Tug-of-war over EMS

By RICHARD LUKEN
Register Reporter

While county and city officials remain adamant about maintaining separate emergency medical services, their constituents are paying for an overabundance of services.
The two services employ 30 full-time employees, 19 part-time employees and have at their beck and call six ambulances — far more than similar-sized counties.

IT’S FOUR YEARS and counting since the first inkling surfaced that Allen County and Iola would have separate ambulance services.
Both sides profess to be seeking the best possible service for all Allen Countians.
Negotiations between the two sides for an updated mutual aid agreement — or possible return to a single service — broke down after a few months with no plans to return to the bargaining table. And with seemingly every issue raised is a distinct — and at times nearly opposite — response.
Take, for example, the single document that most likely started the divorce of the two services — a 22-page summary of Allen County’s ambulance system by the State Board of Emergency Medical Services, issued in October 2005.
The document recommended, among other things, that Allen County develop and operate its own ambulance service. County commissioners have repeated that on several occasions when explaining their impetus for pursuing a single, centralized system.
Iola City Administrator Judy Brigham, meanwhile, said the city’s interpretation of the document was it recommended the county take over only Humboldt’s and Moran’s ambulances.
Brigham pointed to an-other passage in the state’s summary that noted pulling the ambulances from the city’s control would ad-versely affect its fire department.
What was seemingly black and white took on its first shade of gray.
But still the wheels were put in motion. Allen County subsequently applied for, and was awarded, grant funds to start up its own system and build a centralized ambulance station to serve the entire county. (Where the station would go has become a saga of its own).
With grant monies in hand, the county an-nounced its plans to Iola, and asked the city to divest itself of most of its ambulance services. Firefighters, the county proposed, would retain certification to run ambulances, but would do so only in a backup capacity. The county’s proposal also included reducing the annual subsidy to Iola to $35,000 for its backup service.
Rather than go along with the county’s plans, Iola started its own service in late 2008, which in part required licensing from the same EMS board that recommended the county consolidate in the first place. The city received licensing, as well as an opinion from Kansas Attorney General that indicated the city had the right to run its own service.
“It was not just so that we could keep our fire department,” said Iola Mayor Bill Maness. “We had been running our own ambulances for more than 40 years and we weren’t comfortable with giving up that service to our citizens.”

IOLA’S AIM — to run a self-supporting EMS system, operating solely on revenues generated by its runs — appears on course, Director Ron Conaway said.
According to the city clerk’s office, Iola has spent roughly $400,000 in 2009 for salaries, supplies and maintenance of its two ambulances, while bringing in about $218,000 in revenue, plus another $80,000 from the county. The city spent $500,000 for ambulance services in 2006, $600,000 in 2007 and $640,000 in 2008.
Revenues eventually are expected to catch up with expenses, Conaway and City Clerk Roxanne Hutton said, as the city becomes better versed in the collections process.
“The pace of collections has picked up quite a bit recently” as the system gets off the ground, Hutton said.
“And it’s important to point out that for that price, you also are getting a full-time fire department, a rescue team and a crew that handles hazardous materials,” Brigham said. “It wasn’t like we were starting from scratch. We already had the team, the employees, in place. All we had to do was buy and equip our ambulances.”

THE COUNTY, meanwhile, wants to remain within its $1.14 million budget set for 2009. As of Aug. 1, the county has brought in a shade under $660,000 in revenue, while spending $827,000. The county spent a little over $1 million for its ambulance service in 2008.
The county service is supported in part by an ad valorem tax levy of 3 mills. As of Sept. 1, the county has billed out more than $517,000 for its services and collected $290,000. Another $125,000 was written off for such things as Medicare or insurance, leaving Allen County due to receive another $100,000.
It’s important to note that while the county’s EMS tax levy has increased in recent years, such a measure was a part of the State EMS Board’s recommendation in 2005, calling Allen County’s one of the most under-funded EMS systems in the state.
As for taxpayers being ably served, today’s crews could handle a much larger population than the county’s 13,319 residents, based on figures provided to the Register from other similar-sized counties.
Atchison County, for example, has a Type 2 service manned by 25 volunteers. Jackson County, which has a Type 2 service with Type 1 capabilities, has five full-time employees and 24 part-time employees. Marion County has two full-time employees, its director and office manager, and 84 volunteers.
Between Iola and Allen County emergency services, there are 30 full-time employees with an additional 19 part-time employees on the county payroll, three of whom also work for the Iola Fire Department.
Allen County’s crew — designated as a Type-1 service — consists of 15 full-time employees, seven of whom are capable of performing advanced life support procedures.
Iola Fire Department’s, meanwhile, also has 15 full-time employees. Iola’s service is a Type-2 service — designated by the state as one that provides only basic life support services — with Type-1 capabilities.
“We have a Type-1 employee on every shift who can go out on a call if need be,” Conaway said.
The distinction between a Type-1 service and a Type-2 service with Type-1 capabilities is negligible, Conaway contends.
Leapheart estimated Iola EMS crews were about 60 percent as busy as when one system covered the city and county.
The city owns two ambulances, while the county has four, one each in Humboldt and Moran and two in Iola. One of the units in Iola is kept as a backup vehicle.
FOR MORE than 30 years, Allen County owned and was responsible for all emergency medical services in the county.
While the practice was long-standing, it also was unique. It was the only EMS system in Kansas where the county was the owner and operator but individual cities hired the employees and volunteers and handled day-to-day operations.
That changed in 2005 when, after separate review by the State EMS board, the cities of Humboldt and Moran voluntarily handed over operations of their ambulance units to the county.
As County Commissioner Dick Works noted, the partnership was strained at times.
He said that over the years the county was compelled to give larger subsidies to keep Iola interested in operating county ambulances. “For years they said they didn’t want to be an ambulance service, that they wanted to be firemen.”
Not true, Brigham replied.
“If all we did was ask for more money, then we
apparently weren’t very good at it,” Brigham said.
She pointed out the county’s subsidy to Iola gradually decreased on a nearly annual basis, from $43,000 in 2000 to $25,000 in 2004. The 2004 subsidy struck a nerve, Brigham said, because it was less than the $40,000 subsidy the county provided to Humboldt.
And, Leapheart noted, the city’s responsibility increased with the higher subsidy, when Iola firefighters covered the Moran region 12 hours a day.
“That’s three-quarters of the county,” Leapheart said.
The county upped its subsidy to $80,000 from 2005 to 2008, after which the city broke away.
Allen County continues to send $80,000 to Iola on an annual basis, roughly equivalent to the amount of property taxes the county collects for EMS from Iola taxpayers, although there have been murmurs from county commissioners that the $80,000 does not have to be handed back over to the city.
“I’d hope it doesn’t come to that,” said Iola Fire Chief Donald Leapheart, who coincidentally was EMS director for four years, from 2000 to 2004.
Leapheart resigned his EMS director duties because the title gave him “all of the responsibility but none of the authority.”
“They were city employees, so they answered to those cities; not to me.”
Leapheart also recommended that the county EMS director be a paramedic. Newly hired Jason Nelson is a paramedic.

ALL THE while, the county continues to discuss a home for its amublances. For now, the county has one ambulance in Humboldt, another in Moran and two in a garage on the east side of Iola.
County commissioners originally opted to build a station near the intersection of U.S. 54 and U.S. 169 just east of Iola but decided against it because of potential flooding. They then purchased a plot of land owned by Tim Henry farther to the east in Gas.
Those plans were scrapped after current commissioner Gary McIntosh and Robert Francis were elected. Both ran on a platform of bringing the city and county together to offer combined services.
The county then explored building a station on land owned by Allen County Community College — a notion that was rejected by college trustees — and heard proposals for such buildings as the old LaHarpe Elementary School building before purchasing the old Heartland Rural Electric Cooperative building on North State Street.
County commissioners are leaning toward constructing a separate building there to house ambulances and crews, with 911 dispatch services and an emergency operations center in the building. They approved issuance of up to $400,000 in general obligation bonds that could be used for the work. Works said this week there was no immediate expectation to issue the bonds.
And even that site has sparked another disagreement, about whether the building is in the flood zone.
Works said a surveyor indicated the building is
out of the flood zone; maps provided to the city by the Federal Emergency Management Agency indicate only about half of it is.
Iola Code Enforcement Officer Jeff Bauer conceded that the property is on the edge of the flood zone. If the county built a structure for the ambulances just to the north of the building, it would be clear of FEMA restrictions on building in flood-prone areas.
But, as has become a familiar refrain, nothing is set in stone.
County commissioners continue to discuss their next steps. City planners, meanwhile, are content to operate as is until another mutual aid agreement is developed.