Only game in town
Billy McBride, a lifelong Orange County resident in retirement, didn’t have an ambulance of preference when he called 9-1-1 to take his seriously ill sister to the hospital even though she didn’t have insurance and the family was covering costs out-of-pocket. After receiving a bill from Acadian Ambulance, however, McBride decided he’d shop around for an ambulance provider when it was time to bring his loved one back home after battling with a lengthy hospital stay. But as the sister he loved was lying in the hospital waiting room with a terminal prognosis and discharge papers, McBride learned there was a major problem with his transportation arrangement.
“The ambulance company said they were stopped from bringing her home,” McBride said, indicating he didn’t know who made the determination, or even why, at the time. “She didn’t understand why they wouldn’t let her leave and she kept crying and begging me to do something so she could just go home.”He said hours would pass before she got her dying wish.
In the days following her death, McBride reached out to his elected officials to air out his concerns. A few phone calls eventually provided information, but little consolation – ambulance service in Orange County is Acadian or nothing.
Orange County municipalities and emergency service districts, through an inter-local agreement with the city of Orange, elected to acquire the services of an exclusive ambulance provider for 9-1-1 service calls in June 2006. Vidor was the exception, although the city eventually signed on with the city of Orange contract. At that time, the city of Orange Fire Department was the lead entity in acquiring “requests for proposals,” or bids, from ambulance companies interested in providing the emergency service for the collective Orange County group. Assistant Fire Chief Jerry Ziller still remembers the event, which was the first of its kind for him, six years after the ink dried on the initial contract.
When the city’s prior ambulance company announced it would be closing in 2006, Ziller said a consortium of local officials decided the only way to ensure emergency ambulance service for citizens in need was through a contract for service, and he was tasked with seeking proposals from interested ambulance companies.
“We got several proposals, but they were all incredible in that they all wanted exclusive rights to the non-emergency calls, too, and some even wanted a subsidy of several hundred thousand dollars in addition to that,” Ziller said. With the bids he was given, Ziller said Acadian was the best choice for the position.
“We looked at all the proposals, and the majority voted for Acadian,” Ziller said. The veteran fire official said Acadian’s close proximity to Orange County and the company’s abundance of available ambulances were a few of the factors that made the Louisiana-based company stand out as the best selection.
The transition to an exclusive service area wasn’t without its casualties, with several ambulance companies receiving tickets, citations and cease-and-desist operation orders in the months and years following the change. TransStar Ambulance owner Freddye Hare Conner said the company and its drivers were ticketed for fares she was already under contract to cover when the Orange consolidated area opted to go with Acadian for exclusive emergency and non-emergency ambulatory transport.
“That was Orange County’s choice, but the residents there should have a choice, too,” Conner said. “It’s a rule or a law, so I abide by it, but personally if I’m paying for my own insurance premiums, or paying for my own bills in cash, I should be able to decide who I want to use.”
Orange County Commissioner Jody Crump was sympathetic to McBride’s position in wanting to look for a cost-effective manner for ambulance service.“I’ve had several constituents call and ask me why they couldn’t use whatever ambulance carrier they wanted if they’re paying out-of-pocket,” Crump told The Examiner. “The short answer is ‘because any ambulance other than Acadian will be stopped and fined.’
“This whole thing has an air of a problem to it, and it is definitely something that needs to be looked at more closely. I’m still doing research, but we will no doubt honor the contracts that are in place right now.”
According to Ziller, with the contract set for automatic renewal in the coming weeks, Acadian will likely be the exclusive ambulance provider for Orange County for three more years. In 2016, new bids will be necessitated, as per the contract.
The fine print
In accordance with the contract, Orange County gave Acadian exclusivity, but in return was given what Ziller felt was a fair trade-off.
“We also got response times that we can monitor, a company to hold responsible for ur emergency calls, and they even put ambulances all over our service area. No other company was going to do that.”
A compilation of service calls from the city of Orange for Acadian for January 2012 showed the response time well under the target time of eight minutes in urban areas (88 percent of the time) and 12 minutes for suburban areas (93 percent of the time). A target response time of 20 minutes was set up for rural emergency calls, a compliance rate Acadian met 98 percent of the time in review.
Furthermore, a careful examination of the contract revealed McBride’s aforementioned unpleasant encounter when trying to bring his sister home from Beaumont via ambulance was in error. Calls for service originating outside the service area and ending in Orange County can be transmitted by anyone, Ziller confirmed. Only transports originating in Orange County were affected by the ambulance contract agreement.
“We’re very happy with our service. We’re going to renew our contract until we can’t renew anymore,” Ziller said, which was a statement underscored by Orange City Manager Shawn Oubre.
“I can tell you this works really well for us,” Oubre said. “I’m sure this may have cost some people more than it may have elsewhere, but this is the best system for the whole. We need 9-1-1 service, and no one wants a tax levee for it.”
Monopoly versus exclusivity
“The fact is our current environment cannot handle multiple operations,” Oubre said of the ambulance industry in Orange County and dismissed rumblings that Acadian was a monopoly service.
“If that’s the case, then so is Entergy, Time Warner, Centerpoint … the truth is they have to be assured of their investment, and they are making a sizable investment in these businesses.”
Acadian Ambulance’s Vice President of Southeast Texas Operations Mike Burney likewise dismissed talks of a monopoly enterprise.
“We’re first responders, like the police and fire department,” Burney said. “Having one ambulance company get 9-1-1 calls is the same as one police department getting all 9-1-1 calls – it works better that way for the citizens.”
But on a business note, 9-1-1 calls are only paid out about 33 percent of the time, Burney said. Non-emergency service, also known as the calls that pay, make up the majority of the collectible billings for an ambulance company, he said, and with other companies coming in to take the money runs, companies such as Acadian were forced to protect their livelihood.
“This is more or less a trade-off,” Burney said. “It works for the citizens because they don’t have to pay for this care with their taxes, and it works for us because we can recoup some of our losses.”
For the record
Acadian Ambulance started operation in Louisiana in 1971 with two ambulances, eight employees and an operating budget of $190,000. Forty years later, Acadian has grown to more than 3,000 employees spanning Louisiana, Texas and Mississippi. The company even has a monitoring operation in Chicago, Ill.
“It’s no doubt Orange County got us started in Texas, and now we’re one of the biggest ambulance providers in the state,” Burney said. “But with that being said, we also provide the best service available.”
Acadian Ambulance Southeast Texas operations manager Brandon Hebert was quick to tout the presence of Acadian in this area.
“People in Orange County know when they call 9-1-1 they are going to get quality medical care in a timely fashion, great service from professionals trained in their field and consistency,” Hebert said. “We go out there and put our product in the street. Residents know what they’re going to get with us.”For McBride, who only wanted to be frugal and responsible in seeking services he could afford, the question still stands – “Who are they to tell me where I have to spend my money?”
Commissioner Crump is currently looking into billing practices to see if the rates being charged to Orange County customers are high or on par for the industry.
“These are questions that need to be answered,” he said.
Jennifer Johnson can be reached at (409) 832-1400, ext. 231, or by e-mail at jennifer [at] theexaminer [dot] com.