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Strained EMS system hits AMR with $88,000 in fines, forgives over $125,000

In August alone Blount County’s contracted ambulance service, American Medical Response (AMR), racked up an unprecedented dollar amount in fines: nearly $220,000.

According to area company leaders and Blount County officials, that’s mainly due to wait times at Blount Memorial Hospital, where ambulances had to sit for hours before patients could be served.

AMR was recently struggling with staffing issues, but leaders say they’ve overcome that problem to a degree. AMR recently brought on about 25 new employees since July and changed its shift structure, adapting to changing needs in the county.

COVID-19-related strains on the system mixed with an unusually high call volume recently are pushing ambulance services to the limit, according to Blount AMR Operations Manager Jonathan Rodgers who spoke to the county’s EMS board Tuesday.

AMR — the nation’s largest ambulance company — contracts with Blount for EMS services. Crews are required to make it to calls in a certain amount of time — 10-15 minutes — above a certain percentage of calls each month — 90%. If they don’t meet these requirements, the company is fined.

Fines can accumulate for other reasons as well, like when the Blount system reaches what’s called “Level 0.” That means AMR employees are so busy that there are no ambulances are available to take calls.

According to data provided to board members, AMR hit Level 0 a total of 15 separate times in August. That alone cost the company $110,000 in fines. Between Level 0 incidents and late arrival times, AMR was fined $219,500 for that month, according to records provided to the EMS board.

In July, AMR was fined $118,500. In June, it was fined $93,750, which it has paid.

The high fines are why AMR leaders came to the board Tuesday asking for another waiver of fines. This is the third time in less than 12 months that AMR has asked EMS leaders to look past the contract and waive fines. It came to them in November and then again in December 2020.

Since late 2020, AMR has accrued more than a half million dollars in fines: But because of EMS board votes, it hasn’t actually paid that much.

The company has been using Gov. Bill Lee’s state of emergency declarations — the latest was Aug. 6 this year in Executive Order No. 83 — to justify their requests for fiscal grace.

“We do intend and will agree to exercise ‘best efforts’ to meet all compliance requirements as well as continue to provide all reporting metrics related to these response times as required,” AMR Regional Director Joshua Spencer said in an Aug. 9 letter to Don Stallions, EMS board chair and Blount’s Director of General Services.

Spencer called factors leading to high fine amounts the result of “unusual factors beyond our reasonable control,” citing COVID-19, delays at receiving facilities and reduced staff at hospitals.

All these factors combine justify another waiver, Spencer argued.

EMS board members noted Tuesday that AMR should be required to pay at least a portion of the $219,000 the company owes from August fines.

“I think if we continue to exempt everything it’s not fair to the agencies out there using their supplies and manpower to wait until AMR gets there,” EMS board member and Blount County Commissioner Ron French said. He then proposed they fine AMR $88,000 and forgive the rest of August’s fines. French based this amount on response times more than 18 minutes during that month.

The board agreed with French and unanimously voted to only fine AMR that amount.

Next, they agreed County Mayor Ed Mitchell, BMH CEO Don Heinemann and others need to sit down and discuss what to do about staff shortages at the hospital and the ripple effect those staffing issues are having on the EMS system.

Heinemann is an EMS board member but was not present for Tuesday’s meeting.

There are 11 EMS agencies — mostly police and fire — to which the money from fines is distributed and those agencies are struggling to keep up as well.

Alcoa Fire Chief Roger Robinson said Tuesday his crews are having to serve patients when AMR can’t be there quickly. That hurts the department’s ability to respond, too.

“We had two incidents (in October) when our units were tied up on EMS calls,” Robinson said. “On the first call it was 27 minutes before AMR arrived and on the second call it was 49 minutes. What’s happening is... the other day we had four units tied up. All three stations were tied up on EMS calls. Three of those didn’t have an AMR unit on-scene. That puts us down to two people to take a structure fire.

“We’ve got to fix the issue,” Robinson emphasized.

“It’s not about the money ... Our job is to save lives. The system is failing. We’re failing. I don’t know what. But we got to fix it.”

Heinemann emailed The Daily Times on Tuesday, responding to AMR’s assertion that long hospital wait times are to blame for delayed ambulance response times.

“While we know any disruption in the speed of care has ripple effects, I’m hopeful that these issues will ease as COVID cases drop throughout the region,” he emailed.

According to data provided to the EMS board, the time AMR had to wait at BMH’s ER during the month of August totaled 509 hours, 22 minutes and 18 seconds.

The total for the same month in 2020 was nearly 325 hours.

Quick agenda workshop sets up quiet monthly meeting for Blount County Board of Commissioners

It was business as usual for the Blount County Board of Commissioners during a quick agenda workshop on Tuesday evening.

With 15 commissioners present, the board voted to send every resolution and appointment to the full commission, with only one dissenting vote cast during the entire meeting.

Commissioner Mike Akard voted against a resolution that proposes a $31,500 budget increase “to appropriate assigned funds for the clearing, demolition, and removal of property structures at the Transition Facility site.”

Every other resolution was passed through to the full commission in 15-0 votes, with little discussion. The entire meeting took less than half an hour.

It’s a stark change of pace following more than a month of contentious meetings filled with high-stakes resolutions regarding massive subdivisions, zoning regulations, and COVID-19 vaccine mandates.

While those meetings were filled with disgruntled Blount County residents voicing their opposition to new housing developments, the public comment portion of Tuesday’s workshop was empty.

Despite not drawing a sizable crowd like recent meetings, several items pushed through during Tuesday’s session will impact important aspects of the community.

Commissioners voted 15-0 to forward to the full commission a resolution for a budget increase of more than $350,000 to “extend MACnet fiber network to Walland Elementary, Townsend Elementary, and Prospect Elementary,” something Akard said he had received emails about leading up to the meeting.

“I believe the public is assuming that this has to do with 5G cellular network, rather than Fiber going to the school and providing WiFi there,” Akard clarified.

“This has nothing to do with cellphones, this has to do with supplying internet to three schools that does not have access right now,” County Commissioner Tom Stinnett added.

Commissioners also voted unanimously to send to the full commission, a resolution proposing a budget increase of nearly $78,000 “to appropriate funds for Facilities Condition Assessment Services and Capital Planning Software for County Buildings.”

Capital planning software is a program that “automates and streamlines critical Capex processes, and enables finance leaders to assess and consistently compare each project’s strategic value,” according to capital planning management firm Finario.

Officials say the software is something that can help the county take care of its roads and infrastructure, an issue brought up by residents last month.

“This is our part of looking at our buildings and making sure we know what needs to be done in the future,” Stinnett said.

Commissioners also voted to push through a resolution regarding “Coronavirus Emergency Supplemental Funding” for the Blount County Sheriff’s Office, as well as Mayor Ed Mitchell’s appointments for the Blount County Human Resource Committee.

All of the resolutions will be on the agenda at the monthly county commission meeting set for Thursday, Oct. 21

Blount County Schools sees progress in 'growth' scores

While student achievement took a hit during the pandemic, Blount County Schools found much to celebrate in the growth students made during the past school year.

Even looking at student achievement data, BCS scored above the state average in 23 of 28 categories, Director Rob Britt told the Blount County Board of Education during a daylong retreat held at the Central Office on Sept. 30.

“The good news here is we didn’t decline nearly as much as what the state numbers were for the most part,” he said.

Overall the district earned the designation of “Advancing,” from the state, just below the top level of “Exemplary” in a five-category system. BCS also was “Advancing” in 2019, the last time the Tennessee Comprehensive Assessment Program was administered before the spring 2021 exams. Blount County ranked 26th of 146 school systems across the state and received the top system growth score, Level 5. A dozen of the district’s 21 schools also scored at Level 5.

Only one, Carpenters Elementary School didn’t reach Level 3, roughly equating to a year’s growth, but it was among the top in the district in achievement.

At CES, 69% of students scored on track or mastered in science, compared to a state average of 37.6% and BCS average of 42.4%.

“Overall the majority of our schools did an excellent job in science last year,” Britt said.

He emphasized the results came amid a worldwide pandemic when he said BCS employees “poured their hearts and souls into our classrooms.”

Among the growth highlights, BCS scored No. 1 in the state in geometry, No. 2 in Algebra I, No. 3 in English 1 and No. 6 in grades 3-8 English language arts.

Carpenters Middle School was No. 2 in eighth grade science, and a number of Blount County schools were in the top 10% or 20% in the state for various subjects.

“We did all this under tremendous adversity and strife,” Britt noted, citing disruptions not only at school but in homes because of the pandemic.

“There’s a lot of good news and reason to celebrate what happened in 2021,” he said of the results from the state assessments.

However, they also showed plenty of room for growth. For example, less than 20% Lanier Elementary students scored on track or mastered in ELA, and less than 17% of Walland Elementary students reached that level in math.

Ten Blount County Schools scored below the state average in ELA achievement for grades 3-8, and seven below the state average for math in those grades.

Same page

After sharing the state test results school officials also explained to the board a number of efforts already underway to further improve instruction.

Instructional interventionists, for example, are highly focused on the current second graders. They were kindergartners in 2020, when the beginning of the pandemic hit the last quarter of the school year, and their first grade year was far from typical because of the disruptions of COVID-19.

BCS also is working on sharing best practices across classes and schools, as well as building understanding among teachers of the standards covered the year before and after their grade.

Another key has been ensuring the pacing of instruction in every classroom. “We were not all on the same page academically with the curriculum,” said Jake Jones, assistant director of curriculum and instruction.

BCS is working to reduce variability from class to class and teacher to teacher, to ensure “everybody’s singing from the same sheet of music,” said Jennifer Moore, supervisor of secondary instruction.

For example, no longer are some juniors reading a book at the fourth-grade level, according to Terri Bradshaw, instructional coach for English language arts in the middle and high schools. Instead they all are reading the same book but with support where needed.

Jones admitted that “change is hard” and getting buy-in has been difficult, but the district is working to show teachers how data from assessments can be used to shape instruction.

“I’m excited about where we are, but I’m even more excited about where we’re going,” Britt told the school board.

Not all the increases in achievement were based on instruction. Heritage Middle School saw a dramatic increase to 76.5 percent of students scoring on track or mastered in Algebra 1, but it has cut by about half the number of students taking the course, looking harder look at who is most likely to succeed. Most students take Algebra I in high school.