Randy Billings
Portland Press Herald
AUGUSTA, Maine — A $25 million proposal to rescue struggling emergency medical response agencies prompted a testy exchange Monday between a Mills administration official and a Democratic committee chairwoman.
The bipartisan bill would provide emergency funding primarily to rural EMS providers at risk of shutting down. It is one of several bills aimed at saving local EMS providers around the state, which have long struggled with increasing call volumes, reimbursement rates that don’t cover service costs and a workforce shortage driven by demanding work and low pay.
Supporters of the bill, which is sponsored by House Speaker Rachel Talbot Ross, D- Portland, and co-sponsored by House Minority Leader Billy Bob Faulkingham, R- Winter Harbor, argued that the one-time allocation is a much-needed lifeline for struggling EMS services, especially in rural areas.
“I’m standing before you begging you to support (the bill),” said Renee Gray, the Lubec town administrator and an advanced emergency medical technician and service chief for a small ambulance service covering Jonesport and Beals Island. “The lives of our communities and loved ones depend on it.”
But a Mills administration official suggested setting conditions for the funding.
Maine EMS Director Sam Hurley, testifying on behalf of the agency and the Department of Public Safety, urged the committee to consider making the funding available through grants to ensure spending accountability and transparency. He recommended attaching conditions, including aligning the funds with the state EMS board’s soon-to-be-released strategic plan.
Hurley said the funding should be used to engage local agencies about regionalizing ambulance services, which would undoubtedly lead some providers to shut down.
“We have to force those conversations with them,” Hurley said. “I don’t like saying the government has to force something but I think that’s the only future way through.”
Hurley’s suggestion to align the funding with the as-yet unpublished strategic plan prompted a stern response from Rep. Suzanne Salisbury, committee co-chair and bill co-sponsor, who worried that a grant process would be irresponsible and create red tape for service providers. She was also frustrated by what she believed were mischaracterizations of the bill, including a suggestion that providers would use the funding to drastically increase pay or purchase additional equipment, such as an ambulance.
“I feel it’s very out of touch with the original proposal, which is essentially sending a lifeline to services in danger of closing,” she said, adding that the EMS strategic plan doesn’t contemplate shifting to a new system until more than a decade from now. “I’m very frustrated. We cannot wait for the strategic plan of EMS for 2035, because people will die.”
The interaction highlights the challenges of restructuring the state’s EMS system to ensure it is sustainable and equitable throughout the state. It will likely require a balancing act between the state’s history of local control and the cost efficiencies that come with regionalization.
As of January, 276 entities were licensed to provide emergency medical services: 173 fire departments, 41 nonprofits, 35 independent municipalities, 11 private companies, 11 hospital companies, three colleges, two tribal agencies and one airborne medical service. They are divided into six regions of the state.
Staffing and funding challenges mean people seeking emergency medical help in their homes, in public or at the scene of an accident may have to wait longer for aid to arrive. It also makes it difficult for hospitals to transfer patients from one facility to another, causing a backlog of patients in emergency rooms, according to testimony Monday.
The previous Legislature formed the Blue Ribbon Commission to Study Emergency Medical Services. The commission issued a report in December outlining recommendations that include the proposed $25 million in emergency funding to prevent additional services from closing, and $70 million a year over the next five years to maintain the current system of providers.
“EMS in the state is in crisis,” the report says. “EMS services in Maine are at the edge of a cliff, or over it, and changes must occur to ensure that when someone calls with a medical emergency, EMS services are able and ready to assist.”
The state’s EMS board, which is appointed by the governor, is doing its own strategic planning and is expected to vote on a final plan at its next meeting April 5.
EMS providers urged lawmakers to support the emergency funding while acknowledging the need to regionalize services that are now provided by municipalities, nonprofits and hospitals. Providers say insurance only covers a percentage of the cost of transporting patients to hospitals. And insurance companies provide no reimbursement for calls in which a patient declines transportation to a hospital.
An amended version of the rescue fund bill, L.D. 526, presented Monday would allow services in danger of closing to receive $15,000 to $500,000. Eligibility would be based on need, “rurality” of the service area and a department’s number of responses. Recipients would have to file an annual report each May and services responding to fewer than 2,000 calls a year would have to explore other EMS models.
Dr. Erik St. Pierre, emergency medical director at Northern Maine Medical Center and the director of two ambulance services in Fort Kent and Madawaska, said the EMS system is in the worst shape he’s seen in his 11 years working in the state. Recently, he said, he was unable to find an ambulance to transport three pediatric patients, resulting in parents transporting two kids and a nurse and a clinician transporting another.
St. Pierre, who testified by video from Aroostook County, said last Friday he placed 13 calls over a 12-hour period to find an ambulance to transport a patient to a major hospital. By the time he secured transportation, he said, the hospital had assigned the bed to someone else.
“That is a story we hear over and over again up here,” St. Pierre said. “For us in the rural community up here it is a crisis and it is serious.”
St. Pierre suggested lawmakers examine the system in New Brunswick, Canada, which centralizes EMS dispatch and allows for more efficient coverage of communities.
Robert “Butch” Russell, director of the Maine Ambulance Association and CEO of Northeast Mobile Health in Scarborough, urged the committee to approve the onetime funding measure, saying the current system is at a “breaking point.” He also thinks communities and providers should discuss regionalization, although he hesitated to suggest what that might look like.
“It’s not a popular word in our industry,” Russell said. “I don’t want to define regionalization. That means different things to different people. But when we talk about services only doing 100 calls a year, we’ve got to come up with ways of doing that different.”
Talbot Ross presented lawmakers with an amended version of the bill Monday, saying she continues to work with the governor’s office to address concerns, including accountability and oversight by the state EMS board. But she continued to stress the importance of the emergency funding.
“Put it this way: Today you are taking out the defibrillator and ensuring this system gets a chance at a full recovery,” she said. “Our next steps will require a full care plan and regular maintenance — there is no option here. For too many, this is quite literally a life or death option.”
The committee is expected to take up the bill in a work session in the coming weeks before sending a recommendation to the full Legislature.
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