DARLINGTON – The meeting room at the Rural Medical garage on Wednesday night, Nov. 29, was filled with concerned citizens that all wanted the same thing: answers.
Near the end of the meeting, it was approved that the Rural Medical Ambulance Service Board of Directors will proceed with collecting information from EMS services and pursue a proposal for long range planning for staffing and financial issues for emergency services.
This whole discussion came to light because on Tuesday, Nov. 21, members of the Rural Medical Board of Directors gathered at the Darlington City Council to discuss with and inform the council about the future of Rural Medical. What came from the meeting opened up a greater discussion.
“There were no decisions, no votes, no motions, no nothing. We were very concerned about the scheduling for staff. We only presented it to the city because Cindy [Corley] put it on the agenda. We planned on presenting at this meeting first but she put it on the agenda,” board member Dave Ohnstad
explained. “This whole thing came out of discussion at last month’s meeting [Oct. 25] when Bridget talked about how hard it was to fill the schedule.”
Rural Medical Director Bridget Schuchart felt her words were taken out of context from that meeting.
“We have talked every month about staffing. We talked about when weekend coverage was hard this summer. We are at the tail end of that. When we talked about the long hours and the time we put in down here, that was in reference to [the board] asking me about what the membership thought about the $1 an hour pay. I said I couldn’t speak to that but they put in a lot of time and missed family activities but we do that by choice,” Schuchart stated.
Assistant Director Patricia Stauffacher said she does the scheduling for the staff and currently there is no gap in the schedule. “There is not a problem with staffing.”
Nicki Goebel, the clerk for Rural Medical, suggested that board members should have access to schedule to see that Rural Medical is not in a crisis.
Nicki Goebel also asked the board as why she, their paid clerk, was not informed of them gathering at the city council meeting. “The feeling I have is it was done behind my back so that I wouldn’t be able to let the membership know. As your clerk I am the one that passes out your information; I knew nothing of your city council meeting.”
Bob Hermanson took the blame stating that they were unsure if they would be in violation of open meetings law by having four members plus Cindy Corley (who is a member of the Darlington City Council) at the meeting. Hermanson then quick posted the meeting an hour before the city council meeting at the Rural Medical garage.
“We didn’t want to call you and have you come in when nothing was being decided. It was just informational,” Hermanson explained.
“This was blown out of proportion. We are trying to do the best thing for the community. We looked at the financials and the staff and discussed it as the last meeting. We should have waited for it to be on the next [Darlington City Council’s] agenda,” board member Tim McComish said.
“I have been in the dark about the whole thing. I knew you wanted costs. Why was it so rushed? You never even had time to discuss amongst yourselves what information was received,” membership representative Jeff Berget stated.
Corley took the blame for putting the item on the agenda.
“I wanted there to be consistent information. It could have waited,” Corley said.
“We are in a good position, but where are we going to be at in the future? We need to do some long range planning to maintain the service. If it gets a few people upset at first but sparks the conversation then I’m not going apologize for that. We’ve been trying to have this conversation for the past four years and now it has started and maybe it will bring people into Rural Medical,” Hermanson added.
Ruesga stated, with many agreeing, that the lack of transparency is hurting the board and the membership.
Schuchart agreed adding, “This service doesn’t work without the members and doesn’t work without the board. We have to find a way to work together and be transparent.”
Information and Motion
Schuchart updated the board that she received a quote and information from the Green County EMS for weekend coverage from 6 p.m. Friday to 6 a.m. Monday for $1,000 per weekend. They would use Rural Medical’s equipment and rigs and only bring their personnel. Rural Medical would then have to provide them a place to stay.
Board member Andy Schilling stated that Paramount’s Service Director, Marvin Ney, came and looked at Rural Medical’s building and equipment but never gave them a quote for weekend or relief help but just proposed a full coverage of $23/capita.
“So they were not interested in [weekend coverage]? It was only all or nothing?” Schuchart asked.
Rural Medical member Josh Goebel added that Rural Medical provides full service for only $15/capita.
“But we need to raise it $5.50 to make ends meet,” board member Chuck Herbst said. “Personally, I think we should pursue a contract with Paramount to see what they would do for us for five years. I hope they hire everyone in this room because nothing has to change except we loose all the debt and money problems because we can’t charge whatever we want.”
Nicki Goebel didn’t understand how $23/capita would be better when “you have your local doing it for less.”
“I don’t want to come to a meeting every month and be broke,” Herbst answered.
“You need to go to your municipality and ask to be replaced on this board because it needs to be people here for the good of the service,” Nicki Goebel argued.
“If you went to your board and asked for $5.50 more and they said no, how are they going to give you another $8? If we can’t do it as volunteers at their price or less, you think they will come in and do it at a loss?” Josh Goebel asked.
McComish replied that Paramount could do it more efficiently and adds in the money they make from hospital transfers.
It was discussed earlier in the meeting that Rural Medical is not able to provide hospital transfers because they only have a basic level of care versus Paramount and other private entities having an advanced level.
Medical Director, Dr. Matt Solverson stated that there is money in hospital transfers. Paramount does about 150 transfers for Memorial Hospital of Lafayette County a year. He stated that it costs approximately $750 for a patient to get into the ambulance and then that patient would have to pay about $10 per mile to the hospital.
But things could change for rural ambulance services if the Senate Bill 239. The bill allows “a rural ambulance service provider to upgrade its service level to the highest level of license of any emergency medical technician staffing that ambulance.”
“The hospital can’t provide Rural Medical with a nurse to ride along. We do have advanced EMTs and paramedics and RNs that run with Rural Medical, so if [the bill] passes in the senate then they would be allowed to take transfers without needing the nurse from the hospital,” Schuchart explained.
Solverson commented that the original plan with getting the second ambulance that the hospital transfers would pay for the purchase of the ambulance.
“Our understanding was when that new ambulance came in, there would be transfers to help pay for it and there would be enough to help us pay for that second ambulance in 5 years. Then as soon as we got it, that didn’t happen; the hospital won’t let us have transfers. That is why we are sitting on the board looking like idiots,” McComish added.
“Once the law changes, yes we could probably get that away from [Paramount]. But we need to cover our 911 services. We would need to have that second crew available before you roll out the door for that transfer. That is where it comes back to staffing issues,” Hermanson said.
“Even if you pay a service, be it us or somebody else, there is times when both ambulances go out and I guarantee you they need a transfer anyway. It is just what happens. Throw your hands up and say we need a private service because they can do it. Someone is going to pay for it and I will bet it will come out of every taxpayer’s pocket. Someone has to pay for the service,” Josh Goebel argued.
“This was all born from what happened in Cuba City. We are not in the same boat as them,” Tony Ruesga commented.
From October 27 to November 11, Cuba City Area Rescue Squad (CCARS) had to have Paramount Ambulance cover their service area due to a complaint filed against the CCARS because it was unable to respond to a call during the day due to a volunteer shortage.
Dave Ohnstad responded, “It all comes from an August meeting when we were blindsided with a threatened mutiny over something that we had no control over. Members came in here and threatened to leave when we signed off allowing Paramount to cover the fair. That decision was made several years before that. You people blindsided us and threatened to walk out; where would we be?”
Several members present responded in disagreement to Ohnstad’s statement.
“I’m sorry, I just want to do my job,” Herbst began. “Gratiot depends on me to have an ambulance service. I am worried about Gratiot. That is what I am doing. I’m here to run a business. I want to find information from outside services for five years and pursue a proposal. We are hurting.”
Nicki Goebel asked why that offer can’t be proposed to the Rural Medical membership and the board could forget their $1 an hour pay.
“Could the members propose to run the place?” Josh Goebel asked.
Financial Advisor Dave Meister stated that since each municipality has money in Rural Medical, the membership would have to go to each municipality and contract with them for their per capita rate.
“If you can’t get the money, then no one can. If you can’t get us $5, then how can you get the other services $8?” Josh Goebel inquired.
Herbst put forward if the membership could get a better proposal, then they could come back to the board.
Herbst then made a motion with Dave Ohnstad seconding, for the Rural Medical Ambulance Board of Directors to continue collecting information from other EMS services and pursue a proposal for long range planning for staffing and financial issues for emergency services. The motion passed 8-1, with Steve Tuescher abstaining.
Steve Tuescher, who represents Wiota on the Rural Medical Board, told the board that Wiota will be leaving the contract with Rural Medical and will be pursuing a contract with the Argyle Ambulance Service.
In October, Tuescher went to his village board and told them about the $5.50 raise that Rural Medical was proposing. Half of Wiota is in the Woodford Fire Department and is covered by the Argyle Ambulance Service. The Darlington Fire Department and Rural Medical Ambulance Service cover the other portion. The board decided to pursue other options.
“It is nothing against Rural Medical. You are great. It is just the cost,” Tuescher stated.
“What is that going to do to your first response unit because they are all licensed under Rural Medical?” Schuchart asked.
Tuescher was unsure.
Argyle charges their portion of Wiota $2/person. They proposed $3/person to take over the rest of Wiota plus $1,000 towards the ambulance for two years.
More information will be available at the next board meeting.