BRATTLEBORO — The Selectboard has voted unanimously to pursue a municipal-based model to provide the town's emergency medical services (EMS), choosing it over starting a new contract with Rescue Inc.
Staff members recommended the town model, saying it outperforms any other model investigated, including Rescue, by nearly $1.2 million over five years.
Town Manager John Potter said before the vote on Sept. 19 that staff members recommended the municipal model knowing that "for some in our community, this will be a deep disappointment."
Potter said they made the decision based on "quality patient care, sound finances, a unified approach to public safety, and the importance of public oversight."
"I like Rescue," he said. "What I don't like is the Rescue proposal and how it compares with the municipal model."
He called the recommendation "the difficult but responsible decision."
Not all in the audience, which included an overflowing in-person crowd and about 45 attending via Zoom, agreed.
One was local lawyer William Kraham, who also spoke at a Sept. 12 public forum, when he noted Rescue had saved his life after sudden cardiac arrest.
Kraham accused board members of having "predetermined" the outcome of the six-month deep dive into town-based versus third-party EMS models.
Saying the town had "no intention of giving serious consideration" to Rescue, Kraham also said the town "hijacked" the public forum by bringing the staff members' recommendation to the floor out of the gate and having 11 department heads speak to it.
As he did at the forum, Kraham read from the town charter's preamble, noting the line "respecting the will of the people."
"Do the people want Rescue? Do the people want you to spend ARPA [American Rescue Plan Act] money? […] This isn't your money, this is our money," he said, adding a final question: "Do you have the courage to respect the will of the people?"
Kraham then delivered a petition signed by 425 residents asking the board to choose Rescue.
"Don't make a decision," he said, accusing the board of having said in the past, "We'll do what we want."
"Let the town vote," Kraham said.
Next steps include spending up to $1.375 million in ARPA money for startup expenses. Some of those expenses include hiring an EMS supervisor and more firefighter/EMTs to be ready by July 2024 and buying three new ambulances.
Use of this amount of ARPA money will leave about $1.4 million in that fund for other projects. Suggestions from the public for how to spend the remaining money will be welcomed at a Sept. 28 budget open house, Potter said.
Selectboard supports staff recommendation
From the start of the meeting and to a person, Selectboard members stated they planned to vote in favor of the town-based model, in part causing many speakers to then say the outcome had been "predetermined."
Board member Elizabeth "Liz" McLoughlin, noting the Brattleboro Fire Department has been providing service for 14 months with support from Golden Cross, whose contract expires in July 2024, pointed out that each month of that time period the Selectboard had charted progress and details of service.
"The Brattleboro Fire Department is ready, willing, and very able," she said.
McLoughlin noted the fire/EMS union supports the plan, and ambulances can be "readily obtained." She noted the fire department is not too busy to take on the added work, saying that just 8% of calls are fire-related.
The town will keep the insurance fees from the ambulance service, so that revenue will pay for any added personnel costs.
McLoughlin called use of the federal money made available post-pandemic "a valid and valuable use of ARPA funds[…] and investment in Brattleboro's future."
She said using the money now will help prepare the town for future "climate change" and "resiliency" in the face of potential catastrophic climate-related events.
"This comprehensive emergency team is an exciting opportunity […] the best thing for Brattleboro now and in the future," McLoughlin said, adding having EMS under town control "is a good thing."
She also said that, sometimes, rural regional models are best but that indications are that Brattleboro has "outgrown" that model. She cited the "magnitude difference" in several hundred EMS calls annually in previous years to 3,000 in the past year.
Selectboard member Franz Reichsman noted that a year ago, "things didn't have to go exactly the way they did, with disruption and ill feelings and confusion."
Reichsman said the town needs to be "more open and less judgmental," among other things.
Praising Rescue's excellence, he said there would need to be "a basis for repairing" the town's relationship with Rescue, which he said "is simply absent."
"Mediation is not going to bear fruit if the two sides are not operating from a position of mutual respect," which, he said, is not present "at this time."
Noting he had made up his mind about which plan to support only in the past week, he noted again that even with startup costs, the municipal model is projected to be less expensive over the next five years than Rescue's proposal.
Reichsman said he hopes folks will "wish the town well" and support the decision.
Selectboard member Peter Case also acknowledged "the alienation this vote will cause," and noted he didn't like that.
"Some of you will be mad for a few weeks because of this vote, but once it's done, it's done," Case said. "You always have the next election if you don't like the decision made here tonight."
"I know both the fire department and Rescue Inc. are well-liked and well-respected," said board member Daniel Quipp, saying he found it "fascinating" to hear from the public "we already know what you think."
He said he "heard clearly" that many wanted to contract with Rescue and that until one day before the vote he had been "wrestling" with that desire in the face of what he believes will be more "accountability to taxpayers" through the municipal option.
Quipp also said that the fire-based EMS would also be a "more efficient use" of the fire department, which he said would be "well-placed" to take on the full responsibility including EMS and "do it well."
He also said another positive for him is policy and noted the revenue model for the town-run service can work with "a few different rates," which would be set by the town, as opposed to choosing Rescue Inc., which would have set rates for those using the EMS itself.
"[The Selectboard] will get the opportunity to set a rate that's appropriate for the taxpayer […] and the person who needs the ambulance care," Quipp said, adding the municipal model works without "chasing people who are on Medicare down for every little penny."
Quipp added that he has tried "to make our revenue model not work," but the bottom line never turns up more expensive than the proposal from Rescue.
After spending several hours on Sunday with the fire department, he believes that when all EMS is under one roof, "a level of teamwork" that is "really beneficial to patient care" exists.
As to startup costs, he said, "they are high, but they're one-time costs."
"I believe there's plenty in the municipal option to say 'yes' to, and that's what I'll be saying 'yes' to," Quipp sasid.
Board Chair Ian Goodnow, who had corresponded on behalf of the board when the fallout with Rescue occurred, expressed "regret" about how the process began when the contract concluded with Rescue, although he said he still stands by his vote in 2022.
"The way it occurred should have been better for the public and the municipal staff, including the fire department," Goodnow said. "I don't regret that we've undertaken this thorough investigation."
He added that the board has a "duty to ensure we're providing the best possible service" to align with what the town has evolved to be in the past several years.
Citing "quality of care, fiscal responsibility, and transparency and accountability" as prime factors for him, Goodnow said that while there are risks to the adopted model, there were risks in all of the models considered and he is "confident" this is the best direction for the town.
"I also believe this essential service being owned by the town and known by the people is also critical," he said.
Weighing in
Comments from those attending were nearly as equal in support of Rescue as for having the town control emergency services with the Brattleboro Fire Department.
Carolyn Conrad noted her frustration and also was of the opinion that board members had made up their minds early on.
She called the decision "shortsighted" and said she'd prefer that ARPA money be invested in the police department.
Resident David Levenbach noted a 2021 Representative Town Meeting vote that called for a process and "systematic effort to ascertain public preferences" to spend ARPA money and said such was promised.
He called spending ARPA money now "evidence of your bad faith" and said Rescue's proposal costs are higher now because the town ended the relationship last year.
Several speakers called for "working things out" with Rescue, saying it was a "personality" thing.
Others questioned whether the Brattleboro Fire Department would be ready to take on the EMS work and hiring the needed EMS director and seven new people by July 2024.
"The Brattleboro Department is ready," said Fire Chief Leonard Howard, adding that the needed extra personnel will be in place when the program starts. "I wouldn't be sitting here tonight telling you to do this if I didn't know we could do it."
Rescue Chief of Operations Drew Hazelton did not speak, but was seen listening to the meeting from the hallway. Numerous firefighters attended the meeting, and fire trucks were parked outside.
Reasons for the town-based model
The town studied municipal and third-party models for Emergency Medical Service delivery models over the past six months, planning to vote in September.
Scheduling a decision this month allowed ample time for a thorough investigation of the potential models and for the town to incorporate the financial impact of the decision into the fiscal year 2025 General Fund budget.
Plus, the town is more likely to receive needed equipment - including three ambulances - ordered in time for the transition. Golden Cross's contract expires in July 2024.
Potter noted he's served as an EMT as well and lauded their work.
"I think we share a collective thank-you to all of these people," he said.
Two private contractors responded to a Request for Proposals in August. American Medical Response (AMR) of Massachusetts proposed a dedicated, fully contracted model. That was deemed not suitable for Brattleboro's needs.
Rescue Inc. of Brattleboro, which proposed a shared hybrid model, had served the town for 56 years prior to a falling out that culminated in a Selectboard vote to cancel their contract effective July 1, 2022.
In a memo from town staff, members found the Rescue model did "not allow the town any say in the billing rates charged for ambulance services. There is also a limited amount of uncertainty about the exact amount of revenue that will be earned with the municipal alternative, but that is why a revenue range has been employed throughout the analysis."
The memo goes on to state that the Selectboard, "as the elected representatives of the people, must be satisfied that the chosen model is financially responsible. In this case, the municipal model is more than just satisfactory, it is by far the best financial option available. Not only does the municipal EMS alternative outperform the Rescue Inc. proposal year-after-year, but it also covers most or all the ARPA startup costs within five years, a great return on a resilience investment for the town."
It continued: "The town as an organization has worked hard over the years to develop an internal culture, one that is focused on hard work, cooperation, and service to the public. This is evident on the scene of any emergency; all hands go on deck, and the silos that define each of the different public safety departments disappear.
"Maintaining EMS within this unified public safety system is key to present-day efficiency and an important element of resilience and future response posture as the town continues to adapt our capabilities to a changing world."
Staff members stated they believe "a strong system in Brattleboro can, in turn, be ready to better help our neighboring communities. This right of self-determination is closely akin to another fundamental benefit of the municipal model, public oversight.
"Like every municipal government, Brattleboro delivers essential services and does so in a manner that the public has come to expect, and should rightfully be able to demand, with transparency and accountability."
The memo goes on to emphasize that all voices will be heard as the process of the town directing its own EMS develops.
"Staff would like to take a moment and acknowledge that the decision before the Selectboard is not an easy or straightforward one, [and] there are difficult and conflicting factors at play," it states.
"There are high levels of emotion surrounding the change to relationships with Rescue, Inc.[...] Please, in reviewing this recommendation, understand that town staff hear you. […] Please also understand that this recommendation is not about the past, it is entirely focused on what is best for Brattleboro in the future and, for this, staff wholeheartedly recommends the municipal model as the preferred alternative."
This News item by Virginia Ray was written for The Commons.