their contract.  I felt this important to give each department and all of their employees and volunteers some direction for the future, regardless the decision.  Since this was the June meeting, and any action recommended would not be acted upon until the August 2020 Board of Commissioners meeting at the earliest since deadline for topics for the July 2020 agenda had passed, I felt it was important to begin discussions, stop “kicking the can down the street”, and close a topic that had lingered for some time.

After thorough discussion and taking into consideration that terminating the contract with each department would only give them 6-8 months to plan, prepare, notify their employees that they would have to find new jobs, and go through a hiring process at a new employer.  These are employees who work full-time and/or part-time at these agencies and with Johnston County EMS to provide a second income for their families.  Not to mention, the volunteers who would have little to no options as this decision eliminates all volunteer EMS opportunities in Johnston County.

In order to properly approach the topic from the previous paragraph, and any others that are unknown, I proposed our committee extend each departments’ contract for one year (instead of the normal 3 years) from the end of the contract (June 30, 2021 extended to June 30, 2022).  This was for the aforementioned points, in addition to the still drastically unknown circumstances that COVID-19 alone could bring in the coming months.  Moreover, flu season would be upon us soon, and with county officials preparing budgets beginning in January 2021, it seemed to me that when weighing the risks against the benefits of extending the contract to allow all parties to plan, prepare, and make an educated decision as to what was best for everyone, citizens included.  And it seems the Emergency Services Department was already overwhelmed with COVID-19 and didn’t want to take on the burden of additional departments and the associated moving planning that came along with that.  I should mention the most impactful reason to extend these contracts, second to providing employees adequate notice and allowing the departments to prepare, was that these are two highly successful, financially sound, well managed departments.  This is a night and day comparison to precedent set in past years.

I was not the only one who felt this way as my motion was seconded, and carried with a 9-to-1 vote by the advisory committee.  Included in the motion was that the Johnston County Director of Emergency Services, Kevin Hubbard, who was present and voiced support for our decision although he is not a voting member, was tasked with meeting with each EMS department, each board and chief, and gather information to bring back to our committee in the interim while the contract was extended.  This information would be used to present a wholly informed decision of the direction in which the county should proceed with future contracting of EMS service with these two departments.

You can imagine my surprise on September 10, 2020, two days after commissioners met in closed session, to learn from an email from emergency services management that commissioners voted September 8, 2020 “to allow contracts with Four Oaks and 50-210 EMS to expire July 1, 2021.”  While the commissioner representative was not present for our June 2020 meeting, it is the role of the Emergency Services Director to “serve as staff to the emergency medical services advisory committee on all matters that pertain to the committee’s function.” [Johnston County Ordinance – Chapter 10 – Sec. 10-13(a)]

I was left with a few questions:

(1) Did Director Hubbard ever meet with each Chief and/or Board?  If so, what was the outcome?  Was this information from his meetings communicated to the commissioners?  If not, why not?

(2) Did Director Hubbard ever inform the Board of Commissioners or the member of the board who wasn’t present at our June meeting as to the decision and recommendation of how our committee voted unanimously to proceed?  If so, why did they balk at his recommendation?  If not, why didn’t he inform them?

(3) Why would the Johnston County Commissioners, after increasing the Emergency Services budget over 30% for next year (FY22) amid a “budget crisis” caused by COVID-19, approve encumbering more financial responsibility and risk?

(4) How is a County Emergency Services Division, who according to a previous article weeks ago on JoCoReport spent “nearly 98% of CARES Act Funds on Employee Salaries” yet was not able to give EMS field staff hazard pay or bonuses going to fund a cost increase of “$1.5 million to operate the two departments for 12 months, or $916,615 more” according to today’s article?

(5) Finally, why would the Johnston County Commissioners not seek out a recommendation from our committee if, in fact, they had not known about our recommendation on the matter, when our committee was formed, selected, and tasked with proposing guidance on this exact type of matter?

In closing, while I will circle back and say that I am fully aware that the Emergency Services Advisory Committee is simply one who makes recommendations, I believe the recommendations are impactful and serious.  I would also be able to muster more respect for the Board of Commissioners’ decision to vote against precedent and forcefully take over two financially sound departments had they done so in a way that involved gathering all the facts and listening to the voices of the stakeholders involved.  It seems neither of these is the case, and was even masked by a meeting in closed session.

While I am likely not the only one left with more questions than answers from the decision of the commissioners, there is at least one positive aspect that remains solid and uniform:

The Johnston County EMS Division and its tireless field level staff provide a level of patient care that is nationally recognized. This is a level of patient care and training that Four Oaks and 50/210 EMS employees and volunteers have also provided as part of the EMS System for decades, ensuring citizens will remain safe and cared for, while using cutting edge technology, equipment and training to deal with their emergency no matter the situation.

In closing, while I believe that while one county EMS system is and always has been inevitable and certainly has some benefits, I think timing is everything.  Especially with growth and progression.  I can only wonder if this decision would have been handled the same if our current emergency services director had a background vested in the EMS field or shared the community ties to one of these departments, as was the case with a previous director.

Regardless of the future, I know without a doubt that regardless of the politics present, our EMS employees will not waiver nor will they hesitate to provide exceptional service in continuing to provide superb care, and keep our county population one of the best cared for and safest in the nation.