BELTON — Mayor Marion Grayson has struggled over her city’s ambulance situation.
“I really like us having our own ambulance service,” she said, following a 30-minute presentation by City Manager Sam Listi on potentially outsourcing emergency medical services to a private company. “But we’ve been hit with some dominoes.”
First, there was the loss of the city’s contract with Bell County to provide EMS in nearby rural areas. That loss cost Belton $450,000.
“Then the fire and EMS personnel who have left to bigger departments, and the inability to get new (people) on board in a timely manner due to the testing requirements, etc.,” she said.
The Fire Department lost 16 employees in a year — 11 of whom were paramedics. Although the 2019 budget calls for 30 employees, the Fire Department has 23 staff members.
“And then the billing,” the mayor said, continuing to list the dominoes that have fallen to create Belton’s EMS quagmire.
The city is projecting a shortfall in ambulance revenue. Current estimates show Belton bringing in $520,000 in EMS revenue — $230,000 short of the budgeted $750,000.
These dominoes, as the mayor described, are pushing Belton to end its ambulance service and temporarily outsource it to the Colorado-based American Medical Response — the private company that provides EMS to Temple and unincorporated Bell County.
“Even if you add the combination of the loss of revenue from the county services and the fact that we’re not even achieving budgeted revenues as a result of the change of operations has a real impact in terms of revenue and, again, our ability to operate,” Listi said. “So those are realities and situations that we — as a management team and the City Council, which develops and adopts the budget — have to deal with.”
Switch on horizon
The City Council directed Listi to begin working with AMR to transition its ambulance service to the private company.
“I think it’s in the best interest of the citizens and staff for us moving forward as quickly as possible,” Mayor pro tem Wayne Carpenter said. “I think we’d all like for it to go back to the way it was — that’s not an option, to go back to the way it was.”
The city does not have to seek bids for this contract, spokesman Paul Romer said. Bids are sought only when the city is purchasing something, he explained.
When the agreement is finalized, it will need the Council’s approval.
“The cost of ambulance services very possibly could increase — but the rate would be set by the Council,” Listi said. “The budget impact is projected to be neutral to slightly positive.”
The number of on-duty firefighters would increase under Listi’s plan. Six to eight firefighters would be on shift for a total of 24 fire responders. Additionally, four AMR paramedics would be on each shift. These numbers would be evenly split between the city’s fire stations on Penelope Street and Sparta Road.
This is “a significant enhancement in service,” Listi said of the proposed model. “Our current staffing at 23, 24 could accommodate the model that we’re proposing here — guaranteed emergency response in advance of patient care.”
New vs. old model
The new model would be a reduction in total number of staff at the Belton Fire Department. The current budget called for 30 people to be on staff.
“Again, by reduction, you’re talking about a reduction in budget,” Councilman David K. Leigh said to Listi.
The city manager told Leigh he was correct, adding that the positions that would be eliminated are budgeted but unfilled.
“I just want to make sure that’s clear,” Leigh said.
The new model, Listi said, would keep Belton firefighters inside city limits while AMR takes residents to Baylor Scott & White Medical Center-Temple. This, the city manager said, would free up officers to complete other tasks, such as training, teaching fire prevention and having time off.
The current model has two firefighters operating a fire engine and two paramedics running an ambulance for each station.
“We have an opportunity to work with AMR and make it fit our needs,” Listi said, adding that Belton will set service expectations, response times, the terms for leasing ambulances and where AMR can set up in the city. “In a contract situation, we could achieve very similar 6- or 7-minute response time that we have right now in city limits.”
Contracted service ‘not unusual’
Ahead of the EMS discussion, three residents spoke out against the proposal.
“My concern is why does the City Council not provide competitive salaries to the Fire Department so we don’t keep losing the ones we have and get the good ones we should be getting?” Beltonian Regina Spence asked, referring to an issue that has fueled many of the city’s paramedics to leave.
During its recent hiring push, Belton offered starting salaries between $46,478 and $50,897 for certified paramedics. If a person was a certified emergency medical technician, they would have started with a salary between $40,428 and $44,415.
Nearby Georgetown, in Williamson County, has starting salaries of $49,675 for a firefighter and $55,075 for a certified paramedic.
Next month, the City Council is expected to receive a study comparing the salaries of all employees to cities Belton competes against and municipalities that have similar budgets.
“It’s very difficult for us to compete with the Georgetowns and some of the other folks that are paying the kind of salaries they’re paying,” Listi said. “We will do our best to address the need. We recognize there is a need, and we will come back with a recommendation.”
Cindy Black — who ran an unsuccessful campaign for the City Council, placing a distant fifth in the May 4 election — claimed that switching to a private ambulance provider would hinder the rating Belton receives from ISO, an independent organization that evaluates a community’s fire protection capability.
“Please pray, talk to God, talk to yourself, talk this up a lot more than what you have been,” Black said. “Going from public to private is not good for the city.”
That rating, however, does not include a city’s ambulance service, according to the Texas Department of Insurance. It only evaluates fire protection capability.
“A contracted service is not unusual across the country,” Listi said.
Holmes, a councilman, offered examples.
“The county has it. Temple has it. There are a lot of other communities” that use contracted services, Holmes said.
Councilman Guy O’Banion said allowing AMR to run Belton’s ambulance is “a matter of common sense.”
“Again, I commend staff for doing everything you can to get these positions back filled as quickly as you can,” O’Banion said. “But that doesn’t change the fact that we have to act and we have to act now because this problem is not going to get any better while we sit around and talk about it — and we’ve been talking about this off and on for months, several months.”
Leigh compared AMR to being like a temp agency — a short-term solution that allows city leadership to hire more paramedics while also testing the waters of private EMS.
“We’re going to use a temp agency with our own equipment,” he said. “We’re not selling our fire stations. We’re not selling our ambulances. I think the temporary model is a good, prudent thing to do.”
Councilman Dan Kirkley said the ambulance switch would allow for the better care of residents while also helping existing Belton Fire Department members to get a break.
With the Council moving forward with a private ambulance service, Leigh said the city sets itself up to find the best solution for Belton’s EMS woes — possibly continuing with AMR or restarting the city-maintained operation.
“This is one domino toward that (ultimate solution),” the councilman said. “The great thing about this domino is it leads to two paths — not just one.”