By Richard Sullins | richard@rantnc.com

The Lee County Board of Commissioners voted earlier this month to negotiate a contract for emergency medical services with a new company, but that decision is now in question as its members opted to give the issue further study at a work session in December.

The Lee County Board of Commissioners voted Monday to delay awarding a contract to either FirstHealth of the Carolinas or MedEx Medical Transport until the commissioners can do a deep dive into issues raised during the process of choosing a vendor. The commissioners chose MedEx for final negotiations earlier this month after the Ahoskie-based company submitted a bid roughly $12 million lower than that FirstHealth, based in Pinehurst.

On Monday, the board unanimously approved a motion from Democratic Commissioner Robert Reives to hold a work session on December 19 to look into questions that emerged during three rounds of public hearings.

“In light of what I have heard this evening, both from the public and from each provider, I feel it is necessary for the board to reconsider taking any action right away,” Reives said.

The current contract for EMS services with FirstHealth doesn’t expire for another ten months, but county staff had recommended to the commissioners that they move consideration of its renewal to this fall in order to reduce the number of critical issues facing the board before the 2026 election. Now, that plan must be scrapped while the commissioners step back to take a granular look at the proposals that range from $8.2 million (MedEx) to just shy of $20.9 million (FirstHealth).

No clarity from third public hearing

As Monday’s meeting began, there was hope the public hearing would help the commissioners see which of the proposals for EMS services might serve the county better over its projected growth spurt. The U.S. Census Bureau estimates Lee County’s population is 69,653 and will almost certainly be nearing 75,000 by the time the five year contract expires. According to Census files, that makes Lee the 13th fastest-growing county in the Tar Heel state for 2025.

How the county should provide emergency response services over those next five years for that kind of explosive population growth was a hotly debated point of contention on Monday, with more mud being slung between supporters of the two competing vendors than fair comparisons of what each brings to the table.

Eighteen speakers in all stood before the podium in the hour and a half before Republican Chairman Kirk Smith declared a recess. The 14 of speakers favoring FirstHealth, located just 35 minutes from Sanford in Pinehurst, far outweighed the four who spoke in favor of MedEx, which is based in Ahoskie in the northeastern part of the state.

FirstHealth was the only one of the two applicants having experience providing primary 911 emergency service. MedEx told the Board of Commissioners in October that it provides 911 service to Forsyth County and described its arrangement there as a “co-primary” provider of emergency service, but the company’s contract there is for non-emergency service.

Natalie Vaughn of Lillington, a 2023 graduate of FirstHealth’s Paramedic Academy, spoke of her employer’s continuing investments in its employees and equipment as “priceless” and said FirstHealth “merits your consideration as stewards of public safety.” She said she and her colleagues at FirstHealth are “clinicians, not chauffeurs.”

Drew Womble of Sanford warned the commissioners against choosing MedEx, saying “you are about to make one of the most reckless decisions in your history,” and that turning FirstHealth away “would underfund the services that keep people alive. Lee County deserves a provider with a proven track record, not a brochure.”

Womble was also among many speakers who questioned how MedEx could provide the same level of emergency response and transport services that FirstHealth is currently providing for such a smaller price tag. He told the commissioners he believed they’d selected MedEx for final negotiations on a 4-3 party line vote on November 3 because they were cheaper instead of better.

Robbie Wilkins, chief of the Carolina Trace Department, also questioned the commissioners about costs.

“Is it going to cost you now, or cost you later, when the lawsuits start coming?” he asked.

Ed Strickland of Lower Moncure Road saw the issue from a similar perspective.

“How can one company be that much cheaper? It’s not a hard decision here. You get what you pay for,” he said. “I guess it’s a Dollar General steak.”

But MedEx had its vocal supporters in the audience, too. One was Tony Edward, a paramedic from Burlington employed by MedEx with 38 years of experience in the emergency services field. Edward took issue with claims made by some speakers that their paramedics were better trained than those employed by MedEx.

“We complete the same advanced training. We are very efficient at what we do, we are very well trained at what we do, and we are very good at what we do,” he said. “If FirstHealth was doing this job as good as it can be done, then none of us would be here tonight.”

Commissioners question providers

After the conclusion of the public hearing, the commissioners spent nearly an hour questioning representatives from both applicants about the specifics of their proposals, but especially about issues that had been raised during the three public hearings.

Matt Prestwood, president of FirstHealth Moore Regional Hospital-Hoke, was asked by Republican Commissioner Samantha Martin to explain for a second time how his company’s operating expenses were more than $6 million during the first year of its proposal.

Prestwood responded that most of the expense – $3.8 million – was for the costs of salaries, with an additional $750,000 in benefits. Another $300,000 was spent for supplies and fuel, rent was $160,000, capital-related expenses were $350,000, and other directly related support services were $800,000.

MedEx strikes back

MedEx’s owner, Donna Hurdle, citing 36 years of experience as a nurse and 13 as an EMT, reminded the commissioners that her company is the largest private ambulance provider in the state, with a presence in 12 counties and franchised in 9 of them.

“Some folks in this community have sought to portray MedEx as a mere Uber medical transport company, and that is factually incorrect,” she said, explaining that the company had been working with the county for the past two weeks to answer questions that would lead toward the creation of an agreement to provide the type and variety of emergency services sought in the county’s original request for proposals. “I can understand that some folks are uneasy about a switch in the ambulance provider for Lee County, but we are a well-respected and established company in North Carolina. We have submitted a proposal and bid that has been characterized by some as being like a ‘Dollar General steak’ and nothing could be farther from the truth.”

She pointed out an increase of $16.6 million from FirstHealth’s bid in 2021 as compared to now, four years later, and said MedEx was actually expecting to be the high bidder in the competition.

“We were stunned,” Hurdle said. “We were surprised that we came in lower, but what a drastic difference. How can you explain that much of a difference? At the amount of money we have bid, we will still make money. But this is an outrageous amount of money that they have gouged this county for. It also upsets me, as the owner of this company, that the same people – not just our EMTs, but all those across the state – that they are calling unqualified.”

Democratic Commissioner Mark Lovick came prepared with identical questions for both companies aimed at the performance metrics Lee County citizens could expect. Among these was the percentage of calls they respond to that are coded as emergency versus non-emergency for ambulances.

While the national average for emergency versus non-emergency calls for ambulances is now about 50-50, FirstHealth told the commissioners that 80 percent of the calls they are receiving now in Lee County are full emergency, meaning the responding paramedics have determined lights and sirens on the ambulance are necessary and will be operating on the way to the hospital.

In those situations, drivers have full discretion about proceeding through intersections and along roadways based on the severity of the case. MedEx had no data specific to the county but said numbers they are seeing in the counties they serve are like the 80/20 split reported in Lee County.

What happens now?

The unanimous vote to study the issue in greater detail before taking any action indicates an unease on the part of the commissioners to proceed any further on this issue for the moment until the questions raised during the public hearings are answered to their satisfaction. The potential financial impact on county taxpayers is as much as $20 million or more spread over a five-year term.

The commissioners have only bid the EMS contract out once before, and that was four years ago. Central Carolina Hospital had provided emergency medical transport services starting in 1997 and the arrangement remained that way until the county decided to go out for bids in 2021.

The commissioners also indicated Monday that they want members of the EMS Advisory Committee to be present when this working session takes place, so if the date of December 19 holds firm on the calendar, the Advisory Committee will be joining the commissioners and members of the county staff by staying in town for at least part of that Friday instead of heading out for an early start to the Christmas holidays. The EMS Advisory Committee had recommended to the commissioners that they retain FirstHealth before their decision to negotiate with MedEx.