Ambulance proposals raise questions, concerns

SPENCER – This month, Selectmen will interview two bidders who seek to provide emergency medical services for the town. On December 8, representatives from Cataldo Ambulance Services will field questions from the board. The appearance by Action Emergency Medical Services is tentatively set for December 18.

Selectmen on Dec. 3 held a special meeting to discuss both proposals put forth by the ambulance companies.

Town Administrator Jeff Bridges said both parties complied with the request for proposals  but deviated in costs.

Action said it would provide one ALS (advanced life support ambulance) 24/7 at no charge in the first year. Adding a second BLS (basic life support vehicle) would cost $334,054 for 12-hour days. For an advanced life support ambulance, the cost would be $394,459 in the first year, rising to $406,000 to $418,000 in subsequent years.

Cataldo’s quoted price is $425,000 in the first year. That includes a 24/7 ALS  vehicle and a second vehicle with basic services for eight hours, seven days per week.

No information was provided by Cataldo as to costs beyond an eight-hour day or for the possibility of advanced life support services on the second vehicle.

In addition, Bridges said, both companies are willing to provide training of public service personnel and have emergency dispatch services. However, they did not address how they would tackle a problem with mutual aid, namely that Spencer uses mutual aid at a level twice as much as it gives.

Mutual aid ratio is an issue

“We have an upside-down problem with mutual aid,” Selectman Ralph Hicks said. “It can’t go on forever (with this ratio).” Hicks added the board is tasked with finding coverage “that makes sense without sending us to the poor house.”

Fire Chief Robert Parsons noted the town would never be able to eliminate mutual aid because of the “sheer number of calls.”

He cited that morning’s experience of having three or four calls come in at the same time. Later in the day, that same scenario happened. That evening, Parsons noted, Leicester and Charlton were providing services after Spencer’s second vehicle completed its work for the day.

Parsons said it would be reasonable to extend the second ambulance’s hours to at least 12 hours, or ideally 16. His opinion on the RFPs is that the companies provided only what the contract called for and “nothing over and above that.”

“They did not say what coverage would be needed and they didn’t talk about mutual aid,” Parsons said.

The fire chief questioned whether the companies could extend the hours of the second ambulance or backfill from their own vehicle fleet. But that raised the question of where their vehicles are located and how long it would take to reach Spencer calls.

Whether it is responding to three or four calls at once or one accident with a lot of patients to be transported, Parsons added, “It would be nice to have one more truck on. It would help.”

Bridges noted that the board needed to negotiate these things as the process moves on.

Hicks responded that as much as he would like to see two full-time ALS trucks, at a minimum, the town needed a second ALS ambulance for 12 hours per day.

“It’s a tough sell as it is,” Hicks said. “We’ve got to do what we’ve got to do to protect our people. It is critical to have ALS. BLS scares me.”

Bridges noted that the RFP states that one of Spencer’s goals is to cut down on relying so much on mutual aid. “We asked them to propose the level of service the community needs based on call volume. They did not do that. They mirrored what we have with Spencer Rescue Squad (now) rather than estimate a level of service and justify it through numbers.”

“Action (did) give us a vision of, if you want more, contract for more,” Bridges noted.

Selectman Gary Woodbury said the meetings with the bidders would afford members the opportunity to ask questions about the information that is not contained in their proposals.

Lump sum proposal `underwhelms’ selectman

Several selectmen said they had questions as to why Cataldo’s cost had such a large increase since the last time they spoke with the board. (At that time, they said it would be $250,000 and now the proposal is for $425,000).

Of the responses, Vice Chairman Jonathan Viner said he felt “underwhelmed,” because they lacked a plan for lowering or leveling mutual aid and did not spell out what an appropriate service level would be.

“With Cataldo’s lump sum, I’m not sure what we are getting for that,” Woodbury noted. “That’s what bothered me.”

Chair Jared Grigg said he wanted to know the price for one ALS 24/7 ambulance and one ALS  12-hour vehicle.

Another issue raised, but not included in their responses, was a subscription service like Spencer Rescue Squad has whereby a fee covers ambulance rides if insurance does not pay.

Members also talked about how Spencer Rescue “writes off” what it is not reimbursed by Medicare and Medicaid benefits.

Grigg pointed out that Spencer Rescue is a nonprofit and these companies are not.

“They are for profits. Why would they write off debt when they can bill for it?” he noted.

Internal solution investigated

Concurrently, the administrator is looking into what it would cost to make Spencer Rescue Squad a town department.

“If we can do it ourselves for less or the same money, it may be the way to go,” Hicks said.

After setting the two dates for interviews, board members said they would visit both facilities and come to a decision before the end of January.

Parsons reminded selectmen the companies need to follow a timeline that includes getting proper licensures and finding a facility in Spencer from which to operate.

Bridges said that amount of time is also needed to “run numbers on an internal solution.”