Cypress Creek Emergency Medical Services CEO Wren Nealy alleged several issues pertaining to the impending transition of services to Harris County Emergency Services District No. 11’s newly formed EMS provider, ESD 11 Mobile Healthcare, in an Aug. 10 news release.

Tension has risen between the two entities since June 2020, when ESD 11 commissioners initially voiced concern over extending the district’s contract with CCEMS, which provides emergency medical services for approximately 177 square miles of north Harris County. Last September, ESD 11 commissioners voted to terminate that contract after 360 days and announced in December it would form its own EMS provider—ESD 11 Mobile Health Services—to replace the services provided by CCEMS beginning Sept. 1.

According to Nealy, many of the employees that will be leaving CCEMS to work for ESD 11 Mobile Healthcare have requested to use paid time off in the final months leading into the transition of services, which Nealy said has strained CCEMS' ability to provide services.

“ESD 11 Mobile Healthcare CEO Doug Hooten publicly stated all CCEMS employees who wanted employment with ESD 11 must work through the transition if they wanted to be ensured of a job,” Nealy said in a statement. “I had to stop paid time off for July and August because many of the CCEMS employees planning to work for ESD 11 wanted to take time off for one or both months leading into their new job.”

Nealy referenced an email sent to a CCEMS employee from an ESD 11 human resources official stating, "Your status with CCEMS is no longer a factor in your employment with ESD 11."

“This statement encouraged the CCEMS employee and others to leave early,” Nealy said. “When I informed Mr. Hooten of this situation, he supported the position statement and abandoned our agreement that would better ensure a safe and orderly transition.”

While Jerry Thomas, ESD 11 Mobile Healthcare community engagement manager, confirmed that the email was sent, he said ESD 11 officials ultimately do not have the power to dictate what CCEMS employees do prior to joining ESD 11 Mobile Healthcare.

“During our new hire academy, we have made it clear to all new hires coming over from CCEMS that they are highly encouraged to fulfill their obligations to their current employer,” Thomas said. “ESD 11 will not interfere in the employment relationship between CCEMS and its employees.”

According to Nealy, the email sparked a wave of early resignations totaling around 20 employees, which he said was roughly the number of staff members required to run three ambulances.

Answering the call

In addition to staffing challenges, CCEMS officials alleged that ESD 11 is accusing CCEMS of prioritizing private transfers over 911 calls. In an Aug. 4 letter sent to Nealy, Hooten pointed to several new business ventures sought out by CCEMS that he believed were interfering with CCEMS’ ability to fulfill its contractual agreement with the district.

“CCEMS recently announced that to replace the loss of income that will result from the Sept. 1, 2021, end of CCEMS's contract with the district, CCEMS would begin providing pay-per-ride, nonemergency transport services to entities unaffiliated with the district,” Hooten said in the letter. “CCEMS also announced a partnership with an air travel provider for air ambulance services.”

Hooten alleged in the letter that during a recent chemical release incident at Hurricane Harbor Splashtown in Spring, CCEMS had at least one unit that was unable to respond because it was running a private transport call. Additionally, Hooten cited an Aug. 2 incident in which CCEMS sent a truck out on a pay-per-ride transport, while the EMS provider had five 911 calls on the board.

“Neighboring agencies have been calling me and the district commissioners to report that this is but one example of a very disturbing trend,” Hooten said in the letter. “This behavior is unacceptable and irresponsible. It is even more appalling considering that you have recently tried to blame the district for a supposed lack of staff. ... In sum, CCEMS is putting the entire community at risk by showing greater loyalty to its new business model than to the residents it is contracted to serve."

According to Nealy, the two transfers Hooten referred to were emergency transfers from a local hospital to a higher level of care for emergency surgery, which he said was keeping in line with CCEMS' long-standing critical care policy.

It helps the system and ultimately serves the community by freeing up spaces and beds in the hospitals and in the emergency room to allow them to offload ambulances that have been holding the wall for four hours, and then, the ambulances can get back in to service to answer other calls,” Nealy said.

Thomas also alleged that between Aug. 3 and Aug. 9, CCEMS transported approximately 46 private transfers while 911 emergency calls were in holding status, which he said meant that either the answering agency was not able to respond or was relying on backup agencies to respond.

Prioritizing responses

Nealy said that calls are sometimes required to be placed on hold, but only to prioritize responses based on which patients need the most urgent care. Nealy also said that increased call volumes and wait times at hospitals due to COVID-19 has forced him to place one of his highest credentialed paramedics in the communication center to screen and triage calls.

When we did have extremely high call volume and long wait times, which led to calls holding, the calls were being managed by that paramedic, so that paramedic was determining which call got the next ambulance based on the current situation,” Nealy said, pointing to a call in which a girl had been found unconscious and unresponsive. “At face value, that looks really bad, but when they looked at it further, it was a 20-something female who was diagnosed with anxiety who had a panic attack and passed out, and now she’s awake, alert and oriented.”

Nealy noted calls like this could result in a holding status, but he said that did not suggest CCEMS was prioritizing pay-per-ride transports. Further, Nealy said that CCEMS does not check whether their private transport patients have insurance, adding that nearly 30% of those transports go completely or partially unpaid.

“We don’t verify benefits and make sure that they can pay before we accept the call to run the transfer,” Nealy said. “We just do it, so I’m a little offended at the attempt to try and say that we’re prioritizing people who pay for their rides before people who don’t.”

The ESD 11 board of commissioners will meet at 9 a.m. Aug. 19 to discuss, among other items, whether the district will pay CCEMS’ invoice for the month of August.

“The commissioners will be considering CCEMS' performance in August when deciding whether to pay CCEMS, and how much,” Hooten said in the Aug. 4 letter. “I would like to be able to report that CCEMS fulfilled its responsibilities to the district as a responsible provider of emergency services. ... Right now, I cannot say that.”

Nealy said he believed his agency has fulfilled its obligations as best it could given the circumstances regarding staffing and difficulties presented by COVID-19.

I’ve got employees killing themselves working 36- and 48-hour shifts,” Nealy said. “It’s horrible. They get minimal time off, then they have to come right back, because they feel the need to do the job and keep as many trucks on the road as possible."