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A tsunami of factors could work together to create a substantial ambulance shortage while demands for the service continues to increase. County Attorney James Estep III fielded a question about mutual aid during the September Claiborne Commission meeting. Estep was asked if the county is reimbursed for its ambulance services when it assists other counties or if the taxpayers ‘pick up the tab.’

The Bell County (KY) ambulance service was recently dispatched to help during an emergency crunch in Claiborne County. The extra ambulance was needed because one of the county’s trucks had been sent to help out in Knox County.

Estep said the county is no longer in the ambulance business. The service was transferred to Covenant Health, who leases the Claiborne Medical Center.

“What we do is purchase one ambulance annually from a trust fund that was created when they (Covenant Health) leased it with $10 million. That went to reimburse pay debt and to buy those ambulances. And we’re about at the end of that,” said Estep.

He said the money in the escrow account has been or is about to be depleted. He added that next year, the county will likely purchase its own ambulance, but that Covenant will have control as to where it goes and for what the ambulance will be used.

Estep was asked about any charges passed on to the public when ambulances are dispatched to a scene via phone. He said those calls coming through the E-911 service are paid via a rate reimbursed to the state for telephone call use.

On March 25, 2014 the county entered into a sale/lease agreement with Covenant Health/Claiborne Medical Center in which a deferred lease revenue agreement in excess of $9.32 million was paid at the time of closing. No other rent payments are due during the 10-year lease term which comes up for automatic renewal next year.

In its 2022 Audit Report, the Tennessee Comptroller states that the agreement includes an annual payout from an escrow account of $165,000 made by the county to Covenant plus the purchase by the county each year of a new ambulance.

“Upon exhaustion of the escrow fund and Healthcare Fund, the ambulance service subsidy shall be payable from general county revenues,” reads the report, in part.

That means, the county will need to dip further into its 101 General Fund to hold up its end of this bargain. The recent property tax angst could be repeated next fiscal year as more funds will be lifted from the county coffers to continue paying the agreed to $165,000 each year plus the provision of a new ambulance.

Of course, Covenant has the right to discontinue its operation of the ambulance service any time within the lease term with just a 90-day notice, according to the lease agreement, backed up by the state comptroller.

Delving deeper into the 2022 Audit Report, it appears Claiborne County paid a few dollars under $125,000 for the ambulance that satisfied the fiscal year 2021-22 lease agreement. If the 2022-23 Audit Report, which is not yet completed, pans out similarly, the escrow account would have dropped to around $161,906. That means, there won’t be enough in the account to cover the $165,000 annual payment and new ambulance for fiscal year 2023-24.

This means, the escrow account will be in the red and continued funding to satisfy the lease agreement will need to come from the county coffers –likely from another property tax increase or yet another wheel tax, as that is historically the easiest way for the county to acquire new revenue.

On a side note, an independent local ambulance service recently purchased two trucks for $89,000 each.

As Claiborne County continues morphing into a retirement community with a growing senior population, there will likely be a substantial increase in demand for ambulance services. The current trend of young folk who permanently leave the county due to a lack of skilled employment will add to the age-adjustment in population to a more senior community.

The anticipated upswing in tourism will place additional demands on emergency services as they receive calls from all manner of recreational accidents. Add to this scenario the termination of the EMS on-call system that allowed additional personnel to activate more ambulances as emergency calls demanded. It doesn’t help that there is currently a statewide shortage of EMS personnel.

The recent closure of the Clairfield Ambulance Station adds to the problem since it will take valuable time and resources to answer an emergency call in the isolated Clairfield/Clearfork communities.