Editors note: This is the final story in a six-part series on how the EMS crisis is affecting local communities in southeast Iowa.
As the EMS crisis continues to grow local communities are beginning to take a stance on how they will combat the problem. In Henry County, the ambulance service is run by the hospital, the Henry County Health Center (HCHC).
The hospital has previously announced it is not financially able to continue the service and has requested Henry County officials take over. The Henry County Board of Supervisors has formed an exploratory committee but, has made no public statement it will continue the service.
Robb Gardner, Chief Executive Officer of HCHC, said numerous meetings have been set up with different stakeholders across the county. The goal of the meetings, he said, is to determine the best way for the county to deliver a reliable and sustainable service.
“Our part would be providing data, facts, rationale and validity on why they need to look at how (the county could) provide the service differently in the future,” he said.
Gardner said the trained staff at HCHC have expertise in the EMS field, knowledge of how to run the service and ideas for possible changes in the future. He said the role of HCHC staff during this process is to continue to provide data, research and answer questions county officials may have as they explore the possibility of taking over.
“We’ve done this work extensively over the last nine or 12 months and we’ve shared that with a lot of people already so it’s just making sure other people see that,” he said of the research.
Michelle Rosell, Chief Operating Officer for HCHC, said the hospital has created a packet for the county supervisors that outlines which components the county would be responsible for, should it decide to take over. She said the packet outlines framework developed by the state EMS association to show what the service could look like if county run.
Currently, Henry County Officials have not committed to taking over the service, he said. Instead they are still exploring options. However, Gardner said the hospital feels a responsibility to maintain the service until a sustainable option is found.
“We are very committed to provide the service if it is not something that they are going to take over in the near future,” he said.
However, the EMS service has proved to be a financial burden for the hospital and it is not the only one. On Tuesday, Nov. 19, HCHC announced it was dropping labor and delivery services due to cost. Gardner said he could not comment how minting EMS would effect the overall budget or if other departments would need to close in order to maintain it.
“As we go forward with budget season that would be something that would be determined and how we would help and support to sustain that service while having the stuff they need to provide an outstanding service, he said. “It’s one of those (things) we look to restructure as we can but we need to make sure this community has access to 911 service as well as a high-quality transport service to give the people in our community the care that they need.”
Gardner said the community is not in immediate danger of losing their service because HCHC will continue it until a sustainable option is found. He said he feels the best way forward would be to look toward a regionalized EMS service but it will take “baby steps” to get there.
Jefferson County officials previously reached out to Henry County and HCHC officials about a joint service. At the Fairfield City Council meeting on Monday, Oct. 28, it was announced the partnership was no longer being pursued and instead the ambulance board recommended Fairfield look to establish a city run ambulance service.
Lee Dimmitt, Jefferson County Supervisor and member of the ambulance board, said the county, city and hospital, the Jefferson County Health Center, have all teamed up and put out a request for proposal (RFP) to 21 private entities including the City of Fairfield. He said all bids are due by Jan. 3, 2020 and hopes to have a decision made as of Jan 15, 2020.
Dimmitt said in the proposal it is outlined the three entities will provide the ambulances, equipment and maintenance on all the vehicles. This also will serve as a backup plan if the private company were to choose to back out of its commitment. By already having the equipment at its disposal, the board will have a bigger head start than having to start from scratch again.
He said it will be possible for the provider to use the hospital’s buying power for additional supplies, like bandages. This will allow the provider to get the materials it needs at a lower cost.
The provider will be responsible for housing the service, he said and also will be responsible for staffing. Through this format, Dimmitt said he feels the three entities working together will be able to maintain local influence.
The board is looking to purchase three ambulances and the cost will be split in three parts. Because the current contract with Midwest Ambulance Services does not expire until Sept. 30, 2020, there still is time to work out details he said.
Those details include purchasing the rigs and the equipment to go inside. He said once the contract is signed with the provider, the board will look at purchasing the equipment and rigs. He said the board would like to have the influence and opinion of the EMS professionals because it is important to purchase for both cost effectiveness and quality.
However the new proposal will not be a cost to the tax payer, he said. Dimmitt said the hospital already issues a levee that generates between $250-300,000 a year. Each of the three entities will contribute another $25,000 form general funds to help pay for the service.
Dimmitt said he estimated the possible contract length to be anywhere form three to five years. He said because the provider is making a commitment to the county by providing the service, the ambulance board feels it is important the private entity has enough time to recoup their costs.
Another change to the contract will be to have at least one paramedic in every rig. Currently, a paramedic is only required in the first ambulance to be sent out. The rest can be staffed with EMTs, who have a lower level of training and cannot complete all tasks a paramedic can.
In Washington County, the Board of Supervisors has announced the county will take responsibility for the service. Supervisor Jack Seward, and a member of the ambulance committee, said an informal group began meeting in July to discuss the possible options for the future of the service.
Currently, Washington County has a contract with private company Washington County Ambulance Service that expires June 30, 2020. The provider’s director has announced he will retire at that time and the company will sees to exist, prompting county officials to begin the search for a new option.
Seward said in October the decision was made to form a formal committee that would research possible options. After exploring several, he said the ambulance board decided the most viable option would be for the county to run the service.
Seward said the board has come up with a projected operating budget with total revenue at just more than $1.6 million. According to these calculations, this will have a positive difference of $27,000 a year. He said this budget is different from the start up costs which are expected to cost an additional $56,342. The start up cost number provided does not account for building furniture, office furniture or sleeping quarters.
He said where those items will be purchased are yet to be decided. There is a possibility the county could rent space from the current provider, but a third party assessor will need to come in and present the value of the space. The same goes for the current equipment.
Because the current company being used is owned by Washington County Supervisor Richard Young, Seward said the board would require total transparency before money is exchanged. He said he wants to make sure the taxpayers dollars are being used properly and to purchase the best equipment, whether from Young or another company.
The third cost the committee is looking at is that of adding a third rig to the fleet. Currently, the county owns two ambulances and will need to purchase a third. Seward said it will eventually need to purchase a fourth one to use as a back up if one of the other three is down for repair.
Because there is a consistent cash flow, Seward said he does not foresee taxes being raised, but does not rule out the possibility. If they are raised, he said the amount would be minimal. The current tax levee is .38 per $1,000 valuation.
He said the county may need to dip into the capital reserves fund to help with start up costs, but that is dependent on whether the county is able to purchase the equipment used or brand-new. The committee has also discussed asking the cities for a monetary donation if there is a gap between available funds and start up costs. He said city administrators have agreed to look into the idea but no formal decision has been made yet.