A decision has not yet been made as the city of Hudson continues to discuss proposals from the city-run St. Croix EMS and hospital-based Lakeview EMS.
At Monday's meeting, St. Croix EMS presented a new option for service to the committee.
This option would increase the user rate by 8 percent in 2020 and each year after, while maintaining the current per capita rate of $17 to the city and its partners village of North Hudson and town of Troy.
This new option eliminated the 80 percent user rate increase proposed in one of the previous options.
The option does so by reducing the budget for personal services to reflect the actual expenditures for 2018. The proposal recommends a 3 percent increase above the actual cost for next year.
Proposal consultant Jerry Clemens of Synergen Services said the service has not functioned at full staffing for the last three years, and has still provided excellent performance. This option recommends not staffing to the level previously considered fully-staffed.
Instead of two ambulances fully staffed 24/7, St. Croix EMS would operate one ambulance 24/7 and another ambulance for 12 hours. A third ambulance would be on-call.
This provides a savings of close to $200,000 a year, Clemens said.
Mayor Rich O'Connor asked if the mutual aid numbers went up while understaffed. Operations Supervisor Josh Olson said it has remained the same over the past few years. O'Connor said he would expect that as the service has not been fully staffed for those few years. O'Connor added the council knows there was a period of time that the service went without a fully-staffed ambulance. This occured back in February 2018, and then Chief Brandon Lyksett said it was due to hour limits with part-time employees.
Council Member Randy Morrissette II questioned why a proposal would present an option that is not fully staffed.
Council Member Sarah Atkins Hoggatt said the proposal is asking to change the definition of fully staffed.
If two calls came in during the time period when only one ambulance is staffed, Clemens said the service could then turn to mutual aid or an all-call where everyone with their pager would be alerted to respond if available.
The staffing model would continue to be the on-call model that the service switched back to this year. This model has staff working on-call shifts that they are paid for in stipend rather than hourly wages.
The hourly model put a limit on how many hours EMTs could work a week.
O'Connor said he wasn't following why the service wasn't going back to hourly.
Clemens said the answer is the workload has gone down with the loss of town of Hudson and Lakeview EMS taking over as the lead for hospital transfers.
Atkins Hoggatt asked if it would be possible to look at stipend vs. hourly with the new numbers. Clemens suggested that is something that should happen on a regular basis to see how the service is currently running. The proposal includes pieces to improve year-end cash positions, including encouraging patients to use St. Croix EMS for interfacility transfers. Council Member Paul Deziel questioned if that was realistic, saying it seems like wishful thinking.
Olson said some of it is that, but he knows the service will get some transfers not only from Hudson Hospital but other area hospitals as well.
Even in a worst case scenario, Clemens said the option would leave $234,398 in the department's cash reserves.
Council Member Jim Webber asked if maintaining the per capita would be viable for the partners.
North Hudson Village President Stan Wekkin said it is for this year, but he doesn't know next year's numbers.
"I'd rather have the end users pay than people who don't use the service," Wekkin said.
The proposal does include numbers for the renovation of the Ward Avenue building for EMS. It also budgets for an EMS director.
Clemens said one advantage of the St. Croix EMS proposal is transparency.
O'Connor questioned that statement, saying the city was not informed when the February 2018 shift was understaffed and does not get monthly reports.
Olson said nobody has asked for the reports. Clemens said that's something that should definitely be distributed.
Morrissette said the proposal does not project far enough into the future to make a sound decision. The proposal does not reflect the possible population growth, with two undeveloped housing annexations coming up.
Clemens said continuous improvement is a big aspect of the proposal. It means the workflow process will be reviewed regularly and changed to become more efficient as needed.
According to the Wisconsin Department of Health Services, both services are licensed as a critical care paramedic service with the state. The department does not have a record of any formal complaints against either service. This was not discussed at the meeting.
Response times continued to be a topic of discussion for the committee.
"Response times are, I believe, the most important in patient care and this is our citizens, this is our residents, it's us," Atkins Hoggatt said.
She said the static deployment model of St. Croix EMS means at least one ambulance is always available for a 911 call. A chase vehicle also goes out, and likely reaches the scene first at times.
O'Connor said the response times for St. Croix EMS are significantly greater than Lakeview, prompting laughter in the crowd.
At the last committee meeting in February, St. Croix EMS response times were presented as an average of 7.12 minutes. Lakeview EMS response time were presented as an average of 6 minutes, 44 seconds.
The St. Croix EMS response times for this year were 6 minutes 20 seconds for January and 7.2 minutes for February. O'Connor said these numbers do not include town of Hudson now.
Council Member Joyce Hall said they also need to consider how the response times are calculated.
Lakeview EMS uses the Allina dispatch system. This means when a call comes in to St. Croix County dispatch, the county dispatcher calls Allina who then dispatches Lakeview EMS.
Allina dispatch holds the call for an average of about 30 seconds before dispatching Lakeview EMS, Lakeview EMS Manager Muller said.
Lakeview EMS response time is based on the time the service receives the call. Muller said that's how any EMS system in the country measures response. The county dispatch receives different call types, and sometimes takes more time with the caller before calling Allina.
Muller said he doesn't think there's a lag time with county dispatch calling Allina.
Webber said dispatch data showed between a minute and a half and 3 minutes from the time dispatch initiated the call and the time Lakeview received the call.
O'Connor said a software program is available that can communicate between Allina and St. Croix County Dispatch. If the city went with Lakeview, O'Connor said he would suggest the city pays the $100,000 for the software as it will be saving $400,000 by having Lakeview take over EMS operations.
This committee meeting as well as the council meeting included an agenda item for public input, though O'Connor asked that any comments stay focused specifically on the proposals at hand.
"We know that St. Croix EMS and Lakeview save lives, that's their jobs, that's what they do," O'Connor said.
Paul Malecha said the council needs to address the cost of EMS to the city.
“In my opinion the city council’s responsibility is for the city, our fiscal city, money we have here,” he said. “How can you allow us to lose money every year for something we have no control over?”
As a business owner, Malecha said the current EMS set up is not a successful business.
“The city should not be saddled with this expense. If you cannot get it to a zero cost for the city, it is not a benefit for the city,” he said.
Diane Frohlicher questioned if Lakeview EMS will be able to have an ambulance come from surrounding communities if one of its is not available. O'Connor said Lakeview has the same type of mutual aid contract with other communities.
She asked the council to keep St. Croix EMS.
Dave Reker said he would gladly spend the per capita money to keep the service community-based.
"My understanding of the purpose of government is to provide for the welfare of the people," he said.
Hudson resident Ramsey Lee said St. Croix EMS does a lot for the community, and does not want to see the service privatized. Doing so would lead to expenses for people with disabilities, he said.
Council Member Bill Alms later pointed out in the council meeting that Lakeview EMS would be hospital-based, not private.
Both proposals will be made available on the city's website.
The committee will meet again on March 27 at 5 p.m.
This story has been updated to include additional public comment.