Fort Bend EMS asks for $3 million budget increase
Only 2 of county’s 11 ambulances meet 10-minute goal in 90 percent of cases
The man charged with improving Fort Bend County’s beleaguered EMS department is relying on “cold, hard facts.”
Only two of the county’s 11 ambulances met a national benchmark in the spring — reaching scenes in less than 10 minutes at least 90 percent of the time.
That is unacceptable, says EMS Director Graig Temple, which is why he’s asking for a 32 percent, or $3 million, budget increase.
“Yes, there’s sticker shock,” he said, “but this is catching up with where we should have been today.”
Temple says his department needs to factor in the area’s growth and make up for years of lackluster appropriations and poor data analysis that drove bad management choices.
Commissioners will release their proposed budget later this month and hold public hearings in September. Some are skeptical of such an excessive increase, but County Judge Bob Hebert said he will champion Temple’s request. When Hebert himself had a medical emergency recently, he said he waited more than 30 minutes for an ambulance to reach his home.
“This is a big step, but
I’m confident we have to do it, because we’ve got to get these response times and transport times down to a number we will be proud of,” he said. “We’re dealing with our residents’ lives.”
When Erin Tristan’s daughter had a life-threatening emergency two years ago, Tristan said it took nearly 30 minutes for a Fort Bend County ambulance to reach her house.
Tristan, a Fulshear city councilwoman and former Fort Worth EMT, performed rescue breathing as her daughter’s body convulsed, her face turned blue and her skin mottled from a lack of oxygen. She carried the girl in her arms as she ran down the street, knowing that minutes mattered and hoping those extra steps would bring her closer to the ambulance, even though she did not yet hear its siren.
The county’s dispatch records show that the first unit was on the scene in nine minutes, though Tristan wonders whether that’s from the time of the last call the family made as they grew more desperate. Declining quality
In any case, she later wrote to county commissioners, begging them to put more ambulances in service for the fast-growing suburban county.
“I told them how professional the paramedic was and how he apologized several times,” Tristan said, remembering that the paramedic had said they were 15 miles away when they were dispatched. “But he shouldn’t have to apologize. There should be more stations.”
She described county leaders as sympathetic, and they did station an ambulance near Fulshear in September 2013 — five years after one was first proposed by former EMS director Daniel Kosler, ac- cording to county records.
But dispatch data from 2013 and 2014 shows the ambulance stationed there frequently was drawn to calls across the county — from Cinco Ranch to Sienna Plantation — that sometimes caused longer response times in its primary coverage area.
It was not the only ambulance stretched thin.
Fort Bend units in those years responded countywide on a daily basis rather than answering a majority of calls in an area around their stations, according to the dispatch data released after a Chronicle public records request.
For years, Fort Bend paramedics had warned supervisors and county leaders that the quality of service and speed of response was declining.
Frustration also centered around pay: Peers in neighboring locations made 30 percent more and a federal investiga- tion found the county had shorted paramedics “sleep-time” hours for years. A third of the staff left in a single year. Two first-responder units were parked for five months and an intensive care ambulance was unmanned one day because the county could not hire as fast as employees were leaving, according to data from the fiscal year that started October 2013.
Commissioners exacerbated the department’s challenges with the decision year-after-year not to fund new ambulances. Since 2004, as the county’s population grew about 60 percent, to nearly 700,000 residents, the number of advanced ambulances and basic first-responder units has hovered around 12, depending on whether they could staff them.
With too few paramedics and a rising number of calls, overtime hours skyrocketed. Many para- medics earned about 2,000 hours of overtime in a year, the equivalent of an 80-hour work week when county protocol is for about 55 hours a week. Tiered response system
Temple was hired in late April with a mandate to address all the issues.
He said he has instituted reforms that improved response times and employee morale.
He found money in the budget to convert a first-responder unit to an intensive care ambulance and shifted former Sugar Land ambulances to areas that receive the most calls. He created a tiered response protocol so units shift to fill gaps and aren’t pulled for calls on the opposite side of the county.
Seven of the county’s 11 units now respond within their jurisdiction at least 80 percent of the time, he said.
Deputy Chief Brian Petrilla also discovered that the department had been miscalculating the number of calls that ended with a patient being transported to a hospital. That, in turn, misled county officials into thinking that many people were calling 911 when they didn’t need it. Actually, Petrilla found that nearly three-quarters of the calls resulted in hospital visits, tying up ambulances for much longer than if people were treated at the scene.
Now, Petrilla provides Temple with a daily report on response times and type of calls. Only eight callers have waited longer than 30 minutes since Jan. 1, and 84 percent of people saw an ambulance within 10 minutes, according to a report provided by the department.
Temple said more work remains to be done.
In a conference room at the department’s Rosenberg headquarters, he pointed at a framed map of the county. Circles, Xs and lines are drawn on the glass with dry-erase markers. They represent the changes he hopes to make. Shifting units to areas with the heaviest call volumes. Adding units to rural communities on the verge of becoming suburban.
Planning where ambulances will “post” when they shift to help neighboring units during peak times.
And, yes, he said, those changes will require an additional $3 million a year for a fiscal year 2016 budget of $13 million.
Temple has said that as much as two-thirds of the increase could be covered by updating ambulance fees billed to insurance companies. He said the county charges less per call than others in the metro area and, unlike the statewide norm, does not bill for items used on a call, such as catheters. ‘I was ... taken aback’
The decision, however, rests with the commissioners court.
Commissioner Andy Meyers has been the most skeptical of the need for such a large increase, pointing out that Sugar Land has taken over serving its residents, which reduces the Fort Bend coverage area by about 15 to 20 percent.
“So to have a 30-plus percent increase in costs, I was a little taken aback by that,” he said. “They need to sell me on the need for that.”
Commissioner Richard Morrison defends the request, saying that the court bears some responsibility for letting the EMS service fall so far, and Temple needs their support.
“We hired this gentleman here to get us out of the ditch and bring our EMS to the excellent level it once was,” he said. “We need to give him an opportunity to do his job.”