A bruising and contentious meeting of the Brown County Commissioners Court ended Monday morning with commissioners twice voting 4-1 — with Brown County Judge Paul Lilly casting the only “no” votes — to modify the county’s contract with Lifeguard Ambulance to address staffing issues, and to grant the company a one-year contract extenstion.

The contract extension is subject to the approval of the cities of Brownwood, Early and Bangs.

Lilly, who has been openly critical of Lifeguard, grilled ambulance Chief Chris Furry and clashed at times with commissioners over the issues of modifying and extending the contract between Lifeguard and Brown County. Lilly insisted that commissioners individually vocalize their “yes” votes on the two Lifeguard-related agenda items.

The meeting attracted the attention of two Abilene television news crews who crowded into the front section of the commissioners court gallery.

Furry has said Lifeguard has been unable to fulfill its contractual staffing requirements at times because of the difficulty in hiring paramedics — the highest skilled caregivers in the emergency management services profession. Furry said Lifeguard has 35 employees in Brown County, and about half are paramedics.

Furry said the shortage of paramedics is a statewide and nationwide problem. Lilly said that’s not the county’s problem.

 

The votes

Commissioners first voted on modifying the contract. The ambulance oversight board unanimously recommended the modification and is very pleased with Lifeguard’s performance, Commissioner Joel Kelton said. Kelton chairs the ambulance oversight board.

Before the modification, Lifeguard was required to have four Mobile Intensive Care Unit (MICU) ambulances, which requires two paramedics on each ambulance.

The modification requires Lifeguard to run three MICU ambulances, and a fourth ambulance to be run as:

• MICU ambulance — 80 percent of the time • Basic Life Support ambulance — 20 percent of the time, which requires emergency medical technicians rather than the higher-credentialed paramedics

• Buffer and unforeseen circumstances — 5 percent of the time.

Lifeguard will still schedule four MICU ambulances, but the modification will allow Lifeguard to run the fourth ambulance if necessary on calls that don’t require the skills of paramedics 20 percent of the time, Furry said. Previously, if the fourth ambulance couldn’t be staffed with two paramedics, it had to stay parked, Furry said.

 

Opposition, defense

Lilly said was opposed to lowering the staffing requirements, and he was opposed to extending Lifeguard’s contract without going out for bids. Lifeguard, which has been operating in Brown County in January 2016, has received previously yearly extensions.

“If it was a problem just unique to Brown County, it would be different,” Commissioner Wayne Shaw said of the staffing issues. “But it’s statewide, nationwide — everywhere, they have the same staffing problems.

“I’m not in favor of making a mountain out of a molehill. If it was unique to us, that would be fine. But it’s not.”

 

Questions from Lilly

As commissioners took up the Lifeguard matters, Kelton began by saying the ambulance oversight board “has been on this for quite awhile.”

Lilly addressed Furry, saying, “as I said out in the hallway before this began, the next portion of this has absolutely nothing to do with you as an individual, but rather your position there in the office.

“So I have some questions that we need answered before I can, in good conscious, stand before my constituents and allow this to happen.”

Answering Lilly’s questions, Furry went on to explain levels of ambulances and levels of certification for EMS employees.

“The contract that was adopted by the court in 2015 was for minimum staffing of four MIC units, is that correct? And now you’re asking to modify the contract so you can go below that?” Lilly asked.

“The ambulance board has recommended that, yes,” Furry replied.

“You’re Lifeguard,” Lilly said. “The advisory board doesn’t actually have any power whatsoever than to make a recommendation. As a representative of the company, you’re asking to modify the original contract?”

 

‘You’re not listening to me’

Furry said Lifeguard in 2018 was dispatched to Basic Life Support calls 46 percent of the time and to Advanced Life Support calls 54 percent. In 2019, the numbers have been 42 percent for Basic Life Support and 57 percent for advanced, Furry said.

Furry tried to explain how the determination was made as to whether the call ended as a basic or advanced call. “It depends on what patient …” Furry started to say at one point.

“So you’re not going to answer the question,” Lilly replied.

“You’re not listening to me,” Furry said.

Kelton then said, “I don’t think you’re understanding either, Judge.”

“Who signs off that in the end?” Lilly asked.

“It’s the paramedic or the EMT that gave the meds,” Furry said.

 

Back on staffing issues

Lilly noted that the minimum staffing required by the unmodified contract called for about one paramedic per 10,000 population in Brown County “Where does that rank on the national average?” Lilly asked.

“I don’t know the answer to that question,” Furry said.

“I do,” Lilly shot back. “That’s about a standard of care. … What you’re asking us to do is to modify that so you can have less. I heard your justification.”

Lilly said he needed to state his opposition for the record, before voting on whether to lower “even to just one step below the absolute minimum standard” of the existing contract. “I have a problem with that,” Lilly said.

 

‘That’s not our problem’

Furry reiterated the difficulties of hiring paramedics.

“I understand that, and that’s not our problem,” Lilly said.

Kelton jumped in, saying “it is our problem. We have to share in the responsibility to get this to work.”

Lilly noted that Brown County citizens “were promised four paramedics on duty all the time. Staffing those ambulances, whether you need to pay more to get those paramedics in from out of town — that’s not our responsibility.”

 

‘Call the question’

A few minutes later, commissioner Gary Worley said, “I’d like to call for the question, please.” Worley was attempting to invoke a parliamentary procedure to immediately end the debate and force the vote.

“Denied,” Lilly said. “I’ve got just a little bit left and I want to speak.”

“It takes a vote to deny it,” Worley said.

With no more discussion of calling the question, Lilly continued, “the numbers are painting an unflattering picture. I have the highest respect for the EMS advisory board. They recommended this unanimously. I’m just not sure they have total understanding of what it was they were recommending.”

 

‘They’re well informed’

That prompted a response from Kelton, who noted that many of the ambulance oversight board “have been overseeing this stuff for 12-plus years. They’re well informed, well advised. You’ve been here six, seven months, whatever it is.

“They’ve been in this stuff for years. They know where we’re at, what’s going on. For you to say they don’t really know what they’re doing is pretty wrong, pretty much a slap in the face for something you probably don’t know much about yourself, honestly, compared to me or them. To say that you know more than they do …”

Lilly responded, “I didn’t say I know more than they do. I just said I’m not sure if they understand …”

“You don’t think they understand,” Kelton said. “They understand, and we’ve been over this a long period of time. This is the conclusion they came to.”

Lilly noted that the board had recently contained some stand-in members who, Lilly said, would not have fully understood the issues.

Lilly wasn’t finished, asking how many times Lifeguard had fallen before its staffing requirements over a year’s period ending in September. “I know what the answer is,” Lilly said. “It was 40-plus times. … I want to make sure the public knows what each member of this court is voting for.”

Kelton said a few minutes later, “if anybody’s out of touch, I feel like you are, Judge.”

“I’m not,” Lilly said. “And I’ve asked that the ambulance committee come and speak and have their meetings here so everybody in TV land can see what they do, but they refuse to do that. They have them over at the fire station or someplace else.

“ … If you vote to do it, you’re attaching your name to this and I want to make that very clear.”

‘Hard-working employees’

Lilly concluded by saying Lifeguard consists of “very hard-working employees, and my concerns have absolutely nothing to do with the employees.”

After the meeting, Furry told media representatives he was satisfied with the outcome. The modified contract “will allow us to operate more efficiently and actually provide a better service to the citizens of Brown County,” Furry said. “Our top priority is patient care.

“I do understand where (Lilly) is coming from. I think we have to look at the whole picture.”