City Ambulance Service

[Clipper]

www.uticaod.com/latestnews/x177091394/City-plans-appeal-on-ambulance-service

I have no horse in this race, but I find it rather inappropriate blatantly unfair for Kunkel and Joe Taylor from Rome, who runs that city's only ambulance service, to be on a board that decides whether there is a "need" for anyone that might choose to compete with them, and to be able to deny a certificate of need based on their judgment. I personally would not care WHO ran the ambulance service as long as someone showed up when and if I was boobies up on the floor, but I also think that as is true here in Bristol and many other cities, the fire department should be allowed to provide ambulance service. Especially since all of your Utica firefighters are now required to be EMT's or paramedics.

This would be a great subject for Strikeslip's investigative expertise. I imagine there are many arguments to be made about cost, and I would almost bet that Strike has already looked at this when it was in the news in the past.

I thought it would be interesting to see what area residents think about the issue. What are your thoughts Uticans?

[longtimer]

Well Clip, this has been going on since about 2005 and there as been a LOT of discussion. FA has posted a lot on this and is likely to jump on this as well.

I think it is important to note that NY is one of the very few Certificate of Need states left in the country. I worked in the health care field, filed CON's and am very familiar with the process. As much as I battled with the DOH I have come to believe that although the CON process could certainly be improved it is far better to have a CON process than to not have one. That is another discussion so I will only say that the lack of CON is costing all of us a ton of money in duplicate and under utilized medical services of all kinds. One should also take note it is the law here in NYS.

Now, a few things about the dispute here.

The EMS councils were set up here to advise the DOH on things like training and equipment standards and to help them address community needs for EMS services and give recommendations on the best way to handle them. They coordinate and conduct training. That word needs keeps coming up and is critical in this case. They also determine coverage territories and rotations that insure adequate coverage and prevent disputes between companies.

The Kunkles recused themselves from any discussions the EMS council had regarding the UFD's application. That was the proper thing to do and they did it.

Secondly, the city simply ignored the CON process. The City operates under a separate branch of the CON laws known as the Municipal CON. Basically, this was established to allow municipalities to establish a service quickly to take care of the community when the need arises. For example, if Kunkle simply went out of business and had left the city with no coverage nobody would want to take the time to go through a full blown CON review which can often take up to a year. The muni process is much less, usually 60 days or even less in a real critical situation. Of note Utica had no critical situation of any kind.

Even though a municipality can start a service they still must go back and show there was a real need. That need must be supported by facts such as the number of calls, the number of delayed responses, issues with the care given and a lot of other financial data. The city, through the UFD, knew beyond a doubt they could not prove any hint of a need so their initial tact was to get the muni operating certificate and then say they were exempt from the review. They were then told they had to file so they finally submitted data which, as expected did not get approval because the facts did not support them. They appealed, lost and have appealed again.

Now add to that a few other things and you have a real mess. What things? Well for starters the cities 911 service was told to ONLY dispatch the UFD to ambulance calls. That was eventually changed so that the caller could request Kunkle but if they did not the UFD got ALL calls. Throw that in the mixer with The fact that the UFD charges about double what Kunkle or the other services in the area charge and watch the fur fly.

You see Clip, the city publicly stated they were doing this to generate revenue, not to meet a need. My personal belief, and I have posted this before, is the the UFD simply wanted more members and concocted this plan that is costing tax payers a ton, not to mention a small fortune in legal fees defending it.

A couple of personal notes on this. First, I don't live in the city so I don't have a dog in the fight either. I did have a lot of dealings with the ambulance and medical transport companies during my career. During that time I had some disagreements with many of them at times, including Kunkles but I can say this They are all very competent and although some are tough business people none were really unreasonable and you could work with all of them. I also never saw heard of any evidence that Jack Kunkle had influence over the other members of that council which by the way is quite large.

[Clipper]

I also worked in EMS when I was younger. When I first worked at Griffiss, I was a firefighter and an EMT. I went on to become a state EMT instructor and taught at the base, as well as at BOCES in Verona and to several volunteer organizations around the area.

I knew Joe Taylor quite well, as I had taken CPR classes from him, as well as having had him come in to lecture to my EMT classes. He also assisted me by helping to administer the practical part of the final exam for each class. Joe is an expert in cardiac care and advanced life support. He was a pioneer in promoting the paramedic program and training in that area. He is very dedicated to the cause. He worked for Marty Nunn for a long time before buying or taking over the ambulance service himself.

I know Jack Kunkel and the Kunkel organization to be competent and well trained. My only problem with Kunkels was that they constantly would jump our calls when I worked for Hinckley and Wurz years ago. I quit working at H&W because of inferior equipment and slack attention to protocol. I didn't like my reputation being associated with the less than stellar service. The last night I worked there and the last straw was when we responded to an accident on N Genessee St, stabilized and packaged the patient for transport and then had to have Phil Gulla from Beacon Body Shop jump start the ambulance so we could take the patient to the hospital.

If the city's service survives, I would hope that they would share the work with Kunkel on an honest, well observed, rotation, just as it used to be in years gone by and is supposed to be when dispatching tow trucks.

Interesting input Longtimer. I do remember FA and others discussing it on the OD discussion section, and maybe even here at some time in the past. Seems that there should be a fair way for it to be worked out. Utica has some very well trained individuals and the city could darn sure use revenue from the medical insurance payments of an equitable program could be worked out. I don't understand the Certificate of Need law though. Just one more NY State law to put "big brother" in the mix. What ever happened to free enterprise? If an ambulance meets the standards of care and operation, who the hell is the state to keep them from doing business? That is strictly my marginally informed opinion.

[Swimmy]

Even if kunkel recused itself, you really think the other members would vote to cut into kunkel's profits? I have seen where kunkel takes abnormally long to respond to emergencies. Or they over-charge for a mere transport across a street. In fact, they even tried to sue my family for a $400 charge that my grandmother left behind. Then I sent them a letter. Not even an apology was offered for their bullying and unsubstantiated threats!

[Clipper]

After my dad died, the ambulance service continued to send bills for almost a year. Efforts to get it through their heads that he was dead and that he pretty much died intestate, went unheeded, because their billing was done my some nitwits in Alabama that I had to surmise could not understand or read English. Finally as a smart ass remedy, I simply sent back one of their statements with the blanks where one can submit a change of address filled out to reflect a change to Gunnings Cemetery, Blountville Tn. and enclosed a $1 payment. I didn't sign anything or send a check with my name on it, or in anyway identify myself. I just put a buck in the envelope.

I never got another statement, and I have always wondered if they simply got the point or if they were stupid enough to process the change and send his bill to the cemetery board. ROFL. The stupid part of the whole scenario was that they were only billing $13 that medicare and his insurance had not paid. With the hundreds and hundreds of dollars they had received over a two year period transporting him back and forth from nursing home to hospital, I figure they could eat the damned $13.

[Clipper]

Back to the subject at hand, I simply don't believe that ANY ambulance owners should be allowed to determine whether there is a need for COMPETITION to be certified or allowed to exist. It should be determined possibly by emergency physicians or someone else knowledgeable of the pertinent facts, not someone who appears to me to have a conflict of interest in the matter.

[Swimmy]

That was my first point. And I agree with you, Clipper.

[firstamendment]

So should ambulances compete by racing to the scene of calls? That is what used to happen before the EMS councils were formed and the proof of need established.

This isn't about competition. Had this been about competition, the City of Utica easily could have instituted a call rotation like they do with tow truck services. No, the City made their service the DEFAULT service that goes out on every emergency call UNLESS the caller specifically asks for Kunkel. Does that sound like competition to you?

Ok, I will give you guys that point about Kunkel's reach in the local area of the Regional Council, even if he did appropriately abstain from voting. But this has also been ruled against the City on the State Council level and a State court. One of the bases of the City's claim is that they are exempt from State Law in requiring a Proof of Need. Ha! Utica, exempt from State law? I did post a bit on it at the OD, partially because I was a UFD candidate at one time and did hold a valid EMT Basic certification. I also linked to the specific parts of the laws from the NYS DOH website that outlines CON's and MUNI-CON's. In the case of municipalities, they can get permission to immediately create an ambulance service, BUT eventually they have to comply with the law and prove need. They are not exempt from this requirement.

And contrary to the belief of one OD poster, who admittedly is a retired UFD, I am not bitter about not getting an appointment. I had a close family friend on the UFD, along with a neighbor, along with some other acquaintances on the UFD at the time. They all encouraged me to take the civil service test and acquire my EMT Basic. I even took the EMT course with a few other guys who also competed at the very same UFD agility test I did. I had a decent score on the civil service test but was not incredibly high on the list. I think there were only 4 open positions at the time, so my odds were not very good to begin with. I even personally introduced myself to then Mayor Hanna. Shortly before that agility test in March, Hanna announced laying off firefighters. Now my odds diminished even more. It did not stop my motivation that day during the 6 stage event and I put everything into it that I physically could. Even though I was all but certain I would not get the nod, I walked away that day knowing I gave it my very best effort. Days after the test, I even heard from my UFD neighbor, ''I heard you kicked ass on the test''. I am not and never was bitter. I was realistic about my chances and still made the best effort and I will never be ashamed for trying. It just wasn't going to happen. I moved on and eventually found a career that better suits my talents, besides blogging, haha!

[firstamendment]

www.uticaod.com/topstories/x1336444765/Judge-issues-another-blow-for-Uticas-ambulance-service

www.health.state.ny.us/nysdoh/ems/operational_authority/municipal_certificate_of_need.htm

Traditionally, in order for an EMS service to gain operating authority , New York State Public Health Law Article 30 requires that the service make application to the local Regional EMS Council(s) in the proposed area(s) of operation, bear the burden of demonstrating that the definition of public need has been met at a public hearing, obtain a positive determination of public need from the Regional Council and successfully pass a fitness and competency review by the NY State Department of Health (DOH) prior to receiving a certificate of operating authority from the DOH.

A Municipal Certificate of Need, herein after referred to as a Muni-CON, was originally enacted in 1995 by the New York State Legislature to supercede the statutory process as a result of a municipality's desire to operate a municipal ambulance service. The municipality planned to task its Bureau of Fire to provide ambulance service within its boundaries. The municipality was unable to obtain Regional council approval and, as a result, the Legislature passed a State Law that created a municipal ambulance service for the City.

In 1996, the Legislature recognized that there were a significant number of municipalities in the State of New York with issues similar to the municipality referenced above and amended NYS PHL Article 30, creating municipal authority for any municipality to operate an ambulance service. Subsequent to this, the NYS DOH BEMS promulgated policy and procedure (originally Policy Statement 97-01 and subsequently Policy Statement 01-06) for Municipal CONs.

'Public Need' is defined by Article 30 of the New York State Public Health Law, and NYS DOH Policy Statement 06-06 as:

'The demonstrated absence, reduced availability or an inadequate level of care in ambulance or emergency medical service available to a geographic area which is not readily correctable through the reallocation or improvement of existing resources'


Further down the page:

Current NY State statute allows municipalities to establish and operate Ambulance or ALS-FR Services prior to a determination of public need by a Regional EMS Council, but that does not absolve the municipality, from complying with all applicable statutes, rules and regulations for operating such a service, as the certificate is in the name of the municipality

Municipal Certificate of Need Applications
www.health.state.ny.us/nysdoh/ems/policy/09-01.htm


www.uticaod.com/latestnews/x177091394/City-plans-appeal-on-ambulance-service

Despite its investment, the city has lost the majority of the decisions regarding the ambulance service. In 2008, the city lost its appeal that it shouldn’t have to apply for a state certificate. (IE: Utica doesn't feel it has to abide State law)

One of the council members involved in the creation of Utica’s ambulance service said it is necessary, given the revenues gained from it, to continue fighting for it. (IE: revenue is their motivation, which does not prove there is a public need for the service)

The city says running its own ambulance service allows for a continuity of care between its paramedics and the hospital (Just as I opined on the OD today, that continuity of care will exist no matter which ambulance staff is transferring a patient to the hospital. It is a straw arguement that has no basis whatsoever.)

and that the service nets more than $500,000 each year in revenue. (Which is a point they've been highlighting again and again, which should not be the motivation behind this service at all. It always has been the biggest point they've touted the ambulance service since day one. It was pitched to then Mayor Julian as a solid revenue stream).


I no longer live in the city either, so I don't directly have a dog in the hunt. I have no axe to grind with the UFD personally. I do, however, still work in Utica and have friends and coworkers living in the City also. I think their interests, and mine indirectly, are being misused here in this case.

[Swimmy]

Jun 27, 2011 10:35:12 GMT -5 firstamendment said:

And contrary to the belief of one OD poster, who admittedly is a retired UFD, I am not bitter about not getting an appointment. I had a close family friend on the UFD, along with a neighbor, along with some other acquaintances on the UFD at the time. They all encouraged me to take the civil service test and acquire my EMT Basic. I even took the EMT course with a few other guys who also competed at the very same UFD agility test I did. I had a decent score on the civil service test but was not incredibly high on the list. I think there were only 4 open positions at the time, so my odds were not very good to begin with. I even personally introduced myself to then Mayor Hanna. Shortly before that agility test in March, Hanna announced laying off firefighters. Now my odds diminished even more. It did not stop my motivation that day during the 6 stage event and I put everything into it that I physically could. Even though I was all but certain I would not get the nod, I walked away that day knowing I gave it my very best effort. Days after the test, I even heard from my UFD neighbor, ''I heard you kicked ass on the test''. I am not and never was bitter. I was realistic about my chances and still made the best effort and I will never be ashamed for trying. It just wasn't going to happen. I moved on and eventually found a career that better suits my talents, besides blogging, haha!

If there is one thing I learned about posters on the od, it's that they're mostly full of hot air. No one here will accuse you of being bitter about something like that. And I find that when someone has to make it personal like that, they really have no argument and concede by default that their argument fails and yours prevails.

[Swimmy]

Thank you for those links, and definitions. I will be looking at them tonight.

[Clipper]

Good points FA. I have but one comment, and that is about the ambulance racing to the scene without EMS council guidance. There was an EMS council in place at the time I worked as an EMS worker and EMT. That did NOT stop Kunkel from racing to the scene and jumping calls. I still don't believe that ambulance owners should be allowed to govern or oversee their own industry. If there has to be an oversight body of some sort, it should be comprised of parties with no vested interest in the industry being controlled by their guidance.

Having ambulance owners in control of the process is like making the wolf a foster parent, responsible for the health and well being of the three little pigs for gosh sakes.

The legalities that have been skirted by the city in this instance are interesting to say the least. That is precisely the sort of information I was hoping to glean by posting the point for discussion. I had not been able to understand completely why Utica could not simply provide a service with qualified people already employed and trained. Thank you for all the input and information. Hopefully others will also speak to the issue.

[firstamendment]

I have to also concede that point, Clip, on the regional councils. It gives those members a vested interest in protecting what is already theirs. I imagine, without fully knowing the makeup and process of these councils, that someone unbiased and not affiliated with an ambulance service actually sits on these councils who can also weigh in.

In regards to that, Swimmy, its not to say I haven't conducted similar transgressions myself. Typically I only venture to the dark side when provoked. I seem to recall a pissing match with a particular attorney at one point, minimizing them to that of a patent attorney. It was stupid, I made an ass of myself and completely lost focus on the actual issue, which I think might have been abortion. I believe I have since apologized, as I should have. And actually, that is one of the defining instances where I reflected after the fact to better temper my words and approach. Thanks for that!

[Clipper]

It might be noted that many times we would be on scene of a call and Kunkels rig would slowly drive by, checking it out, realizing that we had gotten there first as we were the service dispatched on rotation.

Before universal use of the jaws of life, extrication was often difficult and all the hands available were in the best interest of the victim. That sometimes required the dispatch of a second ambulance and additional EMT's. H&W only manned one rig at night, and Kunkel manned two, so we would request their assistance on occasion. The ironic part of it was that my ex-wife was one of the first female attendants at Kunkel, and also was my assistant instructor at BOCES for a time. We seldom crossed paths in the field though as we seldom were on duty at the same time.

[clarencebunsen]

I understand that there was an incident this past weekend in West Utica where a pig was struck by a car. Both UFD & Kunkel refused to transport the pig to an animal hospital.

They had to call a hambulance.