Fulton County Board of Supervisors mulls ambulance service plan

Fulton County Emergency Management Services Coordinator Steven Santa Maria, right, presents his “County-Wide Ambulance Service Incentive Plan” to the Fulton County Board of Supervisors on Monday. (Jason Subik/The Leader-Herald)

JOHNSTOWN – Steven Santa Maria says he still remembers the feeling that went through him when the New York state Dept. of Health called him and asked him a question he never thought he’d have to answer.

“On Feb. 8, 2019, at approximately noon time on a Friday I was called by the Department of Health and asked ‘what are you going to do about ambulances in your county?’,” Santa Maria said. “I said ‘what do you mean what am I going to do about ambulances in my county?’”

Santa Maria, who serves as Fulton County’s Emergency Management Services Coordinator, was then informed by state that the Ambulance Service of Fulton County [ASFC] had earlier that day abruptly shut down after running out of money.

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Santa Maria told the story to the Fulton County Board of Supervisors Monday as part of his pitch for a “County-Wide Ambulance Service Incentive Plan. He said his plan calls for Fulton County to help stabilize the availability of ambulance services by applying to New York state for its own Certificate of Need — the license needed to operate an ambulance service, or to contract with another entity to provide ambulance service.

Santa Maria said without the CoN to enable his office to get into binding contracts with ambulance companies he doesn’t have the tools necessary to effectively ensure Fulton County has ambulance service available for its approximately 41,709 residents. He said the 2019 ambulance crisis is proof of why the county government must take action.

“I call it a crisis, because I believe it was at that time,” he said. “That was the first, and only, warning that we had that our major provider of ambulance transport services in Fulton County [had shut down]. That was not a good feeling for us that Friday afternoon, not for me but for the residents of the county that need ambulance service. By about 7 p.m. [Fulton County] EMS Coordinator [Mark] Souza and myself had put together a plan working with our partners with [the Greater Amsterdam Volunteer Ambulance Corps.] to continue operating an ambulance service in Fulton County.”

What happened next was a scramble for control of different aspects of ambulance service territory in Fulton County, including the more lucrative interfacility hospital transfer calls out of Nathan Littauer Hospital, which GAVAC and the now defunct Johnstown Area Volunteer Ambulance Corps. disputed control over the ‘first priority’ call status. JAVAC inked a non-binding agreement with Nathan Littauer Hospital to provide the hospital transfer calls, which GAVAC disputed, asking the Adirondack-Appalachian Regional Emergency Medical Service Council to rule on the issue. Both entities argued first priority in performing the higher-profit margin hospital calls were necessary to remain viable in Fulton County, but the AAREMSC never ruled on the issue by JAVAC also shut down, about a month after the ASFC.

“That was another two ambulances out of service, and when [ASFC] shut down they took five ambulances out of service for us, so we lost seven ambulances in one month in Fulton County,” he said. “Luckily GAVAC at that time was able to pick up the shortfall and provide five to six ambulances in Fulton County, and the city of Johnstown put their [fire department] ambulance service into operation, probably sooner than what they had really wanted to, but it was desperate times, and they stepped up their ambulance service quickly, trying to pick up some of the slack.”

Since then, things have been more stable, but there’s no guarantee it will remain that way. He said GAVAC in 2020 responded to 5,942 ambulance calls in Fulton County, but 2,021 of them were non-billable, and 26.6% of them were paid by Medicaid, which does not pay the full average cost of an ambulance trip, putting constant fiscal pressure on whatever ambulance service provides coverage to Fulton County.

“Over the last two years we’ve learned a lot, and we’ve tried to figure out ways that we can at least improve the system, or at least stabilize the system countywide, without having a tremendous impact on the taxpayers of the county,” he said. “The situation that we find ourselves in now, is that we’ve kind of done all we can do for oversight without having more tools in our toolbox. We’ve mostly had to operate from a reactive position, oftentimes trying to handle situations or problems that have arisen after the fact. And we want to get out of that, but that’s hard because we really don’t have any oversight authority or oversight tools to do the job that you’ve asked us to do.”

Santa Maria said members of the Board of Supervisors have made it clear to him that they aren’t interested in expanding the size of government to provide an ambulance service, which he estimates would cost over $542,000 per ambulance to operate. He said if a county-run ambulance service provided only two ambulance transports per day annually, it would operate at a loss, taking in $362,00 per year using current cost and reimbursement figures.

He said if the county obtains a CoN it can set up contracts with any of the ambulance companies operating in Fulton County, and require them to provide the county with:

• financial reporting, to help avoid another unforeseen shut down

• billing and call statistics

• daily staffing levels

• long term staffing trends

• vehicle locators that can allow the county to know how many ambulances are available in the county at any given time, and the ability to dispatch the closest ambulance

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Santa Maria said Fulton County could probably get a CoN for ambulance service operation throughout the county in about two weeks. He said with the CoN Fulton County could contract with multiple ambulance companies for the higher-margin hospital transfer calls at Nathan Littauer Hospital, as well as ensure that ambulance companies will provide service to the more remote western parts of the county. He said the CoN would enable him to reach out to ambulance services outside of the county and bring them in when needed, including to help alleviate the sometimes lengthy wait times that have built up at Nathan Littauer without more ambulance companies available to provide for those calls.

“What the CoN really does for us is allow us to contract with other agencies and utilize agencies outside of their normal operating territories, let’s say,” he said. “For example, St. Johnsville [Volunteer Ambulance Corps.] has parts of the Town of Oppenheim, but maybe we’d like to use them in the Town of Stratford or the Town of Caroga, or something along those lines for a fee. By obtaining the CoN that gives the county operating authority throughout the county, and then we can tell the resources where they need to go.”

Santa Maria said obtaining the CoN does not obligate Fulton County to ever actually operate its own county-personnel ambulance service, although he does think that would be the easiest way to maintain the service. He said Board of Supervisors members have told him they won’t support the service because it’s too expensive. He said he has also pitched purchasing a “Fly car” vehicle, capable of providing advanced life support services and medications quickly to a location that needs them before a transport ambulance can arrive.

Allicia Rice, the former Town of Stratford Supervisor, spoke to the board during Monday’s public comment period, asking them to support Santa Maria’s plan.

“I’m a member of the [Statford Volunteer Fire Company], so I’m on all of those calls, and I see what’s happening,” she said. “You waste time because of confusion between ambulance companies, so it’s really important that there be some oversight over this and some controls over what they’re doing. I’m also there to know the response times, and I think this plan will address those issues. I hope you will consider also the ‘fly car’, because we’ve had situations where the fly car would have been very helpful, preventing a waste of resources, and also the response time.”

Santa Maria said he knows the Board of Supervisors won’t support the fly car this year, and he crossed out that item on his power point presentation to the board Monday. He said he will ask for it again in future years if the county gets the CoN. He said, although GAVAC has proven to be a good ambulance service for Fulton County, the nonprofit has recently announced it will be acquired by a private equity firm Enhanced Healthcare Partners and made a part of its for-profit “Priority Ambulance” service. Santa Maria said GAVAC, which has been renamed Lake Valley EMS, is currently waiting for approval from the New York state Attorney General’s office to sign-off on the acquisition. Details such as the price of the GAVAC purchase have not yet been publicly disclosed.

The Fulton County Board of Supervisors went into executive session after Santa Maria’s presentation to discuss contract terms for providing payment to different ambulance services operating in Fulton County, but when the board returned from the closed-door discussion it took no action.

Fulton County Administrator Jon Stead said the board had resumed some COVID-19 “social distancing” guidelines due to the recent spread of the virus in the county and said no interviews would be granted on the floor of the supervisors chambers after the executive session. Headwell advised that community spread of the virus has reached substantial levels and even individuals who have received a COVID-19 vaccination should resume wearing masks during indoor gatherings.

None of the Fulton County Board of Supervisors wore masks Monday during the meeting, and the seating arrangement for the meeting remained in the schoolhouse style of desks spaced out in rows pointed toward the front of the room, the configuration the board has used since it resumed in-person meetings.

Santa Maria’s presentation to the board was not unexpected. In August the Fulton County Board of Supervisors voted 17-0 Monday to approve purchasing the former Johnstown Area Volunteer Ambulance Corps. building at 231 N. Perry St. for up to a total of $400,000 from its current owner Townsend Leather Corp. After the meeting Stead said the topic of whether the county should apply for a state CoN to either operate or contract for ambulance service would likely come up for discussion soon.

In July, city of Johnstown Mayor Vern Jackson told the Common Council he had been told by Fulton County officials it was likely the county would soon be offering a subsidy payment to ambulance companies in the county. Jackson told the council this during a lengthy meeting discussing whether or not the city should borrow $12.2 million for capital projects, including a second ambulance for its fire department ambulance service. Talk of the county payment appears to help sway the council toward unanimously approving the bond proposal, including the second ambulance, despite there having been opposition to the item by some members of the council prior to the vote.

Santa Maria said it’s his hope the county obtaining a CoN and contracting with ambulance companies will enable them to raise wages for ambulance service employees, helping to reduce a shortage among those critical workers during a time when reimbursement rates for ambulance transport aren’t high enough to adequately sustain the service in Fulton County.

“The funds that we put back into the system, we’re hoping, will help stabilize the system,” he said. “I think we put together a pretty fair package. We’ve had informal discussions trying to get the lay of the land, and we think our numbers are pretty good. We’ll see. Time will tell.

Santa Maria said he hopes the county board will make its decision regarding how to proceed with stabilizing the availability of ambulance service in the county by Jan. 1, 2022.

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By Paul Wager