During a special meeting of Karnes County Commissioners Court on June 20, County Judge Barbara Shaw read Smart’s letter of resignation in which Smart cited health reasons for leaving his position after 42 years of service.
The resignation will become effective June 30.
Smart told the court that he has become a liability to the county instead of an asset.
“My body has worn out on me,” Smart said. “Everything on my right side has worn out.”
The administrator said that there are many options the county should consider in regard of the future of local EMS services.
He recommended continuing with 911 EMS service only, and allowing private contractors to continue handling patient transfers.
Among the options Smart mentioned were hiring a private contractor to provide 911 EMS services for the county, turning the 911 EMS service over to the local fire departments, or turning it over to the Karnes County Hospital District.
“The days of the volunteer are fast, fast coming to an end,” Smart said. “I am not only speaking about EMS, I am speaking about fire departments and everything. People do not have the time anymore. Time is money and they don’t have the time, which is money.”
Smart said he recommended moving to privately contracted 911 EMS service, at least for the near future.
“I don’t say, ‘Kill the system,’ – I am saying, ‘Let’s do what we can to bring the system back in two years or four years – something that we can be proud of – an improved system,” Smart said.
Another letter was read by Judge Shaw from Karnes County EMS Medical Director Dr. Joel Saldana urging the county to move toward a full time paid EMS service.
Shaw said officials discussed appointing local Paramedic Casey Ebrom as Smart’s successor, but Ebrom declined, saying he lacked the experience needed for the position.
Ebrom spoke to the court during the meeting and said Karnes County is no longer the “little county” that it used to be in regard to local demand for EMS services.
“The increase in call volume has skyrocketed,” Ebrom said, adding that EMS patient care has been improving, but is not where it needs to be. He also recommended moving to a full time paid EMS service.
One EMS worker at the meeting said the current EMS service is broken and has been broken for a while.
“We have a chance to fix it,” the worker said. “How we are going to fix it? I don’t have that answer, but I know what we have is broken.”
The same worker said that local EMS facilities are also not up to par, and facilities need to be considered along with the direction the service will now take.
Shelby Dupnik said he works for Karnes County EMS, but in this situation he wanted to speak as a county commissioner, not as a local EMS worker.
Dupnik said that the hospital has had to “get creative” in order to make EMS services happen during times when Karnes County EMS was out of service. He said EMS has lost personnel, but under different leadership and with a better facility, those EMS workers might consider coming back to work.
“I am not in favor of a private service coming in here,” Dupnik said. “We are like roadkill right now, we have got private services circling us like I don’t know what.”
“I would like to see Karnes County people take care of Karnes County,” Dupnik said, suggesting the county use a mix of paid professionals with volunteers.
Judge Shaw questioned the viability of creating a service that mixed paid workers with volunteers.
Smart said he has seen other places try this mixed approach, but it hasn’t worked well.
Representatives from several private companies that offer contract EMS services also spoke to the court and presented information about what they have to offer.
During the meeting, Otto Kaiser Memorial Hospital Trauma Coordinator Mike Tyler said problems with the local EMS service was not in regard to quality of service, but rather that the service simply wasn’t always available when it was needed.
“This is about providing a service to the community,” Tyler said. “Right now, Karnes County EMS does a great job, when they are here. We had two horrific weeks of, ‘Do we have 911? Do we not have 911? Do we have 911 for a couple of hours?’ We can’t do this anymore. We have calls that are missed... They are great people. I like most of them. They are good people, but we don’t have, Karnes County EMS does not have the circle -- the 24/7, the right skill mix, we do not have the right skill mix... The basics on the truck? I don’t have an IV. I have no support from Karnes County EMS on this through the hospital.”
“They need your support,” Tyler said. “They need the financial support... We can’t do this anymore.”
Otto Kaiser Memorial Hospital CEO David Lee said that he does not see much interest from the hospital board in assuming management of local EMS services.
“We have a need for transfer service, as well,” Lee said. “What has been talked about here is the 911 part of the service, if the hospital takes this on, we have the other side of it – we have the need to transfer these patients to a higher level of care, and there is a potential conflict of interest there.”
Lee added that the hospital district is not prepared to immediately assume the responsibility.
“For the hospital to take it over at this point, it would not be a quick fix,” Lee said. “From our perspective, this is something that needs to be addressed much quicker than the hospital would have the ability to do. We don’t know how to run an EMS and we never have and so it would be starting from scratch and it would not be quick, to do it right.”
Judge Shaw said she was unsure of the legal issues that lie ahead regarding taking the next step.
“This is new to me,” Shaw said.
Commissioner Dupnik said that at the end of June the county will have 24 hours to appoint an interim EMS administrator and 48 hours to notify the state and turn in proper documentation. By September, Karnes County EMS would need to be relicensed, he said.
Dennis Kelley, with Texas Regional EMS, a company that has been contracting EMS backup and patient transfer services locally for the past 10 years, expressed concerns about possible changes in the local EMS system.
“I probably, out of this whole group of people here, have more to lose out of this discussion than anybody here,” Kelley said. “I know the ins and outs of Karnes County... I do not think that the volunteer system has gone by the wayside.”
Kelley said Atascosa County, Cuero, Wilson County, Goliad County and others all run services with paid employees and volunteers.
Kelley said his company is prepared to continue to offer professional EMS services.
“Just so everybody knows, in Karnes County, Texas Regional EMS, we run full time paramedic-staffed trucks. So every time you call us you get a paramedic. So it is not like we are a Podunk ambulance service out here that does it... The people in Karnes County are getting the best care that is out there.”
Judge Shaw asked what should be placed on the agenda for the next meeting of Commissioners Court, and Commissioner Pete Jauer said that the appointment of an interim director for Karnes County EMS needs to be on the agenda.
Commissioner Dupnik asked that requesting bids for full paid EMS services also be placed on the agenda.
One local EMS worker told the court that although they are called a volunteer service, the EMS workers are paid for their services.
After further discussion, the court also decided to include on the agenda for the next meeting accepting contract application for back-up EMS services, the possible lease or purchase of the facility currently owned by Texas Regional EMS and acknowledgement of memorandum of understanding between Texas Regional EMS and Karnes County for coverage.
“I am accepting direction right now,” Judge Shaw said. “I don’t know anything about EMS. I don’t like blood.”
“There has never been a problem with EMS in Karnes County until just now,” Shaw said. “I don’t think anybody has ever dealt with this before... I don’t know what statute says.”
The court discussed whether or not the EMS director would be appointed by the county judge or Commissioners Court. County Attorney Herb Hancock said he believed the county judge has the authority to make the appointment.
The court then discussed who would provide EMS service beginning June 22 and continuing through such time new interim leadership would be appointed.
Dennis Kelley with Texas Regional EMS offered to provide immediate EMS service for the county. Another representative of an EMS services company present at the meeting made a similar offer.
Commissioner Dupnik made a motion to have Texas Regional EMS provide EMS services as needed until a new appointment was made to fill the vacancy left upon Johnny Smart’s resignation.
The motion carried on a 3-0 vote with Dupnik, Jauer and Shaw all voting in favor.