Paramedics, County seek common ground

In an effort to resolve the historical budgetary and service level issues of the Mono County Emergency Medical Services (EMS) program, the Mono County Board of Supervisors approved the formation of an ad hoc EMS committee at its regular meeting in Mammoth Lakes on Tuesday, March 16. This came just a few weeks after the Board approved $225,326 in contingency funding at the mid-year budget review to backfill the EMS program budget deficit.

The committee is charged with providing the Board with financially sustainable options for the EMS program—not an easy task given the history and uniqueness of the current system, negotiations with the Mono County Paramedic Fire Rescue Association, and the rural nature of Mono County, which houses one of the largest ski resorts on the West Coast.

Mono County EMS is regulated at the state level by the Inland County Emergency Medical Agency (ICEMA), which encompasses San Bernardino, Inyo and Mono Counties. However, Mono County has an exclusive operating area (complete control) for EMS, which they have used to highly subsidize the program, given the small call volume and large area of the county. As the EMS program stands now, there are four paramedic stations in Mammoth, June Lake, Bridgeport, and Walker. Residents of southern Mono County have long response times, given that Mammoth is the closest station to the communities of Crowley Lake, Swall Meadows, and the Tri Valley. Supervisor Fred Stump, who represents the southern district, said that although the County has land in Hamill Valley for a paramedic station, it lacks the funds to build the facility (~$2 million).

With a revised budget of $3.8 million as of mid-year, EMS is the third largest user of the County’s general fund, behind the Sheriff’s Department and Public Works. More than $3 million of the budget goes towards employee salaries, benefits and overtime to staff the four stations.

Currently the Department has 24 full-time employees, 17 medics and seven EMTs, with six reserves. Annual compensation, including benefits, for Mono County paramedics range from $141,360 to $121,504 and for EMTs from $125,030 to $94,120. In addition, eight medics just received step increases and/or longevity payments. However, breaking down the salaries, EMTs are paid $11.99 an hour and medics $15.35—“pretty defendable numbers,” said Alex Johnson, Mono County Paramedic Fire Rescue Association Treasurer. “[Our salaries] are more than someone who works 40 hours at that pay rate, but it’s because we work a lot more.”

Paramedics and EMTs work 48 hour shifts every six days, which averages out to 56 hours a week. Under the Fair Labor Standards Act, each paramedic has 16 hours of regularly scheduled overtime each week, which is budgeted as part of their salaries and wages.

“No other department in the County runs twenty-four seven,” said EMS Manager, and former Mono County paramedic, Rob DeForrest. “It takes us around 80,000 hours a year to staff. A normal office of 8 people is 32,000 or something of that nature. So right there the Department is way over anybody else in the number of hours we have to pay.”

Overtime was the only category that came in above budget at the mid-year review, accounting for 91 percent of the projected budget of $150,000. DeForrest said that every year in his memory, the paramedics have been over their overtime budget at mid-year, although this year is considerably higher than  past years.

“That’s a budgeting problem,” said Dan Flynn, Vice President of the Paramedic Association. “If you under-budget something, we’re going to go over the budget. And that might provide a convenient avenue for yelling at us, but it’s not necessarily reflecting the truth.”

The only option for backfilling the overtime budget at mid-year was to “brown-out” a station, meaning close one of the four stations for a day or two a week, or close stations based on when people take time off or call in sick. “Basically it is giving them furloughs, but with a service cut to the public,” DeForrest said.

Johnson said the furlough model that is being used in other County departments as a cost saving measure doesn’t work for the paramedics program because “We can’t eliminate people without eliminating coverage,” he said. He also said that although it might not seem like the paramedics are taking cuts, “they’re coming up in a few months instead of happening a few months ago, like they did for other County employees… that’s easily misunderstood.”

The additional funds to cover overtime costs push the paramedics’ budget over the $3,441,721 threshold, which activates certain triggers as of July 1, 2015, and each following year, as stipulated by the three year Memorandum of Understanding (MOU) between the County and the Paramedic Association.

This year, the trigger includes loss of accrued compensatory time off. As DeForrest explained, “When someone takes their 100 hours of comp time off, all those hours are [staffed] using overtime, which turns into 150 hours. But the second guy takes that 150 hours as comp time rather than overtime, which turns into 225 hours of overtime for the next paramedic … It just keeps growing.”

DeForrest added that this trigger is not a cut: “Paramedics get paid overtime for their extra time instead … but they can’t bank it and it can’t be turned into more overtime.”

Starting in 2016, the triggered cuts include “paying up to 20 percent of our health care premium, a 5 percent reduction in base salary of all employees, and changing our schedule to 48 hours per week instead of 56 hours per week,” Johnson said. Cutting the weekly hours would result in a 19 percent decrease in salary, something the Paramedics Association opposes, Johnson continued.

This isn’t the first time the County has tried to find solutions to the issues surrounding the subsidized EMS program. In 2012, the County spent $80,000 on The Fitch Report, a 100 page document outlying the history and issues of the program as well as some basic recommendations for how to improve it. Some of the suggestions in this report have been implemented, including a change in ambulance staffing from two paramedics to one paramedic and one EMT, reducing overtime expenses through hiring reserve EMTs, increasing employee healthcare costs (from $50 to $100 a month per family), and eliminating fire/rescue training.

In FY 2014-2015, the paramedics program was budgeted approximately $1.1 million lower than 2013-14— a combination of cost savings made by Board and management actions ($600,000) and service and personnel changes ($564,000), argued Flynn and Johnson.

“It’s all a matter of priority … we understand there are limited funds available and ultimately it’s up to the taxpayers what kind of a program they want,” Johnson said. The Association is eager to participate in the EMS committee in order to find solutions, he said.

“If we could have any program, [the current one] would be the system, with an additional station in South County,” Lynda Salcido, Public Health and EMS Director, told The Sheet this week. “But is this the best use of our dollars? Is it what the citizens want?”

“There are all kinds of models for this; all around the State people are really struggling with this issue,” said Inyo County Health and Human Services Director Jean Turner. “Mono’s model is kind of an anomaly … When you look around the state, you won’t see any other small rural county paying what Mono County does.”

In Inyo County, EMS is run through the volunteer fire departments, with volunteer paramedics and EMTs. The only exception is in Bishop, where Symons, a private for-profit ambulance service, responds to calls. Inyo County doesn’t provide any subsidies for ambulance services or a paramedics program.

Olancha Fire Chief Steve Davis said the volunteer system in Inyo County is enough to cover the needs of its citizens, with volunteers providing advanced life support responding to 75-85 percent of the calls.

“It has ups and downs because people move around, people leave, people get old, things change. We’re always fighting to maintain staffing and things like that, but we’ve been really fortunate to keep everything staffed,” he said. “For us, it works and it’s the only option we have. Mono County spends an enormous amount on supporting their system and we just don’t have that luxury down in Inyo.”

“The reality is—the problem with that [Mono County] system—is a wage and salary problem,” Davis continued. “Everybody knows the problem but nobody has figured out politically and socially how to address the problem. Everybody loves the paramedics and they are good guys and they provide good care. But the County isn’t going to financially be able to support the system the way it is.”

While admitting the high cost of the Mono County system, “I don’t think anyone is looking at Inyo County as an ideal model for EMS,” Flynn argued. “I would say that’s the worse-case scenario,” Johnson added.

Flynn said a better comparison might be other counties with ski areas, since the Mammoth Mountain Ski Area accounts for a large percentage of call volume. In 2014, Mono County Paramedics responded to a total of 1,635 calls. 1,042 were in Mammoth, and over half of those were to the Ski Area, DeForrest said.

A call to the South Lake Tahoe EMS Manager revealed that El Dorado County, where the California Tahoe ski resorts are located, charges the ski areas a benefit assessment based on risk, which helps the County supplement the ambulance costs. Mono County does not currently impose such an assessment on MMSA. When asked about this, Mono County Director of Finance Leslie Chapman said, “it has been a topic of discussion and an idea that the new committee will most likely be exploring.”

The committee “isn’t going to come up with one idea and say that it is the best, period. They will provide three or four models of EMS delivery that the Board can take a look at, weigh, and then ultimately make a decision,” Salcido said.

The committee will have six months from their first meeting, which has yet to be set, to come up with their recommendations for the Board of Supervisors. The fiscal impact of the committee is also undetermined, as it is unclear how much staff time it will take.

The Board of Supervisors is expected to discuss the details of the committee, including members and meeting times, at an upcoming meeting.