In fewer than 360 days, the more than 600,000 residents living in the approximately 177-square-mile coverage area of Harris County Emergency Services District No. 11 could have a new emergency medical services provider for the first time in 45 years.

Cypress Creek Emergency Medical Services, a longtime EMS provider, and Harris County ESD No. 11 have been engaged in months of disagreements. The conflict came to a head in September, when ESD No. 11 voted to terminate its contract with CCEMS in 360 days.

Formed by voter approval in 2004, ESD No. 11 is the taxing entity that funds emergency services in its coverage area, which includes Spring and Klein. CCEMS, a nonprofit, has provided ambulance and emergency services in that same service area since 1975.

ESD No. 11 entered into a contract with CCEMS in 2004 and provides roughly 51% of CCEMS’ average $20 million budget, which is collected through ESD No. 11’s property taxes.

The conflict has brought uncertainty to the emergency services in the area and concern for outsiders familiar with the situation, including Ponderosa Fire Department Chief Fred Windisch, who has worked in the area since 1975.

“I do not understand how two public safety entities cannot get along to serve the citizens in the best manner they can,” he said. “People deserve more than what is occurring now. There are allegations from both sides, but if there was mission-centric thinking these allegations could be resolved.”

Breakdown between entities

According to CCEMS officials, the conflict between the two entities began in early 2019, when the two entities could not agree on how ESD No. 11 would fund CCEMS—either by agreeing to an approved budget at the beginning of the fiscal year or a flat fee per ambulance call. CCEMS CEO Wren Nealy said district officials also wanted to add performance metrics to its contract. The district has continued to fund CCEMS through an approved budget.

This continued through the budget season into 2020 as the entities debated the price of medical supplies. CCEMS’ $116,500 bill for medical supplies was the same monthly because CCEMS bills ESD No. 11 monthly by taking the total yearly cost and dividing it by 12, not by the actual supplies used, according to Nealy. But district officials wanted invoices for supplies purchased.

Community Impact Newspaper reached out to the ESD No. 11 board for comment, but attorney Regina Adams, who represents ESD No. 11 from law firm Radcliffe Bobbitt Adams Polley PLLC, declined to comment due to ongoing litigation between the two entities. However, the district has also released partial correspondence between the board and CCEMS detailing the conflict on its website.

According to a March 4 letter from Adams, the district can withhold funds and did so because CCEMS was unable or unwilling to release financial information about medical supply purchases. On June 18, the board voted to withhold 30% of all future payments to CCEMS until it could complete a full review of CCEMS’ financial statements.

Nealy said the withheld payments will not affect current services nor employee pay because the payments are for purchases already made. However, he said the situation is unsustainable.

Disagreements were exacerbated by a negative relationship between the district and former CCEMS CEO Brad England, according to Nealy. In a May 5 letter to the CCEMS board, the district commissioners said any reconciliation between the entities could not occur while England and several other administrators were employed by CCEMS. England retired May 27.

Nealy said CCEMS serves about 45,000 EMS calls per year, yet the conflicts with ESD No. 11 take up most of his time.

“I spend 80% of my time dealing with this ridiculousness instead of running the EMS service,” he said.

Seeking a new provider

The payments were only part of the conflict; the district also issued a Request for Qualifications for a new EMS provider March 19, which allowed other EMS contractors to submit bids to provide services for the district.

Originally, CCEMS did not release the financial information for the RFQ because officials did not want to release how it operated to potential competitors, according to CCEMS officials.

“We ... are working with ESD No. 11 to submit our proposal in a way that will not jeopardize the intellectual property we have developed that makes us so uniquely efficient and effective for the people we serve,” CCEMS board President-elect Enrique Lima said at a July 21 meeting.

The RFQ stated the district was seeking providers who can offer 24/7 emergency response coverage for the area’s 17 ZIP codes. Among other requirements, the district also wants at least 90% of provider response times to be within 10 minutes. According to minutes from ESD No. 11’s July 16 meeting, CCEMS averages about nine minutes per call.

CCEMS did not respond to the RFQ. An Aug. 3 letter from Feldman & Feldman attorney George Vie, who represents CCEMS, stated CCEMS’ board is concerned about releasing internal information and complying with the board’s audits.

“[CCEMS] cannot ignore the reality that the financial audit appears designed to obtain enough information to take over the CCEMS operation or system,” Vie said in the letter.

The ESD No. 11 board voted to terminate its contract with CCEMS on Sept. 3. Although the board had no discussion during the meeting when the vote took place, Adams wrote in a public Sept. 9 letter to Nealy that the decision was not made lightly.

“It was made after years of trying to convince CCEMS to live up to its commitments under the agreement and fairly and properly account for its use of taxpayer dollars,” she said in the letter.

An uncertain future

ESD No. 11 has the power to overturn its decision to terminate the contract, and Nealy said CCEMS would be willing to continue serving as the EMS provider. Although he believes this is not likely to happen, he said CCEMS officials would discuss it with the district.

Although the district received applications from prospective EMS services, Nealy and Windisch said the district has indicated it intends to form its own EMS service before the CCEMS contract expires in 2021.

ESD No. 11 has not confirmed this and did not respond to Community Impact Newspaper’s requests for comment.

ESD No. 11 has already received the titles of several ambulances formerly owned by CCEMS, is seeking an EMS provider license, has begun interviewing medical directors and other staff, and has begun searching for property, according to several motions and discussions at public meetings.

No matter which entity provides services for the district, Nealy said he believes there will be a dip in services as the provider tries to match the infrastructure and standards of CCEMS.

“They could hire every single [CCEMS] medic, put them in a different colored shirt, put them on the street, and it’s not going to be the same,” he said.••During an Oct. 1 ESD No. 11 board meeting, Commissioner Kevin Brost asked CCEMS officials if the entity was filing for bankruptcy or if it would disappear when its contract expires.

“You do realize that when we do stop giving you money and you stop running calls and being able to bill for that money, your company will go bankrupt?” he said.

Lima did not respond to Brost’s question during the meeting. In an email, Nealy said CCEMS is “actively engaged in business development.” No other details of what CCEMS will do when its contract expires have been released. Currently, CCEMS owns 17 ambulances, four SUVs and 12 stations, while the district owns 10 ambulances, four SUVs and five stations.

Windisch said officials from many of the 17 agencies, including the Ponderosa Fire Department, that use CCEMS’ communications center and are familiar with the conflict are dismayed at how negotiations between the entities are going.

“I know there’s some significant personality clashes, but it shouldn’t be. It should be about service to the people,” he said.

Adriana Rezal contributed to this report.

Correction: This article originally said Cypress Creek EMS serves 45,000 calls per month. The article has been corrected as 45,000 calls per year.