Hazard some history
Thank you for the excellent story and accurate reporting in the Paramedic article published April 4. As a prior Mono County Paramedic, and program founder, I have some additional information that might explain the structural defects in the funding of the Paramedic budget.
Mono County’s program is unique because of how it is structured. It is not a private ambulance system and it isn’t structured under a fire department system. It is what I’ve always described as a “Third Agency” system. The majority of the citizens and current paramedics likely don’t understand the history of this paramedic system and why it’s such a difficult problem to fund adequately.
I got involved in emergency medicine in 1972 in Los Angeles County. Just prior to that time, the pre-hospital transportation services were simply an ambulance ride from an accident or home to the hospital. It was against the law to provide emergency medical care beyond simple Red Cross First Aid, provide oxygen, and perform suction to clear a patient’s airway in the back of an ambulance. EMTs were just coming to the field as an attempt to provide training for additional treatments prior to arrival at the hospital and improve patient outcomes. I received my EMT certificate at the same time California was just starting the first pilot paramedics program. I became one of the first certified paramedics in L.A. County, graduating in 1975. Beginning in 1976, six of us moved up to Mono County.
During the 1960s and early 1970s Mono County met its requirement to transport the sick and injured by having the Sheriff’s Department transport people in the back of station wagon patrol cars. You can imagine how well that worked out.
Prior to the 1970s, Mono County had experimented with a number of ambulance services, many of them privately owned. At one point in time, in June Lake, a guy had a four-door 1957 Chevy sedan with the back seat removed. He would load the patient on a backboard and slide them through the trunk head first to transport them.
In 1973, American Ambulance Service came to Mammoth and operated until about 1975, but they were unable to collect the ambulance fees and financially make it. This is where the first signs of the problems of today began.
They sold the ambulance to Mono County with the belief that with its accounting and collection services the County would be more efficient banking revenue. The County now owned a private ambulance system, the equipment, and the EMT staff.
Between 1975 and 1976 the EMT’s, with approval of the County Health Officer, began to upgrade the service level from EMT care to Paramedic Care. The EMT staff paid its own way to Paramedic School, equipment was improved and medical drug supplies added. The staff never sought attention for its new skill levels and no salary increases were given. Mono County had a full paramedic system for the price of EMTs.
In 1976, two boys were riding on their dirt bikes out on Sawmill Road when they hit a tree and one of the boys sustained major head injuries. Mono County paramedics transported him to Bishop Hospital, before he was taken to UCLA Medical Center where he lay unconscious for several days. He woke up and spoke to his parents on Christmas Eve. The parents were told that the only reason their son survived was because of the paramedics in Mono County. This endeared the paramedics to the citizens of the County and changed the status of the program from that day forward.
However, an article in the LA Times and the local media marked the first time the Mono County Board of Supervisors learned it had a paramedic program and not just an ambulance service staffed with EMTs. Board members felt deceived, misled, and betrayed. A very real distrust formed between the Board of Supervisors and the medics.
In 1977, the county experienced a budget shortfall in the amount of approximately $300,000. The Board members now believed the budget shortfall was due to the increased cost of having Paramedics and not EMTs. Due to the mistrust that had formed, the Board attempted to end the program.
The Board issued layoff notices to the entire staff in April, 1978, effective if Prop 13, which significantly decreased tax revenue to the County, passed. The Board planned to return the service program to the Sheriff’s Department and figured any problems would go away.
When these layoff notices became public the first group of community leaders began meeting to look at options to save the paramedics. The group considered a sales tax increase and fees, but this wasn’t practical because of voter anger. In August, the State came out with bailout money after Prop 13 passed and the County reinstated the program as it was, without cost savings or reduction of services.
In 1978, the Mammoth Station was handling about 300 calls per month in the winters. Of those calls about 90 were for Advanced Paramedic care while the other 200 were transportation calls.
This 90/210 ratio is important because the service was still based on the private ambulance model. Emergency calls are money losing when you respond and treat anyone who requests service. The 200 transport calls are billed with a profit design to offset the loss on the emergency side. The Mammoth Station was a break even station. In fact, it partly paid for the June Lake and Coleville stations.
From 1980-1983, Mammoth had several large earthquakes and received a lot of bad national press. The County was in bad financial shape and the paramedics were back on the chopping block. Another committee was formed to explore funding options.
They recommended a sales tax increase, which would require a 2/3 voter approval as dictated by Prop 13. This failed at the ballot box. Over the next 12 years at least three sales tax increases were attempted and all failed. After this continued failure, a TOT tax increase was tried and passed. This is part of the funding that is in place today.
By this time, most of the original paramedics had moved on to other career opportunities and the replacement medics wanted to be paid at the average paramedic salary of fire service employees. This is still the situation today.
In the mid-’80s, the Town of Mammoth Lakes was formed. The Town, County, and Mammoth Lakes Fire would jointly fund the program. The medics would move from the hospital to the fire station. This system lasted for several years and was then disbanded.
At about the same time, the County gave up the transportation side of the private ambulance system it purchased when Mammoth Hospital offered to take over the transportation calls at no cost to the County. By doing this, they lost all that income and the budget shortfall became exponential. When the County stopped transporting, the whole money-making, break even, close-that -ap side of the equation was gone. That set the stage for where we’re at today.
In the 1990s, the U.S. Congress passed the Fair Labor and Standards Act (FLSA). In the law, Fire Departments are exempted from the standard 40-hour work week and the requirement to pay overtime after the 40 hour cap. Mono County’s third agency does meet the definition of a fire service and therefore does not get the exemption.
The paramedics work on average ten, 24 hour shifts each month. This mandates that they will be paid overtime on each pay period. Their salaries are listed as lower because when the overtime is added it makes their pay fair and reasonable for the positions held.
In the mid-1990s the medics were again restructured and placed under the management of the Sheriff’s Department. During this time, the Board of Supervisors closed the Bridgeport Hospital and replaced it with another paramedic unit. This increased the budget shortfall again. For several reasons this program was ended and today the medics are now back as a third agency.
Since the removal of the medics from the Sheriff’s Department, at least three other citizens groups have looked at options. Around 2010 the Board of Supervisors went to an outside consulting group and paid for an independent review. The resulting Fitch report is remarkably similar to all the prior findings. The current committee will likely come up with some variation of prior groups’ recommendations that have been made all through the years since 1978.
The big question: does the current Board have the political desire to fix the structural problem. They will be faced with significant political pressure to maintain the status quo. The individual Supervisors will face a choice of changing the system and being threatened with recall or not being elected, or turning away from all the past recommendations. To date the Board has not been able to find the three votes needed to make the needed changes.
Please stop blaming the paramedics for a structure they had no say in forming and don’t have the power to change.
As a side note: This letter was to inform the citizens of the issues at hand. I have fought to save and preserve this program for 2/3 of my adult life. I have sat on a number of these working groups and heard the discussions and the resulting recommendations. I have no interest at this time to become involved in the debate or the outcome of this latest round.
I am proud of my service both with the Mono County Paramedic Service and in support of that service over my 37 years of involvement.
Duane ”Hap” Hazard