Patti Ketterman, president and chief administrative officer of CMC, walked out of a Claiborne Commission meeting last week with two Covenant Health Systems representatives in tow over a Clairfield ambulance service issue.
Prior to her departure, Ketterman read into the official record a lengthy statement while flanked by Covenant attorney Doug Campbell and Chad Clabough, Covenant senior vice-president of business development and managed care.
Ketterman said she had reviewed the records and had found no instances of excessive response times from calls for assistance from the Clairfield area.
“We are confident that no patient harm resulted from the response times as alleged,” said Ketterman during her statement.
She said the Office of the Tennessee Emergency Management Services director told her there are no state standards for ambulance response times.
“In fact, the office said that most counties only have the ambulances on the road they can afford to pay for.
“We also discussed response times with an ambulance provider that holds contracts in a number of counties in east Tennessee, and that provider offered that 45-minute response times are very reasonable in rural areas,” said Ketterman.
When Covenant took over operations of the Medical Center in 2014, she said they continued to use existing stations while considering possible ways to “reposition” the ambulances for better response times to all areas of the county.
A scatter diagram was created to compare from where E-911 calls originated compared to station locations, said Ketterman.
According to the diagram, a one-year period of calls, “clearly indicate that the ambulance stations are well-positioned to respond to the majority of calls in the county,” she said.
Apparently, plans to work with adjacent counties to provide ambulance service to the Clairfield area did not pan out. Ketterman said Campbell County would require an annual subsidy to provide the service.
“The Middlesboro ambulance service indicated very little interest in providing service, in part, because they are licensed in Kentucky and there are a number of legal hurdles to overcome (for routine response to calls in Tennessee),” said Ketterman.
After a “thorough” review of the issue, it was determined that relocating an ambulance in Clairfield would help response times for one community but would significantly increase response times to the rest of the county, she said.
“Given that resources are limited, our goal is to use the limited resources in a manner that does the greatest good for all our residents. Therefore, based on the data and our limited resources, we are not going to make any changes to our ambulances or our staffing,” said Ketterman.
Since taking over operations of the hospital, she said Covenant Health has fulfilled its obligations with the ambulance service.
“In the past two years, Covenant Health has invested over $11 million purchasing assets of Claiborne County Hospital and in renovations and improvements in facilities. Our operations have lost $3 million during this time, bringing the total investment Covenant Health has made in this county over $14 million,” said Ketterman, adding that Covenant has “exceeded” its obligations under the lease agreement.
Commissioner James Hatmaker, who represents the Clairfield community, said the numbers in the scatter diagram do not match those verified from the Claiborne E-911 computer system.
Hatmaker said he had talked with Campbell County the day of the commission meeting, and was assured that “no numbers” had been discussed between the county and Covenant.
He asked Clairfield Fire Chief Carl Mozingo to discuss a recent car accident to which he responded. Mozingo said he had waited for one hour and 20 minutes before an ambulance arrived on-site.
Hatmaker referred to a portion of Ketterman’s statement in which she said Covenant had lost $3 million in the course of operating the Medical Center.
“You can spend all kinds of money (making improvements), but you can’t afford to send a few thousand dollars to Clairfield,” said Hatmaker.
A Dayspring Family Health Center employee spoke of one incident in which one of her patients was experiencing chest pains. The employee said the woman asked that the ambulance driver transport her to Jellico – some 25 minutes from Clairfield – rather than taking her to a Middlesboro hospital, some 45 minutes away.
“The ambulance driver really didn’t want to take a report. He was more interested in getting the patient to Middlesboro, so he could get the truck back in service over in Tazewell,” said the employee.
She claimed her patient later told her the ambulance driver had warned her against future requests to be transported to Jellico.
“It pretty much was a threat. The important thing is, getting our patients the care that they need in a timely manner. When they have to travel about 50 minutes to get to Clairfield and another 40-50 minutes to get them to the hospital, that can be a life, lost,” said the Dayspring employee.
The director of the clinic spoke about the incident.
“I feel like that the patient was harassed (in transport) by the ambulance personnel. I feel like her rights were (violated). You have the right for the care you need. You also have the right to refuse care. My understanding is that she was told she was not having a heart attack. I don’t think that determination could have been made on an ambulance,” said the clinic director.
Hatmaker said he represents some 11,000 people who are citizens of the county. He said he did not appreciate anyone walking out of a meeting, referring to the early departure of Ketterman, Campbell and Clabough.
“That just tells me one thing. They’re not interested in the people of Clairfield. They’re not interested in the people of Claiborne County. They’ve been here two and a half years and I understand they’re still losing money. Do you think they’ll make money in another two and a half years? I don’t,” said Hatmaker.
He then made a motion to freeze the Covenant/Claiborne Medical Center escrow account funds and to offer to take back the operation of the ambulance service, if Covenant no longer wishes to run the facility.
Commissioner Steve Mason seconded the motion.
Prior to the vote, county attorney James Estep III was asked his opinion on the matter. Estep said he had talked with the Chattanooga attorney handling the issue.
“He says that we can’t take this action. But, you have that issue that we’ve talked about – that Mr. Hatmaker has brought up – that there is a difference in this service that’s been provided. Where you’re headed is to litigation, one way or the other. The Clairfield community has told us that they may. Covenant, if we withhold this money — they will,” said Estep.
If the commission chooses to freeze the escrow account, Estep said it would represent a “breach of contract.” Doing so would likely “tie up” the county in litigation for years, he said.
The escrow account currently holds about $1.8 million, which is specified for health needs inside the county. In order to pay out any of those funds, he said there must be a three-party approval.
Figuring from past operational costs, it was estimated by commissioner Dennis Estes that it would take about $150,000 annually to keep the Clairfield substation going.
After more discussion, the motion to freeze the escrow account and approve the possible takeover of the ambulance service was voted on. The motion failed by a vote of 15 to five. Commissioners Hatmaker, Mason, Danny Longworth, Charlton Vass and David Mundy voted in favor of the freeze.
Commissioner Juanita Honeycutt was absent from the meeting.
The Claiborne Progress will have more on this topic as new information becomes available.
Reach Jan Runions at 423-254-5588 or on Twitter @scribeCP.