GOLDEN VALLEY - Golden Valley Fire District's pursuit of a fire district-run ambulance service is coming to an end, for better or worse.
The closing statements by both River Medical Inc. and GVFD were submitted to the Office of Administrative Hearings on Friday, and a decision on the service is expected some time in the next month.
The fire district is pursuing a Certificate of Necessity, a required document for operating a ground ambulance in Arizona. Only one certificate can be issued in a given service area, effectively limiting any area in the state to one ambulance service provider for that area.
Arizona is the only state that requires such a certificate to operate a ground ambulance.
The current certificate holder in Golden Valley is River Medical, which also holds the certificate for the city of Kingman.
In order to operate its own ambulance service, GVFD was required to challenge River Medical's Certificate of Necessity and prove that they could supply a better ground ambulance service to the citizens of Golden Valley. The GVFD submitted its initial application on Nov. 8, 2012, and hearings were held in late 2014 in Phoenix.
"The fire district wanted to provide more consistent and reliable ambulance service for the community," said Tom O'Donahue, fire chief at GVFD. "Change is necessary and safety is important. This speaks to public safety, when they are in the biggest need at the most critical moment of their lives. It's our duty to look out for the best interest of our community and this is one way we are doing it."
If the application is accepted, GVFD would take over the certificate of necessity for Golden Valley from River Medical and operate all ambulance services in that area.
Revenue lost or gained?
During the GVFD governing board elections in November, one hot topic was the cost of operating an ambulance service, and whether it would operate at a loss.
According to the initial application's "Ambulance Revenue and Cost Report," the total operating revenue for a GVFD-run ambulance service in its first year would be $1,032,725.
The total operating expenses are estimated at $1,948,058, with a deficit of $915,333.
Both Director Rhonda Brooks and Director Jack Hommell of the GVFD governing board have expressed their concern about this deficit.
"I see nothing but loss coming out of this," said Hommell in a phone call with the Miner on Tuesday.
"We've invested a ton of money into this thing already. It's ridiculous," said Director Brooks.
The GVFD, however, argues that the loss is attributed to an "accrual method of accounting."
"Under this method, GVFD must allocate a percentage of all of its costs to the proposed ambulance service - regardless whether GVFD is already paying these costs," states GVFD in their closing statements issued last week.
The district argues that they are already paying for most of the paramedics and EMTs required to operate the service, which account for $1.4 million of the $1.9 million in operating expenses outlined in the CON application. O'Donahue estimated the district would need to hire four more people to fill in for the gaps as well as purchase two more ambulances.
The two ambulances already owned by GVFD, according to Hommell, are "junk" and would require a "tremendous amount of money" to outfit and get running.
Regardless, a break-even point was calculated by a GVFD-hired accountant: 682 patients a year. The number of transports in that area exceeds 1,000 annually.
"We already have the stations, the paramedics, and two ambulances. We're doing everything minus the transportation from the incident," said O'Donahue.
That transportation is critical for the department, as any revenue from a medical call comes from transporting a patient to the hospital. River Medical's current base rate is $1,420.08 and $20.57 per mile after that, and no money is shared between the department and the ambulance service. GVFD's proposed rates would be similar.
River Medical does offer a $118.96 per year per household subscription, which covers any ambulance costs that may arise in a given year after insurance has been billed.
No such plan has been proposed yet by GVFD.
Quality of care
GVFD's claim during this process has always been that it is the first on the scene, and that the quality of care would increase because response times would be faster while eliminating any handoff.
GVFD also noted in its closing arguments occasions in which River Medical's response times were too long, sometimes exceeding 30 minutes.
River Medical was quick to refute, stating that it has "never been unable to provide a timely and appropriate ambulance response to the GVFD area, and has consistently delivered service area response times better than the average annual response fractiles required under its CON."
"Right now, we have the best of both worlds," said Brooks. "River Medical is a good steward to the area. We have great firefighters. It's not broke, they don't need to fix it."
River Medical went on to state that "being a first responder is not the same as running an ambulance transportation operation in Arizona."
It isn't uncommon for a fire department to operate its own ambulances, however.
Fire Chief Ted Martin at Mohave Valley Fire - a former Golden Valley Fire Department assistant chief - heads a department that operates its own ambulance service and, much like the claims from GVFD, said that the quality of care increases because of the people running the service.
"The people that operate the service are the same people that they see when they have any type of issue. It's still the same people that they're interacting with," said Martin.
"It's continuity of care: taking care of a patient, all the way throughout. There's some comfort that has to do with that."
The next GVFD governing board meeting will be held at 6 p.m. Jan. 21 at the Golden Valley Public Safety Center, 423 Colorado Road.