Several Knox County commissioners are raising questions about renewing AMR Rural/Metro's ambulance service agreement.

A resolution approving a five-year extension is up for a Knox County Commission vote Monday. It'll be presented without a recommendation, after commissioners discussed the topic at length during an Aug. 21 work session.

The county ambulance contract has been the subject of debate off and on for years. AMR Rural/Metro gets no money from the contract. The document allows them to be the service provider, and they bill customers for services.

County officials signed a five-year contract that's set to expire. With the term coming up, the ambulance company is ready to exercise the first of its two five-year options.

The Knox County Health Department is proposing a commission resolution signing off on the extension.

In a July 13 letter to Mayor Tim Burchett, Dr. Martha Buchanan recommended the agreement continue.

AMR is routinely rated and evaluated. In past years, some criticized it for occasional slow response times to health emergencies or a failure to provide enough units to answer calls.

Over the past year, however, Buchanan has reported improvement.

Based on a points system and a structured evaluation, AMR has scored a 16, records state. It needed at least a 12 in order for the county to recommend that its contract be extended, according to records.

Commission's Aug. 21 meeting was the first chance commissioners could talk about the pact.

Several had questions including Commissioner Charles Busler, who represents the 7th District in North Knox County. Busler said, among other things, that constituents have asked him about double-billing for both ambulance service and firetruck service by Rural/Metro on health calls.

On Monday, he sought - unsuccessfully - to have the contract rebid. He also suggested it might be good to defer the extension resolution for 60 to 90 days.

AMR and Rural/Metro are owned by the same company, KKR & Co. They function, however, separately.

Rural/Metro officials told Busler they weren't aware of double-billing problems but that fire service subscribers should not be charged if a firetruck rolls up on a health call. Property owners pay Rural/Metro a subscriber fee for protection.

Commissioners Carson Dailey and Michele Carringer, both of whom like Busler are relatively new to commission, also raised concerns. They said the ambulance agreement was significant and they didn't want to rush into a decision for a renewal on such a major decision.

AMR is also getting a new owner, Carringer said. That creates uncertainty about its dedication to maintain satisfactory operations. Just two years ago, AMR acquired the county's ambulance service provider when it was known as Rural/Metro.

AMR representatives, however, said the new owner, KKR, is dedicated to provide quality services.

"I just feel like this is being put on us in a rush-rush situation," Carringer said.

Veteran Commissioner Brad Anders offered a counter motion to approve the resolution. Anders, a Knoxville Police Department lieutenant, said he'd worked with the ambulance provider for 25 years. He said he'd been a sharp critic of them in the past but that they'd met county expectations with their contract.