Jodi Summit

TOWER- The Tower Area Ambulance Commission, on Monday, asked the Tower City Council to scrap the existing ambulance service agreement with the townships, and to come back with a new proposal for the commission’s next meeting, set for April.
The commission, which meets four times a year, is comprised of representatives from the city of Tower and each of the townships in the service area, along with the Bois Forte reservation. The governmental units each pay a per capita subsidy amount, currently set at $15 per person, which helps pay for the purchase of new ambulances, other equipment, and training. The reservation, home to Fortune Bay Resort Casino, pays a set amount each year as a donation.
The existing contracts expired Dec. 31, 2019, and none of the parties have agreed to a new contract proposed by Ambulance Director Steve Altenburg, which called for increasing the subsidy over the next three years, to nearly $30 per capita in 2022.
“The commission has nothing to do except pay you and you supply the rigs,” said Eagles Nest Fire Chief Larry McCray to Altenburg. “If that is all there is to the contract, my vote is no, and my board’s vote is no.”
While McCray was the most vocal at the meeting, others also expressed frustration with the management of the service, the lack of business planning, as well as the department’s projections for future ambulance purchases.
“About a year ago you sat at this table and told us there was $800,000 in the ambulance fund,” Breitung Representative Chuck Tekautz said. “To me, if you’d look at this as a business, you’d close the doors.” Tekautz was alluding to the fact that most of the ambulance service’s reserves had been transferred to other city funds, without reimbursement, and that the service’s financial situation has deteriorated under Altenburg’s tenure.
Tekautz also echoed previous criticisms that the ambulance service’s willingness to do long distance non-emergency transfers was putting excessive mileage on the existing rigs.
“When you are doing transports, you are putting beaucoup miles on the ambulances,” Tekautz said. “Your turnover is faster because of the miles being put on.”
Greenwood Representative Larry Tahija asked if those transfers were actually making money for the service.
Vermilion Lake Representative Sarah Schmidt, who is also a member of the ambulance service, said the department’s mission was to care for patients.
“I feel like there is a lot of concern about the money,” she said, “and, yes, we need to be concerned, but let’s keep in mind that we want an ambulance service here with reliable vehicles.”
McCray noted that the mission of the commission was to provide funding for the new ambulances. “We are here for the money,” McCray said. “I don’t think I can go back to my board and have them approve a 100-percent increase over three years. I can justify this year’s 25-percent increase if we don’t arbitrarily say we are buying another new rig in two years.”
Tekautz stated that if the previous city administration had not kept transferring money from the ambulance fund’s surplus to the city’s general fund, there would be enough money now for the new rig. The city currently has $148,490 earmarked for the ambulance purchase. That’s somewhat higher than last month due to a city fund transfer of general fund dollars to the ambulance purchase account and additional revenues that came from area townships before the end of the year. That will leave about $18,000 in additional city funds that will be necessary to cover the purchase of the new rig, which is expected to be delivered in the spring. In past years, the city’s ambulance operating margins were used to cover such shortfalls. But city year-end financial reports show the ambulance department revenues at $415,693 (budgeted revenue was $440,555, and expenses at $513,682 (budgeted projections were $439,655), for a year-end loss of close to $98,000. The city auditors did make a year-end adjustment in 2018 that transferred about $80,000 in 2019 revenue back to 2018, so the actual deficit is smaller than it appears.

Altenburg responds
Altenburg reminded the commission that they had earlier approved the contract they were now asking the city to scrap.
He noted that the department’s ambulances were purchased in 2005 (Unit 3 with 101,406 miles and a rebuilt engine), in 2011 (Unit 2 with 141,295 miles), and in 2013 for the newest rig (Unit 1 with 100,214 miles).
“We used to do a five-year replacement cycle,” he said.
“This commission was put together to purchase rigs,” Altenburg said. “We haven’t done that in a long time. I’ve done everything I can to stretch those rigs.” Altenburg has been ambulance supervisor a little over three years.
Altenburg said criticism of the department having a third rig was misplaced. “I don’t want to hear anything about the third rig,” he said. “The ambulance service paid for the new engine.” The department had tried to sell that rig for several years before simply putting it in storage.
“That rig is not costing us money,” he said. “Every time we use it, we make money.”
McCray repeatedly asked Altenburg to come back to the commission with a plan that addresses questions that have been raised, including how many times multiple rigs are out on calls at the same time, how many miles on each rig are for rescue/911 calls versus transfers, how  the new rig will be used (rescue versus transfers), and if there is a plan to use the new rig in a manner that would prolong its service time to as long as feasible.
Tower Representative Rachel Beldo said that commission members were asking both foundational and longer-term questions and agreed that the commission should be given the information they need regarding rig mileage, along with call numbers and type, and plans for each rig in a single document. “So we are confident we understand where we are going.”
Altenburg asked, “Who is going to make this plan? Besides mileage, what other information do you need?”
Beldo noted these questions had already been asked at the meeting.
McCray responded that the group wanted breakdowns of each unit, their repair history, cost to run each rig, number of times there had been a rig failure and why, as well as tracking the mileage and usage for each rig.
“You are the person in charge,” McCray told Altenburg, noting he needed this detailed information to justify the increase in the subsidy rate to his board.
McCray said he hopes the transfers are making money for the service so they can afford to upgrade to ALS but said the concern of the commission is purchasing rigs.
Altenburg told the commission that transfers were making money for the TAAS but when he asked Tower City Clerk-Treasurer Victoria Ranua to back up his claim, she declined, noting that the ambulance service has not broken down its expenses and revenues in a way that could determine the answer to that question.
In the past there was no detailed breakdown on the costs of adding the paid-on-call service and housing for the paid-on-call staff, but that data is now being tracked at city hall so it should be available in the future.
Transfers were 22 percent of the service’s calls in 2019. Estimates of 2018 data from Virginia Ambulance Director Al Lewis, however, showed they were responsible for about two-thirds of the total mileage for the service’s ambulances.
The board then decided to have members come up with a list of suggestions for the new agreement which will be sent to the city by early February. They also may ask the city to allow the commission to have input into any new ambulance purchases. The commission’s next meeting is Monday, April 6 at 7 p.m. at the Tower Civic Center.

Part-time ALS
Altenburg reported that the department will not be able to add part-time Advanced Life Support (ALS) care this year.
“We need to have $50,000 up front to pay for the education and stuff we need,” he said.
Altenburg said the department had paid out $20,000 for ALS transports in 2019. “It’s becoming a bigger and bigger need.”
The service currently offers basic life support (BLS) with EMTs. ALS uses paramedics who can administer advanced care and more medications on route.
Dr. Pettinelli, the service’s medical director, said the need for ALS transports is increasing, and that the waits for ALS transfers often mean patients end up needing emergency transport by air, which is very costly as well as dependent on good flying conditions.
“Anything with trauma needs to go to a trauma center,” he said.
Pettinelli said he is trying to get the Ely Ambulance Service to do more ALS transfers.
“A good, strong ambulance service is more important in Ely,” he said. “There is lots of crazy stuff in the summer.”

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