The Washington County Emergency Medical Services Authority (WCEMSA), which has been serving 17 member communities as the county's primary ambulance service since its inception in 2001, received a February 17 letter from the City of Calais stating that the city would withdraw its membership from the authority, effective at the start of the new fiscal year, July 1, 2009. In addition, a February 13 letter from Assistant City Manager Jim Porter gave his resignation as the authority's chairman. Citing "recent developments" Porter wrote that he could "no longer effectively represent" the authority, but he will remain the voting member of the City of Calais until "they leave the organization." The city has created a business plan with the intention of creating its own ambulance service.

The actions by Calais were unanticipated by members of the authority, who had felt that some concerns raised by the city were manageable in nature. With the help of counsel, Eaton Peabody, the authority had begun a work plan, which states that it would be addressing "a number of legal projects relating to collections, organizational structure and possible changes to the WCEMSA enabling legislation," as well as personnel issues. WCEMSA Treasurer Linda Pagels-Wentworth says, "We were trying to make progress to address Calais' concerns."

Newly elected board Chairman Brian Schuth says, "I do believe that almost all of the individuals and communities believe the authority has been well run. We would all like it to be cheaper, of course, but at our last meeting to set the member community contributions, the overwhelming majority of communities stated that they were satisfied with the level of service and with the concomitant expense. At no point has the quality of service of the authority ever been questioned. Downeast EMS is an excellent ambulance service and has been a model for regional collaboration."

At the February 18 authority board meeting, where both letters were read, Pagels-Wentworth suggested that the city's letter be considered a "letter of intent." Saying that the authority needed to "keep the lines of communication open," she stressed the importance of continued discussions and negotiations with Calais regarding their concerns. Chairman Schuth stated, "We are in business, and we intend to stay in business."

Revisiting the past

The City of Calais is not a stranger to the concept of creating its own ambulance service. In November 2000, Washington County's primary ambulance service, McGovern Ambulance Service, and its owner Dana McGovern were charged with a 214-count indictment for falsely billing health benefit programs of almost $1 million from August of 1996 to November of 1999. Former U.S. Attorney Jay McCloskey said at the time, "This is the largest health care fraud case to date in Maine." It also meant that 30 communities in Washington County were suddenly going to be without ambulance service.

Meridian Mobile Health of Bangor contracted to fill in for a period of two to four months, with the hope that during the interim period a permanent solution would be found. At the time, Calais city councillors entertained the possibility of the Calais Fire Department researching and creating an ambulance service, as well as the possibility of a Calais Regional Hospital ambulance service, but voted to enter into an agreement with Meridian instead. Dan Bahr, then regional coordinator for EMS, stated, "Calais could start its own ambulance service and make money."

On January 21, 2001, the 110th Maine Legislature enacted emergency legislation to create the Washington County Emergency Medical Service Authority (WCEMSA) as a quasi-municipal nonprofit agency to provide emergency medical services. Despite the legislation, the City of Calais continued to pursue the possibility of its own ambulance service. According to a January 31, 2001, report filed on WQDY's website archives, Fire Chief Dan Carlow was asked to research the feasibility of a service run by the city's fire department. Meridian refused to participate in the planning process suggested by the city, saying that it would not consider any option but a regional approach to a new ambulance. A few weeks later the city agreed to participate in the newly created ambulance authority.

A small margin for error

“The action by the City of Calais has made it very precarious for everyone," says Pagels-Wentworth, who is also Washington County manager. However, Calais City Manager Diane Barnes insists that the business plan has taken the regional impact into account. The plan says, "The percentage that Calais makes up of the total subsidy is of great importance. Other paying communities may be at risk of increased cost of service or the potential loss of service. It may be possible and desirable to have the city contract with and provide coverage to the surrounding communities once established within the city."

Because the Calais ambulance service business plan budget has a small margin of error, with only $41,956 in estimated annual savings to the city's overall budget, unanticipated budget items could play a critical role in its viability, as well as the regional health of emergency service. Line items that are not described in the budget include the increased cost to the city for items that the authority currently pays for, such as fuel. WCEMSA has an annual budget of $55,000 for fuel. Pagels-Wentworth comments that the margin of error for the plan is very small. Fire Chief Carlow says that while he did not put the ambulance proposal together, he feels that the plan as put on paper appears viable.

The City of Calais Emergency Medical Services Business Plan, dated February 2009, was created by Barnes after the city brought a series of concerns to the authority's attention from January through September 2008. According to a list of actions taken by the City of Calais and provided to the press on February 20 by Barnes, the city's primary concern is what it perceived as an inequitable stipend fee structure.

"The stipends were put together because we needed to have enough to run the system," says WCEMSA Chairman Schuth. "I am confident that if Calais were to remain in the authority and work actively with us to resolve the issues in question, we could retain a strong emergency service that protects all of us, without undue burden on any single community."

The city houses the authority's vehicles and has provided fire department assistance at the city's expense. The business plan states that out of a city budget of total expenses for ambulance service to Calais of $246,520.68, the authority reimburses the city $32,000 for one-half the annual expense of the fire chief's salary and overtime expenses. The city's budget includes: the annual stipend, $93,750; cost of benefits for fire chief and firefighter, $40,346.94; firefighter, $27,097.72; firefighter's 5% pay increase, $8,320; dispatching, $4,160; and one-quarter of all utilities, $10,937.

"The real issue," suggests Chairman Schuth, is that "there were a lot of arrangements in the early days that intertwined functions of the authority and Calais that are no longer useful."

Each WCEMSA member community pays $15.50 per capita, with Calais, Eastport and Lubec assessed additional amounts to cover capital expenses. For 2008 Calais paid a total stipend of $93,750, and Eastport and Lubec paid total stipends of $94,500 each. Danforth paid the next largest stipend of $41,173. The remaining communities ranged from $2,200 to $13,132. Calais is the largest member community with an approximate population of 3,400, and Eastport and Lubec each have about 1,600.

According to figures provided by Eastport City Manager George "Bud" Finch, Calais is paying $61,488 in total per capita and $32,261 in capital assessment; Eastport is paying $29,481 in total per capita and $65,019 in capital assessment; Lubec is paying $27,822 in total per capita and $66,677 in capital assessment. Finch says of the amounts, "It is a complex formula designed by Calais, Eastport and Lubec when the authority was created to fairly offset the costs of the three base stations adjusted to cover the cost of basing the transfer business in one of the base stations as well as to meet the needs of each base stations operations."

WCEMSA receives approximately 2,200 calls for service per year. The Calais business plan uses Maine EMS figures that show that the Calais base responds to 60-70% of all calls. The business plan calculates that the city could expect about 1,400 calls with 700 being transports. Their budget is based on the assumption of 700 emergency transport runs. The plan cautions that call numbers are expected to remain level because of "stagnant or decreasing populations."

At the authority's February 18 meeting, the member community of Baring showed a letter it had received from Barnes. The letter states in part, "The City of Calais is open to discussing a business arrangement with any community that may want to contract with the city for its emergency medical services."

Debt collection is anticipated to be an area of concern and one that Calais had brought to WCEMSA's attention in its list of actions. The business plan states, "There is a large Medicare population in the proposed service area with an average age of 45. This population will continue to age over time causing reimbursements for services to decrease. It will be necessary to be aggressive in collections to balance the decrease in reimbursements from the state and federal governments."

The business plan budget has a line item for annual uncollectible debt of $50,000. Currently WCEMSA has over $500,000 in outstanding bills, accrued over the lifetime of the authority. WCEMSA's debt load averages to about $65,000 per year over the eight-year period. Using these figures, Calais' line item of $50,000 would fall within a similar range of annual write-off as WCEMSA has experienced if using the 65% calculation. In the city's list of concerns presented to the authority in September 2008, it states, "Billing/collections C Calais wanted the authority to take a strong approach at handling the uncollected debt." According to Calais Fire Chief Carlow, "A large portion of debt is built in as write-off C $600,000 [for WCEMSA] is not a large amount."

Four months to plan

WCEMSA is working quickly to ensure that there is ambulance service continuing at the start of July 1. While keeping the lines of communication open with Calais, both Chairman Schuth and Treasurer Pagels-Wentworth recognize the need to start the planning process. The finance committee is meeting weekly and the board every two weeks. Top concerns are the future location of the authority's administrative office and vehicle housing; communication and dispatching; and staffing. Carlow had suggested to the authority's board that they find an alternative location as soon as possible. "Much fairer working situation if that happens," he said.

At the authority's February board meeting, the suggestion was raised that the future of the ambulance service could be with county management. Pagels-Wentworth said, "The county has a strong interest in seeing the ambulance survive. No specific discussions have taken place yet, but the county commissioners are meeting the first week of March." She suggests that there may be a way to blend different county organizations or contract with other sources that have not come into the area before. "What other ways can we meet the needs of the area?" she asked. She then said, "Keeping in mind what's best for Washington County is in everyone's best interest."

Chairman Schuth, reporting on a February 25 meeting with Barnes and Regional Emergency Medical Services Coordinator Rick Petrie, said that it was a productive meeting. "There is still some opportunity to work on negotiations."