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Serving Northern St. Louis County, Minnesota

Ambulance impasse

Greenwood and the city of Tower should discuss issues that could make a difference


Representatives from Greenwood Township and the city of Tower should stop talking past one another and sit down to discuss what is really at issue in their ongoing impasse over financial support for the ambulance.
None of the minor complaints raised to date by the area’s largest and wealthiest township justify failure to support its local ambulance service. If Greenwood has real concerns, such as the city council’s lackluster management of the Tower ambulance service, they should sit down with council members and talk it out. That could actually be constructive.
Anyone with a calculator can determine the primary causes of the ambulance service’s recent budget shortfalls. While Medicare reimbursement rates and other factors are stressing most ambulance services, Tower’s service could at least be cash-flowing if the city council and the Tower Ambulance Commission would make two changes. As we reported last week, the city had to contribute just over $40,000 to ambulance operations last year due to the enormous cost of its ambulance payroll. It’s too small a community to sustain that.
Tower’s on-call pay is exceptionally high compared to other area services, as our report this week makes clear. Tower’s ambulance is in trouble in large part because it was saddled by a previous city council and the former ambulance director with an on-call pay rate that was never properly analyzed and that is clearly unsustainable.
The city could cash flow operations of the ambulance if the city council reduced that rate of on-call pay by $2.50 an hour and the ambulance commission agreed to eliminate its $1.66 charge for every mile the ambulance is driven on an inter-hospital transfer. The Emergency Medical Services Regulatory Board identified precisely these two issues in its 2021 evaluation of Tower’s ambulance service and recommended elimination of the mileage fee as well and cutting its on-call pay by half. Unfortunately, neither the city nor the ambulance commission took any action in response to these recommendations.
As the EMSRB noted, the $1.66 charge assessed to the Tower ambulance was unprecedented in their experience, since most would-be benefactors to an ambulance service don’t actively harm that service by imposing a penalty for trying to boost revenues.
If Greenwood officials wanted to be constructive, rather than simply combative, they would raise these legitimate management concerns with the city council and the ambulance commission. While some try to lay the blame on the current ambulance supervisor for the service’s financial woes, the supervisor has little control over the service’s finances. It is the city council and the ambulance commission that control pay rates and the mileage fee and they have been unwilling to take the obvious steps to get the service back on track financially. While the service is likely to continue to show deficits for the foreseeable future, due to uncompensated depreciation, the two changes addressed here would at least allow the city to cash flow the service without having to cover the bleeding with regular infusions from its general fund.
Rather than address substantive issues, the city and the township argue about inconsequential matters. Such as whether the city has kept up with its payments of the $1.66 charge. Here’s the reality: When the ambulance replacement fund (where the $1.66 funds go) ends up short of cash for ambulance purchases, it’s the city that makes up the difference from its general fund. In other words, the city ends up making its payments to the ambulance replacement fund, and then some, one way or another.
Greenwood’s liability concern over its contributions to the ambulance replacement fund is another example. The kind of liability at issue with an ambulance service would involve an injury or a “tort” in legalese, which requires a demonstration of negligence. Making a donation toward the purchase of a new ambulance, from a reputable supplier, to be used by trained and certified staff of a state-licensed service, is never going to meet the definition of negligence, regardless of what some attorney says. Greenwood should quit using it as an excuse to refuse contributions to the ambulance fund.
The debate over basic life support versus advanced life support is more of the same. As Ely’s ambulance has demonstrated, funding ALS service is impossible without massive subsidy (as in many hundreds of thousands of dollars annually) from taxpayers within the service area. Ely has the advantage of more runs and its own hospital, which guarantees it as many transfers as it can handle. Even so, it’s hemorrhaging red ink to the tune of a quarter million dollars a year. The red ink would be far worse in Tower’s case. Who’s going to pay for that? If history is any guide, it won’t be Greenwood.
It’s time for honest conversation about how to fix what ails the Tower ambulance service. Let’s drop the talking points and roll up our sleeves.