HIGHGATE — More than 50 people attended a raucous public meeting in Highgate Wednesday night to discuss the hiring of an ambulance service for fiscal year 2017.
The board was considering whether or not to replace Missisquoi Valley Rescue (MVR), which has served Highgate for 39 years, with AmCare Ambulance Service.
At the start of the discussion, Highgate Selectboard Chair Chris Yates made it very clear to those attending that the decision to sign with a particular emergency service was ultimately up to the selectboard.
Despite a clear majority of the audience wanting MVR, the board went in the other direction.
A one-year $100,800 contract with MVR would include two ambulances, certification levels up to Advanced EMT (one staff member certified as a paramedic) and an average response time of 8.08 minutes or less for all areas of Highgate.
A $81,305 three-year contract with AmCare would include a guaranteed 2 percent increase each year, six ambulances, certification level up to paramedic and an average response time to Highgate from St. Albans of over 10 minutes.
Swanton Police Chief Leonard Stell, who has been providing administrative assistance to MVR, told the Messenger the selectboard never asked MVR for a three-year contract, to which MVR would have agreed. He said MVR was “blindsided.”
Yates set the ground rules: only Highgate residents could speak, questions must be directed toward the selectboard and although concerns and comments would be taken under advisement, the selectboard would go the route of what they thought was the best business decision for the town of Highgate.
What came next was an emotional, intense two hours as personal testimonies and tears came pouring out from former and current MVR employees, people who had been cared for by either emergency service and concerned residents.
“Recently I was in the hospital and had to be transported to Fletcher Allen and AmCare responded,” Anne Ives of Highgate Center said. “I have to tell you that it was the worst ambulance ride that I’ve ever had in my life. It was bumpy. I felt like a piece of meat being put in the ambulance.”
“I’ve never had that experience with Missisquoi ever,” she said. “They’re more personal.”
Ives asked where the $19,495 in savings would end up if the selectboard decided to go with AmCare. With $30,000 equal to one cent on the tax rate in Highgate, the savings would be less than a one-cent tax break.
It would go to the taxpayers, Yates confirmed. But then he said, “We have a capital campaign that was cut from our town plan, so we have to figure out how to save money or raise money to fill that gap.”
In the end, Yates did not clarify to the audience where the money would go.
“And is that one cent worth it to have a longer response time?” Ives asked. “I think its something that as a human being, you need to think of it and be conscious of your decision as to if you would have gotten there three minutes earlier, would that person have lived or died?”
“We’re looking at a difference of less than $20,000 between the two, which is a pretty significant amount of money for the town of Highgate,” Steve Bushey of Highgate said. “What I would ask the board is that we don’t just consider that $20,000. I want to make sure that we’re going to get the best value, whether it be MVR or the AmCare folks.”
“I’ve worked in health care now for 18 years,” Katie Davis of Highgate Springs said. “And when it comes to budget and health care, they’re oil and water.”
“I’ve worked with both of these ambulance crews and I have nothing bad to say about either of them but I know all these people,” Davis said, gesturing to those wearing MVR blues. “These are the same people that were in the park when I was a kid during the parade and they are the same people that will be there for my kids.”
“And that means the world to everybody around here,” she said. “It doesn’t speak badly about AmCare, but convincing a patient into having good health care, is trust. And we have that and that’s worth $20,000.”
“It came about because 10 years ago, we were paying $37,000,” Yates said, explaining why the selectboard starting looking for another contract. “Today, we’re paying over $100,000. Kay. So that’s a ten percent increase, a year, averaged out over 10 years.”
“So if you look at a line item that’s over $10,000 a month, you say geez, are we getting the best bang for our buck?” Yates continued. “So we owed it to the taxpayers to go out and get a competitive bid and that’s exactly what we did.”
Kelly Rainville of Highgate Center asked the selectboard to look at the 10 percent increase in MVR costs over 10 years differently.
“You’re using that 10 percent each year, which is them going from being totally volunteer to a paid service,” Rainville said. “So I think you need to stop using that 10 percent because it’s not accurate.”
Stell, who has been assisting MVR with administration, said there was a zero percent increase from last year to this year. If the spike in cost from switching to a paid service was taken out, it would average out to be a 3 percent increase in each year, he said.
“These days and times people cannot afford to give that kind of time to the ambulance service,” Rainville said, without getting paid.
If the $100,000 were to be divided evenly among all 22 members, it would average out to be $4,500 per person every year, one attendee pointed out. However, increases for staff were not that large, because funds also had to be used to maintain ambulances, fuel, medical expenses and more.
Savings versus quality care wasn’t the only comparison up for debate at Wednesday’s public discussion. Both the selectboard members and residents dissected each contract, but for different reasons.
The selectboard said they wanted to make the best business decision and the audience’s clear and unanimous response was that MVR was the better option.
Who has better response times? MVR.
Who has more ambulances? AmCare. Many residents pointed out though that AmCare serves multiple communities and MVR can always call in mutual aid if there is an emergency larger than their two ambulances can handle.
Which service is cheaper for the patient who rides in the ambulance? Moot point. Expenses are calculated by the level of care and amount of mileage, starting from where the patient is picked up to the drop off at the nearest hospital, according to AmCare Director Walter Krul.
In addition, both services will write off a patient’s co-pay if they demonstrate an inability to pay.
What can Paramedics do that Advanced EMTS can’t? Krul said paramedics can use more advanced levels of medication and perform small surgeries like creating a hole in the patient’s trachea. Krul said with the higher pain medications, patients will be in less pain on the way to the hospital.
Stell said MVR currently had one certified paramedic on staff and the application for another staff member was submitted as well. Stell said currently, if they need paramedic assistance, they would call AmCare. They would never deny a patient a service, he continued.
Who will respond on a more emotional, personal level with the client? Some people in the audience said AmCare employees were professional but cold, citing their previous experiences as a patient. One woman from the audience pointed out that AmCare is a for-profit business while Missisquoi is a non-profit.
One audience member asked if MVR would be able to survive without a contract with Highgate.
“We can survive without Highgate definitely for one year,” Stell said. But for longer than that, the reduced number of calls would make MVR unable to serve either Highgate or Swanton.
One man from the audience was concerned at this revelation, saying there will be no competition, no other place to get bids or other ambulatory services.
In the future, AmCare could potentially price their contract at any amount it sees fit.
“I’m looking at AmCare and I feel really bad for you,” Tanya Bailey of Highgate Center said. “You’re alone and nobody else from your crew is here. And I’m looking at MVU, sorry MVR, and you’re like all here.”
“The people that want to go with AmCare, where are they?” she asked, to cheers from the audience.
Yates said the people who wanted the contract with AmCare were too afraid to show up and voice their opinions. Yates continued by saying he had received 25 emails from people who want to make the switch in services.
Yates questioned the professionalism of MVR. In recent weeks, comments were made by MVR employees against the potential switch in contracts with one directly threatening Yates on Facebook.
Stell said MVR is dealing with the matter swiftly. At the next board meeting, MVR will follow their disciplinary policies outlined in their bylaws, according to Stell.
“The emotion in this room is just bubbling and bubbling,” Kyle Lothian, a Highgate resident and former selectman of a nearby town said. “When you get that emotional to me, you get a one-track mind in many ways. The board is asked to look at every line item to save money.”
Lothian said he also knows what it feels like to be on scene during an emergency, having fought fires for 30 years as a volunteer. “That same emotion is here tonight,” he said. “It’s amazing.”
“The voters feel that you guys are elected to search out the information, bring it back to us, let us vote on it,” a woman sitting at the front of the room said. “I don’t think we ever elect selectboard to be a Gestapo kind of thing and sometimes that attitude comes across.”
Town Administrator Heidi Britch-Valenta reminded voters that the board didn’t even have to bring the contract in front of voters for public discussion.
“We hired you,” the woman, who declined to give her name, replied. “We’re equal partners with you. You’re not the end all here.”
But in the end, they were. A petition with over 200 signatures asking for a contract with MVR and multiple testimonies from employees and patients did not sway the board in MVR’s direction.
After two hours of discussion, the motion was made and passed in less than 30 seconds. Yates made a motion to sign the three-year contract with AmCare, Paulette Tatro, the vice chair seconded it and Randy Connelly gave the third aye. Joshua LaRocque, the newest board member, was the only person to say no.
The ayes had it.
One woman stood up from the back of the audience and asked, “Do you even care about these people?”