Open Letter to the Brattleboro Selectboard re: EMS

In the September 11 edition of the Reformer Selectboard member Daniel Quipp is quoted as saying “a pretty clear vocal majority,” referring to those who “would like the board to contract with Rescue again.” Majority of what is not clear, so I checked with Daniel. He told me he meant the majority of those who have expressed their opinion on this matter to the board. When I checked the Town’s “Fire-EMS Transition Project” web page (9/12): a quick run-through of the feedback submitted by email does show an overwhelming majority of Rescue supportive comments. I counted 75 out of 77.

Here are some thoughts from a member of the minority expressing an opinion. I hope they resonate with the majority of citizens that have been silent on this matter.

While a lot of heat has been generated around this issue by some parties it is essential to shine a light on some of the factors in this decision. If I were responsible for this decision my criteria would include, not necessarily in priority order:

1. Cost
2. Transparency
3. Accountability
4. Level of Service

On all four of these metrics, the fully municipal approach is the hands down winner. Summaries of my review of the available documentation follow.

1. Cost –

In the latest analysis (see September 7 & 15 memos on Towns Fire-EMS Transition page, of the options for Emergency Medical Services (EMS) it is clear that from a strictly financial perspective municipal services are the least cost option. Specifically, with regard to the Rescue Inc. proposal the finding is “Not only does the municipal EMS alternative out-perform the Rescue, Inc. proposal year after year, but it also covers most or all of the ARPA start-up costs within five years, a great return on a resilience investment for the Town.”

The last point might benefit from more detail. Under the Rescue Inc. proposal the Town makes payments to Rescue Inc., is still responsible for some EMS which have costs, and receives none of the revenue from EMS services. As a point of reference on revenue in 2020 Rescue Inc. reported $6,458,402 of revenue, $4,613,908 of expenses for a net $1,844,494 of revenue less expenses. The payment to Rescue Inc. under its proposal starts at $454,422 and rises to $552,353 in the fifth year for a total $2,510,968. This is a fixed cost regardless of the revenue Rescue Inc. receives from the provision of EMS.

The municipal option has two components, a start-up investment of American Rescue Plan Act (ARPA) funds, and the ongoing cost of operations. On March 21, 2023 the Selectboard set aside $1.75M of Town ARPA funding for potential use in EMS Start-Up expense. The Town prepared two revenue scenarios to analyze the municipal option. The five-year operating costs under the low revenue scenario are $1,322,906. Under the high revenue scenario they are $783,673. What this means is that in between 5 and 7 years the investment of ARPA funds will be saving us upwards of $552,353 per year. (Source – Table 1, September 15 memorandum)

2. Transparency –

Information on all Town matters is available to the public, within the constraints of the law. The “sunshine laws” under which the Town operates only allow a few exceptions from transparency.

While preparing for the last Representative Town Meeting (RTM) I asked the Town staff to provide information on the costs, revenues, services, and many other matters with regard to the generational improvement proposal at Memorial Park. Town staff were responsive, prompt, courteous, and helpful. For those who do not know, I am a member of the RTM and also a member of the Board of Listers. Based on what I have heard from others my experience is the way it generally works when you ask the Town for information. If they can legally provide it, they will.

The Town produces a report annually which contains detailed information on activities during the past year, proposed activities for the coming year, revenues and expenses and audited financial statements. For example, please see 2022-2023 Annual Report available on the Town’s RTM page, right side.

The Town has repeatedly requested current audited financial statements from Rescue Inc to support its decision making. Rescue Inc. has referred the Town to a publicly available document, IRS Form 990, Return of Organization Exempt From Income Tax (990). The form is for the tax year 2020 and as of today (9/17/23) it is the most recent available. I am not a CPA, but in my experience in business and in public service, this is a far cry from a current audited financial statement.

AMR, the other proposer for EMS services, provided an audited current financial statement.

3. Accountability –

All of the organizations proposing to provide EMS services are accountable to the law and certifying organizations. Beyond that:
• The Town directly accountable to its citizens. Those making decisions on the Town’s behalf are required to make the best decisions possible with the information available with the goal of serving all of the citizens.
• Rescue Inc. is a tax exempt organization. The 990 lists its chief operating officer, the trustees, and representative from the other Towns it serves. It is accountable to this group.
• AMR is a private corporation accountable to its shareholders

4. Level of Service

The September 7 memo summarizes the levels of service provided under the Municipal, Rescue Inc. and AMR proposals, in some cases under more than one scenario. Here are a few of the factors:
• Dedicated ambulances in Brattleboro – Municipal -3, Rescue Inc.- 0, AMR -1
• Shared ambulances in Brattleboro – Municipal- 0, Rescue Inc.-5, AMR-0,
• Brattleboro Fire Department (BFD) call responsibility –Municipal-All Calls, Rescue Inc.- Est. 100 calls, AMR-None
• BFD staffing model – Municipal-3 platoons of 10, Rescue Inc.-3 platoons of 8, AMR-3 platoons of 6
• Billing Rates – Municipal-Selectboard sets rates, Rescue Inc.-Set by contractor, AMR-Selectboard sets rates
• Guaranteed Priority 1 Response Time –, Municipal- Under 8:30 min, 90% of time, guaranteed and demonstrated, Rescue Inc.- Approximately BFD times + 71 seconds (subject to further data analysis), guaranteed , AMR-“Timely fashion”

As noted earlier, there has been a lot of heat generated on this issue. Tempted as I am, I will not add to it at this point. I will only urge the Selectboard to proceed as recommended by Town staff and supported by all the available data.

Comments | 3

  • Level of Service is what matters most when your life is at risk.

    First, I want to thank TomF for contributing to the discussion.

    TomF raised a number of issues, many of which are no doubt important factors, yet it can feel that for many of us like, “getting in the weeds.” Listening to debate about cost analysis and other technical matters, frankly my eyes glaze over. But in the end, I hears people on both sides of the Rescue vs Municipal EMS making cogent-sounding arguments for opposite positions.

    I noticed that, without exception, everyone who currently has a position with the town, supports a municipal system. Yet knowledgeable people like former Selectboard Chair Kate O’ Connor and other former Selectboard members and another former Chair, argued for Rescue. Jeanette White, who this year stepped down after two decades as a State Senator, argued for Rescue. White has served as director for Sojourns Community Health Clinic.

    In the end, I felt that there was no clarity for the “in-the-weeds” issues, as it became clear from listening to knowledgeable speakers at the recent public forum that there is a lot of unknowns and ambiguity regarding how costs will compare between the 2 proposed systems, beyond the first year.

    For me, having suffered a major heart attack which put me in a coma for 3 weeks, and 2 months of hospitalization in 2004, and currently living with chronic, congestive heart failure, the quality of care in an emergency ambulance is the one issues which stand out for me. Should I need an ambulance, can I count on there being at least one (and hopefully 2) paramedics? My understanding is that a paramedic can provide a level of medical care well beyond that of an EMT.

    I tried to find that information in the Triton Report and the additional material on the Town website. If it is there, it is not front-and-center, and I was unable to get specifics, although everything I have seen appears to favor Rescue regarding paramedics vs EMTs.

  • P.S. Quality of Care

    I asked William Kraham, a local attorney who spoke at the recent forum about Rescue having saved his life, about the quality of care issue. Here is his response:

    The Town failed to address the quality of emergent medical care that Rescue, Inc. provides vs. anyone else. If this is about healthcare and saving lives, the choice is obvious. A regional EMS system is the model for the future. Will

  • I have added this to my comment:

    I noticed that, without exception, everyone who currently has a position with the town, supports a municipal system — an unusually perfect harmony for any group, particularly regarding a controversy. “

Leave a Reply