Paramedic program costs growing, county seeks solutions

When sirens wail and police cars scatter oncoming traffic like a flock of geese, it’s usually Mono County’s paramedics that are behind the wheel of the ambulance.

It’s an unusual system in a world of private ambulance services, but it has worked well for this small, rural county—a place where population is low, hospitals are far apart, and private ambulance companies would be hard-pressed to make a profit.

But the paramedic program is not cheap and it has been growing in cost by about $500,000 a year, far outstripping the revenue stream that was set aside by voters more than a decade ago to help fund a paramedic program.

Mono County Supervisors met Tuesday to figure out how to cut costs to the program after a private company conducted a preliminary, $65,000-study report.

Audience members raised concerns over the report.

“I’d like to see this be a truly county-wide evaluation and it’s not, the Highway 6 corridor is not addressed in here at all,” said Rick Mitchell, a Mono County Paramedic.

Sheriff Rick Scholl said he had not been consulted regarding the report.

“We have never been involved in this process,” he said. “(We) have some real questions about this, before it gets to the final stage.”

The supervisors had other problems with the study, too, including problems with publicizing the study—it wasn’t—and the supervisors essentially said it was time to go back to the drawing board.

“I see some problems with this study. I need to see comparisons to other communities, what have they done?” said Supervisor Byng Hunt.

“How can we combine public services with privatization? I’d like to see some scheduling options—how to save overtime costs. I love how the paramedics help us. I want to remunerate them properly, but we need to do it so as to not break us. We brought you on to help us put the brakes on.”

The issue was made more critical because the county recently entered negotiations with the paramedics union, said supervisor Vikki Bauer.

“Right now, the program costs the county about $2.9 million a year, and that money comes out of the general fund,” she said Thursday.

She added that when the voters agreed to raise the county sales tax from 9 percent to 12 percent 16 years ago, two percent of the increase was set aside to help fund the paramedics program.

Annually, the amount collected for the program through this increase is about $380,000 to $400,000, she said, not enough in the face of exponentially increasing personnel costs.

“It is an unsustainable situation,” she said.

“It’s a paramedic program on steroids. We need to figure out a way to freeze this cost, at minimum. We cannot afford to keep paying another half million a year indefinitely.”

Hunt said he believed the best way to control costs would be to change how overtime is reported, and, to allow Emergency Medical Technicians (EMTs) to ride with paramedics on incidents, instead of sending out two paramedics for each incident—as is now mostly the case.

“EMTs, or perhaps some part time employees, would cost the county less. Most of this could be accomplished by attrition,” he said.

The consultant suggested the county use its paramedics more intensively within each community.
“We think the focus of paramedics should expand to doing more community medicine (called paramedicine),” said Rick Keller, of Fitch and Associates, the company that conducted the study. “There is a nation-wide move toward community paramedicine.”

For example, if an elderly person is discharged from the hospital, a paramedic could be used to check on her, make sure she’s okay, he said.

“Mono County is the ideal place for this,” he said. “You only have one hospital. You should consider integrating and expanding the paramedic’s capabilities.”

The supervisors asked the consultant to address the issues and come back to them in the near future.