City approves EMS ordinance
MANISTIQUE – A controversial city ordinance passed Monday, amid a crowd rarely seen during regular Manistique City Council meetings. Although public comments were few, residents filled council chambers, even lining the hallway of Manistique City Hall, to learn the fate of a regulation deeming Manistique EMS the primary responder within city limits.
The ordinance came to light two weeks ago, introduced during a city council meeting as a method to “protect” the city’s interest in the EMS realm. The introduction came on the heels of the announcement of a new business – Rapid Response One, Inc. – establishing itself in Manistique.
Since that time, city officials, most notably Manistique Public Safety Director Ken Golat, and supporters of the private EMS service, including owners Shelly Baker, and her husband, Tracy Keskimaki, an A-EMT, have been at odds, each defending their existence and service offerings within the city.
The ordinance, as presented, designates Manistique EMS as the primary responder to all medical emergencies within the city limits. It notes the city will provide advanced life support, limited advanced life support, and/or basic life support, transportation and other services, and that any other ambulance service must notify the director of public safety of their intent to operate within city limits and participate in a mutual aid pact with Manistique EMS.
The ordinance notes that the ALS portion of the ordinance will not go into effect until the city is actually licensed as an ALS provider. Currently, the Manistique EMS has one ALS-trained employee, also known as a paramedic, but that employee is unable to use their training, as the city is limited by its LALS licensure.
According to City Manager Sheila Aldrich, the way the ordinance is worded, the city of Manistique will receive all emergency calls until Rapid Response receives its license from the state. Once the private company receives their license, and until Manistique EMS advances to an ALS license, 911 dispatch out of Negaunee will direct emergency calls to Rapid Response, since they have more advanced training. Any calls coming in while Rapid Response is responding to a call will be directed to Manistique EMS.
When Manistique EMS receives its ALS license, which Golat said they are “aggressively” pursuing, the ordinance ensures they will be the primary responder to calls within the city. How calls will be split between the two services after the primary call, both within the city and in the county, will be determined by Negaunee dispatch protocol, Aldrich said.
Before the ordinance was discussed during Monday’s meeting, two residents spoke under the public comment period – one against and one for the city’s ordinance.
Manistique resident Richard Brook said he had the right, as a citizen, to choose which service, Rapid Response or Manistique EMS, he would want to respond to a medical emergency.
“I wish that the council would think about … how close you are to obstructing free commerce if you should pass this ordinance,” he said.
Brook also said council should consider tabling the matter and holding public hearings to involve the residents in the decision.
Kristi King, a member of the Manistique Recreation Board, expressed appreciation to Manistique EMS for volunteering their time during events, such as football games and Folkfest.
Following the public comment period, Terry F. Burkhart, of Burkhart, Lewandowski and Miller in Escanaba, representing Rapid Response One, Inc., addressed the board. He explained that, while he had not had an opportunity to investigate at length, he had seen some letters in which Schoolcraft Memorial Hospital questioned the quality of service from Manistique EMS and Golat defended the city’s service.
“Clearly there’s a controversy,” he claimed.
Burkhart said Rapid Response had already been approved by the local Schoolcraft County Medical Control Authority, which expands beyond the city limits. He noted that the ordinance does not give a definite date when Manistique EMS will acquire an ALS license, or what they will invest in obtaining that status, and that the service had been content as a LALS for the past 17 years.
“It’s kind of a preemptive strike, or a warning,” he said. “The question you have to ask yourself is what kind of public policy is that?
It would seem to me that this is an item of critical importance that needs public debate, it needs public dialogue,” he added.
Burkhart said that, looking at the city’s records, the ambulance service operated at a $50-60,000 loss last year, and that was before any attempt to become ALS certified – which adds additional costs for training.
He requested the city withdraw the ordinance and work together with Rapid Response to come up with a solution to appease everyone.
“This will not stop my client from getting into the business – it will not stop my client from getting into the hospital business; it will not stop my client from getting into the county business, other than the city of Manistique,” Burkhart said.
He noted that the lack of an ALS license for Manistique EMS had been a controversy for a long time, and the city only acted on seeking the advanced designation after a business expressed interest in coming to the area. Burkhart said the city was looking for a “protectionist” ordinance and that they should craft the relationships in an “intelligent manner”.
Burkhart also said the citizens deserve the best service available, and that there is a business in the private sector ready and willing to provide that. He called Manistique EMS a “money losing and substandard” service and said it was “not fair” to introduce and pass the ordinance within two weeks.
“Why are we trying to scare Rapid Response out of town?” he added.
In response to Burkhart’s claims and comments, and to present the finalized version of the ordinance, Golat addressed the council. First, he clarified that the ambulance budget is self-sustaining, and only pays for salaries and equipment.
“No tax dollars go toward the support of this ambulance service,” he said. “We are a nonprofit organization.”
Golat also countered that the Manistique EMS has been “aggressively” pursuing an ALS license for nearly two years – most aggressively in Oct. He explained the service had worked with the Schoolcraft County Medical Control Board, along with SMH, and it had been decided that the city would wait until new SMH CEO Tanya Hoar was in place before continuing with the process.
“This ordinance is not about keeping paramedics out of Schoolcraft County or Manistique,” Golat said. “This ordinance is about protecting our city residents by ensuring that the city provides quality EMS services to our residents, as we always have.”
Nothing in the ordinance prohibits another service from operating in the city or county, Golat explained. It merely gives Manistique EMS the right to be primary responder.
In response to claims made by Baker, Keskimaki, and Burkhart that Manistique EMS was outdated, Golat outlined response times for its service. For the 68 emergency 911 calls made between October – December 2013 within the city, Golat said the average response time was 4.91 minutes. In the county during the same period, response time was, on average, 13.56 minutes.
“That’s very fine response,” he said.
Golat added that although “minutes seem like hours, seconds seem like minutes” when a resident or loved one is waiting for an ambulance, the data shows Manistique EMS has good response times.
In total, 910 ambulance calls were made to the city EMS in 2013, but only 831 of those were transporting calls – ones the EMS gets paid for. Golat added that, on average, the service experiences a 40 percent loss from write-offs – bills unpaid by insurance companies or by people unable to come up with the money.
Over the course of five years, Golat said the city averages less than two calls per day.
“Are there really enough calls in this community for two ambulance services?” he said. “Should we, the city, who have protected the city and county, as a mission, for 55 years, just step aside with our four ambulances, 17 EMS personnel … to make way for new, private service, that hasn’t been in business yet?”
Golat added that if Manistique EMS “goes down”, they will likely be forced to liquidate equipment, ambulances, and eliminate personnel, which would affect the 24/7/365 service fire, police, and EMS services provided for city residents.
“What then will prohibit any private EMS service from walking away for any reason?” he said. “What will Manistique and Schoolcraft be left with?”
Golat said now that ALS is coming to the community, whether it is Manistique EMS or Rapid Response, ambulances fees will be increasing.
“Patients are going to have to pay more for paramedics and ALS care,” he said. “Currently, as limited advanced life support … we charge $400 base fee, plus $11 per mile for transporting.”
ALS service providers around the U.P. charge anywhere from $600-1,000, he added. While a private service could charge what they choose for ambulance runs, Golat said the Manistique EMS will continue to be regulated by the city, since they are “designed with the mission to serve the public.”
He noted that, currently, Manistique EMS provides lift assists, life alert response, and standby at events for free.
“We run a very competent ambulance service here; sincerely appreciated by the vast majority of Schoolcraft County residents,” he said. “We’ll continue to improve our service into the future, as advanced life support or anything else that the state of Michigan requires.”
For those with complaints about the ambulance service, Golat stated he would like to receive those complaints directly and in a “timely manner”, not years later or via letters to the editor or Facebook.
“I want to know about it,” he said. “It will be investigated; it will be discussed and resolved. And, if we are at fault, I will take action.”
Councilperson Bill Vandagriff stated he had done some research into ambulance services, particularly private versus public EMS. He asked aloud questions about whether the employees of Rapid Response are from the area, if the private business would be able to make it, if the ambulance would sit for free like the Manistique EMS does at sporting events.
“With the price of employees’ wages, gas, upkeep of vehicles, insurance and non-payments, I really find it hard to believe that there is much profit in the business in this area,” Vandagriff said. “Manistique Public Safety is what I call service for the good of all – they’re not in it for the profit. They’re a service provided to the citizens by the city.”
He questioned, without subsidies provided by the city or hospital, how an area private ambulance would be able to survive, adding that, if the city was for profit, it would be out of business by now.
“You may call this a monopoly – I say it is simply a safety net for our citizens,” Vandagriff said. “Manistique Public Safety EMS will always be there for them – profit or not.”
Following Vandagriff’s comments, Aldrich took the time to thank Manistique EMS, which she said had over 140 years EMS experience among them.
“We do have top notch equipment,” she said. “It’s maintained second to none.”
Aldrich noted the city’s EMS has an obligation to take care of the community.
“What we’re being asked to do right now is to play Russian roulette with our ambulance service, and, to me, that’s not acceptable,” she said. “I don’t think that it’s a road that we can afford to go down to take a chance.”
No comments were made by councilpersons Rick Hollister or Liz Hill, and no other discussion was had on the subject. Vandagriff made the motion to approve the ordinance and the measure was unanimously approved. Mayor Jan Jeffcott and Councilperson Dan Evonich were absent.
Following the vote, during the meeting’s second public comment period, more residents expressed their opinions on the matter.
Connie Diller, Schoolcraft County Chamber of Commerce director, suggested businesses ask her office what types of businesses need to research what we don’t have, and what we need,” she said. “Our community has so many volunteers. If it weren’t for the volunteers that we have, we wouldn’t be anywhere.”
Michelle Goudreau, a nurse for SMH, thanked Manistique EMS for their service, while Julie Johnson, a Manistique resident, explained that she doesn’t want to be told what ambulance to use.
“If there’s another business that wants to come to town, let them decide if they can run a business,” she said. “Some of the concerns that you (Vandagriff) brought up, it sounded like you were already in favor of the city of Manistique … it sounded like your research was one sided.”
B.J. Rubick, of Manistique, said he was a paramedic and, while crediting Manistique EMS for their service, reminded residents that Manistique does not offer the highest level of care. He also made a comment that at a resident’s house and in an ambulance, a paramedic can do anything a doctor can do in an emergency room – claims that were quickly dismissed by other audience members.
Rubick also claimed that he and other paramedics had been denied employment at Manistique EMS. Golat countered that he offered Rubick a job less than two weeks ago, but Rubick turned it down.
In the final minutes of the meeting, Aldrich made one last statement regarding the ordinance, which caused a complaint from an audience member.
“Ken doesn’t fail at anything … when he says that he’ll accomplish something,” she said.
The ordinance, to take effect 10 days from Monday, is published on page B3 of this week’s edition of the Pioneer Tribune.