worry about the future of
note: This is the first in a series of articles on the financial
problems in the Hyde County Department of Emergency Services, which
will directly affect Ocracoke in some manner. The Island Free Press
will run more articles as the attempts to avert a crisis continue.)
Emergency Medical Services on the island
After a special work session and two public meetings, the Hyde County
commissioners are still working on a solution to their quest to reduce
the emergency medical services budget.
A presentation on the EMS by paramedics Brian Carter and Jeff Hibbard
at a special meeting Sept. 22, while informative, did not provide all
of the information the commissioners sought.
Carter, though not the overall EMS director, described the differences
in what basic emergency medical technicians (EMTs), intermediate EMTs,
and the more advanced paramedics do and the costs incurred during an
He also presented budget and staffing scenarios for all three levels of
Hyde County is currently without an EMS director.
One of the issues is the increased cost of having paramedic-level
service for the entire county, which was put into effect in
Before that, only Ocracoke Island had paramedics, while the rest of
Hyde County had basic- and intermediate-level EMTs.
Paramedic service began on the island in 2003 when the Federal
Emergency Management Agency sent a paramedic crew to Ocracoke after
Hurricane Isabel cut an inlet between Hatteras and Frisco, basically
leaving long ferry rides to the mainland as the only route off the
island. Paramedics were needed on Ocracoke to provide emergency care
while waiting for air ambulances, which was the only way of
transporting patients off the island.
Cheryl Ballance of the Ocracoke Health Center was instrumental in
retaining paramedic service on the island, and the OHC contracted for
it and was reimbursed by the county. Hyde County took over
EMS service in December of 2007.
Before 2009, the entire EMS expense budget was $928,672. The
estimated total EMS expense for 2010, as of April 30, was $1,430,916,
according to the most recent budget online at www.hydecounty.org.
The current budget includes $1,578,141 in EMS expenses. At the end of
Carter’s presentation, his numbers showed a savings of about $30,000
against the approved budget amount.
Commissioner Sharon Spencer noted that in the spring, the then-director
of the EMS had asked the board for an additional $364,000 to fund the
program to the end of the fiscal year.
“We are pleased to have paramedic care, but can we afford it?” she
asked. “Will we get these requests (for more money) every year?”
Included in the total budget is $190,000 in overtime pay. Carter noted
that they’ve already spent 25 percent of that. Current full-time salary
expenditures are at 13 percent and part-time are 20 percent. Salary
figures are $705,000 for full-time staff and $90,000 for part-time.
Another issue is whether better scheduling can reduce overtime. The
board discussed at length the disparity between the part-time and
full-time staff budgets and whether hiring more full-time staff would
Better collection on billing would also help the coffers. The
current collection rate is 42 percent of billing, which is done by
David M. Smitherman, interim county manager, noted that he is looking
into the costs of outsourcing billing, which might yield a better
collection rate. Billing had been outsourced but was brought back
in-house in 2009.
According to Carter, last year $701,000 was billed and $252,009 of that
was collected, leaving an uncollected balance of $448,991.
The shortfall results mostly from Medicare and Medicaid paying only a
fraction of what each emergency run actually costs, which Smitherman
said is $859. Medicare and Medicaid reimbursement rates change
quarterly, he said, and these agencies will only pay up to 80
percent of what is billed, never 100 percent.
“Right off the bat, we’ll always have a 20 percent write-off from
revenues,” he said.
Moreover, no one reimburses the county for the 400-plus responses that
don’t result in transport to a medical facility.
On hand also at this special meeting on the EMS service was Allen
Johnson, a regional specialist with the Office of Emergency Medical
Services of the North Carolina Department of Health and Human Services,
which is a regulatory agency and does not set policy.
“You are in a unique situation here,” he noted. “You had
paramedic-level service on Ocracoke and then had to provide the same
level of service to the entire county.”
While other North Carolina counties’ emergency trips to the hospital
are eight to 10 minutes, Hyde County’s average is 35 minutes or more,
he noted. During these longer trips, “paramedics can actually
medications working on the way to the hospital,” he said.
Another situation that must be considered is that the Ocracoke Health
Center is a family practice for residents of the island, IGC
administrative director Cheryl Ballance explained. Although
not a critical care facility, it treats everyone who walks through the
door, with many critical emergencies immediately referred to the EMTs
in the building behind the health center. Though fewer than 1,000
people live on the island, the population swells to thousands in the
summer. Caring for the summer visitors can be a strain on the facility,
but it also generates income for the practice.
At an Aug. 19 county board meeting, a comment was made that paramedic
service on Ocracoke might have to be discontinued, said Cheryl
Ballance, who said she was “shocked” by the idea.
More recent suggestions have included keeping paramedics on Ocracoke
and using the basic and intermediate EMTs in the rest of the county.
Johnson said if the final decision is to retain paramedic-level service
only on Ocracoke and a lower level on the mainland, this would require
a recertification issued by the state. Smitherman thinks this
could be accomplished before the end of the fiscal year.
While members of the public who attended this special meeting were not
allowed to comment, they were allowed to do so during the regular Board
of Commissioners’ meeting held immediately after the EMS work session.
Among those who spoke was the new doctor at Ocracoke Health Center
(OHC), Dr. Erin Baker, who joined the staff this summer.
“I took this position knowing there would be paramedic-level care,” she
said. “I am a family practice doctor and not qualified to intubate.”
Soon after she began, she had a case that required an airway opened and
the helicopter was out of commission, Baker said. “I was so thankful a
paramedic was here to accompany the patient to the hospital,” she
said. “Eliminating paramedics here would be a step backwards.”
Gail Covington, the recently re-hired nurse-practitioner at the OHC,
said she had worked here 15 years ago when there was only basic
EMT-level care. She urged the commissioners to explore better
“One of my reasons to come back was paramedic-level care,” she said.
“There are increasing numbers of boaters having paramedic-level
accidents. We had a drowning and three near-drownings where paramedics
Cheryl Ballance, administrative director of the OHC, said if the EMS
service was reduced from paramedic-level it would affect all the
“Of the 103 paramedic calls we had, at least 50 percent originated from
the health center,” she said. “We’re here to serve the citizens. (The
county providing) health services to the community is so important.”
Leslie Lanier, owner of Books to be Read, testified that it is two and
a half hours from Ocracoke to a hospital (via ambulance).
“We’ll be remiss if we go to a lower level of service,” she said. “We
have thousands of visitors with anything from a hangnail to a shark
attack. We need to get overtime under control, which needs a strong
At the Monday, Oct. 4 regular meeting, the commissioners again talked
about the need to have more solid figures about the true costs and
revenues of paramedic-level service vs. a lower level.
At one point, commissioner Anson Byrd said, “Ocracoke is a unique
situation. Perhaps we can have basic and intermediate services on the
mainland and leave paramedic-level on Ocracoke.”
They commissioners decided to have another special meeting on Oct. 18
to rehash the numbers at 3:30 p.m. before the regular board meeting at
Leinbach’s career has included jobs as a daily newspaper journalist and
freelancer. She now owns a home on Ocracoke, where she hopes to spend
most of her time. She is a reporter for the Ocracoke