City Ambulance Service

[Ralph]

I was involved before this was ready to be voted on, and at that time I did support it.

BUT…….it has not evolved into anything that was discussed!!!

This was to be a service that would not charge more than Kunkel, and if the bills could not be paid due to financial constraints, they would basically be forgiven.
However, as soon as the service was in place that all changed. Far as I know there has NEVER been a real accounting of funds either spent or collected, nor any breakdown on exactly who, what, and where the money goes. It was to be a plus for the City and the residents……not a constant Rubik’s Cube of “show me the money”.
So far as I can see it has become an “overtime hog” and a “pension booster”.
While I have no qualms about the service being run by the City, it would be nice if it was scaled back to what it should have been instead of what it has become.

[firstamendment]

Consider that when the city rolls on emergency calls, they send both an ambulance and a fire truck. There was a call in of a man with chest pains a few weeks ago across from my work. The city ambulance along with a ladder truck showed up. Yeah a waste of resources.

[larry]

Jun 28, 2011 7:18:40 GMT -5 Swimmy said:

Jun 27, 2011 18:23:03 GMT -5 larry said:

It's a very slippery slope when government starts competing with private business. There are certain things government should do, and many they shouldn't. There was never a need for the service, which is the law. The only rationale was to raise revenue (which has also been debated). In that case, why don't we open a grocery store, too? Maybe a gas station, department store? We can raise revenue with those too. Hotels make money. Why not foreclose on Hotel Utica and go into the Hotel business? You see my point? It's not about the Kunkels or Taylors, or even the UFD. It's about the intent behind the original idea and the fact that they invested taxpayer money without ever following the process. Again, it's a slippery slope for government. Just my two cents. For the record, I think we have an outstanding fire department, but that's not the point here.

I have news for you, Larry. Government has been mettling with private business since it first started subsidizing corporations! We've already ventured down that slippery slope. There is no real concern with having a government-operated ambulance service. It is an extension of their Fire fighting services and law enforcement services. Unless you are advocating we privatize fire fighting and law enforcement, I really don't see your argument carrying any weight against it.

Swimmy, you're right, and that's where the problem is. And, no, I'm not advocating privatizing firefighting or police. That's a different subject and a diversion. There are plenty of municipal ambulance services. However, they have all received a "certificate of need" because there was a NEED for the service. Clearly, there was/is no need here. It was never even created to fill a need. They sold it then, and are still selling it now as a "revenue generator". Well, that's not what the state or the law cares about. They care about "need". Two panels and several judges have made this clear already.

Furthermore, it has already been established in a case out of Long Island, that a municipality can not legally use revenues from an ambulance service for it's general fund. That's what Utica has been doing all along. In that case, which you would probably know how to find online better than I, it was written that any surplus revenue from a municipal ambulance service must be placed into a dedicated account - similar to the water trust fund. And the money must be used for enhancing that service or paying for bonding, etc. So, their claims of losing revenue (which is in dispute) are crazy. They are using any revenue they may even be gaining illegally.

Also, the fact that they NEVER even considered a Plan B for if this happened, is absolutely insane and should be malpractice. Finally, your comparing this to wasting money on the OIN case can be flipped right around on you. You are against that, but for this. Why? This seems way more clear cut than that. That's an issue that raises real legal arguments that will NEVER be answered - unless you can bring the founding fathers back to life and depose them. Otherwise, I kind of agree with you.

[larry]

Because I left that last reply somewhat open-ended on the OIN issue, I want to state this so that we don't digress on the subject:

As President Lincoln used to say whenever someone called him a flip-flopper, "I'd like to think I'm smarter today than I was yesterday." With that said, I agree with you on the OIN issue. One of my biggest regrets as a county legislator was fighting that deal with the Nation. If I could go back to then, I'd take the deal. And if I did support it, I'm very confident that it would have passed - for reasons I won't discuss here. I have few regrets, but that is one of them.

Back to the ambulance...

[JGRobinson]

Hi Stony,
She is the program director at MCARC so I dont think they will let her expand out past DD Clients. I believe she's on her way to 10 homes now might end up with whats left of the States Homes. Her program is much less expensive to run than the States Version of it yet more successful at placement and retention.

[Swimmy]

Then stick to the issue of need. The slippery slope argument just does not carry weight on this. As for whether I support the municipal ambulance service, I'm on the fence. I appear to support it merely because I believe they have not had a fair review of the matter and the legal doctrines on agency review do not lend support to those seeking to overturn administrative decisions. Even with kunkel allegedly abstaining (probably should have recused itself instead), its influence was still there. And the legal doctrine for judicial review of agency decisions is whether the agency decision was arbitrary and capricious, a standard that initially sounds like a strong standard in favor of the appealing individual, but in fact is most favorable toward agencies because all the agency has to do is cite to some form of evidence that supports the agency's determination. And the case law is very generous with that "form of evidence." It is why many argue there is a 4th branch of government that is neither elected nor redressable in court. The courts have such a strong preference for deference toward agency decisions that I am not surprised the state judges affirmed it. I would rather see the Utica Ambulance Service have a fair shot, not the railroaded one that appears to have happened.

[longtimer]

Swimmy, the issue of need is what was addressed by both the local and state EMS councils. I don't know of one person on the council or in the community who would object to a city service if there was a demonstrated need.

I am having a hard time understanding why you feel the UFD got the shaft on this. I have spoken to a couple of the council members and was told that Jack Kunkel did not just abstain from the vote but he did not participate in the council review at all other than to respond to requests for information. While that is second hand info I have no reason to doubt these people so until I do I will accept what they say. He certainly has no influence over the state council.

The EMS council is a pretty large group and most of them are not beholding to Jack Kunkel for anything. I have worked with many of them and have found them to be hard working honest people. I believe it is a bit unfair to the members to say they gave the shaft to the UFD without one shred of proof or even a hint of what they got wrong in their review. I have not heard one fact presented that indicated a need for the city to start the service, other than to create jobs for the UFD. As a matter of fact the UFD chose not to present any facts until ordered to do so.

Prior to retirement my job required me to interact with with many emergency preparedness agencies locally and at the state level. Although nobody is perfect I never heard of one issue regarding the service Kunkel provided that indicated a problem.

As for the slippery slope, I agree that we have gone way down that slope but that does not mean we should continue. Government should do only what they need to do, not what they want to do. Where do we stop the extension of services? I bet the local legal community would be up in arms if Oneida County decided to start a law firm as an extension of the public defenders office because it would be a great way to increase revenue. So what if it closed a few local law firms, think of all the added government jobs and pensions we could pay out. How about having the Department of Public works paving driveways. they could generate revenue and it is just an extension of paving the roads.

Now that may seem ridiculous and obviously I don't want that to happen but there was a time when the fire department had one job, fighting fires. Now they have their tentacles in lots of thing nobody ever dreamed possible so why not the same thing for the public defenders office and the public works guys? It is the same logic as far as I can see.

In my opinion every time the a government agency reaches it's tentacle into private business they should have it cut off unless they can demonstrate a compelling need. Such was not the case here and the proof is in the fact the UFD did not even want to file a CON. The facts say to me that nobody did anything to the UFD or the city, they did it to themselves.

[firstamendment]

It serves no purpose to deny a CON if a true public need exists for additional resources. Based on the way the law gives special treatment to municipalities, Utica could get started immediately without having to prove that need existed. And that is exactly what they did, by law. But, also by law, eventually they have to get a CON like everybody else, which includes a need exists. The basis of part of the City's claim was that they don't have to prove anything, that they are exempt from it. That defense was completely blown to pieces.

And since the 911 calls are handled by either the City or the County, depending on how the call was routed, it makes it hard to say Kunkel can fudge their numbers to make it look like no additional need exists. If there is this need, then it is up to the City to prove it. The burdon is on them and they simply cannot meet that burdon.

As I posted on the OD last night, now the City and their attorney came out stating they were going to disobey the order and keep running. They claim that they are entitled to an automatic stay on the court ruling. While I cannot determine whether that is true or not since I am not versed on court appeals, what the City and their attorney seem to ignore is that the order to shut down came from the Dept of Health, not the court. They don't have an automatic stay from the DOH ordering them to shut down. They'd have to petition for an injunction to block that order. The DOH is not a listed party in the case against the city, the State Attorney General and Kunkel are. Unless the AG is acting on behalf of the DOH, then the DOH order is outside of any court proceedings and not subject to an automatic stay. Not only that, but how does it look for the city in their case if they crassly state we are going to disobey your order? Arrogance.

[Deleted]

What I don't understand is that we have three hospitals within 5 to 14 minutes of each other and we have two ambulance companies. I started a volunteer ambulance company years ago that worked along with the volunteer fire department. The city it serviced had the closest hospital at 80 miles away. This is the reason why I and some other's presented our idea to the city governement and the thing took off like lightening. It still exists today.

[Clipper]

Aside from all other arguments, it seems that Kunkel should not be allowed to be the ONLY service available or to have a monopoly on ambulance service in the city. SOME people don't like the service offered by Kunkel for whatever reason, and SHOULD have a choice. Seems simply unfair and favoring Kunkel.

[Swimmy]

Jun 29, 2011 8:00:47 GMT -5 longtimer said:

Swimmy, the issue of need is what was addressed by both the local and state EMS councils. I don't know of one person on the council or in the community who would object to a city service if there was a demonstrated need.

I am having a hard time understanding why you feel the UFD got the shaft on this. I have spoken to a couple of the council members and was told that Jack Kunkel did not just abstain from the vote but he did not participate in the council review at all other than to respond to requests for information. While that is second hand info I have no reason to doubt these people so until I do I will accept what they say. He certainly has no influence over the state council.

The EMS council is a pretty large group and most of them are not beholding to Jack Kunkel for anything. I have worked with many of them and have found them to be hard working honest people. I believe it is a bit unfair to the members to say they gave the shaft to the UFD without one shred of proof or even a hint of what they got wrong in their review. I have not heard one fact presented that indicated a need for the city to start the service, other than to create jobs for the UFD. As a matter of fact the UFD chose not to present any facts until ordered to do so.

Prior to retirement my job required me to interact with with many emergency preparedness agencies locally and at the state level. Although nobody is perfect I never heard of one issue regarding the service Kunkel provided that indicated a problem.

Thank you for that insight. I wish the paper did more research and investigation into its reporting. Your insight certainly changes my perspective. Having read your post, I reverse my position about Utica UFD not receiving a fair shot. Again, thank you.

Jun 29, 2011 8:00:47 GMT -5 longtimer said:

As for the slippery slope, I agree that we have gone way down that slope but that does not mean we should continue. Government should do only what they need to do, not what they want to do. Where do we stop the extension of services? I bet the local legal community would be up in arms if Oneida County decided to start a law firm as an extension of the public defenders office because it would be a great way to increase revenue. So what if it closed a few local law firms, think of all the added government jobs and pensions we could pay out. How about having the Department of Public works paving driveways. they could generate revenue and it is just an extension of paving the roads.

Now that may seem ridiculous and obviously I don't want that to happen but there was a time when the fire department had one job, fighting fires. Now they have their tentacles in lots of thing nobody ever dreamed possible so why not the same thing for the public defenders office and the public works guys? It is the same logic as far as I can see.

In my opinion every time the a government agency reaches it's tentacle into private business they should have it cut off unless they can demonstrate a compelling need. Such was not the case here and the proof is in the fact the UFD did not even want to file a CON. The facts say to me that nobody did anything to the UFD or the city, they did it to themselves.

There are several different law firms, sotospeak, at the county level. There is the District Attorney's Office, the Public Defender's Office, the County Attorney's Office, and the Department of Social Services Legal Unit. In Broome County, the BC Department of Health has to pay $175/hr to the county attorneys to petition courts to shutdown unsafe properties. That's a job that could be reserved for private practitioners. If my memory serves me correctly, and feel free to correct me, but back in the day firefighters were also required to perform EMT services, e.g. bringing people to hospitals, helping people ready to commit suicide, long before it all became privatized and commercialized. In any case, I think the slippery slope argument is not a strong one in this case. As for the rest of your post, I don't disagree. I think most of you will confirm that I lean libertarian and am a little "r" republican. Therefore, from that perspective, I agree that the government should stick to the basics of its existence, maintaining infrastructure, providing governing leadership, and protecting us from our enemies.

[Swimmy]

Jun 29, 2011 9:06:38 GMT -5 firstamendment said:

It serves no purpose to deny a CON if a true public need exists for additional resources. Based on the way the law gives special treatment to municipalities, Utica could get started immediately without having to prove that need existed. And that is exactly what they did, by law. But, also by law, eventually they have to get a CON like everybody else, which includes a need exists. The basis of part of the City's claim was that they don't have to prove anything, that they are exempt from it. That defense was completely blown to pieces.

And since the 911 calls are handled by either the City or the County, depending on how the call was routed, it makes it hard to say Kunkel can fudge their numbers to make it look like no additional need exists. If there is this need, then it is up to the City to prove it. The burdon is on them and they simply cannot meet that burdon.

As I posted on the OD last night, now the City and their attorney came out stating they were going to disobey the order and keep running. They claim that they are entitled to an automatic stay on the court ruling. While I cannot determine whether that is true or not since I am not versed on court appeals, what the City and their attorney seem to ignore is that the order to shut down came from the Dept of Health, not the court. They don't have an automatic stay from the DOH ordering them to shut down. They'd have to petition for an injunction to block that order. The DOH is not a listed party in the case against the city, the State Attorney General and Kunkel are. Unless the AG is acting on behalf of the DOH, then the DOH order is outside of any court proceedings and not subject to an automatic stay. Not only that, but how does it look for the city in their case if they crassly state we are going to disobey your order? Arrogance.

I was wondering that when I read the article: how can they obtain a stay order from the Court of Appeals when the shut down order isn't coming from a lower court? I agree that procedurally, the city would need to petition for an injunction with the Court of Claims. However, typically, the AG represents any state agency. So I guess the city could argue that the DOH is part of the suit because the state is involved, but absent the DOH being named a party, specifically, I think that is a stretch of an argument to make.

And very good point about the impression it will create for the city to ignore the DOH shutdown order. I agree. But another question I was wondering was what recourse the DOH had to enforce its shutdown order, absent going to court.

[firstamendment]

The DOH certainly is free to fine them for not complying. Short of actually going to Utica and physically taking the ambulances out of service, I don't know what more they can do to enforce it. The OD actually has the pdf of the DOH notice to the City and it outlines the timeline of this pretty well.

www.uticaod.com/archive/x2069929744/file

Clip, if competition is what you'd rather see, then your issue is with the state, who regulates against competition in favor of providing adequate services for a given need.

Even though I am registered "D" I also believe government need only be involved with the minimum they should be. I am not for big government and can't say I ever have been. Hell, if the case is made that government should be running ambulances on the basis of continuity of care, why not government run hospitals?

[Clipper]

Don't be surprised if in the next few years, with government's current ventures into the private sector, if government DOESN'T try to intrude into the hospital business. Especially if socialized medicine is to be the norm in this country. lol

Looks to me like there could possibly have been a case made for the city run ambulance service had it not been promoted in the manner it was, as a profit making, revenue source for the city. I still believe that there IS room in the city of Utica for two ambulance services, and many other cities successfully and justifiably have city ambulances run by the fire departments. I still believe that the EMS Council should be comprised of parties with no financial gain or interest to be garnered by their decisions or rulings. ER Doctors and other healthcare professionals. Leave it to Utica and the run of the mill Utica politicians to skip the legalities and simply jump the gun. Leave it to Utica to jump in the shit, uninformed, and without proper research into the issue, and then spend your tax money defending their stupidity in court cases.

[clarencebunsen]

I've lived in a number of places where a municipal or county government ran a hospital. In the Twin Cities one of the largest hospitals is Hennipen County General. MY wife did her ER training there, very busy ER. The TV show ER was set in Cook County Hospital in Chicago.

There are also numerous Veterans Hospitals operated by the federal government.