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Emergency? Fulton County officials grapple with ambulance service shutdowns

A St. Johnsville Ambulance Corps. ambulance waits after transporting a patient to the emergency room at Nathan Littauer Hospital in Gloversville on Wednesday morning. (The Leader-Herald/Michael Anich)

JOHNSTOWN — Fulton County isn’t prepared yet to assume administration of all emergency medical services within its borders. Officials maintain numerous issues must be pondered before they take that step forward.

But authorities are gearing up for that possibility, especially after the county was thrust into a now-evolving situation created earlier this year when the county’s two highest-profile ambulance units shut down.

Now, the county is deciding whether to pursue an official Certificate of Need, or CON, from the state Department of Health. They are working on a “business plan” about ambulance services.

“We are slowly and surely coming to a decision on that,” says Fulton County Board of Supervisors Chairman Jack Wilson. “I definitely see a Fulton County CON coming at the end of the year.”

Fulton County officials have either visited or communicated with other counties, which have experienced similar EMS crisis situations and created their own countywide units or are considering it. Those include Schoharie, Essex, Warren, St. Lawrence, Columbia and Greene counties.

Fulton County Emergency Management Office Director Steven Santa Maria is the point man in the county's information-gathering process into whether county government takes over EMS services. (The Leader-Herald/Michael Anich)

Current estimates are that it may cost up to $6 million for Fulton County government to create its own ambulance unit.

Wilson said if the county decides to assume all EMS, and secures proper documentation, its CON would supersede or have preference over any scheduling of ambulance operations currently going on in the county. He said it more importantly allows Fulton County to sit down with organizations such as the Greater Amsterdam Volunteer Ambulance Service — currently handling most of the county’s calls — and work on a county-guided, controlled plan moving ahead.

“We’re taking this very seriously,” Wilson said.

What happened

Fulton County is currently in a fact-finding process. County supervisors responded when the longtime Gloversville-based Ambulance Service of Fulton County — the county’s busiest EMS unit at the time — pulled its around-the-clock critical care services off the road Feb. 8. Financial reasons were cited.

The Fulton County Board of Supervisors has a decision to make on whether county government will be assuming all emergency medical services and ambulance transport in the county. (The Leader-Herald/Michael Anich)

Financially-troubled JAVAC in Johnstown followed suit shortly thereafter on March 16.

Prior to that time period, the Broadalbin Volunteer Ambulance Corps had merged with GAVAC.

Most regular ambulance calls with advanced life support in Fulton County are now mostly being handled by GAVAC. Officials say GAVAC has handled over 3,000 calls in Fulton County since Feb. 8.

Aside from GAVAC, Fulton County is getting EMS assistance from the one-ambulance Johnstown Fire EMS unit, and Northampton Ambulance Service, and other regional sources serving the western part of the county such as the St. Johnsville Ambulance Corps and the Mohawk Valley Ambulance Corps.

The Johnstown unit is pursuing a second, new ambulance estimated at $200,000 through the city.

About 60 percent of Fulton County’s EMS calls are in the city of Gloversville — the county’s population center.

“We are probably doing 98 percent of the calls in Fulton County,” said GAVAC Executive Director Tom Pasquarelli.

He said most of the rest of the calls are being handled by Johnstown and Northampton. Since February when the Ambulance Service of Fulton County went out, Pasquarelli estimated his agency has handled more than 3,000 calls in Fulton County. He said a similar amount of calls are handled by GAVAC in Montgomery County.

Looking at the future

But Fulton County officials wonder if any other existing ambulance services could fold. Officials earlier this year started talking about whether the county should take over, creating one county operation.

Gloversville 4th Ward Supervisor Charles Potter in May was one of the first to publicly bring up the possibility of the county itself running future ambulance services. He said he wasn’t suggesting the county get into the ambulance “business.” But Potter said Fulton County needed to “take a bigger seat at the table” regarding EMS coverage, especially as it relates to the county’s 2020 budget.

Potter said this past week that he pretty much feels the same — that Fulton County needs to prepare better for EMS for the future.

“I believe the county should pursue a Certificate of Need,” he said. “I don’t know where the ambulance services stand financially, with reimbursement.”

Potter said that at “any given moment,” EMS services could be greatly diminished, leaving Fulton County residents high and dry.

Oppenheim Supervisor Cynthia Breh, chairwoman of the Fulton County Board of Supervisors’ Public Safety Committee, said the financial aspects of assuming EMS responsibility is overwhelming.

“We all know the ambulance services have been a really contentious situation with the Medicaid and Medicare reimbursements,” Breh said. “It’s really sad.”

Breh noted ambulance units have had to shut down because reimbursements are not there to keep them afloat.

“There’s still a lot of work to be done on this,” she said. “We have to figure out the financial aspects, as well as the safety aspects.”

For GAVAC, she stated, “That’s a huge undertaking for them.”

But Breh said the county taking responsibility for EMS will also trickle down with costs to municipalities, such as her small town of Oppenheim.

“Our revenue is limited,” she said. “Someone will have to bear the cost.”

Fulton County Emergency Management Office Director Steven Santa Maria said the county continues to collect data and no decision is forthcoming in the very short-term. But he said more “significant” meetings on the subject may be coming up this fall.

In other words, stay tuned.

“We’re still meeting with stakeholders across the county,” Santa Maria said.

Preparing for the unknown

The county is so invested in improving the advanced life support situation — especially following the decisions by ASFC and JAVAC — that it created a full-time emergency medical services position, now filled by Mark Souza. He has been working closely with Santa Maria to see what Fulton County needs to plan ahead.

Santa Maria said Fulton County has been “unique” over the years, having more numbers of volunteer ambulance corps than most counties. To some extent, he said the county has relied on unpaid ambulances.

On the subject of whether a county operation would put smaller operations out of business, Santa Maria stated, “I think that’s looking too far ahead.” He said the county has to balance the taxpayers’ concerns with public safety need. Medicaid rates are being studied. More training will be needed.

Santa Maria said there is also a shortage of skilled ambulance staff statewide and nationwide.

“We’re really trying to look at this CON process and see if it makes sense,” he said. “There’s a lot happening behind the scenes.”

Seventeen counties in New York now have county-run EMS operations. Officials say Fulton County’s calls are being answered, but some counties that don’t run their own units are only getting 80 percent of their calls answered.

Fulton County Administrative Officer Jon Stead said county government would “not necessarily” have to create a new department dealing with EMS.

“I think there’s actually a number of options,” he said.

But Stead said the CON would make the county “responsible” for coordinating EMS services throughout the county.

“We have not determined that,” he said.

GAVAC

GAVAC, now the biggest EMS game in town based on Guy Park Avenue Extension in Amsterdam, has stations in Amsterdam, Fonda, Fort Plain, the town of Broadalbin and the Berkshire firehouse.

Pasquarelli said GAVAC has been licensed to serve Fulton County “forever,” well before February. Prior to that time, he said GAVAC served communities in eastern Fulton County such as Perth, Broadalbin and Mayfield.

He said GAVAC may not have a station in the Glove Cities, but can reach a distressed person very quickly. The corps has 15 vehicles, including 12 ambulances. He said GAVAC has more than 100 staff members available for its daily operation.

“We’re always moving,” Pasquarelli said. “We generally try not to sit at the station. We stay busy.”

Pasquarelli said he meets regularly with Fulton County officials, claiming there is no concrete plan yet for EMS.

“They don’t even know what they’re doing at this point,” he said.

There are many decisions to make, such as who will fund a county operation, including the question of whether it will be taxpayers, he said.

“The fee for the service model is broken,” Pasquarelli said.

Pasquarelli said that 28 ambulance businesses have closed this year in New York state.

“We’re a fairly strong organization,” he said of GAVAC.

He pointed out that one typical day this past week, GAVAC handled 36 calls in Fulton County.

“There’s days when there’s 60,” Pasquarelli said.

He said GAVAC won’t be broken financially if Fulton County takes over running EMS, noting GAVAC was “doing just fine prior to this.”

Pasquarelli also noted Fulton County is in a preliminary regulatory process, even if it is looking at securing a CON.

“A CON doesn’t really mean anything,” he claimed.

But Fulton County officials are treating the future of EMS and advanced life support as something.

Stead said that Fulton County, which has tried to downsize in the past decade such as selling its former infirmary, has a “big decision” to make.

Asked if taking over EMS would represent Fulton County again increasing the size of government, the county’s top administrator had a direct answer.

“Yeah, I guess it would be,” Stead said. “That’s one of the reasons it’s taking awhile to evaluate. It would be an expansion of government.”

Michael Anich covers Johnstown and Fulton County news. He can be reached at manich@leaderherald.com.

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