Glasgow Daily Times, Glasgow, KY

Local News

April 23, 2014

Ambulance board members struggle over money vs. service

GLASGOW — No action was taken other than routine approval of minutes and financial reports, but plenty was said Wednesday during a two-hour meeting of the Barren-Metcalfe Ambulance Board.

At the board’s previous meeting in February, Barren-Metcalfe Emergency Medical Services Director Mike Swift proposed hiring an additional crew that would work during peak times, with an eight- to 10-hour shift instead of the usual 24-hour shift. Discussion resumed this week, but the issue is now tabled until at least May, when the board expects to invite the service’s billing company to a special-called meeting.

With current staffing, between three and 12 instances per month had occurred since June 1 when no one was available to respond to a call, Swift told them in February. On Wednesday, he provided them a list of 110 instances from Feb. 25 to April 19 provided by dispatchers. While many of these were considered nonemergency calls, at least 24 were designated as emergency calls, which Swift defined as when a threat to life or limb exists. An example of a nonemergency call would be a transport back to a nursing home from the hospital.

The service keeps four ambulances staffed at all times, and Swift said he only allows one to go out of county – to take a patient to a hospital elsewhere, for example – at a time, but sometimes more are needed for those trips at one time.

“Why is this just now coming to a head?” asked Edmonton Mayor Howard Garrett, board chairman and longtime member.

“We’ve never had this in 40 years,” Swift said.

Changes in health care have led to increased demand on the ambulance service, he said.

Board member Bill Bucher, looking over a copy of the bylaws for the service, said the fundamental question is: “Does not adding this part-time crew cause us to not provide adequate emergency ambulance service?”

“Yes, it does,” Swift said.

As part of his response, he said, “If we didn’t do nonemergency work, the deficit would be unbearable.

“To me, the deficit doesn’t come into play when we’re talking about this,” Bucher said. “Our duty, at least from what I can see here, is to provide emergency (medical assistance). If we’re not doing that to the extent we’re supposed to do it because we don’t have the crew, then we’re not doing what we need to do.”

Garrett asked whether the board wanted to postpone a decision, especially since only six of 10 members were present Wednesday. Some nodded in agreement.

“I don’t feel that way,” Bucher said. “I’m satisfied that we can take Mike at his word that not having that crew does adversely affect what we’re supposed to be doing with providing emergency ambulance service.”

In addition, he said, “I also have to think it would add to our revenues, and not necessarily cost us an unreasonable amount to do that, but even if it did, our first focus is still providing emergency medical service.”

He said he was ready to move forward with a decision.

At that point, Glasgow City Councilman Wendell Honeycutt asked to speak. A member of the council’s finance committee, Honeycutt had proposed re-evaluating the proportions of the service’s deficit the four contributing entities – Glasgow, Barren County, Metcalfe County and T.J. Samson Community Hospital – pay. This led to a joint meeting of the finance committee and a newly formed ambulance service committee of Barren County Fiscal Court. The two groups ultimately decided they would like to ensure BMCEMS is as efficient as possible, including in its billing, which it contracts to a separate company. The two committees decided to recommend hiring an outside consultant to review the operations and billing.

Honeycutt briefly reviewed this proposal with the ambulance service board.

“There may not be anything. Sitting here, I don’t see anything that’s being done wrong. It all looks great, but I’m not an expert on ambulance services,” Honeycutt said.

Trautman advocated the consultant idea, and Barren County Judge-Executive Davie Greer said it needed to be done, but she also later said the board needed to look at how much it would cost.

Greer asked about the cost of the extra crew. Nancy Jolly, ambulance service office manager, said the estimated cost is roughly $93,000, not counting any revenue that would be brought in by their runs.

“The Saturday that we had six runs,” Swift said, “we gave enough money in revenue away (because of giving the runs to other services) to have paid for a week of a 10-hour crew. … I can assure you of that.”

Greer said she didn’t expect the ambulance service to make a profit.

“It is a service to the citizens of Barren County,” she said. “But I don’t think we should write a blank check (for whatever the ambulance service’s revenue can’t cover).”

Bucher said Glasgow’s mayor and Barren County Fiscal Court had been on the board “forever,” and expressed dissatisfaction with these two committees making the joint suggestion.

 “Now, all of a sudden, out of the blue, for us to be put under the microscope by some group that doesn’t formally exist, I’ve got a problem with that,” he said. “It offends me as a member of this board.”

Interrupting an objection from Honeycutt, Bucher said the question that needs to be answered is whether the board is doing what it must to meet the needs of its jurisdiction.

“We’re starting to jump through a hoop here that I’ve got a little trouble jumping through,” Bucher said. “We’ve got other people who are trying to take control of the board.”

Trautman said she and Greer were both at that joint meeting, and they each pointed out they were trying to plan their budgets for next year, as the money needed from the city and county is already over budget for this year.

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