August 7, 2008

City of La Crosse Unveils Ambulance Plan

By Samantha Marcus, La Crosse Tribune, Wis.

Aug. 7--The La Crosse area would have one city-operated ambulance by 2010 along with the privately run Tri-State under a proposal released Wednesday.

City officials for the first time revealed details of the plan, which calls for training La Crosse firefighters to staff a single municipal ambulance to serve both the city and outlying areas. The proposal, however, also would retain Gundersen Lutheran-owned Tri-State Ambulance as the region's dominant provider. Ambulance service in La Crosse County has for decades been the province of the private sector.

But La Crosse Mayor Mark Johnsrud argued Wednesday that across the state, fire department-run ambulances are the norm, not the exception.

Tri-State owns 13 ambulances, with eight in operation each day, director Matt Zavadsky said. An internal Tri-State study indicated another unit would be needed by 2010.

La Crosse would purchase two ambulances, with only one in operation at a time, then tap new growth rather than chip at Tri-State's existing business, said La Crosse County Board Chairman Steve Doyle.

"There's this fear we're trying to take over service," Johnsrud said. "That's not our goal. We're not here to threaten the current service provided by Tri-State."

The county would dispatch the closest ambulance, regardless of whether it is city or Tri-State owned. "Ideally, no one would even know which ambulance it was," said Doyle.

City officials estimate adding the ambulance will cost more than $1.2 million in the first five years for training, wages and benefits, vehicles, equipment and other expenses.

But the city should recoup its expenses within five years, Johnsrud said, and generate $5,000 in profit, based on predictions the ambulance would have 1,000 runs a year, or three per day.

The goal is to provide better service, Johnsrud said, rather than making money.

Tri-State Ambulance Director Matt Zavadsky said the company's total expenses run about $4.7 million annually, and it costs $650,000 to operate a single ambulance for a year.

Anticipating a backlash from taxpayers at a public meeting Wednesday evening, Johnsrud guaranteed the plan would have no effect on property taxes.

But most of those who spoke at the meeting, which drew a crowd of nearly 300, doubted the city-run service would survive without a subsidy.

"It seems to me we have a very simple system. No taxpayer dollars involved. And now we want to make it more complicated" said Dave Drewes of Citizens for Responsible Government -- La Crosse County.

The audience cheered in support when Steve Gores called on officials to take the proposal to referendum.

"This is a crucial decision. This is a life-and-death decision," he said.

Several Gundersen Lutheran emergency medicine physicians and paramedics attested to Tri-State's long-held argument that saturating the local paramedic pool would lower skills proficiency.

"You are setting these guys up for failure," 27-year paramedic Kevin Kuchar said, adding a typical Tri-State paramedic sees as many patients in a month as city paramedics would see in a year.

Johnsrud attributed the strong opposition to an audience mostly with Tri-State or Gundersen Lutheran ties. But refusing to be minimized, dozens stood up declaring no such affiliation.

Fire Chief Gregg Cleveland repeatedly emphasized the intention is to enhance existing service in La Crosse.

About $72,000 will be spent to train 12 emergency medical technicians, Cleveland said, planning no new hires.

A paramedic also will be sent along each time first responders are dispatched. First responders typically are first on the scene but can give only limited medical care.

"You can't have a paramedic first response program without an ambulance," Cleveland said.

The city/county joint resolution creates a multi-jurisdictional governing board of mostly elected officials and one representative of each of the medical centers.

"Right now, we have absolutely no say in the operation of Tri-State Ambulance," Cleveland noted.

But Zavadsky called the make-up of the Joint Emergency Medical Service Commission a deal-breaker for Tri-State. Company officials want two more medical professionals on the board.

Johnsrud countered that physicians should be advisors but shouldn't carry a vote on the commission, which would set standards and protocol.

"People of knowledge shouldn't be the decision-makers on the body," he said.

Tri-State leaders also argued the city should compete for the 2010 ambulance, although the plan guarantees Tri-State the the next ambulance after that.

"They should prove that they can do it in the same manner or a better manner," Zavadsky said.

The plan in its current form is the result of months of mediation between the city, county, Gundersen Lutheran and Franciscan Skemp.

While mediation didn't build a consensus, it successfully mitigated a major disruption in service, Doyle said.

"This is the closest I could get to something I could say is fair," Doyle said. "I'm doing everything I can to prevent the city from bankrupting Tri-State."

Doyle positioned the county as a mediator early on, concerned if the city bit off too much, it would jeopardize service in other parts of the county.

In a letter to the mayor in March 2006, Doyle wrote, "I believe that a city-owned ambulance service would cherry pick the most lucrative calls in the city leaving Tri-State Ambulance with the outlying areas that won't generate enough runs for them to remain in business."

Both Johnsrud and Doyle seem confident there's enough support within their respectively elected bodies to get the agreement passed.

The earliest the council could vote on the proposal is during its September council cycle. The county, Doyle said, wouldn't vote for another five weeks beyond that.

Plan by the numbers


Paramedic training $72,000

Wages/benefits $587,420

Vehicles/equipment $530,000

Operating costs $25,000

FIVE-YEAR TOTAL $1,214,420


FIVE-YEAR TOTAL $1,219,440

(based on three calls a day for four years; first year is training and purchasing)


Samantha Marcus can be reached at (608) 791-8220 or [email protected]


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