Bobby Cox is 22 years old, born and raised in Hickory Flat, Mississippi, and considers himself an old soul.
Who or what would you say has been the greatest influence on your music?
Jason Isbell, Tyler Childers, and Sturgill Simpson are a few modern artists that are very inspirational to me.
Favorite song you’ve composed and the story behind it?
I wrote a song once for a little lady named Louise that I met while I was in rehab at Parkwood. She helped me out a lot through my stay there, and she was such an angel. Haven’t seen her since then, and I don’t know where she is, but I feel she is with me every time I sing those words. The song is called “Louise.”
If you could meet any artist, living or dead, which would you choose and why?
Probably John Lennon. He was a man who really wanted to make a difference through his music with songs like “Imagine” and “Working Class Hero.” He was one of the few that didn’t just waste his fame.
Most embarrassing thing ever to happen at a gig?
I was playing a cover of Tyler Childers “Feathered Indians.” I got through the first two lines, went completely blank, had to stop mid strum and start over.
What was the most significant thing to happen to you in the course of your music?
I was blessed enough to be able to play at the Magnolia Civic Center in New Albany, Mississippi, at a benefit for a fellow named Dustin Pratt. As a musician, it feels really good to be able to use your art to help people.
If music were not part of your life, what else would you prefer to be doing?
I honestly couldn’t imagine my life without music, but if I absolutely had to, I guess I would prefer my day job that I have now which is working in a transmission shop.
Please recommend another band or artist(s) to our readers who you feel deserves attention.
My dudes from the band “Noyz” out of New Albany MS — a group of some truly talented dudes!
Interested in seeing your own artist profile highlighted here on Our Tupelo?
Getting the week started can sometimes be a little, well, complicated. Yes, deep down (very deep), we are happy to begin a new week. A new week of opportunities. A new week of surprises. A new week of fun adventures. (Maybe. Okay, there may be some exaggeration on that one.)
But the week can also be complicated by rushing schedules, early morning work days, long commutes, or dreaded deadlines. Unfortunately, these are the facts of life for most working adults. But where does focusing on the negative get us? You guessed it: Nowhere.
The only thing negative thinking will do is breed more negative thinking. Before long, you will be caught in a cycle of defeat trying to scratch your way through another day. Who wants to dwell in that cycle day after day? Why start your week off dull, when you can start your week off bright?
Negative thinking can sometimes start out quite naturally, so you need to be intentional with positive thinking. You must be intentional with seeing the bright side of the new week. Do not get me wrong, sometimes you have to look deep…very deep. But the potential is always there. The bright side can shine through with a little help.
To start your week off on a high note, try these few tips:
1) Practice an attitude of gratitude.
2) Get plenty of rest the night before.
3) Plan something enjoyable for the week to look forward to [i.e. catching up with a friend, eating at a favorite restaurant, grabbing a coffee, watching favorite tv show, etc.].
4) Set realistic goals for the week so you can be productive in achieving the things on your to-do list.
It doesn’t take a lot to set your sights on starting the week off bright!
by Shirley L. Smith, Mississippi Today, October 24, 2019
Mississippi’s poorly constructed mental health system gives mental health providers insufficient funds to provide court-ordered, community-based services, and a poorly conceived Medicaid system cuts into their revenue stream, said Richard Duggin, chief executive officer of Region 7 Community Counseling Services center in West Point.
“Not all community health centers get funding for (crisis-diversion services), partly because of the inequities in the funding provided by the counties they serve,” Duggin added. In his seven-county regional Community Mental Health Center in northeast Mississippi, more than a fifth of families – and a third in one county alone (Noxubee) – live in poverty.
Mississippi’s Legislature delegated the responsibility of providing community-based mental health services to 14 independent regional Community Mental Health Centers. A 15th center – Region 5 – closed over financial troubles.
Last year, the centers provided over $33 million in uncompensated indigent services to underinsured and uninsured individuals, said Phaedre Cole, president of the Mississippi Association of Community Mental Health Centers.
Officials at several community centers said revenue shortfalls and disparity in government funding from a fragmented mental health system, along with limited resources in the state’s rural areas, is making it difficult for some centers to remain viable and provide much-need mental health services.
The fallout from this has been devastating.
A significant number of Mississippians with mental illness are cycling through jails, emergency rooms and psychiatric hospitals because the treatment and support services they need at the community level to manage their illness do not exist or they are insufficient.
And the lack of adequate community-based services is also costing the government more money.
“The most expensive ways to deal with mental health are emergency departments, inpatient hospitalization and the criminal justice system including using the police as first responders. So, if you can keep people from repeating that cycle, it saves the state and county money and it makes for healthier communities,” said Debbie Plotnick, Mental Health America’s vice president for mental health and systems advocacy.
Plotnick said it can take eight to 10 years for people who developed a mental illness in childhood to get a proper diagnosis. As a result, their condition worsens, making it hard for them to finish school or maintain employment, so by the time they reach adulthood they are not only poor but disabled, and they qualify for Medicaid.
Mental illness does not just affect those with the disease, “it destroys families,” said Jackson psychiatrist Dr. Marshall Belaga. “You have more divorces and abuse, and children cannot learn as well if they are in an unstable environment.”
“If you address the issues before people are repeating these expensive cycles and before they become disabled, they are less likely to need public benefits, because they continue working and going to school,” Plotnick said.
This requires having an adequate infrastructure in the community to provide individuals with treatment and support before they reach a Stage 4 crisis that can be detrimental to their life and lead to hospitalization, incarceration and homelessness, she said.
Disability advocates say Region 8 Mental Health Services community center, located in the metro area, provides such an infrastructure. It has managed to keep innocent people with mental illness out of jail, and it is a model of what can be done with adequate funding, resources and intervention services.
Region 8 implemented a Crisis Intervention and Diversion program in partnership with local private hospitals, law enforcement agencies, the courts and jails to ensure no individual in the region is held in jail solely because of a mental health issue, said Emile Craig, the region’s director of administration, in a statement. He said Region 8 also trains law enforcement officers and other community partners on how to interact with people with mental illness.
“Since we started the program in 1998, not a single individual in any of our five counties has been held in jail for a mental health issue,” Craig said.
The crisis services are just one component of Region 8’s success in helping people receive care in the least restrictive environment, the other is the coordination between Region 8 and all of its inpatient and outpatient services, he said.
Region 8 serves 18,000 people and includes two of the wealthiest and fastest-growing counties in the state – Madison and Rankin.
Unlike some counties, Region 8 has the benefit of having a Crisis Stabilization Unit, a short-term, inpatient acute care facility that stabilizes people in crisis, said Dave Van, Region 8’s executive director. “We also have local contracts with private acute care facilities for the placement of individuals that are determined to be mentally ill if our Crisis Stabilization Unit is full.” He said some counties also do not have private facilities that provide acute psychiatric care.
One of the main reasons people have a mental health crisis is because they do not comply with their medication or they are uninsured or underinsured and cannot afford their medication, Craig said. “Region 8 works with pharmaceutical companies and local pharmacies to help ensure that each individual we serve is able to obtain needed medications regardless of their financial resources or access to adequate health insurance coverage.”
Angela Ladner, executive director of the Mississippi Psychiatric Association, said, “Region 8 is offering more than the required core services, and I think they are doing a nice job presently. It’s what all the mental health centers should do.”
Providers at other community centers are just as dedicated, she said, but until they get appropriate funding, they will not be able to provide the same level of services as Region 8.
The issue is the inconsistency in care
Mississippi’s Department of Mental Health disburses state and federal grants to the community centers, but they must apply for them. The centers also receive funding from the counties within their region. Some centers may have other sources of revenues like private grants and donations, Cole said.
“Generally speaking, I believe each (community center) does a great job of providing services,” Cole said in a statement. “Each of us has our own unique, local challenges and advantages in addition to the challenges inherent to a rural, impoverished state such as Mississippi, (for example) general lack of health insurance coverage, spotty public transportation and a shortage of mental health professionals.”
Seventy percent of the community centers’ revenues come from Medicaid, private insurers and out-of-pocket payments from clients, said Cole, who is also the executive director of Life Help in Region 6, which serves 12 counties nestled primarily in the Delta, one of the poorest and most rural regions in Mississippi.
Micah Dutro, legal director of Disability Rights Mississippi, said he also believes the centers generally provide good care. The issue is the inconsistency in care.
That issue was at the core of a Sept. 4, ruling against the state by U.S. District Court Judge Carlton Reeves. He found that Mississippi has been unnecessarily institutionalizing thousands of people in psychiatric hospitals who could have obtained treatment in the community, but the state’s community-based services are inadequate. Reeves ordered state officials to work with a special master – a person appointed by the court to make sure judicial orders are followed – to expedite and prioritize community-based care.
Officials at several community centers located in the rural, less populated, economically distressed areas of the state, say they do the best they can with the resources they have available.
“We can’t provide more services without funding,” said Duggin, whose Region 7 is mostly rural area.
‘Whole new level of complexity’ affects client care
In 2011, Mississippi’s Division of Medicaid implemented a managed care program giving several private insurers the authority to manage reimbursement claims. Duggin and other providers say the managed care program often refuses to pay for certain necessary services.
For instance, the Day Treatment Service in Mississippi is not an inpatient program as it is in other states, said Sandy Rogers, the executive director of Communicare in Region 2, which serves 13,000 people in six rural counties, but Medicaid and the managed care companies often refuse to pay for this service, because they say that people do not need this level of inpatient care.
Matt Westerfield, the director of communication for the Mississippi Division of Medicaid, said Medicaid will not pay for certain services like Day Treatment if it is provided on the same day as another service that Medicaid deems as duplicative.
“The mental health care system was already overly complex before the managed care program was instituted, and the managed care program added a whole new level of complexity that affected client care,” Duggin said.
Last year, the community centers served over 110,000 Mississippians, according to the centers’ association 2018 Economic Impact Statement.
Most of the people served by the community centers are poor or have low incomes, and they either have insurance through Medicaid or they are uninsured because they do not qualify for Medicaid, Dutro said
The state can solve this problem by expanding Medicaid to allow more people to obtain insurance and increasing reimbursement rates, he said
“Medicaid is 72.6 percent of our revenue,” Duggin said. Additionally, he said, “We spent $3.1 million in 2018 in indigent services to children, youth and families who could not afford mental health treatment services or supports.”
The Warren Yazoo Behavioral Health center in Region 15, located in west central Mississippi, also absorbs the cost of people with no insurance. “We provided over $980,000 worth of uncompensated indigent services last year to adults, children and youth,” said Bobby Barton, executive director of Region 15, which served 3,600 people in 2018. He said the region provides services regardless of people’s ability to pay, “but now it’s starting to hurt.”
“The main thing is we would like sufficient funds to reimburse us for all the indigent services we provide,” Barton said.
Region 2’s other major challenges are its geographic location, getting clients to appointments because many lack transportation and a dearth of psychiatrists, Rogers said.
Medicaid provides non-emergency transportation, but Rogers said it is not dependable and “readily available in all areas in our region.” Although she said Region 2 provides in-home services for people who do not have transportation, this service puts a strain on their operation, because they are short-staffed, and it consumes a lot of manpower hours. If Medicaid would reimburse for mileage, that would help defray the cost, Rogers said.
To help fill the void left by a shortage of psychiatrists in the region, Rogers said they use psychiatric nurse practitioners.
In 2017, the American Medical Association Master File/MMS reported that Mississippi has the second lowest number of psychiatrists in the country with 4.86 psychiatrists per 100,000 people compared to the national average of 9.35.
Dr. John Mitchell, director of the Office of Mississippi Physician Workforce, said the relatively few psychiatrists in the state are concentrated in the metro area where Region 8 is based.
The Physician Workforce is working with the DMH to develop a psychiatry residency program at Mississippi State Hospital to increase the number of psychiatrists in the state. “Statistics have shown that people stay within a 50- to 100-mile radius of where they did their residency. So, if you train more, you have the potential to retain more,” Mitchell said.
‘Bad rap’ or well-intended system ‘gone awry’?
Under pressure from the federal government, the state increased its community-based services over the past few years, but Judge Reeves said, Mississippi still “operates a system that unlawfully discriminates against persons with serious mental illness.”
DMH expanded its mobile service teams known as PACT from two in 2014 to 10 in 2018. These teams provide ongoing intervention services to people with serious mental illnesses, but the rural areas cannot sustain PACT teams because of their limited workforce. DMH officials said in fiscal year 2020, that began July 1, the DMH will be providing funding for the same kind of direct mobile service in Regions 1, 2, 7, 11 and 14 through a new program called ICORT, Intensive Community Outreach and Recovery Teams. Like PACT, these teams operate 24-hours a day and go directly to clients, but they require less staff. The DMH piloted the ICORT program in Region 2 in October 2018.
Joy Hogge, executive director of the Mississippi-based Families as Allies disability advocacy organization, says parity in the state’s mental health system can only be achieved by building a better infrastructure that will offer more support, training and backup technical assistance to the community centers, and allow them to share electronic health records and track the services that each center offers.
Jackson psychiatrist Belaga, who recently retired from St. Dominic Hospital after 10 years and joined Hinds Behavioral Health Services in Region 9, also says a statewide electronic medical record system is necessary to keep track of patients and ensure that they do not fall through the cracks.
Belaga explained that if someone experiencing a mental health crisis goes to the emergency room or is brought there by a law enforcement officer or a loved one, the doctor cannot check to see if the person has received treatment at a Community Mental Health Center, because medical records between the centers and the hospitals are not shared. Consequently, doctors at the hospital cannot develop “a cohesive treatment plan,” he said.
“I have seen people coming to the emergency room 18 times for the same psychiatric complaint,” Belaga said.
If the DMH developed a statewide electronic medical records system, he said, it would allow emergency room doctors to access patients’ medical histories, see what medications they are on and contact their regional community center to get them connected with the support services they need to help them remain stable and avoid hospitalization and future crises.
Van from Region 8, who has been in the mental health field for 30 years, said, “Our out-patient community mental health system in the state of Mississippi may be somewhat fragmented, but for the most part, I think the system is getting a bad rap.”
Van said the mental health system was created with good intentions by legislators in the mid-1970s to give local officials and residents the authority to determine the best way to address the specific needs of their community.
Ladner said the design of the system was well-intended, but it has gone awry.
“I would correlate the current mental health system to charting a course to a destination, but not providing everyone with a map on how to get there, but we still expect you to get there, but not everybody will make it,” Ladner said.
Report for America corps member Shirley L. Smith is an investigative reporter for the Mississippi Center for Investigative Reporting, a nonprofit news organization that seeks to hold public officials accountable and empower citizens in their communities.
Email her at Shirley.Smith.MCIR@gmail.com.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
by Erica Hensley, Mississippi Today, October 21, 2019
MEADVILLE, Miss. — Driving 80 miles an hour, Tyler Blalock eases off the accelerator and careens his neck to shout over the engine’s roar. “I’ll take it easy over the bridge,” he reassures his partner who’s hunched over bracing himself between two floating medical cabinets while setting up a stretcher and IV in the back.
That narrow, concrete bridge with rusted metal reinforcements casing the top, heads out of downtown Meadville and opens up into Franklin County’s country roads, many of them gravelly, bumpy if not closed to traffic all together.
The sun is starting to set behind heavy storm clouds that have threatened to erupt all afternoon. Blalock wants to get to his destination — a house about 15 miles away — before dusk, because residents don’t label their mailboxes well and they can be easy to miss.
Blalock, a Natchez native and self-described adrenaline junkie, has been in ambulances since 1999. He started his own emergency medical services company in 2010. Over the past two decades, he became increasingly troubled by an industry that prioritizes profits over patients. Specifically, he points to the growing influence of national emergency medical service companies that can dictate the terms of their contracts with local governments and local hospitals, some of which choose to opt out of the trauma care system.
Neither, he believes, is in the best interest of patients.
That’s why he believes he represents an innovative experiment where small independent companies like his can serve as an additional safety net in an emergency medical services industry that includes ambulance companies, health care facilities and local and state governments.
In 2012, the Franklin County Board of Supervisors hired Blalock’s Rural Rapid Response over larger ambulance companies to provide 24/7 ambulance coverage across the rural county because of his personal touch and familiarity with the county’s residents.
“Patients actually matter, they’re not just a number in business and in health care, period,” he said. “The only thing I’m able to compete with [the big companies] against is the quality of the care and the straightforward moral aspect of it, that the patient care is more important than making a dollar. But, I’ve got to make a dollar, because without the dollar I can’t give good patient care.”
“Patients actually matter, they’re not just a number in business and in health care, period.”
— Tyler Blalock
Given competition, Medicare reimbursement policies, navigating rapidly deteriorating state roads and bridges and the hospital bottlenecking phenomenon known as wall time, making a dollar is increasingly challenging for small emergency medical services business owners like Blalock, who calls himself a paramedic first and a CEO second.
As a result, these challenges are especially pressing for the rural counties, which often have small tax bases, that rely on his company. Despite the uphill battle, he expanded his operation into Lawrence County last year.
Those low tax bases have to supplement ambulance service contracts to cover emergency transport across their rural counties. Whereas suburban and metro ambulance services struggle to navigate larger populations and their traffic, rural areas struggle to cover the large swaths of land with limited resources — often only one ambulance to cover 700 square miles or more, with further travel to get to an emergency room capable of treating trauma injuries.
More often than not, Blalock takes trauma patients to Jackson. One night after the 85-mile trip last year, he remembers being immediately inflamed as his ambulance rolled to a stop in the emergency bay, when he saw six trucks lined up in front of his.
“It’s instantly frustrating to pull in and see that line and know the hospital accepted your patient knowing how long you’d have to wait,” he said.
By the time he finished his patient’s paperwork and the line of paramedics hadn’t budged, he knew he was in for a long wait. Paramedics dub it wall time — this delay in time between the paramedic arriving at the emergency department and the hospital finding room for the patient.
Blalock’s frustration is two-fold: The delay hurts his patient who’s in pain while waiting for a bed and, possibly, other patients still waiting to be picked up. He got to his patient in time to stabilize her pelvic fracture, but between the scene-treatment, transport back-and-forth and hour-long wall time, he estimates his ambulance was out of commission for five hours — and not getting paid to boot.
During peak hours — from around 11 a.m. to 11 p.m., according to Mississippi Today’s data analysis — ambulances log-jam at emergency departments and are unable to return to service. So, while ambulance service companies may technically have enough staff to meet their county’s emergencies, emergency department wall times burden those staff and response times disproportionate from actual demand.
Blalock says he missed a bad multiple-car rollover wreck that day because he was holed up, standing on the wall. His informal mutual aid agreements kicked in as his backup, but the cycle continued as those ambulances were pulled out of their home county.
“We are a finite resource,” Blalock said. “I can’t do my job because I’m stuck [on the wall] doing theirs.”
Hospital closures across the state put more pressure on the centralized hospital system in Jackson. Hospitals deal with variations in supply and demand of available beds differently, although triage principles prioritize patients based on immediate needs. In Mississippi, University of Mississippi Medical Center is the only Level 1 trauma facility. Paramedics take most major emergencies or cardiac cases, “life or limb” complications as medics say, to UMMC.
As the state-run training hospital, UMMC has the most beds in the state and sees the most patient traffic from ambulance transfers followed by Forrest General in Hattiesburg, Tupelo’s North Mississippi Medical Center, and Jackson-based St. Dominic’s Hospital and Baptist, according to data from the state health department. Because the Jackson-based hospitals have the most space and offer some of the highest levels of care across the state, more often than not, high-need emergency transports end up in the capital city — and that means longer wall times in Jackson, and longer response times in surrounding rural areas.
As rural hospitals close and insurance models change, much government and news media reaction has focused on ambulance response times. Response times usually refer to the amount of time between the 911 call and when the ambulance arrives at the patient’s side.
Multiple variables affect that response time including: when the ambulance gets that call, the distance they must travel to pick up the patients and the number of ambulances available to respond.
But, according to our data analysis, paramedic reports and research, it’s often the wall time — which comes at the tail end of the process — that clogs up the entire ambulance system and lengthens response times across the board. Jackson hospitals have the longest wall time across the state, which costs local and traveling paramedics uncompensated time away from the next 911 call.
Rural areas are often disproportionately saddled with the cost of centralizing care. Maria Bianchi, executive director of American Ambulance Association that represents ambulance services across the country, says the result makes it harder for ambulance services, and the counties who contract them, to make ends meet. She adds that ambulance providers in rural areas also tend to have more people lacking insurance, low call volume and lengthier times on task.
“In rural areas the challenge that we have is it’s also an inverted system because you’ve got to be prepared as an ambulance service provider to respond 24 hours a day, 7 days a week, 365 days out of the year, regardless of whether you get a call or not … but you do need to have a certain level of surge or cost of readiness embedded.
“And unfortunately, especially in rural, super-rural and frontier areas, their reimbursement rate for even the highest levels of care of a medical transport is never going to meet, at least through Medicare or Medicaid, the actual cost of providing that service.”
“Their reimbursement rate for even the highest levels of care of a medical transport is never going to meet … the actual cost of providing that service.”
— Maria Bianchi
Nationwide, Medicare is the largest reimburser of ambulance service followed by private insurance and Medicaid. Federal protections dictate that emergency services cannot deny a patient based on their insurance status — but if a passenger lacks insurance, more often than not, the ambulance will not be paid for that call.
Average reimbursement for emergency calls ranges from $200 to $300, which is usually less than an ambulance’s costs, depending on the distance and nature of treatment. Research estimates that reimbursement rates are at least 6 percent less than actual costs and more than 70 percent of calls are carried out at under-cost, evaporating profit margins for small companies. The reimbursement rate is set in stone with Medicare and Medicaid as a “transport supply,” not a medical treatment that would reimburse at a higher rate. Private insurers follow the same suit. Emergency medical services advocates argue that the service is tantamount to mobile health care — paramedics stabilize and treat patients on the way to the hospital, just without the time to or benefit of a full diagnosis — and falls into a billing grey area between transport and medical treatment.
Kevin McGinnis has seen every aspect of the emergency medical services business — from the provider perspective, the state and hospital. He currently manages programming for rural emergency medical services with the National Association of State EMS Officials. He says the perennial funding problem stems from having to navigate too small a pool of resources for too big of a need.
“There’s one other thing that’s tying EMS’s wrists behind the back from a funding point of view and that is that (Medicare) has always had an upside down incentive for modern (emergency medical services) in how it pays EMS … based on a 1960s model where we were horizontal taxi cabs and all we did was transport patients,” he says, when many EMS were staffed by volunteers, and reimbursement was designed to just keep systems afloat.
Because ambulance services are regulated and reimbursed more like medical supply companies or buses, rather than medical providers, they have to take a patient to a hospital to get paid. In what advocates argue is an inverse incentive in modern health care that has morphed to prioritize treating patients in place, EMS are burdened with uncompensated time if they keep a patient who doesn’t need to go to the hospital out of the ER.
According to advocates, the model causes cyclical problems for the business side, like trouble attracting and keeping good medics. Essentially, the risk is high, but the benefit is low.
“Here’s the bottom line: If you don’t pay adequately, you’re going to have recruitment and retention problems within your workforce. If you do not receive adequate revenue, you’re going to be unable to pay your workforce adequately,” McGinnis said. “If on top of all of that, your history is deeply bound in the foundation in volunteerism, you’re set up from Day One to have problems with the other two.”
For Blalock and many of the other 2,100 emergency medical technicians and paramedics across the state, the low reimbursement and as they see it, lacking respect — they bristle at the term “ambulance driver” — is a big source of frustration and worry. The reimbursement rates aren’t enough to make ends meet, much less bolster an industry plagued with recruitment and retention issues.
“I can’t run enough calls to break even.”
— Tyler Blalock
“In Franklin County, with 8,000 residents, I can’t run enough calls to break even. They subsidize me with a certain amount every year … I actually competed against AMR when I got this contract. So to go up against the world’s largest ambulance company and to prevail, there’s no reason I should be in business,” Blalock said.
Due partly to those recruitment issues, Mississippi averages about seven emergency medics for every 10,000 people. Funding structures to secure the safety net are fragmented and sparse. No Mississippi law mandates counties to supply or fund emergency medical services, although all have some type of coverage. But how they fund and regulate that emergency service is largely up to supervisors and their budgets.
The health department regulates permits and equipment, but does not oversee any performance-based accountability, like response times. The state’s trauma fund, which Jackson-based Baptist and St. Dominic’s pay into to avoid accepting high-need trauma patients, kicks 15 percent of its annual budget to counties based on population counts for the sole purpose of aiding ambulance service. But, it’s barely a drop in the bucket to cover the around $800,000 needed yearly to run just one truck. Additionally, the Legislature recently reduced the health department’s spending power and swept the dedicated trauma fund into the state’s general fund, which equaled a $2 million cut to the trauma system last year, though it’s fluctuated since.
The trauma fund allocation varies from around $4,000 for the most rural to $90,000 for Hinds County, the state’s most populous. Franklin County pays Blalock’s Rural Rapid Response an annual subsidy to respond to 911 calls. Due to budget cuts last year, the county cut his subsidy down by more than a third, to $140,000.
“I’m absorbing that cost. I’m borrowing money and they’re going to slowly get me back to full funding over the next three years, but until then I’m basically working for free … I don’t know what answer there is. We are pushing it onto the smaller governments who aren’t equipped to do it because they can’t afford to fix the bridges that are out all across the state, let alone subsidize ambulance service.” Franklin County made good on their promise and recently re-upped his subsidy by $25,000 for the next year. It helps, but it’s still made for a tough time, he says. “This has been my hardest year ever,” he said, but not for lack of lessons learned. If he faces a cut subsidy again he’ll walk away, he says, “I’ll have to just close up shop.”
Over the past decades, ambulance services have been asked to do more with less. Regulations are scattered across agencies and increasing as medical technologies and care systems grow, but reimbursements and EMS wages are stagnant. Mississippi EMTs and paramedics make around $33,000 a year, according to the Bureau of Labor Statistics.
“I don’t know how I’m in business,” Blalock says, as he prepares for another 24-hour shift to give his staff time off in hopes of saving them from burnout and himself from the high cost of turnover.
“I can’t do this forever,” he says. “[The job] wears on your conscience, and there’s things you can’t unsee.”
At quarterly state EMS Advisory Council meetings, he advocates for more mental health resources, like psychiatry evaluations and therapy, and more support from the state. He wants to offer his staff resources, rather than react when the pressure mounts. Though talks of grant proposals are mentioned, as of this summer no formal support network is in place for paramedics across the state. A bill to address health care needs among first responders that was signed into law this year, does not include paramedics or EMTs.
They rely on each other, leveraging their tight-knit internal support network. But the divorce, suicide and substance use rates are high among paramedics; Blalock says something has to change.
“We carry a lot of weight, and it gets heavier over time,” he said. “It’s a big problem and nobody pays attention to us. I feel like I’m the little dog just yapping sometimes, just saying, ‘Hey look at me, look at me,’ but the squeaky wheel gets a little oil.”
