Firestorm surrounding ambulance service in South Lake Tahoe

In the mix you have El Dorado County, the City of South Lake Tahoe, Lake Valley Fire Protection and the Cal Tahoe JPA. More importantly, and most likely the reason for the passionate responses from all involved, the mix also contains the safety of the public.

On March 15, 2016, the City of South Lake Tahoe sent a letter to the JPA, stating their intent to pull out of the agency that was created in 2001 to supply ambulance service to the City and the County and a portion of Alpine County.

That letter was the catalyst for press releases to be sent out Thursday from Lake Valley Fire Protection and the El Dorado County Chief Operating Officer.

“I am disappointed in the press releases from both El Dorado County and Lake Valley Fire Protection District that contain false information," SLT City Manager Nancy Kerry said in a statement. "The County’s statement is a knowingly false and misleading statement intended to feign surprise at the City’s action. The City will continuing serving on the Cal Tahoe JPA and ensure adequate ambulance and medical emergency service are provided as evidence by the hiring of six EMTs and six Paramedics in the last couple of months.”

That El Dorado County press release stated, "El Dorado County officials have initiated discussion with the Cal Tahoe JPA to jointly consider the consequences of this action. The County is expressly concerned about the threat to public health and safety of residents and visitors to the South Lake Tahoe region should the City of South Lake Tahoe terminate its ambulance service contract, with the Cal Tahoe JPA, without making adequate provisions to ensure that its action will not put ambulance service in the South Lake Tahoe region at risk. Due to the nature of the action by the City of South Lake Tahoe and its repercussions to public health and safety, El Dorado County will be submitting a letter to the City requesting an immediate meeting."

As of Friday afternoon, South Lake Tahoe Fire Chief Jeff Meston, City Manager Nancy Kerry, the City's representatives on the JPA Mayor Wendy David and Councilman Tom Davis, nor JPA Executive Director Ryan Wagoner had heard from the County as claimed in Thursday's release.

"This decision deeply concerns the District, as it would ultimately mean the City would stop providing ambulance services within the City of South Lake Tahoe," Lake Valley Fire Protection said in a statement late Thursday. "The District is cooperating fully with El Dorado County’s requests, and has the health and welfare of its constituents as its highest concern. The District strives for the highest quality emergency medical services and takes pride in providing full advanced lifesaving capabilities."

On December 7, 2015, a City Council consent agenda item was asked to be pulled by Tom Davis. That item was a memo of understanding concerning staffing between the City and the Firefighter's Association. It outlined a plan to have temporary EMT (non-safety) employees staff the ambulances and not firefighters. At that time, JPA board member Dave Huber, and Wagoner, said they were concerned about the level of service on the ambulances.

"Will this, in any way, shape or form, affect the health and safety of our citizens?" Davis asked Meston during that meeting. Meston assured him that it met the terms and conditions of their agreement with the County and was a cost effective move that wouldn't affect service.

Since 2013 the City has been trying to get more funding to the JPA from El Dorado County to cover ambulance services on the South Shore. Chief Meston made a presentation to City Council on July 7, 2015 about withdrawing from the JPA. On that same date, Lake Valley FD said they could provide the needed service in 120 days, if they had to. Wagoner said that statement was only in a "what if" scenario and not their actual position at the time.

"We have to get everyone to the table," Chief Meston told South Tahoe Now, a comment echoed by Wagoner.

Meston was concerned about the scare tactics initiated by the County. "Don't tell the people they won't be safe," he said. "I have the support of the Firefighter's Union to extend out the temporary EMTs another 90 days if that is what it takes to transition to Lake Valley. At no time will the public not be safe."

Meston was Director of EMS in Novato, Calif., in 1986 and has taught EMS Management at the National Fire Academy (fire departments' equivalent to the FBI). He said many fire agencies in the state are re-looking at the way they do business to be more cost effective at the same time to not reduce services.

A major cost to the JPA are the inter-facility transfers ambulances are called out on to transfer patients from Barton Hospital to another hospital outside of the area, many times to the Bay Area. Meston said many hospitals are now the ambulance service in a community, thus being able to schedule their own transfers. In the California cities of Alameda and Anaheim, registered nurses staff the ambulances along with EMTs and they do house calls to reduce the costs of emergency room visits. These nurses can remove casts, address cuts and elder health concerns.

Another area that is costly to the JPA is increasing costs of dispatching services. Wagoner said the committee formed with the City and JPA to transition ambulance services to Lake Valley Fire. "Progress was moving very slowly (in committee discussions) and basically came down to Lake Valley needing additional funding from the County.

Meston suggested Barton Hospital take over the ambulance services, thus eliminating the cost the City bears with the growing number of interfacility transfers.

In December, 2015, the City and Meston hired twelve new Emergency Medical Services (EMS) to staff the ambulances and leave firefighter paramedics on the fire and medic trucks. The increase in staffing now features South Lake Tahoe Fire Rescue as the only fire department in the Tahoe basin to have three firefighters on each engine at all times and two EMS specialists in the ambulance. He said this move did was it was supposed to do, save money while not reducing public safety.

"I feel much better about our effectiveness now," said Meston.

When firefighters had to leave South Lake Tahoe on an interfacility transfer, that left less staff to protect the City. With EMTs doing that task, the public is safer according to Meston.

Both Lake Valley and Wagoner have stated they believe an ambulance should be staffed by firefighter paramedics who can assist with fire suppression.

Perhaps none of the debate would have started if the Cal Tahoe JPA got the amount of funding they feel they deserve from El Dorado County. The County controls the money that comes into them from the State, and the soon to be reimbursement from the Affordable Health Care Act that will pay them three years in arrears along with future funding. The JPA feels they should have a bigger chunk of that money so they can operate at a break even pace, and not at a loss. The ambulance services on the West Slope are reimbursed 100%. Meston says the City is reimbursed at 50% of cost. He said they don't want a profit, just to break even on the cost of operating the ambulances.

An April 11 meeting at City Council Chambers is planned for the Cal Tahoe JPA and open to anyone interested in attending. There may be an earlier, emergency meeting, but that is not planned as of Friday.

In 2001, the Cal Tahoe Emergency Services Operations Authority (Cal Tahoe JPA) was formed to bid for and provide ambulance services for the South Shore and the northern portion of Alpine County via a contract with El Dorado County. No private company bid on providing the services as was feared by some on the South Shore. North Tahoe Fire Protection District was part of the initial JPA to help the group with their knowledge gained from experience in the same type of system. They left in 2006 as originally planned, leaving the City of South Lake Tahoe and Lake Valley Fire Protection District as the two agencies in the JPA.

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