TOWER— Council members had billed Monday’s special meeting with the city’s ambulance staff as a listening session, and they got an earful from members who were concerned by a new …
TOWER— Council members had billed Monday’s special meeting with the city’s ambulance staff as a listening session, and they got an earful from members who were concerned by a new business plan that laid out possible changes to the service’s current pay structure for its on-call staff.
The proposed change of most concern to ambulance personnel was one of three scenarios, drafted with assistance from Betsy Olivanti, of the Northeast Small Business Development Center, which called for full-time paid on-call staffing, but at a lower hourly rate of pay than at present. Council member Dave Setterberg had also proposed a fourth scenario for consideration as part of the business planning effort.
The city converted its ambulance staffing from an “all-call” system, under which every member was subject to page at all times and was paid for responding, to a paid on-call model in 2018. While many area departments have taken similar steps in recent years, in order to attract additional EMTs, Tower’s pay structure was substantially higher than other small services in the area, with pay rates of $10.50-$11.50 per hour. The council, back in 2017, agreed to the shift to paid on-call staffing and the relatively high wage rates with the promise by then-ambulance supervisor Steve Altenburg that an increase in the number of inter-hospital transfers would pay for the higher expenses.
Many of the ambulance personnel who spoke Monday night appeared to believe that the paid on-call system has worked well and that the service had maintained its level of profitability. “Why change the pay structure if the service has been profitable?” asked Dean Dowden, currently a paid on-call member of service.
Clerk-treasurer Victoria Ranua responded from a legal standpoint, noting that the ambulance service had not been operating in accordance with state law, which requires that all services maintain a written on-call schedule, with two staff in on-call status at all times, 24 hours a day... Even under the paid on-call system implemented in 2018, the service had on-call personnel scheduled only half the time, she said. That kept down the cost of the paid on-call system but left the service out of compliance. Staffing the system in compliance with state law would cost well over $200,000 annually at the current on-call pay rate, on top of the per-run pay that ambulance personnel receive— an outcome that would never be economically viable for the service.
Even with half-time paid on-call staffing, the service has seen its profitability diminish significantly, according to the financial data outlined in the business plan— from an average of just over $100,000 annually prior to the shift to paid on-call, to less than $20,000 since.
While department revenues did increase with a higher number of transfers, the department’s expenses more than doubled with the higher payroll costs and related expenses, and travel costs associated with transfers.
The department is currently showing a $13,000 operating profit for 2020, according to data in the business plan, but that does not include the cost of purchasing the department’s new ambulance. With associated equipment, the cost of the new rig reached $250,000, a significant portion of which was paid out in 2020.
In the past, the service’s surpluses had helped to cover the cost of ambulance and equipment replacement, so the sharp decline in profitability is a concern, unless the service can obtain grants or other revenue sources to cover those costs.
Robert DiCasmirro, a close friend of Altenburg, made it clear he wasn’t accepting Ranua’s explanation, the numbers in the business plan, or the need to comply with state statutes regarding staffing. “I don’t understand how you people think,” he said angrily to the council. “You want to comply with state statutes, but sometimes in a rural area, you need to bend a little.”
The state recently did provide rural departments additional flexibility, by allowing them to staff just one EMT, rather than the two previously required. Lesser-trained personnel, called emergency medical responders, or EMRs, are now allowed to be included in the schedule to make it easier for rural departments to meet staffing requirements.
DiCasmirro argued that the department would be doing better if it took more transfers, as Altenburg had proposed. “When Steve [Altenburg] was here, we did 40 percent of Ely’s transfers,” he said, and he suggested that the service accepts fewer transfers because its personnel don’t have confidence in the city council. “People don’t want to do them because of what this council has done,” he said. “I’m so disappointed in you.”
The viability of Altenburg’s model has never borne out, however, as the financial data in the business plan makes clear. An extremely low utilization rate of its on-call personnel is part of the problem. On-call staff, on average, have had calls only seven percent of the time for which they’re paid, according to the financial data in the draft business plan. Most ambulance services seek to maintain their utilization rates at between 30 and 50 percent, to maximize resource efficiency. While smaller departments generally see lower utilization rates, they make up for that by running as volunteer systems, or with a lower pay rate for on-call personnel.
City officials have also been advised by legal counsel that the current wage rates are a virtual acknowledgement by the city that the on-call hours are “compensable,” which means they could be subject to overtime pay after 40 hours. The ambulance service did not pay overtime under Altenburg, although the service could still face liability for back pay if any employees were to challenge that decision. More recently, the service has limited staff hours to 40 per week to avoid overtime liability, and that has already had an impact on the pay of its on-call personnel.
Several ambulance personnel argued Monday that any move to cut the on-call hourly pay would likely lead to the loss of personnel.
“Under the model you’re currently proposing, I’d be making roughly $200 every two weeks,” said Steve Freshour, who says he joined the department last year because he wanted to help people. “Who do you know who could make a living on $400 a month?” he asked.
Taunya Erickson, who lives in Buhl and covers staffing hours in Tower on Mondays and Tuesdays, said it wouldn’t be worth it for her to travel to Tower if the on-call wages were cut substantially. One of the scenarios in the business plan calls for reducing on-call pay to the $3-$4 range, which would be in line with the rates paid by the Cook and Orr services.
“This is my full-time job,” said Erickson. “Four or five dollars isn’t going to cut it. I’d be paying more in gas than it’s worth,” she said.
Yet, depending on the pay rate for on-call personnel, it’s not clear that they would necessarily see significant reductions in overall pay under the lower hourly rate, at least compared to their present circumstances. That’s because the lower pay rate would largely resolve the city’s concerns about overtime liability, which would allow ambulance personnel to schedule more on-call hours, as many used to do prior to the enactment of the 40-hour limit. In addition, on-call personnel are not currently paid extra for ambulance runs, whereas they would receive the higher run pay, of $25 an hour, under the alternative scenario. While the unpredictability of when runs occur could make for peaks and valleys in the paychecks of ambulance personnel, over the course of the year, it could leave them with equal or even higher pay than at present, depending on how many on-call hours they schedule.
On-call personnel are not required to be at the hall or at the ambulance residence but are free to remain at home or anywhere else, as long as they can respond to a call within ten minutes. Technically, ambulance personnel, like members of the fire department, are considered subject to call at all times as it is. But a significant number of the members have not regularly responded, leaving the bulk of the runs to just a handful of members, prompting concerns over burnout. The shift to paid on-call was supposed to address that concern, but it’s had mixed results as it prompted a number of previously responsive members to cut back sharply on their runs or leave the service altogether.
Ambulance personnel might have benefitted from a better explanation of the business plan, but the business consultant Olivanti. was not at the meeting, as some on the council had expected, and it wasn’t clear why.
The council had delayed calling the meeting to order for several minutes after its scheduled start but opted to go on without her after it was clear she wasn’t coming. Councilor Setterberg told the ambulance staff that the council wanted to hear their concerns before making any decisions on any changes on the service. “We don’t want people to only express their concerns around the water cooler,” he said. “We want to get them out in the open.”
Setterberg said he was interested in allowing the department to conduct more transfers, which pay significantly more than emergency calls, although they typically require much more time. The transfers proved controversial with township representatives on the Ambulance Commission, who were concerned the extra wear and tear on the ambulances would require more frequent rig replacement. The townships contribute each year to pay for ambulance replacement. Last year, at the behest of the Ambulance Commission, the city agreed to contribute $1.61 to the ambulance replacement fund for every mile an ambulance travels on a transfer. Those contributions have further reduced the operational profitability of transfers.
Setterberg suggested the ambulance service could use its own funds to buy a lower cost van to conduct patient transfers, essentially setting up a separate transfer business within the ambulance service, using ambulance staff who are seeking extra pay.
The council had seen no numbers on that option as of Monday’s meeting and they had no information to share with members of the ambulance department.