January 30, 2023

The ambulance bay at Brattleboro Memorial Hospital. Photo by Kevin O’Connor/VTDigger

BRATTLEBORO — City-funded consultants and the area’s top emergency medicine physician agree in a $39,000 review of local ambulance options that all provide quality care.

If only they could agree on everything else.

A new feasibility study by Wyoming consulting firm AP Triton concludes that Rescue Inc. – Windham County’s largest and longest serving ambulance service – is the most economical choice to maintain current local coverage.

By comparison, a proposed takeover of emergency services by the Brattleboro Fire Department would increase costs but also strengthen the city’s understaffed crisis response system, the report said.

“I think they’re all going to provide a good service,” Rich Buchanan, senior project manager at AP Triton, told VTDigger. “The only caveat to consider is that the department, which is dedicated solely to providing firefighting services, is understaffed to meet a national standard. It’s an advantage to add firefighters who can fill two roles.”

As for the price tag? Researchers from AP Triton and Rescue cite significantly different amounts, leaving taxpayers with their own questions as the city prepares to discuss the issue on February 7.

“A lot of details that have yet to happen”

The Brattleboro Selectboard surprised residents last spring when, without public announcement or debate, it voted to terminate the city’s nearly 60-year contract with Rescue, a private nonprofit, and hire competitor Golden Cross Ambulance to serve with the fire service to help take over rescue tasks.

Local leaders at the time claimed the plan would not only cost less than Rescue’s $285,600 annual fee, but also yield an estimated $500,000 to $700,000 in annual insurance revenue after expenses.

“After careful internal analysis of the feasibility of a fire department takeover of the emergency services, I felt that after a year of transition, BFD could not only provide a high level of service, but also made financial sense,” said then-City Manager Octavian “Yoshi”. Manale, who abruptly resigned eight weeks later under an agreement that included a $72,515 severance package.

Manale told the press that his experience working for the city of Trenton, NJ “gave me a perspective that I don’t think my predecessors had.” But its sales forecast hasn’t panned out, as evidenced by financials six months after a test run and by AP Triton.

According to the feasibility study, if Brattleboro added enough firefighters and equipment to cover all rescue calls, it would collect an estimated $935,626 in annual insurance payments, but would still have to pay more than $300,000 per year on top of that, by 1.2 Millions of dollars in expenses to cover – a number that is higher than the last Rescue contract.

The only way the city could save money from an EMS acquisition, the report says, is if it cuts its current service levels.

However, Rescue questions whether AP Triton’s cost projections for each city model capture all the required spend, which it says could leave taxpayers with an even larger bill than projected.

For example, AP Triton’s firefighter salary figures are based on an ongoing contract that expires on June 30. The selection committee is proposing a budget for 2023-24 with a 4% cost-of-living adjustment and will thereafter begin collective bargaining with workers to determine how much more wages and benefits will rise on July 1st.

Rescue, which regularly replaces its 11 ambulances and equipment, also wonders why AP Triton’s estimates for the city takeover included such expenses as training, certification, inspections, equipment from stretchers to disposables, and an annual tax payment of about $30,000 do not show for state providers .

“I know our numbers are correct because we’re just giving this out to get another ambulance out on the road,” Rescue operations director Drew Hazelton said at a recent public meeting. “It’s very expensive equipment and has a very short lifespan.”

In response, AP Triton said it stands by its financial numbers – but added that the numbers are estimates aimed at helping the city choose an option and then put together a more specific budget.

“We have a reasonable idea — enough to start a discussion about the cost of running a system,” Buchanan told VTDigger. “There will still be a lot of details that have yet to happen.”

“An analysis based on what was available”

The selection committee approved the EMS change well before it requested, let alone received, the feasibility study.

When board members approved the transition plan last April, they raised concerns about Rescue’s costs and what they called the “incendiary” tone of a March 25 letter from the provider requesting an update.

“It’s our job to negotiate contracts that are best for the city,” selection committee chairman Ian Goodnow said at the time.

Colleague Elizabeth McLoughlin added: “We are the city and we can hire Contractor A or Contractor B. Contractor A sent us a nasty letter, so let’s go to Contractor B.”

But since hiring Rescue in July, Brattleboro has spent enough on contingencies to eat up promised savings. Local leaders, who had focused on finances in the spring, pivoted in the summer, stating the need to consider greater municipal oversight.

“It was never just about the money,” said board member Tim Wessel after the move last September used up the expected surplus — four months after he thought the alleged cost-cutting move was a good move, “but I’m quite willing to say those words.” to eat if this turns out not to be the case.”

The selection committee is now focused on the feasibility study’s claim that average fire service response times are five minutes faster than Rescue’s. But the latter agency questions the accuracy of AP Triton’s figures, which it has not provided.

Rescue, which presented its own figures at a recent public meeting, calculated that its average response time is just 71 seconds behind the fire service.

In response, AP Triton said it stood by its findings – but cautioned that they weren’t foolproof because Rescue didn’t take part in the study.

“I could have done a more thorough analysis if they were willing and gave us their data,” Buchanan told VTDigger. “They just didn’t do it. So we had to do an analysis based on what we had available.”

AP Triton asked why Rescue was withholding information. For its part, Rescue said it lost faith in local leaders after the city severed their six-decade working relationship, but sought to blame the agency — beginning with a municipal memo dated Dec. 11.”

(The “erroneous” admission came as local leaders, demanding “transparency” from Rescue, denied a series of VTDigger public record requests for any paperwork behind their EMS decision.)

Rescue added it is not challenging the AP Triton trial to bring Brattleboro back into its ranks. The agency has filled the city’s void by signing contracts with the Vermont Department of Health and the community’s two largest medical facilities, Brattleboro Memorial Hospital and Brattleboro Retreat. It’s also busy running its new Vermont EMS Academy, whose students include Brattleboro firefighters.

AP Triton is scheduled to answer questions at a Brattleboro Selectboard meeting on February 7th. The session is expected to draw interest from both taxpayers and the city’s Citizens Finance Committee, which is creating its own list of requests.

The consultancy said the high level of local debate and division was unusual.

“Most communities tend to have public services,” Buchanan told VTDigger. “By contrast, Rescue Inc. provides good care and has been around for a very long time, so I think there’s a greater affinity with the organization. That means you have more options. But you’re just getting started here. The community has a lot of things to figure out over the next year.”

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