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Rural Medical on life support? Board seeks cure
Rural Medical pulling out of the garage heading to a medical emergency.

DARLINGTON – The Darlington City Council meeting was held Tuesday, Nov. 21, 2017 at the City Council meeting room. The Board of Directors of Rural Medical Ambulance Service (Dave Ohnstad, Andy Schilling, Tim McComish, Chris Andrews and Bob Hermanson) presented their plans for the future of Rural Medical. Cindy Corley is the city’s rep on the Board of Directors.
    McComish stated, “At a recent Rural Medical Board meeting we discussed ideas, concerns regarding the lack of volunteers that serve as EMT’s, first responders and drivers. We are looking for ideas.”
    Ohnstad outlined the board’s case and said, “Rural Medical has served the community very well for 40 years, it is a needed and a statute required service, I want to make it very clear that this has nothing to do with personnel or performance of our EMT’s. This is strictly about the business end of the service. The service has evolved and faced a lot of changes over the years, many of these changes were because of unfunded state mandates. There’s more equipment, training, continuing education required and the state is considering adding another 40 hours to the initial course for EMT certification.”
    Ohnstad continued, “The biggest challenge the board has now is the staffing issue, specifically volunteers and their decreasing numbers. There are many reasons including declining demographic numbers in the 20 to 30 year olds; employment takes a lot of perspective members out-of-town; financially some people just can’t afford to give their time and overall it seems the desire for volunteerism continues to decline. The problem is not unique to Lafayette County.” Ohnstad gave examples of the Platteville Ambulance service taken over by the Southwest Health Center and an issue that happened in Cuba City and Montello ambulance services shutting down.
    Ohnstad said, “We as the Board of Directors would be remiss in our duties if we didn’t recognize this problem and develop a plan. Therefore, the Rural Medical Board of Directors is taking a proactive approach to this and it is the consensus of the Rural Medical Board of Directors that the solution lies in privatization of the service. We feel that privatization is inevitable and we feel we should proceed in that direction. We have taken no votes or official action on this. At this point we are in the information gathering stage. We are certainly open to any and all suggestions or solutions.”
    Ohnstad, “The process of privatization will be difficult and involved and we will have several options that we will need to consider. The big challenge is to insure that all parties involved – City of Darlington, lending institutions, creditors are made well financially.”
    Ohnstad, “At our October meeting, we decided to get some quotes. We have received a proposal from Paramount Ambulance Service of Dubuque, Iowa with several options. The most likely option would be the sale of all equipment and the ambulance garage. We feel this is the most attractive option, where we would get 24/7 coverage with the same level of service and certified EMT’s around the clock. The provider would be responsible for all state requirements and assume all liabilities. The cost comes in at $23 per capita, guaranteed for five years. We would also negotiate an escalation clause.”
    The Rural Medical director, Bridget Schuchart, received a quote from Green County Ambulance service for weekend coverage and that was $1,000 per weekend. They would use our equipment and the time span would be Friday 6:00 p.m. until Monday 6:00 a.m.
    Ohnstad, “At present Rural Medical coverage costs $15 per capita, that covers the city and all the townships. We are having budget shortfalls and our accountant suggested we raise the per capita $5, bringing the total to $20 per capita. So with the $23 proposal from Paramount, or whatever organization, it would only be $3 more per capita than the $20 suggested by our accountant, and all of the responsibilities would be transferred to Paramount or whoever we would choose.”
    Ohnstad stated, “Some advantages if we go to privatization include: bringing new business into town with employment opportunities of full-time and part-time EMT’s; other towns near Darlington are discussing making this change which would set up Darlington as the hub for service in other towns; the ambulance garage would go back on the tax base.”
    Ohnstad finished up, “In closing I want to say that change is never easy, however, in the interest of the community the Board of Directors are looking into the future and we want the excellent service that we’ve had for the last forty years to continue.”
    The other Board of Directors made comments reiterating their agreement with the plan going forward.
    Jason King, Darlington Police Chief and Rural Medical member said, “Where is the membership’s board representative? You said the board has made this decision. Where’s our rep? Ohnstad said, “We didn’t say it was decided, we said it was a consensus and we’re looking at possible solutions.” King said, “I understand that, but where’s our rep? Why isn’t the memberships rep here?” Ohnstad said, “The meeting was posted.”
    King continued, “The membership’s rep has been deliberately excluded from these discussions, and now we know why. You’ve betrayed the membership. Nobody knows anything about this.” Ohnstad said, “Bridget knows about it.” King said, “All we know is you wanted to take away our $1 an hour wage, because you couldn’t afford it and now you want to go private. The by-laws require that the membership has a representative and a say at the board and he’s not here. I know he’s been deliberately excluded, in fact he was asked to leave a meeting. In the interest of full disclosure the council needs to know there’s something else going on here and it’s not what the membership thinks is on the up-and-up.”
    McComish said, “At our last meeting Jeff Berget, membership rep, and Bridget were there and they stated they were struggling to get help. She told us to get a price, so we reached out to Paramount. Jason if you can get us ten or fifteen certified EMT’s then we won’t have this discussion.”
    Schilling said, “We have great people in Rural Medical, we just don’t have enough of them. I think Jason, you are taking this the wrong way.”
    King said, “No I’m not taking it the wrong way, I think that you need to be aware that this has been done behind the backs of the membership. We knew you were getting prices for extra help. That’s what we were told by our representative. We were not told that there was going to be a complete takeover of Rural Medical.”
    Alder John Sonsalla asked, “What is your time-line?” McComish answered, “We don’t know.”
    Alder Dave Gough asked, “What is the population that Rural Medical serves?” Hermanson answered, “Right now it about 5,992, that’s the number we are basing out figures on.” (That would be the per capita number)
    Alder Don Osterday asked, “Would Paramount bring in staff on a full time basis?” Ohnstad answered, “That’s what their plan would be, to have living quarters right in the ambulance facility and there would be staff there around the clock.” King asked, “And that’s cheaper than volunteers?” Schilling said, “We figured the price would be outrageous, we were just looking for a price for fill-in help and they threw something like this at us.” Ohnstad added, “In the near future we won’t be able to operate for $23 per capita.” King said, “And neither will they.” Ohnstad responded, “They will for five years, if we have a contract.”
    Alder Steve Pickett asked, “We pay them $23 per capita, that equals to about $140,000 a year and they’re going to pay EMT’s $40,000 a year plus benefits and have full time coverage seven days a week. That’s a lot of people. It would take seven or eight people to staff a week. They would be receiving the revenue for the calls.”
    Jeff Berget, membership rep entered the meeting.
    Pickett asked “Would their rates change from what Rural Medical charges now?” Hermanson answered, “We never asked that question. One thing we know from our service is that when you get into Medicare and Medcaid, those payments are set by the state. We charge $550 per call, the state will come in and say we’re going to pay you based on a state wide rate and only pay us $300.”
    Picket said, “I would be concerned about that.” Hermanson said, “If these conversations go any further we will pin those numbers down.” Ohnstad added, “There’s a lot of things that would have to be worked out. We are just in the information gathering stage right now.”
    King said, “ I want to comment on a few things. I think this is premature. If you were having this conversation five years ago when Rural Medical was literally falling apart, I could understand it. But now when it is more stable than it has been in many years, it surprises me to even hear this. Of course Paramount is going to come to you with all these glorious ideas, they are a for profit business. Paramount already opened a hub in Mineral Point and it went belly up, it failed because it couldn’t make the revenues needed. The same thing, I’m afraid, would happen if they came here.”
    King continued, “They can’t use our ambulance station because it doesn’t meet fire code for sleeping quarters. So the first thing they would do is build a $500,000 station and that cost will be passed off to the taxpayers.” Ohnstad said, “Why would that be? If they built it, it would be a private business.” King said, “Well how do you think they will pay for it?” Ohnstad said, “That would be their problem.” King said, “No it will be our problem. There’s just a lot more going on behind the scenes that I would want this city council to know before even entertaining this idea. When our membership doesn’t know about it and they deliberately exclude our membership rep from a meeting. That should be a red flag.”
    Mayor David Breunig asked, “What we need to be looking at is where are we going to be in six months, where are we going to be in a year? That’s why we have a board of directors. All I can say is do your best, for us.”
    Hermanson said, “Hopefully us coming here tonight will open up the eyes to this issue and maybe get more volunteers. I’d rather start talking about this on this end and making a few people upset, rather than coming here and telling you that we need an exorbitant amount of money because Rural Medical has been shut down by the state.”
    Pickett asked, “Maybe it’s time to pay the volunteers more.” It was stated members get paid $1 an hour when they are on call and $20 if they have an actual call.”
    King said, “I just hope this doesn’t backfire and upset the membership because this is getting really old.”
    Sonsalla said, “What I’m hearing from you Jason is you’re concerned about local control. If you privatize it, you better find out what you really lose. If they’re a business, they can say we don’t need your input at all, then we’re cut out of it and then they can start raising prices. I think you better find out what we lose if we privatize. ” He also asked about a time-line. It was stated that any changes would not be made until after 2018.
    King said, “On behalf of the membership, I would respectfully disagree with the notion that you’re trying to be open as a board. You’ve deliberately excluded the members from these conversations.”
    Mayor Breunig thanked the board for coming to the meeting and sharing their concerns and plan.
    In Other Business:
    •Approved the 2017 financial statements for the city’s water and sewer departments.
    •Presented a notice of spring election schedule for Tuesday, April 3, 2018.

Statement by Bridget Schuchart

    We were shocked to hear that Rural Medical Board of Directors presented a proposal to the Darlington City Council to replace Rural Medical Ambulance Service with Paramount Ambulance. The membership has come together as a group to try to understand this recommendation from the board’s perspective, and from there, we look to determine our best next steps as a membership. We did not suggest, nor do we support this recommendation, as it will negatively impact the service provided to our coverage area while substantially increasing the cost. We look forward to our first opportunity to discuss this with the Board on Wednesday, Nov. 29, at 6:00 p.m., at the upcoming Rural Medical Board of Directors Meeting.