By John Marks
The Herald
YORK COUNTY, S.C. — Six years after the “hospital war” between health care companies ended in Fort Mill, a new skirmish over ambulance service again pits Piedmont Medical Center against Atrium Health.
Fort Mill EMS and Atrium have an agreement for the Charlotte-based hospital system to purchase the long-time rescue squad for an undisclosed amount. That arrangement would allow Atrium to run ambulances in York County, as Fort Mill EMS does today, alongside Piedmont and the nonprofit River Hills /Lake Wylie EMS.
Because York County franchises 911 response services, York County Council has a say in whether to amend its contract with Fort Mill EMS to let Atrium operate it.
Piedmont officials asked Council on Monday not to do it.
“I ask that you allow the York County primary 911 service provider for the past 40-plus years — Piedmont Medical Center EMS — to staff the needs that the Fort Mill EMS currently provides, versus assignment to an out-of-state provider,” said Piedmont market CEO Teresa Urquhart.
A final decision won’t be made until at least April 7. Several Council members said they need more information, and that the decision is an important one for medical service across York County.
“This is a turf war that’s been going on for many, many years,” said Councilman William “Bump” Roddey.
‘Hospital war’ in Fort Mill
More than two decades ago, under since-repealed state laws that required medical facilities to get a permit called a certificate of need, several healthcare providers applied to build a Fort Mill hospital.
Piedmont won the right in 2006. Carolinas HealthCare, since renamed Atrium Health, and North Carolina-based Novant Health, appealed. South Carolina reversed course and awarded Carolinas HealthCare the Fort Mill hospital in 2011.
Appeals judges in 2014 and 2017 sided with Piedmont, the latter decision prompting an appeal to the South Carolina Supreme Court. That court wouldn’t settle the case in Piedmont’s favor until early 2019.
The Fort Mill hospital, Piedmont’s second in York County along with one in Rock Hill, opened three years ago.
“It was pretty rough,” said Roddey. “It was a lot of back and forth, a lot of trips to Columbia, lawsuits and everything going on in the battle to see who’s going to get the hospital. And I stood with Piedmont at that time.”
Roddey still supports Piedmont and believes the company can meet the local ambulance needs.
Along with Councilman Tom Audette, Roddey asked Council to delay a decision to see what the ambulance options are and how they’d impact both the county and Piedmont.
“It’s worth doing our due diligence just a little bit longer to make sure everybody understands the situation,” Audette said.
Other Council members see it differently.
“Fort Mill EMS is a business,” said Councilman Andy Litten. “And it’s not for the government to say who can or cannot sell to who or who else.”
Business or public service decision
There’s some sentiment on Council that competition for ambulance services could improve them, as can happen in other businesses. There’s also an uneasiness with stepping into a financial deal between other parties.
“We shouldn’t allow the government to hold a company back on what is their privilege,” said Councilwoman Debi Cloninger. “I would hate when I sold my business, for someone to come and tell me who I could sell my business to.”
Multiple Council members said they haven’t seen details on a deal between Fort Mill EMS and Atrium. The EMS did not return messages from The Herald seeking comment on the deal.
Atrium provided a statement, but no details on the purchase.
” Atrium Health has a large presence in York County and a strong commitment to serving this community. Fort Mill EMS has been providing high-quality emergency services to the residents of York County for 70 years, and we believe by joining together, we will be able to elevate the level of care our communities deserve,” the statement said.
Councilman Tommy Adkins didn’t agree with the idea that Fort Mill EMS should try to work something out with Piedmont before bringing Atrium into the mix.
Bringing Atrium in wouldn’t harm or diminish Piedmont, Litten said. As long as service demand, response times and similar measures in current county contracts are met, some members don’t see any problem adding another provider.
“Who is it for us to say no you can’t sell to this other entity and we want you to be sold off this other way, to somebody else?” Litten said.
Roddey argued, though, there’s a difference between business-as-usual and life-saving ambulance service. “Our job is taking care of the citizens,” he said, “regardless of what the business is.”
Fort Mill EMS plans
Last year Fort Mill EMS responded to more than 4,100 calls and transported 2,600 patients.
“We provide a vital, necessary service to this community,” Fort Mill EMS chief of more than 15 years Tim McMichael told Council on Monday.
Fort Mill EMS began in 1955. It’s now a mix of paid and volunteer staff, including paramedics. The agency tried working with Piedmont multiple times, McMichael told Council, without success.
“My phone call to Atrium was well received,” he said. “Their staff welcomed our ideas.”
Fort Mill EMS and Atrium have a plan that will ensure the long-term viability of the agency while providing a living wage for employees and continuing to serve citizens in York County, McMichael said.
Piedmont opposition to Fort Mill EMS, Atrium plan
Piedmont responded to more than 32,000 calls and transported 22,500 patients countywide last year.
With two hospitals, three emergency departments, two urgent care centers and other medical services, Piedmont is the third largest employer in York County. It’s the largest in Rock Hill. Piedmont has 2,240 employees or contract workers countywide.
EMS is Piedmont’s largest department.
It has 185 employees, 25 ambulances, seven quick-response vehicles and three support vehicles. The company invested more than $3 million for new ambulances, equipment and other EMS services in the past three years, Urquhart said. EMS operated last year at a $2.2 million loss.
In her two years as market chief, Piedmont wasn’t contacted about the possibility of acquiring Fort Mill EMS, Urquhart said.
It would be a “notable operational outlier” across South Carolina, said Fort Mill hospital CEO Chris Mitchell, to have a hospital system without a hospital or beds in the county provide ambulance service — especially when the current hospital system would willingly assume the extra duty.
“We at Piedmont Medical Center are fully prepared to increase our operating trucks and staff to continue to meet the needs of this county and its residents,” Mitchell said, “as we’ve done since 1983.”
Fort Mill hospital preference
Cloninger, who represents part of Fort Mill, understands how location plays a critical role in medical choices.
While Piedmont relied on its existing and sole presence in York County during the “hospital war,” many Fort Mill and Tega Cay residents live as close to several Charlotte hospitals as they do to Rock Hill. “We’re almost like a merged community there,” Cloninger said.
Patients have a choice in where any ambulance service in York County takes them, especially for non-critical service calls where the shortest distance to a hospital isn’t paramount. While Council members laud Piedmont’s service record, there are many people in Fort Mill who want another option too, Cloninger said.
“My job is to listen to my constituents,” she said. “And I had some very strong opinions, that they welcomed this change.”
The county doesn’t provide direct financial assistance to any EMS provider, said Assistant County Manager David Garner. The county only has contracts with providers that require a host of standards, like response times.
Both Piedmont and Fort Mill EMS have served York County for decades, said Council Chairwoman Christi Cox. She doesn’t want to make a decision that harms either one. From her understanding, the new arrangement would keep many of the same staff members and services.
“The only difference is ‘Atrium’ would be on the truck instead of ‘Fort Mill EMS,’ ” Cox said.
Medical turf wars began, she said, because of the certificate of need program that didn’t allow all hospital systems to participate. Most of those requirements are gone now.
Cox agrees that the county decision isn’t a simple business one.
“The county’s job is to build the best public safety response system for our citizens,” she said. “And that means all qualified resources and providers that are willing to help us meet that need, I think we should welcome them here.”
That’s assuming, she said, Atrium meets or exceeds all qualifications. There’s nothing in any contract the county has with its providers, including Piedmont, that would stop them from adding more ambulances or services to compete, said County Manager Josh Edwards.
The pending decision on his end is more about public service than any one company. “This is about making sure we have more ambulances in the system responding to 911 calls,” Edwards said.
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