UNION — Monroe County officials are grappling with the cost of providing ambulance service to residents, and a special fee they enacted in 2017 continues to stir resistance and controversy.
That $100 “ambulance fee” for each residential property owner in the county has seen only about 60 percent collections, bringing more than $400,000 of over $700,000 billed for this fiscal year, which ends June 30.
“We are going to have to enforce it,” Monroe County Commission President Bill Miller said. “I don’t know exactly yet how we will.”
The dilemma for the county started in early 2017.
“The Union Rescue Squad was going out of business because they could not afford it and sold out to Greenbrier Ambulance Service,” Miller said. “Greenbrier took all their debt and their equipment. We had no power over that.”
Greenbrier (based in Lewisburg) then came to Monroe County, he said, and told commissioners they would continue to provide service and “make it work,” but then came back three months later and said “no money can be made.”
“Then we had to start looking to serve the population of the county on the Union end,” Miller said, referring to the fact that the county is obligated by law to provide an ambulance service if one is not available.
Peterstown Volunteer Fire and Rescue covers the eastern/southern portion of the county, but that also presented a problem.
“We met with Peterstown and they said they will be in the same shape as Union was in three to four years,” he said. “It is easier to put it (the fee) on the whole county (rather than on the Union side only). That is what we agreed to on this.”
Ambulance services were asked to estimate the needed annual supplements to be able to run in the county, providing a crew ready to go 16 hours a day.
“We worked off those figures and came up with the $100,” he said. “If we collect all of it maybe we could lower it.”
Miller said that, despite some misinformation circulating, when the ambulance fee ordinance was first presented two public hearings were held, the last one at James Monroe High School in August 2017, with about 50 people attending.
The plan was to use the money from the fee to supplement Greenbrier and Peterstown with $260,000 a year each, with $40,000 going to Alderson for backup when needed and $5,000 to Paint Bank, another reserve squad.
Miller said that would put ambulances on duty 16 hours a day, with on-call personnel being used the other eight hours if needed.
“The ambulance service costs about $800 to $900 a call,” he said. “If they collect back $300, they are lucky to do that on Medicare.”
Miller also said that if an ambulance is called and transport is then refused, “they get nothing.”
That is why rural, sparsely populated counties like Monroe (13,400 estimated population in 2017) struggle to provide the service, compared to Mercer County with a population of more than 60,000.
With that many people and two major hospitals that often need transports, enough calls come in to cover the service and residents pay no fees or taxes to support it.
The Bluefield Rescue Squad and Princeton Rescue Squad serve all of Mercer County.
Sean Cantrell, president of the Bluefield squad, said it’s all about the number of calls.
“We are large enough to do it,” he said. “We bill for our services when we run a call.”
Although the collections from Medicare may be overall no more per call than in Monroe County, the volume of calls during shifts makes the difference because the personnel are paid the same whether they go out on a few calls or many.
Private services look at the same way, he said, and if enough calls come in, they can make money and serve counties, just as Greenbrier initially tried to do in Monroe County.
Jerry “Boomer” Brown, chief of Peterstown Fire and Rescue, said at a recent community meeting on the ambulance fee issue held in Peterstown that he does not receive the volume of calls needed to be self-sustaining.
Brown said, for example, that during the month of February, 76 patients were transported out of 94 contacts and the majority of transports were over 70 years old.
“We get paid $350 (Medicare),” he said, adding that some calls they collect nothing because it’s a younger person with no insurance at all. “The actual cost per call is about $800.”
Brown said Peterstown receives only a few “transport only” calls but other larger squads like Bluefield and Princeton receive many.
With trained ambulance personnel (EMTs and paramedics) making about $70,000 a year including workman’s compensation and insurance, support is necessary, he added.
All proceeds from the ambulance fee are to go toward salaries only and Brown said the ambulance services are required to send the county details of calls, transports, invoices and expenses and expenditures each month.
Brown also said if an ambulance is dispatched and there is no need for transport, if the person insists on being taken, they are obligated by law to transport them.
“For some, it’s a cheap way to get to the ER,” he said. “If I refused to haul them, I could be sued. You have a lot of people who misuse EMS services everywhere.”
All equipment as well as routine operating expenses and insurance are expenses the squad must bear as well, he said, and the real financial problems started when volunteers were being phased out for paid personnel.
The cost crunch is always an issue in rural counties, said First Lt. Bridget Allen with the Bland County, Va. Volunteer Rescue Squad, which is a combination of paid staff and volunteers.
With no funding from the county for operations, she said the rescue squad survives with billings for calls and fundraisers.
“We get about 170 to 180 calls a month,” she said of the service, which has a crew at the station 24/7. “But most of those are non-emergency transports. We get about 60 or 70 911 emergency calls a month.”
Allen said if a second crew is needed, they may have to respond from their homes or from another jurisdiction.
“We do have mutual aid agreements with Tazewell, Giles and Wythe counties,” she said, adding that Wythe is most likely to respond because of I-77.
Allen said she understands the reluctance to pay through taxation for a service a person may not ever need.
“But if you need that ambulance service and it’s not available, what is a life worth to you?” she said. “You have to weigh the pros and cons.”
The Peterstown community meeting was organized after the ambulance fee created opposition from many residents, who say it’s too much, too many people are not paying it and not every property owner is receiving a bill.
Fred Blackmer led the meeting and said the commissioners did not consider alternatives and ran the ordinance through too quickly without getting enough citizen input or follow proper legal protocol.
In fact, Blackmer was kicked off the county’s planning commission over his opposition to the ordinance, which the planning commission had approved.
In the letter from the commissioners, Blackmer was told he had a “conflict of interest” considering his opposition to the fee the commission had supported.
“The goals of the commission and planning commission are to make Monroe County a better place to live, work and raise a family,” the letter said. “It is unfortunate you don’t share these goals and we won’t have members on the planning commission that don’t share these same goals.”
But Blackmer said he has a right as a citizen and taxpayer to express his views regardless of whether he is a member of the commission.
Miller said that, as a member of the commission, Blackmer should have worked with other members of the planning commission to make any changes that may be needed rather than basically remove himself as a member to speak to his fellow members.
During the community meeting, Blackmer said it’s not a question of whether the county needs money for the ambulance service.
The issue, he said, is the county’s perceived lack of accountability and transparency as well as the need for more community involvement.
“The county commission is either unable or unwilling to look at the problem and fix it,” he said. “So the community needs to get them to maintain a balance between transparency, affordability and funding emergency medical systems. It’s up to the people.”
Blackmer said the commission, based on the number of people who have not paid the fee, “will run out of money” to pay for the service.
“This is not about paying it,” he said. “This is really about how to figure the level of service and how to pay for it.”
Blackmer presented options, including the current system and price tag with an average 11-minute response time. He said another option may be to have a protocol in place to speak with a medical professional to assess the need before an ambulance is dispatched. And another is to rely on a mix of volunteers and paid ambulance personnel, but with a slower response time.
It’s a matter of determining, with community involvement, what level of service is needed that is “practical, affordable and sustainable,” he said.
Several of those attending the meeting said the information being considered by the commissioners for the ordinance was not made public, at least to a reasonable extent.
They called for the county to do a better job of being transparent and having accountability information available for residents and routinely disseminated, especially on the county’s website.
Whether all residential property owners were being billed appropriately, or being billed at all, also came up. According to the ordinance, all residential property owners, including owners of mobile homes and “campers” that are used at least 30 consecutive days of the year, should pay the $100 per residential unit.
Several of these issues were addressed at the county commission meeting in Union on March 3, which was held a week after the community meeting.
Lewis Buckland, president of the planning commission, told county commissioners “not many people know the amount of hard work that went into this thing when the Union Ambulance service went under. We put in hours and hours of work on this trying to come up with something that we felt would work.”
Buckland said he agreed that “it’s not perfect,” but the county commission “had to do something.”
“If it needs tweaking, it needs tweaking,” he said.
Miller said the $100 may be lowered, if it can be.
Commissioner Kevin Mann said they are open to needed changes.
“How are we supposed to do it?” he said. “I was not happy about it. It upset everybody. We have to try to fix it if we can get this better. We tried to get the state to help fund it.”
Buckland said the county is not the first to enact an ambulance fee “and we won’t be the last” and it’s not the first to meet controversy.
The issue of how the county can collect unpaid fees was also addressed.
State Attorney General Patrick Morrisey’s office was contacted about the issue, he said, and an opinion was received.
Monroe County Clerk Donnie Evans said at the meeting the questions to the AG related to the county having a legal right to collect the unpaid fees through a collection agency and/or civil action.
Both means are acceptable options, according to the AG opinion, Evans said.
Miller also said creating an ambulance authority was considered but met with opposition and the commissioners did not think collecting the needed money through a levy would be approved by voters. Yet, they knew they had to take action to raise the money.
Miller addressed the letter to Blackmer as well, saying he called the other planning commission members and they felt Blackmer was “trying to undermine what they had already accomplished. We don’t need those kind of people on the board.”
Blackmer was at the meeting and told commissioners there was the “perception that I was trying to destroy or not improve the ordinance.” But he said he was only asking fellow planning commission members to look at information he was providing and ways to improve the ordinance and provide transparency.
“What do you mean, transparency?” Evans asked Blackmer. “I have got you every document you have asked for.”
Blackmer agreed that he had, but said he was referring to transparency being “a community event, and all information and documents should be easily accessible to the public.”
“Everybody doesn’t understand the process of contacting the county for special requests,” he said. “Transparency is being able to look on the website or Facebook or newspaper about an upcoming meeting, the topics, the decisions made, explanations, asking for input before taking action.”
The commissioners did not disagree with him, and Miller later said the county does need to take a look at how to do a better job communicating with residents.
Amy Moloney, Farmland Protection Board executive director, attended the meeting and said Monroe County is rural and “everybody doesn’t do social media. This is a challenge.”
She also accused the commissioners of having a “good ole boy network” and “shutting down” an outsider (Blackmer), who moved to the county about 10 years ago.
“With all due respect, Fred hasn’t brought anything to the table on how to bring it together and how we should do it,” Evans said.
Blackmer said he offered options and had questions related to whether the ordinance was “properly created.”
Miller said later that the ordinance and the process used had been vetted by an attorney retained by the county and he was told it was “as legal as it can be.”
Miller did say the county has had issues with making sure all residential property owners are being billed properly, with some being left out of the billing process and others exonerated (removed). A new billing system is being used to help solve those problems.
“Things are going to happen,” he said. “We are not perfect. If something comes up we handle it and go on. I would say we will end up with about 6,000 residences (to pay the fee).”
Miller said he did not want to have the fee either, and “we looked at every possible way” to raise money, and he still hopes the fee can be adjusted.
“We have to get a full year (of collections),” he said. “Then we will get a handle to see what the figures may be.”
Miller said the commissioners wish they would have done a better job of communicating with residents.
“We do blame ourselves,” he said. “We didn’t get it out there maybe as we ought to. But we have public meetings and nobody shows up. When people do come to us and ask (about the ambulance fee), they are okay with it. They heard so much negative things that are not true.”
The bottom line is, he said, the county has to provide for an ambulance service and the commissioners have done what they are convinced is the right thing to do.
“I think we need to take a stand and end this (controversy),” he said.
— Contact Charles Boothe at firstname.lastname@example.org