TriStar Greenview Regional Hospital has renewed its efforts to establish an ambulance service in Warren County to compete with Med Center Health affiliate Med Center EMS, despite finding heavy resistance to its 2018 application for such a service.

Greenview, through an affiliate called Warren County Ambulance Service, has filed a certificate of need application with the Kentucky Cabinet for Health and Family Services to start a ground ambulance service. The application was made public Sept. 19, almost one year after the original certificate of need application was filed.

An emailed statement from Greenview CEO Mike Sherrod acknowledged that a new application had been made.

“We remain committed to providing residents with a choice in emergency services,” Sherrod said in the email. “Bowling Green is one of the fastest-growing cities in Kentucky, yet it has only one existing ambulance provider. If approved, our new ambulance service will fill a critical gap in access to care. We hope to begin transporting patients by early 2020.”

Greenview, owned by Nashville-based Hospital Corporation of America, submitted a certificate of need application with the state Sept. 26, 2018, to establish a ground ambulance service called Southern Kentucky Ambulance Service. That application met with opposition and a court challenge from Med Center Health, based largely on Greenview’s attempt to submit the application under an emergency administrative regulation issued by the CHFS in response to a study of Kentucky’s certificate of need regulations done by Louisville’s Pegasus Institute think tank.

That Pegasus study pointed out that counties as large as Warren – which has a population of more than 130,000, according to U.S. Census Bureau estimates – typically have more than one ambulance provider and concluded that Warren County is so underserved by the one ambulance provider that it faces a “public health crisis.”

The emergency regulation meant Greenview could submit its application through a “nonsubstantive” review that “fast-tracks” the process. At the time of that original application, Med Center Health Chief Financial Officer Ron Sowell said a nonsubstantive review shifts the burden of proof from the applicant to the existing provider.

“We have to now prove that we don’t need another ambulance service in the county,” Sowell said.

Med Center Health was quick to oppose both the certificate of need application and the basis for the emergency regulation.

Wade Stone, executive vice president of Med Center Health, said there is no need to change an arrangement that has worked well since 1980, when The Medical Center took over operation of the county ambulance service with no financial support from the city of Bowling Green or Warren Fiscal Court.

Stone pointed out that Med Center EMS has won numerous awards and accreditations and has grown along with the county, despite operating at a deficit.

Med Center EMS now has 13 vehicles and about 100 employees. Operating out of a new 28,000-square-foot headquarters building on Bowling Green’s Third Avenue, it made more than 23,000 runs in 2017.

Warren Fiscal Court and Warren County Judge-Executive Mike Buchanon have expressed support for the existing ambulance service.

After Greenview’s original application, Buchanon said he saw no reason to disrupt “what we consider to be an ideal situation for county taxpayers.”

Greenview’s original certificate of need application was denied in January when a Franklin County administrative law judge granted a motion for summary judgment requested by attorneys for Med Center EMS. That motion pointed out that the nonsubstantive review doesn’t apply to Warren County because it doesn’t meet the criteria laid out in the emergency regulation.

Med Center attorneys were able to demonstrate that Warren County truly isn’t served by just one ambulance service. Franklin-Simpson County Ambulance Service is licensed to provide ambulance service in a “substantial portion” of Warren County.

Shortly after that summary judgment, the CHFS passed amended regulations that stated that a nonsubstantive review is appropriate when “there is no more than one licensed … ground ambulance service that has both a license to serve the entire county that the applicant is proposing to serve and that has a base station or a satellite location, or both, located in the county.”

Med Center Health challenged the amended regulations, but a vote in April by the Kentucky General Assembly’s Administrative Regulation Review Subcommittee cleared the way for Greenview to submit another application.

That subcommittee voted 4-3 to find deficient the amended regulations, but that result fell one vote short of the number needed to find the regulations deficient.

Now the battle to see if Greenview will be allowed to start a competing ambulance service is expected to be heard by an administrative law judge. CHFS online documents did not indicate when or where that hearing would take place, and Greenview Marketing and Communications Specialist Andria McGregor said Monday that no hearing officer had been assigned, but the CHFS Office of Public Affairs lists Oct. 24 as the decision date.