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By Anton Riecher
Disagreement over how often Allegiance Mobile Health must rely on neighboring ambulance services to respond to local calls arose during the Nov. 13 meeting of the Medina County Emergency Services District 4 board of commissioners.
EMS Director, Jason Miller, said data he obtained from the Medina County Sheriff Department indicates that at least 97 mutual aid calls requiring a response from outside MCESD4 were reported over this past year.
“It’s taking their unit out of service that’s supposed to be servicing their community,” Miller said.
Allegiance District Chief, Patrick Bourcier, questioned the accuracy of those figures. A report he obtained for ESD4 ambulance dispatches covering the month of October indicated only one such occurrence when compared to data compiled by Allegiance.

“I would just challenge that number because I have a hard time believing that the county would drop those calls to nobody,” Bourcier said.
However, Miller said that the report from the Allegiance computer-aided dispatch (CAD) software only reflects calls done by Allegiance.
“For the month of October, I got a report that eight of our mutual aid calls were done by other Allegiance ambulances, whether it be Frio or Bexar counties, whatever,” Miller said. “Thirteen additional calls were sent by other services.”
The report provided by Medina County 911 dispatch only identifies those responding ambulances as generic EMS units, not by the agency that operates them, he said.
“In a mass casualty situation, no one questions the need to muster additional units from surrounding communities to respond,” Miller said. “However, responding to everyday routine medical calls is a different matter.”
“It is a problem for the other providers because it’s not their obligation and the other EMS providers are upset,” Miller said.
Board member, Jerry Beck, asked how the numbers for the monthly report are compiled. Bourcier explained that once Medina County 911 dispatches the ambulance, each vehicle is tracked using global positioning system (GPS) technology.
“Sometimes there can be a ‘lag time’ in receiving that dispatch from the county,” he said. The result is the possibility that ambulance calls being placed by the public are not being received.
“We have a radio in this facility so when they call us it’s on that radio,” Bourcier said. “So if we’re not here we don’t hear that call” (to other mutual aid counties on Frio or Atascosa channels).
Allegiance carries two radios in their ambulances, one to communicate with Medina County, and the other to communicate with Allegiance dispatch at all times.
Procedure is for the dispatch to notify Allegiance through the sheriff’s department if the station cannot be reached. “That does not always happen,” Bourcier said.
“I’ve asked the county why they don’t do that and the response I get was that they didn’t want to bother us,” he said. “So if I don’t get it we don’t know about it.”
“Mutual aid ambulances from Lytle, Moore, Castroville or Hondo are dispatched when Allegiance personnel are away from the Devine station making a response call,” Bourcier said. “Allegiance responds as well when needed as mutual aid to other cities, common practice.”
“It’s just a question of if they tone out and we don’t respond they’re supposed to tone out somebody else or switch that call over to our dispatcher,” he said. “It’s their choice which one to do.”
Miller told the board that the routine work load for local ambulances is often difficult to manage.
“Devine is unique because we tend to get three or four calls at a time and we only have two ambulances,” he said.
Bourcier recommended that either Miller or Allegiance get with county officials to better determine how the county CAD system works.
A proposal to upgrade two Apple iPhones purchased for the new ambulances to iPads that would be used for direct real-time contact with the sheriff’s dispatcher, was tabled. Using software purchase through the county, the iPADs could be used to directly access the sheriff’s CAD system for more accurate data, Miller said on the new ambulances.
(The question remains if the new ambulances are going to stay or be sold, so upgrades would not be relevant.)
In his monthly report on response statistics, Bourcier said Allegiance, under its contract with Medina County Emergency Services District 4, made 213 ambulance runs in October, up more than 15 percent from the previous month.
“It looks like all the response times were well within the range of the contract within the city and the county,” he said.
The number of ambulance responses within the Devine city limits totaled 61 with an average response time of 4.8 minutes. In Natalia, Allegiance made 21 ambulance runs with an average response time of six minutes.
“In the MCESD4 area outside Devine and Natalia, Allegiance made 131 ambulance runs with an average response time of 8.7 minutes,” Bourcier said.
MCESD4 logged 15 mutual aid events in which the district either assisted or received assistance from neighboring ambulance services.
“Eight of those came from Allegiance from out of the Moore station or the Castroville station,” Bourcier said. “The remainder came out of Lytle, at least those I can track.”
In other business, Miller reported to the board that the two ambulances recently purchased by ESD4 were scheduled to go into service Nov. 14 staffed by Allegiance personnel.
In the course of discussing the purchase of a third ambulance as a reserve unit to guarantee two functioning ambulances on the road at all time, board treasurer, Juan Zamora, made known his concern that allowing Allegiance to operate ESD4 owned equipment without some compensation to the district may violate state procurement laws.
The current contract “shows favor to Allegiance, especially if we are now burdening ourselves with additional cost and (Allegiance) are charging the same rate (while using) our units, our equipment which saves them money, unless they’re paying us back at some rate I don’t know.”
“In effect, operating under an earlier contract negotiated with the intention of Allegiance providing its own ambulances unfairly grants them more profit,” Zamora said. The board never reconsidered that issue after the decision earlier this year not to operate its own ambulances as planned, but to continue under the existing contract with Allegiance.
Beck noted that the agenda item under discussion called for considering the purchase of a third ambulance, not the renegotiation of the Allegiance contract.
“We need to put that on another agenda,” Beck said. He then made a motion that the board not move forward with buying the third unit. Seconded by Zamora, that motion to table was approved unanimously.
The board did approve the purchase and installation of storage organizers in the district’s new Ford Expedition command vehicle. Plastix Plus in Houston was the winning bid at $4,600. The storage organizers are for the protection of emergency equipment carried in the command vehicle.
Board president, Anthony Martin, explained that the command vehicle is for the use of the district’s EMS director, Jason Miller, in emergency situations. Comm. Beck said Miller should not take the vehicle home and the policy should reflect that.
“Jason responds to calls when they are going to wait 15 or 20 minutes for another unit to respond,” Martin said.
The board tabled the purchase of a lawn mower for the Devine station after Beck and others asked for time to reach out to local landscaping contractors. Beck and others also asked the board to table action on plumbing work at the station to move the washer and dryer located in the ambulance bay.
In a lengthy discussion on district job descriptions, Bourcier addressed the board on the disciplinary chain of command for employees under the current Allegiance contract.
“We have an open relationship where if Jason comes to us with a problem, we’re going to solve it to whatever extent satisfies the district,” Bourcier said. Allegiance has gone as far as removing employees under those discussions.
Miller verified Bourcier’s assessment.
“The agreement with Allegiance and the attorney was that if there was an incident or personnel issue, that I would bring that to Pat’s attention and Pat would take it to his leadership and then do whatever Allegiance decides to do with that employee.”
No action was taken following a closed executive session to discuss personnel matters.
ESD Coordinator, Chrissy Merendon, confirmed for the board that applications had been issued to board members George Moralez, Jerry Beck, and Viola Potter, all of whom have terms expiring in 2025.
After several exchanges with board treasurer Zamora during the meeting, one on payroll liabilities on the October balance sheet and one on leases for new emergency medical equipment. Regarding the renegotiation of lease agreements for ventilators and auto pulse devices to equip the new ambulances, Zamora said that the district administration is only authorized to approve purchases affected day-to-day operation to a threshold of $2,000 to $3,000. He also pointed out that the monthly bank statements were not provided again as he requested.
“I can’t remember voting on changing the terms of the leases?” Zamora said,
Merendon pointed out that the leases were approved by action of the board in September. She later asked to make a statement to the board, stressing that she has always made it a point to issue paperwork regarding the meeting agendas at least two to three days before each session.
“So I’m asking the board to look at your paperwork before you get to the meeting, so when issues come up such as the treasurer’s report or any of the other stuff, it can be discussed, so it’s not discussed here to make somebody look like a fool.”