Editorial: Western District subsidizing Eureka?

Tuesday, January 11, 2011

On Jan. 18, the Western Carroll County Ambulance District (WCCAD) commission will meet, and among other items, will consider once again whether to purchase a second LUCAS Chest Compression machine, to be housed on a City of Eureka Springs ambulance.

The first machine they purchased, for $14,000, is housed in Holiday Island, which is part of the Western District. Eureka Springs is not, although Eureka is the contractor that provides ambulance service in the Western District.

The LUCAS can be a wonderful, lifesaving device. It provides CPR indefinitely at a depth, pressure and rate difficult for Emergency Medical Responders (EMRs) to maintain, and it doesn't get tired like human beings.

But under the contract for ambulance service, WCCAD cannot buy equipment for the ambulance provider, in this case Eureka, to use, and even if it could, that equipment cannot be used inside the city limits. If WCCAD purchases that equipment to be housed on a Eureka Springs ambulance, both conditions will be violated. They have been before.

This was one of the principal reasons for a class-action lawsuit filed in 1998 and refiled in 2005 against WCCAD, county officials and the city for the city's use of WCCAD-owned ambulances inside city limits and for not having ambulances dedicated exclusively to the district.

While the suit was never settled, and the plaintiffs all passed away, in 2002, the WCCAD board, after copious legal advice, rewrote the contract to specify that an ambulance provider would provide its own ambulances and equipment in exchange for 85 percent of the tax millage revenue. Western District residents pay a 2-mill real and personal property tax for their ambulance service. Eureka residents pay their own city tax for such service.

Should the LUCAS be used if it can save a life, even in the city limits?

Of course it should. No one would argue otherwise.

But if Eureka wants a LUCAS in order to provide better care to both city and district residents, it needs to pay for it, according to the contract and the legal use of district tax dollars.

There is also the fact that it takes most EMRs in their districts from one to five minutes to reach a patient, while it takes the Eureka ambulance around 15 minutes to reach patients in Holiday Island, Grassy Knob and Inspiration Point, and often longer than that, due to distance.

Wouldn't it make better sense to have a LUCAS available to be put on a patient within five minutes rather than waiting 15 minutes for Eureka to get there?

Eureka has consistently come before the WCCAD board with hands out to buy equipment it claims will provide better care to Western District residents. The requests have been denied on several occasions because most commissioners saw and understood the legal ramifications of the misuse of tax dollars.

Recently, a request to spend $34,000 on advanced extrication equipment, to be housed on a Eureka Springs ambulance, was granted, under the proviso that it supposedly would only be used by volunteer EMRs on Western District residents. The rationale is that there are no streets inside the city limits permitting speeds high enough to necessitate the use of the equipment to extricate victims from a high-speed crash. That may be debatable.

There is also the fact that very few Eureka rural EMRs show up to calls. The people using the equipment are likely to be paid Eureka personnel.

In addition, Eureka Fire Chief Rhys Williams could not guarantee the LUCAS would be removed from a city ambulance handling a transfer call, that is, a money-making, non-emergency transfer between a hospital and a nursing home or even out of the county. Thus, some of the time, the LUCAS might not even be available for use in the Western District.

Eureka Assistant Fire Chief Bob Pettus has argued that the city subsidizes Western District calls, that the millage revenue is not enough to cover its service.

Let's look at the figures.

Under the contract, Eureka gets 85 percent of those millage revenues, while WCCAD retains 15 percent, with which it pays for training, equipment, clothing and supplies for each of the five rural fire district's volunteer EMRs.

Those departments are Inspiration Point, Grassy Knob, Holiday Island Rural, Holiday Island District and Eureka Springs Rural (which is outside the city limits).

Former Justice of the Peace Frank Renner questions whether that use of tax dollars is even justified, as the ordinance says nothing about equipping EMRs, but only about providing ambulance service, but that's an issue for another day.

The last few years' tax revenues and disbursements to Eureka are as follows: 2006: revenues of $186,000, with $158,100 to Eureka; 2007: $207,000 revenue, $175,950 to Eureka; 2008: $216,000 revenue, $183,600 to Eureka; 2009: $249,000 revenue, $211,650 to Eureka; 2010: $257,000, with $218,000 to go to Eureka in 2011.

In addition, the provider is allowed to bill Western District residents for ambulance calls and charge up to the amount Medicare would reimburse for such a call. That charge is around $500.

One could argue that this is double taxation, but again, that's another issue, to be taken up in a future editorial.

The department averages between 500 and 600 Western District medical calls per year, which is about 45 percent of its total. That means around $250,000 to $300,000 per year billed to district residents, in addition to the $218,000 they will now be paying on the contract for ambulance service.

Those lucky enough to be insured or on Medicare most likely have those calls covered. Those who aren't get a bill and, if they can't pay it, a collection agency hounding them. Eureka doesn't play the bad guy here: it outsources the billing and later, the collection agency for outstanding invoices.

In addition to these monies flowing into the city's coffers, the city funds the fire department's operating budget, according to Pettus' figures last year, at $232,000. Those operating funds include fire call expenses.

If Eureka is billing half a million dollars per year from the Western District, whose share of medical calls is 45 percent, and the city is only funding $232,000 in operating funds, to include fire department expenses, who is subsidizing whom?

Furthermore, Eureka also gets to bill its city residents for ambulance calls.

Even if Eureka is not getting full recovery of its per-call billing, and according to Pettus, it only recovers about $305,000 per year, who is not paying? Sixty percent of the district ambulance calls are in Holiday Island, most of whose residents are covered by Medicare, have private insurance or have enough personal funds to pay the bills.

Again, who is subsidizing whom?

Aside from the questionable legality of the Western District funding equipment for Eureka to use, there is the issue of whether WCCAD is simply taking in too much money.

What has it been spending its 15 percent of the revenue on, and is that justified?

Space does not permit a more detailed examination of WCCAD's own expenditures, but that can also be taken up in a future editorial.

In the meantime, Western District residents who are concerned about the vote on the LUCAS might want to come to the Jan. 18 meeting of the board. It will be at 4 p.m. at the Grassy Knob Fire Station.

Residents can also contact the commissioners prior to the meeting at the following numbers: John Dolce, chairman, 253-4939; Chuck Olson, treasurer, 253-0119; Steve Hudson, 253-7071.

-- Kathryn Lucariello

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