BY ANNIE HOLLER
MOUNTAIN CITIZEN

INEZ — For Martin County residents, calling 911 has long come with a basic expectation: an ambulance crew will arrive in time to make a difference. Now, amid layoffs, missed payroll and station closures at the region’s largest private provider, county officials are preparing for a possibility that once felt unthinkable — that Martin County could be left without an ambulance service.

Patriot EMS, an Ironton, Ohio-based company that has served as Martin County’s sole ambulance provider since August 2022, has faced mounting instability. Less than two weeks ago, Patriot shut down its sole station in Mingo County on U.S. 119. Employees have since said additional closures may be pending in Floyd and Magoffin counties, and possibly Martin County. Workers reported that payroll has not been met since Feb. 3.

Martin County Judge/Executive Lon Lafferty confirmed that he met last week with the owners and management team of Patriot.

“The thought of calling 911 and being told there’s no ambulance that can respond is very frightening,” Lafferty said. “We cannot leave our residents without this vital service.”

Lafferty said he remains hopeful Patriot can stabilize and continue serving the county. However, he is exploring alternatives in case it cannot.

The stakes are particularly high in Martin County because it does not have a secondary EMS provider, unlike Floyd, Lawrence and Boyd counties, which have additional service contracts, including LifeGuard and Emergent Care, or Prestonsburg, which operates its own service through its fire department.

“I not only serve as the county judge, but I’m also a physician who knows full well the importance of having an ambulance respond when there’s a medical emergency,” Lafferty said. “It’s not uncommon for my office to call 911 for an ambulance because we have a patient who is in a medical crisis, such as a heart attack or stroke. You only have a certain ‘window of opportunity’ and that ‘golden hour’ you hear about to transfer the patient to a medical center for specialized treatment.”

Patriot expanded rapidly after buying out NetCare, growing to serve Martin, Floyd, Lawrence, Magoffin and Boyd counties in Kentucky, along with Mingo and Wayne counties in West Virginia and locations in Southern Ohio. Like many private EMS providers nationwide, officials say the company has struggled financially due to low reimbursement rates, low call volume and rising fuel and supply costs.

A layoff notice from Patriot to employees, effective Feb. 17, linked staffing reductions directly to reimbursement pressures.

“Due to continued decreases in reimbursement rates from Medicare, Medicaid and commercial insurance providers, combined with ongoing financial pressures across the EMS industry, Patriot EMS has made the difficult decision to consolidate operations and reduce staffing levels,” the letter states. “This decision was not made lightly. After carefully evaluating all available options, we determined that restructuring our resources is necessary to preserve essential services within the communities we are still able to serve.”

The letter, signed “Patriot EMS Leadership Team,” encouraged terminated employees to file for unemployment. It said information about final pay and benefits would follow in separate correspondence.

Some Patriot employees have contacted Eddie Slone, executive director of the Kentucky Board of Emergency Medical Services (KBEMS), about missed paychecks and he referred them to labor authorities.

“That is not something we oversee, although it is very concerning,” Slone said. “We are responsible for ensuring high-quality emergency medical services in Kentucky by licensing ambulance services, certifying EMS personnel and setting training standards. We also oversee compliance, investigate complaints and manage state grant funding.”

Slone confirmed that he has heard “rumors and rumblings” of possible shutdowns but has not received official notice from Patriot owners Krista Ellison, Vicki Rotter and David Rotter.

He noted that under state regulations, a prolonged lapse in staffing can quickly jeopardize a provider’s license.

Martin and Magoffin counties are the only two of Patriot’s five Kentucky counties without backup.

Jessica Isaac, executive secretary in Magoffin County Judge/Executive Matthew Wireman’s office, confirmed that county officials met with the owners of Patriot EMS. However, she did not reveal details of those talks.

Isaac said numerous concerned residents and Patriot employees had contacted the judge’s office, with Patriot employees alleging a closure/suspension of service Sunday in Magoffin County.

Slone spoke of the KBEMS’s willingness to assist the counties. He encourages officials to contact him sooner rather than later, as time is of the essence.

“My office will do everything we can to guide them through the process,” said Slone. “The last thing we want to see is for any of our counties to be without ambulance coverage. When that happens, you’re talking a recipe for the perfect storm.”

Slone explained that, for example, Patriot holds the certificate of need for Martin County. If it were to end service, the county would need to be ready in advance to use multiple EMS providers.

Slone said another possibility for counties is to establish their own ambulance service, typically based out of a fire department.

“You’re talking the cost of buying an ambulance, equipping and maintaining it, having the required insurance in place, staffing it around the clock, and having a knowledgeable person to do their billing. The list is long,” said Slone. “The monthly costs would be ongoing, and the county would likely have to raise taxes or pass a levy to offset them.”

Lafferty said he sympathizes with private EMS providers because he believes they struggle daily to stay afloat. He has been told the average cost of operating one ambulance for 30 days is about $40,000, while reimbursements remain low and expenses continue to rise.

“This latest crisis with the ambulance service, in my opinion, is just the tip of the iceberg,” Lafferty said. “I fear that whether we manage to avoid the bullet today and find a short-term solution to avoid a lack of coverage, it’s only a matter of time until we find ourselves back here again.”

In Floyd County, Missy Allen, special projects director at the Floyd County Judge/Executive office, said the office had not been officially informed of any closure of Patriot’s Auxier station, which serves both Floyd and Martin counties.

“We are very blessed and in much better shape than others,” Allen said, noting that Floyd County has three providers. “My heart goes out to everyone who may be negatively affected by these closures. A dependable EMS service is crucial to the welfare and safety of our people. The thought of scrambling to find one is daunting.”

Patriot owner Krista Ellison did not provide a statement in response to a request for comments.