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Commission weighs waiving AMR fines, extends contract debate amid hospital offload delays
Summary
Knox County commissioners advanced a proposed amendment to the AMR ambulance contract that would extend the agreement to Jan. 31, 2024, and forgive millions in penalties tied to response-time 'level 0' events while commissioners pressed staff on preserving penalties for time-sensitive calls; a separate resolution to discontinue the AMR agreement was deferred depending on the amendment's final outcome.
Knox County commissioners spent much of their Dec. 12 work session examining a proposed 10th amendment to the county's ambulance services contract with Rural/AMR, which would extend the contract through Jan. 31, 2024, and expand an exemption to certain time-response penalties that AMR says were accumulating because of hospital offload delays.
The amendment, presented as Resolution 605, would extend existing relief from time-response fines (previously waived under Amendment 9) and, as drafted, could forgive roughly $3.9 million more in fines from June'October 2022; staff said eliminating all "level zero" penalties for that period would raise total relief to approximately $4.3 million. Commissioners voted to move the item forward with no recommendation and asked for more data before a final vote.
Why it matters: Commissioners framed the proposal as an attempt to keep ambulance services solvent while the county finishes an RFP and consultant review of system-wide performance. Supporters argued that fines assessed when ambulances cannot clear hospital offloads would otherwise jeopardize providers, while critics said the county must retain enforcement for priority, time-sensitive calls such as stroke or heart attack.
AMR representatives and county staff described investments AMR has made locally and operational steps intended to blunt delays, including a locally run "earn-while-you-learn" EMT training program, nurse navigation, ET3 telemedicine pilots, quick-response vehicles (QRVs) and surge staffing at hospitals. AMR'identified figures included an aggregate local COVID recovery investment exceeding $5.1 million, $2.6 million in annualized wage adjustments, $1.6 million in shift incentives and $300,000 in training costs for roughly 50 EMTs.
Still unsettled were policy thresholds in the amendment: staff said relief would apply when hospital system status reached certain levels (for example, when three of five county hospitals reported 'yellow' or 'red' status), preserving penalties when fewer hospitals were affected. Commissioners repeatedly pressed that penalties should remain in force for priority-1, time-sensitive calls, and asked staff to provide the 2013 contract language, detailed penalty tallies, and models underlying the proposed relief.
Separately, the county introduced Resolution 606, the mayor's recommendation to discontinue the AMR agreement effective June 30, 2023, under a contract provision; staff advised the commission that the 803 notice would become irrelevant if an extension like Amendment 10 passed, and the commission moved that item forward with no recommendation as well.
What's next: Commissioners requested additional documentation, proposed a longer workshop on operational and transport issues, and expected the consultant recommendation and refined contract language to return to the commission next week or in January for a final decision.
Representative quote: "If we don't, we're not gonna have an ambulance service," Commissioner Daley said as he pressed for short-term relief while a new contract is negotiated.
Ending: The commission advanced the amendment discussion without recommendation and kept the discontinuation resolution contingent on the amendment's outcome; staff work and consultant review were scheduled as follow-up steps.
