AMBULANCE— Nome Volunteer Ambulance Department Chief Jim West Jr., standing, addresses the Nome Common Council as council members weighed their decision to retain or relinquish the ambulance service

Council hands Nome’s ambulance service to NSHC

The Nome Common Council voted on Monday to relinquish the ambulance department to Norton Sound Health Corporation. The city has run the Nome Volunteer Ambulance Department in its current form since 1996, but an uptick in complaints from the public in regard to lagging response times and a smaller pool of ambulance volunteers forced the council to weigh the pros and cons for a city-run ambulance vis-à-vis an ambulance service operated by Norton Sound Health Corp.
In response to the council’s decision, NSHC CEO Angie Gorn wrote in an email to the Nugget: “We are thrilled to hear that the City Council has made the decision to allow NSHC to provide ground ambulance services for the City. We are confident we can deliver a fully staffed, efficient, and effective program. We know there are a lot of trained emergency responders in our community and we look forward to working with them. There are a number of important details that need to be negotiated with the city before a tentative agreement and date can be reached.”
Council chambers were packed for the work session to discuss the ambulance service, with the notable absence of any NSHC representative. Asked about the absence, Gorn responded: “NSHC has been proactive throughout this entire process, attending many meetings and answering all questions from the City prior to last night’s decision. We attended previous City Council work sessions, had in-person meetings with the city manager, and exchanged multiple emails over the past several months. Our understanding was that there was nothing left to discuss, with the exception of ‘next steps’ if the city decided to transfer the program.”
Norton Sound had expressed interest in taking over the ambulance since 2019 but volunteers at the ambulance and other Nomeites were skeptical of the proposal. The resistance came from the belief that local volunteers could deliver a more caring and compassionate and knowledgeable service compared to the specter that NSHC may send EMTs on calls who are not familiar with Nome. Another concern was that NSHC may raise rates or not respond to emergency calls outside city limits. NSHC Medical Director Dr. Mark Peterson in previous council meetings pushed back on those assumptions and assured a high level of service under NSHC, including the promise that the department would be staffed with locals and that responses would cover the current response area, including outside Nome’s city limits.

Work session discussion
During the work session the council, still weighing their option to retain the service, chewed on numbers. Assuming that volunteer burnout would be alleviated by increasing the number of hired emergency staff to seven full-time equivalents, the payroll for the department would increase. For example, the FY2025 ambulance budget would show a deficit of $563,000, but Finance Director Nickie Crowe explained, about $375,000 would be recouped the following year from a state program called Supplemental Emergency Medical Transport, or SEMT program. It draws funds from Medicaid and allows public EMS providers to collect 50 percent of their uncompensated costs for providing care to Medicaid patients. A large percentage of those calls that the ambulance volunteers respond to involve Medicaid patients.
Still there would be deficit, even if the city would increase its rates and even if there were more billable runs. Crowe told the council that the majority of payments come from Medicare or Medicaid, which pay fixed rates for ambulance runs. Only patients with insurance would be paying the full rate, and those are constituting the minority of ambulance runs. The city does not balance bill to cover the discrepancy between their rates, and Medicaid or Medicare.

New revelation
City Manager Glenn Steckman then informed the council that he learned on Monday that there is another option to increase revenue that could cover the deficit. He said he just heard that the city controls the license that allows NSHC to do the ground transportation for medivacs. “That’s where the money is,” he said. “Unless we have an alternate source of income, the deficit is going to be funded by tax revenue.” Why do we only hear about this now, asked Council Member Mark Johnson. Management wasn’t aware of that, said Steckman, and it was nowhere in city documentation.
Given the open format of the work session, Mayor John Handeland allowed audience participation. With the city’s ambulance department employees present, Emergency Services Technician Hunter Bellamy spoke up, saying that when the city provided the ground service to medivacs — the transport of patients from the hospital to the airport— it made money for the ambulance department. “I can’t say if adding new paid positions, how that would affect it. But the fact that previously, [medivac ground services] not only decreased the deficit, it actually put the ambulance into a profit.”

Core service
Adam Lust, from the audience, reminded the council that ambulances are usually a local government-run, basic service. “Five years from now, we have a beautiful port, we’ve got a graphite mine that’s continuing to inch forward, our fisheries are doing well, and a high-level government official comes to Nome, and they want to know about our emergency response capabilities. And we have to tell them that, well, we have to turn it over to a third-party vendor because it was just too challenging a problem for us to figure out,” Lust said.  He then gave another scenario. “Let’s say we have some event planned, unplanned or otherwise, it could be as simple as we’re doing the Polar Bear Swim, and we want to have an ambulance on standby. Well, the city has to check with our third-party vendor to see if they’re available during that time, and then we probably get to pay for it.” Lust made the argument that core government services such as police, fire, EMS, are inherently the responsibility of the city to make those work.

Breaking up with the city
Included in the council packet was a letter from Angie Gorn, NSHC CEO, dated December 15 that tersely informed Steckman that NSHC gives its 60-day notice to end the Memorandum of Agreement between NSHC and the ambulance department. Under the agreement, according to Gorn, “NSHC provided a medical director at no cost, all supplies, medications, and oxygen at no cost.” The letter lists a host of other contributions by NSHC to the ambulance department, volunteers in form of stipends and matches to fund ambulances. Gorn wrote that NSHC has been aware of community concerns regarding untimely ambulance response times and has submitted a letter to the council in October 2019, proposing that NSHC take over the ambulance service. This found no traction back then. However, Gorn said in her letter to Steckman that “despite continued community concerns and comments about untimely or lack of emergency response, the City of Nome has not made any changes other than to ask NSHC to provide more resources. This has been a more than four-year conversation between organizations and the discussions are not going anywhere.”
The letter ended that NSHC is withdrawing from the partnership.
It was included in the council packet but not discussed during the council meeting.

The vote
When it came to the vote in the regular session of the Common Council meeting, Council Member Scot Henderson condensed his reasoning to vote relinquishing the ambulance service to NSHC for three reasons: fiscal, staffing and a track record of inaction on the part of the city.
“I want to remind people that the community has brought multiple complaints to this body, previous volunteers, family members of people, that were supposed to get an ambulance. And for some reason, it didn’t happen or took too long. And it continued to happen. And I was concerned that management was not addressing these issues,” Henderson said. He added that he has the utmost respect and admiration “for anybody that’s willing to put in the time and effort to try to keep the service operating [under the city].” Admitting that it’s not an easy decision, looking at the entire ambulance department staff in the audience, he reasoned “we represent the community and we are responsible for the efficient, responsible operation of all of the services that we provide.” Henderson said that the deficit would be more than a mill point in property taxes and that he canvassed constituents if they were willing to pay more property taxes in order to have a city-run ambulance department. “The answer was a resounding No,” Henderson said.
  Even if the city would continue to run the ambulance department with a proposed seven-staff would the city – just like other employers nationwide – be able to fill the positions?
Steckman wasn’t confident to be able to do so. He said he was concerned about staffing and filling the newly created EMT positions. “Can I find folks that are willing to come up and live in Nome and not be two weeks on, two weeks off?”
Henderson said that when the police department was having problems, the city had to increase the budget to fix the shortcomings. We had no choice, Henderson said. But with the ambulance department, the city has a choice, he said. “We have a partner in our community in our town, a corporation that has agreed to step up and fill that role, we have that option.”
Cameron Piscoya declared a conflict of interest with the mayor as he sits on the board of Norton Sound Health Corporation, and is involved in policy decisions. Mayor John Handeland recognized the conflict and Piscoya was recused from voting. Council member Maggie Miller disclosed that she works for NSHC, is not in a policy-making position. Handeland ruled that she has no conflict and can vote on the matter. With the exception of council member Mark Johnson, the remaining council members remained silent during discussions. Eventually the vote was unanimous in relinquishing the ambulance to NSHC. An alternate resolution drafted for the retention of the ambulance service under the city did not even get a motion to adopt, dying on the table.
Negotiations and an agreement between the city and NSHC yet have to be finalized.
On Tuesday, City Manager Glenn Steckman said in a brief interview with the Nugget that four city employees are impacted by the Council’s decision. He said he had no opportunity yet to talk to them if they want to stay with the City in other capacities.

In other business, the council passed an ordinance through second reading to lease space at the Nome-Beltz campus for a cell tower operated by Atlas Towers.
The council passed a resolution certifying a that the city suffered effects in 2022 related to fisheries business activities.
The council passed resolutions extending labor agreements between NJUS and labor unions and a resolution directing the city manager to work with the state and Alaska Housing Finance Corp on a $5 million grant for housing for professionals and affordable housing.
The council left on the table a resolution dealing with five cab licenses that are not being used. Henderson requested a work session to address the cab licensing issue that has been brought to the council in the past two months.
Steckman in his report also said that there will be another meeting with the Public Safety Advisory Commission on Saturday regarding the Police Chief search and that the council is invited.  He said one candidate dropped out. “The question is will we continue or re-advertise again?”
The council went into executive session to discuss matters relating to the hire of a new city clerk.

 

The Nome Nugget

PO Box 610
Nome, Alaska 99762
USA

Phone: (907) 443-5235
Fax: (907) 443-5112

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