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Windham County’s EMS saga, even with a surprise resignation, may be just starting

24 May 2022 7:17 AM | Matt Zavadsky (Administrator)

Windham County’s EMS saga, even with a surprise resignation, may be just starting

By Kevin O'Connor

May 23, 2022

https://vtdigger.org/2022/05/23/windham-countys-ems-saga-even-with-a-surprise-resignation-may-be-just-starting/

When leaders of more than a dozen towns met at Windham County’s largest emergency medical services provider last Thursday, they wrestled with the ramifications of a sudden plan by Brattleboro — its hub community for nearly 60 years — to pull out of the district.

Then the Brattleboro town manager behind the surprise withdrawal gave his two weeks’ notice Friday, just a month before his municipality is set to depart with a full third of the provider’s funding.

Many area residents, critical of the lack of notice and public debate over the ambulance change, are wondering if a last-minute reconciliation will be the end of the story. But based on the latest actions of both sides, it’s more likely southeastern Vermont’s EMS saga is just beginning.

Brattleboro is still scheduled to leave the private nonprofit Rescue Inc. on June 30, having just approved a one-year contract with Golden Cross Ambulance of Claremont, New Hampshire, until the town can complete a feasibility study on whether the municipal fire department should take over local EMS calls.

Rescue, for its part, has told its remaining 14 member communities it won’t cut care or raise rates for the coming year, but will consider whether to charge Brattleboro if it requests mutual aid as of July 1.

“Is it reasonable to dissolve a 56-year relationship without any discussion and then ask us to provide the backup coverage you need?” Rescue Chief of Operations Drew Hazelton said of Brattleboro.

Brattleboro residents approved a 2022-23 municipal budget in March that included a $285,600 ambulance service assessment figure sought by Rescue. They weren’t told that Town Manager Yoshi Manale, who started less than three months earlier, had reopened talks his predecessor had completed and other municipal officials had confirmed in a January operational letter of agreement.

Manale won’t elaborate on what was said at a private February meeting between the two sides other than to note he and Rescue “have different recollections” and “I’m not going to continue a back and forth.”

But Rescue’s chief of operations, the head of its board of trustees and Brattleboro’s resident representative all contend that Manale asked for drastic changes in a longtime connection that former Town Manager Peter Elwell supported publicly before his December retirement.

“The system is working,” Elwell told Rescue at the end of its most recent annual meeting, aired and archived on Brattleboro Community TV.

Manale, however, told the provider it either would have to work under the oversight of the municipal fire department, even though Rescue is a private nonprofit, or provide services to the town at no cost, all three EMS representatives assert.

“We declined to accept either scenario,” said Kathy Hege, president of Rescue’s board of trustees, “and unanimously rejected the proposal.”

Manale also verbally asked for data on the private nonprofit’s administrative costs and Brattleboro insurance compensation, both sides confirm, although he never followed up with those authorized to release such data to learn it isn’t broken down by community, but instead reported as a unified district.

Manale went on to issue a press release last month, saying Rescue had written him to report it wouldn’t serve the town as of July 1, even though the EMS provider’s actual letter noted it simply couldn’t agree to offer free care but was open to talking about continuing paid work.

The resulting news, coming just weeks after a Town Meeting report that featured Rescue’s future plans and just months before the end of the current contract, has sparked criticism everywhere from social media to selectboard meetings to the Statehouse, where retiring Democratic Windham County Sen. Jeanette White called it “one of the worst decisions ever made.”

Critics of Brattleboro’s plan have stressed they support both Rescue and the fire department, but simply can’t understand why the town is dropping its current EMS provider before completing a feasibility study to see if it makes sense to invest in an in-house model.

“The Town of Brattleboro’s unilateral withdrawal from Rescue Inc. is the destruction of an integrated system of personnel, equipment, communication and services,” Putney resident Howard Fairman wrote in the latest edition of The Commons weekly newspaper, “disdaining and imperiling residents of and visitors to 14 lesser towns while looking out for number one.”

At a meeting Thursday, Rescue outlined its district finances — available on its IRS form 990 for tax-exempt organizations — to show how its collaborative structure allowed Windham County towns to pool their resources to provide specialized staff, equipment and services that none could pay for on their own.

Vermont has a higher-than-average number of people covered by federal Medicare health insurance for older adults or Medicaid for anyone with low incomes, statistics show. But Medicare pays only 80% of a bill, while Medicaid pays only about 64%.

“Every patient we see with Medicare or Medicaid is being reimbursed at least 20% less than the cost of delivery,” Hazelton said.

That requires Rescue to charge each member town an additional per-person assessment — in Brattleboro’s case, $285,600 for the coming year to cover its population of 12,184 — to meet expenses after receiving what private and public insurers pay for reimbursement.

Manale, however, has estimated Brattleboro could reap up to $700,000 in revenue if its fire department took over local EMS calls — a claim several experts have dismissed and no other local or state leader has supported.

Manale said his figures anticipated the receipt of a federal Staffing for Adequate Fire and Emergency Response (SAFER) grant used at his past job as an administrator in Trenton, New Jersey. But a check there shows that city couldn’t rely on such funds, leading to threats of layoffs.

In 2017, for example, Trenton was set to let go of 64 of its firefighters when it didn’t receive the federal money. The city of 83,387 people ultimately averted staff cuts by reducing overtime. That, in turn, dropped the number of professionals working at each of its seven stations at any time down to three.

“It’s a safety concession — federal standards recommend four,” the news website NJ.com reported.

Manale has acknowledged that, for all his charges against Rescue and confidence about a town EMS takeover, his estimates may not hold up to independent review.

“If it does say, hypothetically, this doesn’t financially make sense and the model doesn’t work here, we would go out to a bid and ask providers — including Rescue,” Manale told the Selectboard at its meeting on April 19.

Since then, the Selectboard has signed a nearly $40,000 contract for the Wyoming-based consulting firm AP Triton to study the costs, staffing needs and related challenges of the municipal fire department taking over EMS responsibilities.

A recent AP Triton study for the Vermont town of Williston, which made national news after a firefighter shortage left its station empty for almost an hour, required the community to increase its fire and EMS budget by 42% this year to pay for the nine additional employees recommended in the report.


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