By Stephen T. Watson
The Buffalo News
TONAWANDA, N.Y. — The Town of Tonawanda’s paramedics unit costs about $2.6 million a year in salaries, benefits, equipment and supplies, far more than the revenue the service brings in.
A consultant, however, projects the town could shrink the cost to taxpayers to just over $2 million by combining its paramedics division with a new ambulance corps, thanks to a surge in insurance payments for medical transports the town would begin to collect.
Twin City Ambulance, the town’s current provider, said the Fitch & Associates report is based on inaccurate or incomplete information.
The company said the town would take in less revenue and spend far more to operate its own ambulance service than the study anticipates.
Representatives of the town and Twin City will meet Friday, two weeks after the company said it was blindsided by Tonawanda’s ambulance announcement. A top Twin City executive said he hopes to persuade town officials to reassess the viability of a municipal ambulance corps.
“This is a disaster in the making,” Terry Clark, the company’s president, told The Buffalo News.
Town Supervisor Joseph Emminger and other town leaders on Oct. 3 announced a plan to purchase four new ambulances and hire 20 EMTs to staff them. The town also would hire two additional full-time paramedics to add to its roster of 16 full- and seven part-time paramedics, who would continue to serve on the town’s paramedic fly cars.
“Why it was done was not because of Twin City, OK?” Emminger said in an interview. “It was done because we believe that we can provide a better service to our residents in a more cost-effective way.”
Two of four ambulances would be in service around the clock, with one operating 12 hours a day and the fourth available as a backup.
The service, which would also cover Kenmore, should start early next year and reach full capacity by the end of 2025, Emminger said.
He said the town began to explore launching its own ambulance corps after hearing concerns about how long officers and paramedics have waited at emergency scenes.
Emminger, at the public announcement, said crews wait as long as 30 to 60 minutes for an ambulance to arrive, though he didn’t say the words “Twin City.”
Clark, following the news conference, called the supervisor’s description of the company’s response times “absolute fiction.”
The average response time was just over 10 minutes for Twin City’s 10,600 dispatches in the town over the previous 12 months, Clark said. No call had a wait time of more than 40 minutes, he said.
The town’s announcement prompted questions about whether the move would make fiscal sense.
Emminger said the Fitch & Associates report showed the town could see improved response times without busting its budget from forming its own ambulance corps.
Officials had not previously made the study public but released it after The News filed a public-records request.
The financial section of the report noted the town spends $1.85 million annually on its paramedics division, a figure that doesn’t include employee fringe benefits. Emminger said the cost rises to $2.6 million yearly with the benefits included, after taking into account the $96,000 the town receives annually in paramedic service income.
Keeping paramedics and adding ambulances would increase the town’s costs but also its income, the report found, because the town would receive payments from private insurers, Medicaid or patients for emergency transports to hospitals.
Revenue for the combined operation would rise to $2.7 million, according to Fitch, while total expenses, including EMT fringe benefits and annual depreciation on the ambulances, would rise to nearly $4.8 million yearly.
So town taxpayers who now pay $2.6 million a year for a paramedic service would pay about $500,000 less annually to receive both paramedic and ambulance services, the report projected.
“I don’t think it’s conservative. I think it’s a realistic number,” Emminger said.
He also said he’s convinced the town’s pay rate and benefits package would make the positions attractive at a time when private ambulance companies have difficulty hiring and retaining EMTs.
Twin City’s Clark, for his part, predicts the town would end up receiving closer to $2 million – not $2.7 million – in annual insurance payments.
The bigger problem with the projections, Clark said, is it would cost much more to operate the service.
He said the town would need more ambulances and more EMTs to staff the ambulances than assumed in the report.
He pointed to one part of the report that addressed average “wall times” at several of the hospitals where town residents are taken by ambulance. That’s a reference to the period of time between an ambulance’s arrival at a hospital and when the hospital takes responsibility for the patient, allowing the ambulance crew to leave.
The report acknowledged wall times have risen at those hospitals, but Clark said Fitch vastly understated them, perhaps because it tracked when a town paramedic was cleared to leave.
For example, the Fitch report indicates an average wall time of 18 minutes at Erie County Medical Center for 2023. But Clark said the average wall time at ECMC for Twin City ambulances carrying patients from throughout its coverage area was over an hour during September.
“They’re greatly underestimating how long their ambulances are going to be tied up,” Clark said.
The News also obtained a letter sent to Twin City after Clark objected to how the town supervisor characterized ambulance response times in Tonawanda.
Clark issued a “cease-and-desist” letter that demanded the town retract those statements.
In his Oct. 7 reply, Emminger declined to apologize for statements he made to the press but in a conciliatory tone said the town looked forward to working with Twin City in the future.
Emminger noted, however, that Twin City found in a review of its own data that the company reported delays of more than an hour on three occasions since 2021, including one call during the 2022 blizzard.
Clark said the other two hourlong delays may have been data-entry errors.
Clark said he hopes the town at Friday’s meeting will agree to pause its shift to a municipal ambulance service and allow Twin City to provide data to Fitch for a more accurate study of this proposal.
“It would be great, but I don’t think it’s going to happen,” Clark said. “But we feel an obligation to the citizenry here. And I hate to see what’s going to happen here if they go ahead with this plan.”
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