By Shalom Baer Gee
Rapid City Journal
PIERRE, S.D. — A South Dakota bill classifying emergency medical services as essential died in committee this week. House Bill 1043 would have required counties and municipalities to fund EMS.
Proponents of the bill argued EMS is just as important and lifesaving as law enforcement, which the state classifies as essential.
“We are disappointed it was shot down but understand that there needs to be more education around this topic,” Rapid City Fire Chief Jason Culberson told the Journal.
The South Dakota House Local Government Committee voted 8-5 to defer the bill to the 41st day of the legislature. The Legislature meets for only 40 days, so a deferral to the 41st day effectively kills a bill.
Locally, committee members Rep. Tina Mulally, R-35, of Rapid City, and Rep. Mary J. Fitzgerald, R-31, of Spearfish, voted against the deferral, while Rep. Trish Ladner, R-30, of Hot Springs, voted in favor of the move.
Culberson said the state should classify EMS as an essential service.
“When someone calls 911 for an ambulance, the expectation is that an ambulance will respond much like police and fire. If some of the services have to shut down, who picks up that area? What happens if nobody responds? The issues EMS has in the state will only get exponentially worse when services begin to shut down due to no staffing,” he added.
Culberson said response areas were set up many years ago by services getting together and drawing lines, but they are not mandated. If a service shuts down or decides they cannot respond to an area any longer, there is “zero requirement for anybody to pick up that area and provide service.”
“For services that are stretched thin already how can we ask them to do more? Really, as services struggle it will put more strain on the neighboring service which will then create a domino effect that once started will be difficult to stop,” he said.
Culberson’s comments to the Journal mirrored what several others representing emergency services in South Dakota told the committee: volunteerism has decreased while call volumes and response times have increased.
“Make EMS essential because to every life we save, we already are essential, and it’s time South Dakota recognizes that,” testified Shawn Fischer, critical care paramedic and firefighter, Sturgis ambulance director, and secretary of the South Dakota Ambulance Association.
Fischer noted that Sturgis’ ambulance service responded to 550 calls in 2012. Now, the service responds to over 2,000 annually.
“The days of volunteerism being able to fully staff EMS are completely over. Call volumes have increased drastically, and so has the complexity of providing medical care,” Fischer said.
House Bill 1043, in addition to defining EMS as an essential service, would have established a state emergency medical services fund by increasing a court fee from $50 to $55 and allocating an additional $1 million from the state’s general fund.
That additional $5 in court fees — based on 2024 collections — would come out to about $400,000 each year, according to Yolanda Sung , a budget analyst with the South Dakota Bureau of Finance and Management .
Currently, the $50 fee is allocated to provide personnel, training and facilities relative to the criminal justice system and to the 911 emergency reporting response system. The additional $5 would go towards the emergency medical services fund.
Counties with 5,000 or fewer people and municipalities with 1,000 or fewer people would have been eligible to apply for grants from the fund.
“This raises concerns of fairness, as court costs are paid by citizens across the state,” Sung said.
Rep. Eric Emery, R-26A, who sponsored the bill, told the committee a 2016 survey found 92 of the 95 rural ambulance services in the state face difficulties in recruiting and retaining volunteers, and a 2021 study found one-third of rural EMS agencies are at risk because they can’t cover EMS operations.
“Every second counts when emergencies happen, whether it’s a heart attack, a car accident, or another critical incident,” Emery said. “Yet, here in South Dakota, EMS is not classified as an essential service like other emergency services such as law enforcement.”
Maynard Konechne, representing the South Dakota Emergency Medical Services Association, told the committee it’s “high time that the state and communities step up to assist EMS.”
Other proponents for the bill included the South Dakota EMS Association; Matt Thompson, Keystone ambulance director and the district vice president of the South Dakota Ambulance Association for West River; Kevin Killer, representing MRGB Consulting, which represents both Rosebud Sioux Tribe and Yankton Sioux Tribe; and Robert Rendon, vice president of the South Dakota Ambulance Association and section chief of medical operations for the Rapid City Fire Department.
Rendon said the Rapid City Fire Department responds to approximately 17,000 medical calls for service annually. That number includes over 2,500 calls that are done outside of the city but inside the 2,800 square miles of Pennington County.
“Those calls are generated to us due to a lack of coverage in those areas throughout the county,” Rendon said. He added the bill would help provide additional funding outside of health insurance reimbursements, which are often at a heavily discounted rate.
The RCFD took over the provision of EMS outside city limits from a private company that was no longer wanting to provide the service in 2003, Culberson told the Journal.
The department covers Rapid City, a large portion of Pennington County to the Wyoming line, Southern Meade County, Eastern Custer County, and a small portion of Lawrence County.
“All told we cover 3,200 square miles as our primary 911 response area,” Culberson said. “As you can imagine, (for) some of those sparsely populated areas the response times can be in excess of one hour.”
Opponents to the bill were the South Dakota Association of County Commissioners, the South Dakota Municipal League and the Bureau of Finance and Management.
“We just don’t have the money, to be honest with you,” said Eric Erickson, representing the South Dakota Association of County Commissioners.
Erickson said the association appreciated the issue and said it needs to be continually researched, but House Bill 1043 is not the answer. He added that $1 million is not enough to fund the mandate.
“Although the bill establishes the Emergency Medical Services Fund, the source of this funding is unpredictable and unreliable. Without guaranteed consistent funding from the state, municipalities could be left with a difficult task of either cutting essential services or increasing local taxes to fill the gap, both of which are negative options,” said Sara Rankin, executive director of the South Dakota Municipal League.
Emery said he discovered during his research it would take $50 million to fund EMS in the state, but he knew that was not a realistic ask.
“I get that that is not enough to fund EMS here in the state, but this is a start,” he said.
Rep. Kevin Van Diepen, R-22, expressed concerns about piggybacking off of a fund designed for law enforcement funding.
Emery said EMS is an essential service and should be treated under the same statute as law enforcement. Culberson told the Journal EMS is young compared to law enforcement and fire, which he believes is the driving force behind it not being considered an essential service.
“It is slowly becoming very evident that EMS is essential to a community and its overall safety, health, and wellbeing,” he said.
Rep. Mellissa Heermann, R-7, asked whether there would be limits on the grants that local governments receive from the fund.
Rep. Kadyn Wittman, D-15, said in reference to the financial questions, that it wasn’t the role of the committee to “wrangle with the funding.”
“I think it is up to us to determine if this is a bill that will provide a much-needed service and support for our EMS and rural providers,” she said.
Rep. Bobbi L. Andera, R-10, also spoke in favor of the bill.
“My family has benefited from rural EMS, and it was a life and death situation,” Andera said. “On top of this, the police officers, the hospitals, the ambulance services, the volunteer fire departments, they are like family, and when one of those chains in that link gets weak, everybody is burdened.”
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