Officials differ on ambulance pact

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Commissioners don’t want 5-year commitment

Managing Editor

LEOPOLD – Perry County commissioners will continue a discussion Tuesday about whether to sign a five-year contract to have Perry County Memorial Hospital continue providing ambulance service for the county.

Meeting at Perry Central Community School Tuesday because the county courthouse where they normally meet is undergoing renovations, they drew an audience of approximately 20 people.

Discussion about ambulance service didn’t come up until they got to the last, “miscellaneous” item on their agenda. The News reported March 31 the commissioners voted to amend the annually renewed agreement under which the hospital provides the service. Under one of several changes, the contract wound remain in effect until the end of this year, and would continue to go year-to-year unless the commissioners give notice of nonrenewal at least two weeks before it expires, county attorney Chris Goffinet said.

He said at the latest meeting he erred in having the agreement specify two weeks before expiration, and the version he sent to hospital President and Chief Executive Officer Joe Stuber for the hospital board of trustees to approve required 90 days’ notice. The contract should also have stipulated it would automatically be renewed each year unless either party provides termination notice to the other at least 90 days before the end of a year.

“That’s what it was before,” Goffinet said. “This contract was entered into in 1987 and it’s always been year-to-year unless it was terminated within (sic) 90 days of the end of a year.”

“We kind of questioned in our minds at the last meeting, where’d that come from,” Commissioner Randy Kleaving said. “We just thought the hospital had put that in.”

Stuber called him and questioned that change, he continued.

“He was right … neither one of us could get out of it in two weeks,” he said, adding the time requirement should be returned to three months.

In recommending those changes be approved, Goffinet referred to a contract valid for this calendar year.

“Since we’re halfway through this year,” Commissioner Bill Amos suggested making the current contract expire at the end of 2015 instead of this year.

Changing tack slightly, Kleaving said “a lot of miscommunication” has occurred between the county commissioners and the hospital. As the News has previously reported, the commissioners and county council agreed to spend up to $20,000 to make improvements at the county highway garage to accommodate ambulance crews. The building was constructed in a central location in the county to include that purpose. It has a console dispatchers can move to if their offices in the Tell City Police Department are damaged. It also houses rescue vehicles. Making the improvements needed to add living quarters and siting an ambulance crew there was seen as the fulfillment of a promise made when the building was erected.

“Our primary goal when we started looking at everything,” Kleaving continued, “was to put an ambulance at the north station.” Issues that emerged as he examined the idea over the last year, he said, included the county not having the coverage it should due to the volume of runs the emergency medical service makes. That led to Spencer County terminating a mutual-aid agreement it held with Perry County, he said. “We need to work on getting that back.”

“The big thing was, when I started looking into this,” Kleaving went on, “it was promised 14 or 15 years ago to put an ambulance at the north station … that’s still our primary goal for the future, how we can find some money to put a crew on.”

Hospital should provide service
The examination included asking what’s best for the county, for the hospital to run the ambulance service or for the county to take it over?

“We did research on that,” Kleaving said. “We had to because we were doing our job. Then we met with the hospital board on Dec. 16 … and they put in the contract what we wanted, the four amendments. So at that time, we said we need to focus on what’s important, putting another crew on for the county.”

Their research resulted in a determination it would be best to have the hospital continue providing the service, he said. All that remained was to work with the hospital and county council to find funding for the additional crew.

A primary and backup crew should remain in Tell City while one is added at the north station, he said, “and that’s all we’re trying to do here. I’ve heard so much stuff, it just about blows your mind. I don’t know where it’s coming from, but I want it stopped right now.

Because this is what we’re doing here. And we’ve got to work together, because it’s Perry County hospital, Perry County commissioners, Perry County council. From here on out, we’re one, and we’re going to work together. So with that, they proposed a five-year contract. I really don’t think we need that for building that new building.”

That building is a new hospital under construction along Indiana 237, plans for which include an ambulance station. Commissioner Tom Hauser said at a January meeting it’s 11 miles from the north station.

“It’s been a tough year trying to figure this out,” Kleaving continued, “and we’re not done with it. We’re not trying to tear the county apart because of the ambulance. We want what’s right for Perry County.”

He compared this issue to a comprehensive plan the commissioners voted to have developed at a cost of $50,000. That spending will go before the county council for approval this month. He and the other commissioners put a lot of time into that decision, he said before asking, “do we spend the $50,000 to see this county try to grow? It’s all about trying to grow the county.”

He said he kidded with Stuber once that, “20 years down the road, we might need an ambulance at the original EMS, the new EMS and one at the north station – you don’t know how this county’s going to grow. You’ve got to look for the future. And I wasn’t really kidding. It could happen.”

He was happy with the contract with the change back to a 90-day notice requirement, he said.

“I want to get this behind us and move to the next step,” he added. It would entail working with the council and the state, “trying to do anything we can do to get some more revenue.”

The purpose for including an ambulance station with the new hospital is identical to the one behind improving the north station, Stuber said from the audience.

“Moving EMS to the new hospital site will cut eight to 10 minutes off the response times to the northern part of the county,” he said. “At the time we decided to take that on, the north station wasn’t even being discussed. But the hospital is spending $500,000 of its own money to put that out there. That’s the reason why we’re requesting a five-year contract.”

The hospital has held the contract for 28 years, Stuber continued, and since it’s spending that much for the station, a five-year commitment is not unreasonable.

“We weren’t even sure if the commissioners intended to move EMS out there,” he said. “We really need to know if you intend to move it out there, because (if you do) we’re going to redesign it and use it for another purpose and I guess you all would be leaving the EMS station where it is now. So we need a decision from you guys.”

Five years is too much

“I’m fine with moving it out there,” Kleaving replied, “but I’m really not comfortable with a five-year contract, because there’s a lot that could happen in five years. We don’t know how the Affordable Care Act’s going to treat us; we probably won’t even know that in five years.”

He said he wanted to meet with the hospital board every year – a requirement of one of the amendments – because much uncertainty exists, “not to take it away from you guys or anything like that.” Adding a crew at the new hospital or the north station would be fine with him, he said, adding any move is going to shortchange some people while others benefit. “What I mean by that is if you move it 10 minutes closer to the northern part of the county, you’re taking 10 minutes away from somebody at Cannelton, Tobinsport or someplace like that.”

Any new building would be an asset, Kleaving said, so “I say go for it.”

Guaranteed contract?
Stuber noted an EMS building has specific design requirements, and justifying the construction of one would be difficult if it might be used for something else or if “we don’t even know if we’ll have the contract” in coming years.

“You’ll have it,” Kleaving said.

Amos addressed J.B. Land, chairman of the hospital-trustees board, saying the contract calls for a five-year term that can only be terminated within 90 days of that period.

“What you’re asking us to do is sign a contract for five years, and if something goes south and (Stuber) leaves and the new guy comes in and says, ‘no, we’re not going to pay for (some administrative costs) like we do now, we’re going to stick the county for it and stuff like that, we can’t say anything about it. I don’t think in your job you would ever sign a contract like that with anybody.”

Land noted the board’s responsibility is to do what’s best for the hospital and it is the commissioners who appoint its members. Fiduciarily, it wouldn’t be responsible to build a half-million-dollar building with no guarantee it could be used for five years, he said.
“I think it’s within that contract that if within that five years you guys decide to outsource the ambulance service or whatever, then at that time, whoever is doing your ambulance work, we would bill them at a fair market value for the rental of that building on a monthly basis,” he said.

Amos reiterated the contract can only be terminated 90 days from the end of its five-year term.

“That’s not to say within that five-year period you can’t say, ‘hey, guys, we don’t want you to run the ambulance service, we want this entity to run it.’ ”

Stuber added that Goffinet could add language about different contingencies.

That could include, the attorney said, changes to the hospital’s billing practices, which now benefit the county.

“As I understand it, Joe, you’re not necessarily billing separately for administrative costs,” he said as an example, “and if the hospital were to change that it would give grounds to terminate. We can write this thing any way you guys want. We just need to have a good discussion about how to do that.”

Stuber said later the billing practice effectively means the hospital is subsidizing the ambulance service approximately $250,000 annually.

He had told the commissioners the hospital may have to start charging for that, Kleaving said.

He also suggested the commissioners and hospital board may have lost trust in each other.

Unity needed
“We need to get that back and we need to pull together,” he said before proposing again the contract be signed for this and next year.

“We’ll work year-by-year after that with a 90-day out,” Kleaving said. “I think that’s fair. That will give us time we can build our trust with each other and move from there on out, move to the future of Perry County. I have a real hard time with a five-year … if we’d be throwing a five-year contract at you right now with something like this on a different side, you’d probably feel the same way as what we feel.”
“With Obamacare, you don’t know what’s going to happen,” audience member Fred Weaver said.

“Exactly,” Kleaving replied. “That’s a scary thought in the medical field. I hope it’s good.”

Changes in Medicare payments, “which is where the hospital gets most of its funding, if that is reduced,” added Pam Granderson, also from the audience, the county could be liable for payments “because we backed it up.” She was referring to agreements from the county council and commissioners to use property taxes to repay the loan if the hospital becomes unable to.

When the county officials signed those agreements in late 2012, Goffinet noted they’d seen presentations showing the likelihood was very low that hospital revenues would be insufficient to repay construction bonds.

Amos said that before he agreed to back the project, he was told by the presenter the county would be safe if Medicare was reduced by 5 percent.

“I’m saying if it drops more than 5 percent or Republicans do away with it,” Granderson said before explaining, “all the years my husband worked at the prison, we were not allowed to go to Perry County. We had to go to Evansville for everything unless you weren’t breathing.”

“You’ve got an elderly population in this county,” she added. “They’re all on Medicare and so that’s where the business is.”

The hospital holds a year’s worth of payments in reserve, which would provide a cushion if needed, Amos said.

“Elections come and go,” audience member and County Councilman Stan Goffinet told Kleaving. “You cannot say you’re going to be here (and) the hospital needs certainty. I’m really concerned because we have cosigned with the hospital and I do not want anything to jeopardize that. We need the hospital to make money. The county cannot afford to subsidize any of the hospital. It’s making a profit right now and the EMS is the best, probably in the state.”

Two years isn’t certainty
“The people of Perry County would be awful upset if that EMS building is not at the new hospital,” he added before agreeing the hospital needs certainty and asserting two years “is not enough.”

The commissioners tabled the issue until their meeting scheduled for 9 a.m. Tuesday in the cafeteria at Cannelton High School.

Further discussion from this meeting and from that one will be reported in an upcoming story.