Officials met privately with MedEx for EMS services after county declared negotiations over; company submitted another proposal days later, The Rant learned

By Gordon Anderson and Richard Sullins

Months of controversy over the selection of a vendor for EMS service negotiations ended on April 17 with less of a bang than many in Lee County expected.

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It had been a process with high stakes for all involved. Eastern North Carolina-based MedEx had spent a good portion of late 2025 working to win the county’s upcoming five-year EMS franchise at a price tag substantially lower than incumbent FirstHealth of the Carolinas, promising the board of commissioners it could meet or exceed FirstHealth’s level of service for $12.6 million less over five years.

So the commissioners’ 5-2 vote in December to go with MedEx (voting in favor were Republicans Andre Knecht, Samantha Martin, Kirk Smith and Taylor Vorbeck, as well as Democrat Robert Reives Sr.) placed a lot of public weight on a negotiation process that was supposed to definitively answer not only how much Lee County taxpayers would spend on EMS, but also which company would begin answering Lee County’s calls for medical emergencies beginning on July 1.

Many in the local first responder community had expressed skepticism about changing EMS providers, questioning at multiple commissioners meetings whether MedEx could provide the level of service the county had received from FirstHealth at the substantially lower price it proposed. An advisory committee appointed by the county to evaluate the competing proposals had recommended sticking with FirstHealth despite the higher cost.

And MedEx’s selection had been controversial for reasons beyond its price. 

It had come to light during the bidding process that MedEx claimed to be a “primary” or “co-primary” provider of emergency medical service in Forsyth County, but the company’s contract there actually showed it to be a non-emergency provider only authorized to perform emergency medical transport when specifically authorized.

But commissioners still went the other way, and the concerns didn’t stop when MedEx and the county sat down to negotiate.

A day earlier, on April 16, it became public for the first time that negotiations between Lee County Government and MedEx were at an impasse. MedEx issued a statement indicating it remained open to an agreement, but that the parties were deadlocked over “provisions … essential to ensuring operational stability, financial certainty, and the consistent delivery of high-emergency services.” 

Lee County Government followed suit the next day, issuing a statement that covered much of the same ground, but with more finality.

“MedEx ultimately indicated that they could not agree to the terms the County felt were essential,” the county wrote on April 17. “At that point, it became apparent that we were not going to find common ground on these outstanding issues, and negotiations could not continue further.”

For most of the public, it just meant MedEx wouldn’t be the county’s next EMS provider. 

The county indicated in the April 17 statement that it was ready to engage with “another provider” for EMS provision going forward, and that’s what happened — by the start of June, the board of commissioners had awarded a franchise for the EMS contract to Pinehurst-based FirstHealth, and within weeks those parties — already more than familiar with one another on account of the existing contract for EMS which ran from 2021 through June of this year — had an agreement in place to work together for another five years.

But April 17 wasn’t where it ended.

Records obtained by The Rant show MedEx submitted another contract proposal to the board of commissioners on April 25, eight days after the county said negotiations “could not continue further.” The company submitted a version containing a minor correction the next day.

The documents were among more than 200 pages of contract drafts released by Lee County in late August after a public records request. The documents themselves didn’t shed much light on why there was a new contract proposal days after both parties announced they couldn’t come to an agreement.

But MedEx CEO Dillon Lowe had an explanation.

Lowe told The Rant the late proposal came after two commissioners, whom he declined to identify, contacted MedEx following the April 17 announcement and asked to meet “without county staff involvement.”

“They expressed that they still wanted MedEx to provide the service and wanted to better understand why an agreement had not been reached,” Lowe said.

According to Lowe, MedEx explained its position on the remaining disagreements, and he said the commissioners told the company their understanding of several issues, based on information provided by county staff, was “materially different” from what they’d heard from the company.

Lowe said the commissioners went further, questioning “whether this was done intentionally by the county staff in an attempt to derail the negotiations.”

“After discussing the actual concerns and the practical effect of the disputed provisions, the commissioners present indicated that they agreed with the resolutions MedEx was requesting,” he said.

Lowe said the commissioners also spoke on the phone with other members of the board, and that MedEx left the meeting believing there was agreement among those members that the remaining issues could be resolved. The commissioners then asked MedEx to prepare a new agreement incorporating the resolutions discussed at the meeting and submit it to the county, Lowe said. That agreement was submitted April 25, with a corrected version following the next day.

Republican Commissioner Samantha Martin — who is the board’s chair, but wasn’t at the time of the meeting — confirmed commissioners met with MedEx after negotiations stalled, but declined to say whether she was one of those who attended. She also declined to address Lowe’s account that commissioners came away from the meeting believing county staff had given them a materially different understanding of the disputed contract provisions.

“The commissioners met with MedEx to better understand the factors that stalled the agreement. This was an attempt to save the taxpayers $12 million, which is equivalent to a 2-cent tax increase on property taxes,” Martin said.

A review of contract proposals exchanged by MedEx and Lee County from January through early April shows the parties began negotiations fairly far apart, but narrowed the gap considerably through the late winter and early spring.

MedEx’s first detailed response to the county objected to or sought changes in a wide range of provisions governing how the company would operate in Lee County. Those included staffing, ambulance deployment, operating locations, medical oversight, training, reporting requirements and other aspects of the service.

Many of those disagreements disappeared as the parties continued exchanging revisions. But the scope of those early disagreements is notable because of what MedEx had told commissioners about the service it proposed to provide.

Months before negotiations began, lobbyist Sam Shumate, working on behalf of MedEx, had sent commissioners materials promoting the company’s proposal as both substantially less expensive than FirstHealth and capable of matching or improving on several aspects of the existing service. The county provided those materials to The Rant in response to a public information request in November 2025.

The materials promised MedEx would “meet or exceed” existing response times, provide a second operating location to better serve remote areas, and offer newer ambulances, additional staffing and other improvements while saving the county more than $12 million over five years.

“At the heart of the issue is quality of service and a $12 million difference in taxpayer money,” Shumate had written to members of the board a month earlier.

Lowe said the differences weren’t evidence MedEx had backed away from the service it proposed. Instead, he said the county’s contract included requirements he believed nobody had discussed when MedEx responded to the county’s request for proposals and developed its price.

“The remaining disagreements were relatively minor in number, but the provisions themselves mattered because they materially changed the operational and financial requirements contemplated when MedEx responded to the County’s RFP,” Lowe said. “Certain provisions would have imposed additional operational constraints and costs that were not part of the procurement upon which MedEx developed its proposal.”

The drafts illustrate the kind of differences Lowe described. MedEx initially sought changes to county requirements involving where ambulances would operate, how they would be staffed, training and medical oversight, among other provisions.

More specifically, the differences ranged from how many employees MedEx would have available for each ambulance and where those ambulances would be based, to requirements for employee training and how frequently medical supervision would be on site. In several areas, MedEx initially sought more flexibility than the county’s proposed contract allowed, while the county sought to spell out specific operating requirements.

Those and many other operational disagreements largely disappeared from later drafts. By early April, the dispute had mostly boiled down to what financial consequences MedEx could face if it failed to meet the county’s requirements. 

Lowe said MedEx didn’t consider those remaining differences insurmountable. Instead, he believed they were the issues the commissioners were trying to resolve when they re-engaged with the company after negotiations had apparently ended.

“The post-April meeting resulted in an understanding that those remaining issues could be resolved. MedEx was therefore asked to put the agreed-upon resolutions into a revised contract, which we did,” he said. “That makes what happened afterward particularly difficult for us to understand.”

Lowe said that following the meeting and MedEx’s submission of an updated proposal, the company didn’t get a response.

“MedEx made one additional effort to determine what was happening,” he told The Rant. “When MedEx’s representative contacted members of the Board seeking an update, we were told that they had been advised by the county manager and county attorney not to speak with us. We cannot explain why the process stopped there.”

Whatever happened to MedEx’s final proposal, it didn’t change the ultimate outcome. The county returned to FirstHealth, which had continued providing EMS service throughout the negotiations, and commissioners approved a new five-year agreement with the company in June — an agreement that cost the county just over $21.2 million, slightly more than the $20.8 million FirstHealth had originally proposed.

Lowe also said the contract FirstHealth was ultimately awarded differs significantly from the one MedEx was trying to negotiate with the county, claiming the county “demonstrated through its agreement with FirstHealth that material changes to that contract framework were possible” when MedEx had been told otherwise.

FirstHealth disputed that characterization. 

Jonathan S. Davis, chief operating officer for FirstHealth of the Carolinas and president of Moore Regional Hospital, said there was “no substantial difference” between the company’s original proposed contract and the agreement ultimately signed with the county. He said the only difference was FirstHealth’s request for $347,459 to cover workforce costs incurred after MedEx was initially selected, including retention incentives, transition planning and later recruitment when FirstHealth was awarded the contract on short notice. 

Lee County Government declined to respond to Lowe’s account of the meeting, his characterization of the disputed contract provisions, or his comparison of the MedEx and FirstHealth agreements.

The EMS controversy prompted calls for outside scrutiny before the existence of the new contract proposals became public. 

At a June 1 commissioners meeting, Lee County Republican Party Chairman Jim Womack called for the North Carolina State Auditor’s Office to investigate the county specifically over the failed MedEx negotiations.

“I think we need to get the state auditor down here and sort out how the process got screwed up,” Womack said.

The State Auditor’s Office did become involved with Lee County Government that month, sending the county an “engagement letter” that typically marks the beginning of an auditor’s work with a government entity. But neither the auditor’s office nor the county has disclosed whether the auditor’s engagement is connected to the EMS issue at all or something else entirely.

The sequence of events described by Lowe and documented in part by the records produced in August — individual commissioners re-engaging with MedEx and the exchange of additional contract proposals that followed — also differed from the public process through which the county had selected MedEx and negotiated with the company for months.

Under North Carolina law, county governance is generally exercised by the board of commissioners as a body, while the county manager serves as the chief administrator responsible for carrying out the board’s direction.

This doesn’t mean commissioners can’t talk with constituents, vendors and others about county business. But Lowe’s account describes something more than two commissioners simply seeking information.

Instead, there was a meeting to discuss specific, disputed provisions in a contract, there were communications with other commissioners, and MedEx was asked to draft and submit a new proposal to the county for consideration — and the public was never invited to attend.