Published in the Big Sandy News on Sept. 13

Paintsville ambulance cash flow is source of concern for city council

By CHRIS McDAVID
Big Sandy News Johnson County Bureau

PAINTSVILLE — Officials with the city ambulance service reported to council Tuesday that business is gradually picking up, but some council members expressed concern about a continued negative cash flow.

Last month, council delayed accepting bids for the purchase of new equipment to put another ambulance in service amid financial concerns raised by council members. No action was taken on the issue during Tuesday’s council meeting, either.

“Looks like the figures are worse,” councilman Jim Meeks said Tuesday, referring to the ambulance service’s monthly financial report. Meeks later said that the purchase cannot be justified with the ambulance service’s current revenue.

Mayor Robin Cooper explained that the ambulance service not being fully staffed and the expense for overtime is “sort of eating us up.” The mayor also noted that the service had a positive cash flow at one time.

Cooper said the service’s revenue would have to be increased or expenditures decreased in order to correct the financial strain. “We can pull back or continue,” the mayor said, noting that council was “very wise” in looking at the service’s financial status before taking action on accepting a bid for the new equipment.

“We’re not sitting on our hands,” Cooper said. “...We’re trying to match overtime and labor expenses to our revenue. He also said that the ambulance service has a consistent payroll expense, but inconsistent revenue.

“We’re going to go into our busy season,” the mayor said. “I think you’ll see increased runs.”

One ambulance official said the city ambulance service is “slowly increasing runs” at least by ten a month. She also said ambulance workers have also increased transfer runs by about 15 a month. “It’s just a slow climb,” she added.

The August 2002 ambulance service report reflects a decrease of $59,207.50 in revenue compared to last year’s totals. The August revenue receipts were increased from last August’s receipts, but six out of the other seven months in 2002 reflect a decrease in revenue.

Overall, the ambulance service has experienced a decrease of 195 runs so far this year when compared to last year’s totals, and expenditures have increased because of overtime issues and other purchases, which were expected to boost the service’s revenue.

Cooper said he was “not trying to paint a rosier picture,” but noted that within the first ten days of September, the ambulance service was “almost up to what (it) took in last month.”

The ambulance official, who maintains and tracks the service’s finances, noted that the totals included on the report are misleading because of outstanding revenue which had not yet been received.

She explained that payments from Medicaid had not been received because the federal assistance program distributes payments on a twice monthly basis. “But, when it comes in, it’ll be thousands,” she said.

“Are we trying to get additional service to gain more income to cover operating expenses?” councilman David Trimble asked.

Trimble also noted that he would feel more comfortable subsidizing the service for city residents instead of all ambulance patients throughout the county. “I just hate to lose it because of such a large subsidy on our part,” Trimble said.

Council woman Fran Jarrell said council needed to give the ambulance personnel “a chance,” and noted that the service was not provided by the city to make a profit.

The ambulance official noted that the city service lost 730 runs to First Response. “We received 360 of those runs as of today,” she said, “considering the 720 plus runs, that’s 720 runs we could have had.”

The official also suggested that the Paintsville Ambulance Service advertise for business. “We need a chance,” she said. We can’t build up runs...if people don’t know we’re out there.”

Jarrell noted that First Response claims a lot of private calls, which are not dispatched through the 911 dispatch center. She also said that she didn’t even know a number to call the city ambulance service other than 911. She was advised that residents can call 789-2200 to contact the city ambulance service instead of call 911.

“We’re in the ambulance service and we need to run it like a business to have it pay for itself,” Cooper said, noting the city ambulance service has upgraded from Basic Life Support (BLS) to Advance Life Support (ALS) to improve medical services to residents.

“I feel like it’s one of the top medical services in the state,” the mayor said.

In response to council’s discussion Tuesday and during previous meetings, Phillip Elliott, president and CEO of First Response presented the panel with a letter disputing recent comments made by city officials in reference to the private ambulance service.

In a packet of information provided to council, Elliott alleges that there were 11 occasions in which the city ambulance did not respond to a county call because the Paintsville Ambulance Service did not have an available unit.

Elliott said he was concerned about council’s talks related to First Response’s availability and response times. Information provided by Elliott says the city ambulance service had a delayed response to a scene on July 4, but the incident was not noted on the rotation log.

Elliott said he requested the official logs from the dispatch center, but was given a copy of the rotation list. In reviewing his ambulance company’s own logs, Elliott alleged that the city has indicated First Response did not have an available unit on eight occasions.

“A review of our dispatch log outlined on a time line does not support the rotation log,” a letter from Elliott says.

“Finally,” the letter continues, “our dispatch program revealed 87 occasions that the city did not have a unity available for a city call, and 911 dispatched First Response and we responded. Add the 11 occasions on non-ability to respond to county level calls, and you have 98 times that the city could not respond and First Response was called.

Elliott also disputes Cooper’s comments last month pertaining to the ambulance company periodically taking itself off the rotation list.

“We schedule two units 24, seven, the same as the city,” Elliott’s letter states. “We also run a third unit on most day shifts, and call in for the third unit at nights as allowed by regulation. While the city has experienced a decline of approximately 200 calls, we have seen our overall volume increase. The 911 volume has declined, but private calls have more than offset this.

“As a result, periodically, we have taken ourselves off of 911. This is usually less than an hour as units complete runs or our call-in unit is covered. However...it has not impacted our ability to respond to calls.”

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