AUSTIN — Emergency medical services could look different following contract changes between two agencies in Hays County.
The North Hays County Emergency Services District No. 1 (ESD 1) Board of Commissioners unanimously voted on Nov. 19 to terminate its contract with San Marcos Hays County Emergency Medical Services (SMHCEMS), which will be effective 180 days from the legal notification in May 2025.
“The ESD board has been evaluating this change for several years and has not taken this decision lightly. The chief and deputy chief are very experienced in the delivery of emergency medical services, with over 60 years of experience in EMS between the two of us,” said North Hays County EMS Chief Bob Luddy.
ESD 1 is the emergency medical services provider for the northern portion of Hays County, including Dripping Springs, Driftwood and Henly; its service area covers 244 square miles. As for SMHCEMS, it has provided ambulance services to areas like Kyle, San Marcos, Dripping Springs and more in Hays County since 1983.
There were a number of reasons behind this vote, all of which are directly related to providing services to our citizens, explained Luddy. Those reasons include the following:
• ESD 1 believes it can provide a higher level of service at roughly the same price point as the current contract with SMHCEMS.
• In the contract, SMHCEMS provides staffing for ESD 1’s ambulances, as well as operational oversight, medical direction and a supply chain for supplies. Due to this arrangement, ESD 1 has very little control over the daily operations of the ambulances and has not been able to effect changes in deployment of ambulances to better serve the citizens.
• SMHCEMS has been deficient in several contractual items that they have not successfully rectified.
• In October, SMHCEMS attempted to increase the cost of services to ESD 1 by more than $800,000 a year without explanation. This increase was not reflected in ESD 1's contract with SMHCEMS and SMHCEMS made no attempt to amend the contract to reflect an increase in the cost of service, as is stipulated in the contract.
• There have been several instances in 2024 where SMHCEMS has not been able to staff the ambulances or provide event coverage to Dripping Springs High School football games.
• Medical staff have begun to resign from SMHCEMS to seek employment opportunities elsewhere. ESD 1 has concerns about this as it may lead to SMHCEMS not being able to staff ambulances.
Luddy added that ESD 1 has concerns about the stability of the leadership of SMHCEMS, as this year, two assistant chiefs left the department “due to what they describe as a bad working environment.” In September, a very large percentage of the employee body presented the SMHCEMS Board of Directors with a vote of no confidence against the department chief and on Monday, Nov. 18, the chief resigned, Luddy said.
“This has left the top two leadership positions in the department being filled with interim personnel and the job responsibilities of the other vacant position being redistributed among other workers,” he said.
The change in EMS delivery will mean that the tax dollars allocated for EMS will stay in the community and “we will be able to better control the delivery of service,” said Luddy.
According to Luddy, ESD 1 is in a unique position to deliver and improve on services directly for reasons, including: ambulances, stations and most of the items used to deliver EMS services are already owned by ESD 1; when the contract is terminated, ESD 1 will no longer be paying SMHCEMS and that money will be used to deliver services directly, rather than through a contracted vendor; when ESD 1 begins delivering services directly, it will recoup all revenue from medical billing; and the ESD 1 staffing model will have all four ambulances staffed and on duty at all times.
ESD 1 will also retain the battalion chief, while also hiring approximately 32 EMS personnel and adding an additional battalion chief over education, a deputy chief over operations and a chief of the department, who are all paramedics and will have the ability to act as first responders, Luddy explained. The provider has also retained a medical director that is a renown and well-respected leader in the EMS community, said Luddy: “When ESD 1 takes over service delivery, we will be able to work with Dr. Remick to ensure that the medical protocols are tailored to the needs of our area and stay up to date with changing science in emergency medicine.” While ESD 1 claims that this vote to terminate the contract is for the betterment of the community, others like Zack Phillips of the Hays County EMS Association — which is the union that represents employees of SMHCEMS — still have concerns.
“Currently, there are four ambulances staffed in North Hays or ESD 1. If all four of those ambulances are out, or on days that there aren't four, because some days there are only three, we preemptively send up an additional unit to cover those areas in case there's a 911 call. Going forward, with this being canceled, they will enter into a mutual-aid agreement like any other neighboring agency, meaning when they run out of ambulances, that fifth one's not going to come until somebody calls 911 instead of coming and waiting in town,” Phillips said. “So, that can lead to extended response times and then further fracturing an EMS service throughout the county into multiple smaller EMS services will lead to inconsistencies in protocols, treatment and training. Patient care will have a little bit of an inconsistency.”
There is a potential for reduced staffing, Phillips said, with this terminated contract decision. ESD 1 has contracted SMHCEMS to provide services since its inception more than 20 years ago.
“There's 25 to 30 people associated with North Hays, or ESD 1, that work for San Marcos Hays County EMS. While we know a number of those will take jobs with North Hays once they open up that process, there's no guarantee,” said Phillips.
“And essentially, it is reducing the workforce of our department by nearly 30 jobs.”
Phillips added that this is coming on the heels of the Hays County EMS Association finalizing its collective bargaining agreement in its fight to become a voluntary union for employees, which has been on the company’s desk for ratification for a number of weeks, but has been prolonged again until next month.
Ultimately, the major concern is the fracturing of EMS service, which will lead to inconsistencies throughout the county, said Phillips.
“The ESD board and the chiefs of ESD 1 are working diligently to ensure that there is no gap of EMS services,” said Luddy, “And we are working with the management of SMHCEMS to ensure a seamless transition with the goal being that the citizens of ESD 1 will not experience a decrease in the quality of EMS service, but rather an increase.”
More information about the agencies can be found at www.northhayscountyesd1.org and www. smhcems.com.
