County Supervisors vote in changes for South Lake Tahoe ambulance service

South Shore ambulance service has been a hot topic both locally, and across the county with growing concern over the costs and resulting manpower shortage of providing interfacility transfers (IFTs) to facilities outside of El Dorado County.

To understand the recent actions of the El Dorado County Board of Supervisors (BOS), a look at the past year is warranted.

The City of South Lake Tahoe Wants Out of the Ambulance Business

The county is divided into two ambulance districts, CSA-3 and CSA-7. For the lake side, the California Tahoe Emergency Services Operations Authority (or "Cal Tahoe") was formed in 2001 as a Joint Powers Authority (JPA) to be the exclusive transport contractor for ambulance service under a contract with the County of El Dorado to the Tahoe South Shore service area and parts of northwestern Alpine County.

Since 2011 the Cal Tahoe was made up of the City of South Lake Tahoe and the Lake Valley Fire Department and as a joint entity they provided ambulance service to the lake portion of El Dorado County.

Since fall of 2014, the City of South Lake Tahoe wanted out of the ambulance business due to rising costs incurred for dispatch services and IFTs. They also wanted to leave their firefighters and paramedics in town in case of emergencies. With rising costs and reduced service to the local community during these transfers and with no increased funding from the County, the City wanted to change the way ambulance services were provided as they couldn't continue with the hit to their budget.

This move made the JPA rework their operations to have EMTs/Paramedics working the ambulances, and have them based at the Fire Station #2 across from South Tahoe Middle School on Highway 50. SLT Chief Jeff Meston reorganized his department well before that move to have ambulances staff by newly trained EMTs and paramedics, leaving the firefighters and medics off the ambulances.

As of July 1, the Cal Tahoe JPA is now in the new home, and with newly trained staff.

"The JPA was able to staff an extra transport ambulance for the 4th of July weekend 2:00 p.m. to midnight," said JPA Executive Director Ryan Wagoner. "This greatly improved our response to Barton for Interfacility Transfers (IFTs) and assisted in calls in the City."

Wagoner said he is proud of the EMTs and Paramedics that make up the new service.
"The guys took down the flag pole outside Station 2 and sanded and painted the pole," he said. "This may not sound like much but they took this initiative on their own and it shows their pride in their job and new station. We also had one of our guys receive a job offer from Lake Valley last week."

BOS Chairman Ron Mikulaco of District I blamed the City on the current situation. "This was brought about because one of our partners decided they didn't want to be a partner any more," he said.

Awarding REMSA an Emergency Contract

The BOS awarded an emergency service contract for CSA-3 to REMSA (Regional Emergency Medical Services Authority) during their July 19 meeting.

Even with the success of the JPA ambulance service, the County Supervisors voted to have REMSA as a "stand by" ambulance service.

"I can assure you this is for stand-by services only," said El Dorado County's new Chief Administrative Officer Don Ashton. "That point is clearly identified both in the recommendation posted on the agenda, as well as verified in the staff report for the item. So far, it appears the transition with the JPA has gone very smoothly which is great news, but considering the consequences if something were to change, it is essential we have a back-up plan."

Interfacility Transfers on the Rise

In the 2015/16 fiscal year there were 652 IFTs from South Lake Tahoe, 519 to take patients from Barton to out-of-county hospitals (usually ones within a patient's insurance network closer to their home), and 133 for mental health patients being sent to a facility with an open bed.

In comparison, during the 2012/13 fiscal year there were 445 IFTs from the South Shore to hospitals outside of the county.

With the increase in transfers, the County is able to bill insurance companies for the rides, but that funding doesn't come back to CSA-3 since they are working under a 2011 contract, a point made up by the City prior to their decision to not provide ambulance service. The current contract expires in 2019.

The Cal Tahoe JPA would like to be offered the same income from IFTs offered to an outside agency should one come into the area, but to date they have not been.

Exclusive vs. Non-exclusive Contract

After Tuesday's BOS vote, the Cal-Tahoe JPA no longer has an exclusive contract for ground mental health transfers. This move was made to open the door for new discussions on the future of psych IFTs.

During the BOS meeting on Tuesday, Barton Health representatives spoke of their concern for a change in the way mental health transfers are changed. They want to make sure the patients get the care they need as quickly as possible.

Their vote directs staff to bring back proposed language of a new ordinance at a later date. Discussion on how that will read starts with the BOS fire sub-committee will be holding discussions for emergency services and responses in the County. That group will involve mental health and local hospitals as well, and they bring back findings to the BOS.

Richard Todd of El Dorado County said he concurs that with the City backing out, increased costs and increased call volume shows that change is needed.

During the BOS meeting on August 2, Chairman Mikulaco repeatedly said that ambulance service wasn't his specialty though he is a member of the sub-committee. They have already held one meeting and many more are planned.

"I thought I was on the fire sub-committee," Mikulaco said when he heard of their recent meeting. "Why wasn't I there?" "You were," responded Don Ashton.

"This approval opens up the door to opportunity," said District 5 Supervisor Sue Novasel. "I look forward to the idea to come up with better ways to service those in need."

Novasel said the system needs to change and wants to make sure those involved are made part of the conversation, including mental health representatives.

Ashton said the California Hospital Association has reached out to help with the situation and that they look forward to helping.

Concerns

How mental health IFTs are handled was a topic of concern at the meeting. EMS Medical Director at Barton Dr. Corey McLeod spoke of the hospital's concern that patients won't be treated the same as others if a new system were in place.

"We have concerns on how it will impact patient care," McLeod said.

Options of future psych IFT transport could be smaller ambulance, caged cars or law enforcement vehicles, transportation that could get the patient to a needed facility but without as much cost or wear and tear involved with larger ambulances.

The County's Mental Health Commission stated they want to make sure all remains the same until a solution is in place, which the BOS guaranteed.

With the Cal Tahoe JPA contract expiring in just over three years and the 18 months required for a request for proposal (RFP) for services, the BOS said they want to get the discussions moving forward quickly on South Shore ambulance services.

Wagoner reminded the board that the current JPA has an annual right to extend the contract until past the 2019 end.

With all parties wanted what is best for the safety and care of patients, the discussion will continue publicly until the situations are resolved.

Previous South Tahoe Now Stories on the subject

Feb 4, 2015 - City wants County to pay up

Feb 15, 2015 - County needs to pay their fair share

July 7, 2015 - City takes first steps to get out of ambulance business

Dec. 18, 2015 - South Lake Tahoe Rescue expands EMS staffing

March 16, 2016 - Firestorm surrounding ambulance service in South Lake Tahoe

April 4, 2016 - County sends Cal Tahoe JPA a letter

June 30, 2016 - No change in JPA service