By Richard Sullins | richard@rantnc.com

The Lee County Board of Commissioners instructed county staff on Friday to prepare a draft ordinance that names MedEx of Ahoskie as the county’s next EMS provider. The county and MedEx will still have to come to a final agreement, but the move is a step toward a switch away from FirstHealth of the Carolinas, which has been providing ambulance service in Lee County since 2021.

Barring any unforeseen obstacles, a contact could be negotiated and finalized as early as next spring. It would take effect on July 1.

The 5-2 vote, with Democrat Robert Reives Sr. joining the board’s four Republicans (Andre Knecht, Samantha Martin, Kirk Smith, and Taylor Vorbeck) and Democrats Mark Lovick and Cameron Sharpe voting against, came at a work session on Friday which had been called after a large group of first responders spoke against MedEx and in favor of FirstHealth at a series of public hearings this fall. It also came to light during the bidding process that while MedEx had claimed it was a “primary” or “co primary” provider of emergency medical service in Forsyth County, the company is actually a nonemergency provider only authorized to perform emergency medical transport when specifically designated by that county.

The decision to select MedEx for negotiations also comes over the recommendation of county staff, which had recommended staying with FirstHealth.

County staff had recommended early in 2025 that the commissioners speed up a decision on the renewal of the EMS contract by more than a year so the issue would be off the table well ahead of the 2026 election. The commissioners agreed and things kicked off in early April. An appointed EMS Advisory Committee pored over proposals and allowed each potential vendor with an opportunity to discuss their ideas with the committee during July.

By the end of August, the committee had narrowed its recommendation for the commissioners down to one company – FirstHealth – and public hearings were held on that recommendation at two meetings in October.

“By a whole bunch of country miles”

One issue the commissioners appeared to weigh heavily related to the costs of the unpaid ambulance services, or subsidies, that are ultimately passed on to the county for payment. Proposals made by FirstHealth in 2025, as well as in 2021, were higher than those submitted by their competitors.

FirstHealth’s bid over the next five years came to just shy of $20.9 million, while MedEx’s proposal was about $8.2 million.

Donna Hurdle, owner of MedEx, told the commissioners on November 17 “we didn’t expect to be the lowest bidder in this competition. We thought we might come in second, maybe even a close second. But we were totally stunned when we found out that not only were we the lowest bidder, but we were lowest by more than a whole bunch of country miles.”

When FirstHealth was awarded the EMS agreement in 2021, the actual amount of the contract turned out to be several million dollars more than what the commissioners had initially approved.

Those additional contract addendums were explained as increased labor costs, the purchase of new vehicles and equipment to serve Lee County, and inflationary increases in the costs of everything from minor equipment to rent to fuel and electricity. They were presented for approval every few months and at the time, few questions were raised about the reasons for passing these on to the county.

Matt Prestwood, president of FirstHealth Moore Regional Hospital, told the commissioners earlier this month that the cost for his company to provide emergency response capabilities this year in Lee County was $6 million. The amount contracted with the county during the first full year of service by FirstHealth for EMS services in Fiscal Year 2022-23 was $795,000.

Prestwood has consistently said the increased costs have come largely through inflationary costs passed on to FirstHealth and that a few million dollars here and a few million dollars there can add up to produce a sizeable adjustment in the cost of doing business.

While the commissioners have been at work all year by collecting cost estimates on big-ticket items they know are coming over the horizon, the estimated costs of a new five-year deal for emergency medical services were expected to be much smaller in comparison to those for building new schools or jails.

So, almost no one could have predicted the extent of the surprise generated when the county’s Emergency Medical Services Advisory Committee was presented with a proposal from FirstHealth, the current franchise holder, in this year’s round of proposals. That document proposed increasing the contract’s value by nearly $17 million dollars over the life of the contract.

Hurdle, the MedEx owner, called it “an outrageous amount of money that (FirstHealth) have gouged this county for.”

Clearing the deck

The county commissioners appear to be moving toward an understanding that the clock is ticking and there’s a finite amount of time available to resolve this issue, as well as others they can expect in 2026.

So, at the board’s November 17 meeting, Reives requested a dedicated workshop on the EMS issues be held as quickly as practical so the options available might be clarified, giving members a chance to clear up any lingering questions they have before a final vote is taken to choose the winning bidder.

The duration of Friday’s meeting was just a bit short of 90 minutes, but it seems to have been long enough to answer most of the questions about the ways this agreement might be framed to serve the needs of the county’s population.