BETTER THAN HEARSAY - If Consultants Could Chuck Wood

By Michael Ryan

CATSKILL - There is starting to be a plethora of reports floating around out there on the dire present and undetermined future of emergency medical services in Greene County and across New York State.

They all seem perfectly wonderful to someone not educated enough to make a guess about whether they make a lick of sense or not.

On the other hand, nothing much seems to be happening despite all that analysis, with one person very knowledgable of the situation suggesting nobody wants to be the one pulling the trigger on change.

The county legislature is currently considering creating a county ambulance system to replace a municipal-based network widely considered fated for failure, due to increasing costs and worker shortages.

County lawmakers, at the behest of all six mountaintop town supervisors, hired a consultant, in December, 2023, to assess today’s status of ambulance service and develop possible options, if needed.

Since the fall of 2024, lawmakers have hosted a continuing series of talks that sometimes appear headed toward a consensus county plan and at other times appear to be bogged down in territorial mud.

Two more sessions are planned for May and June, including government officials and EMS professionals from the various towns and county.

At that point, everyone should have a pretty good idea of how much more the shift to a county system would cost above today’s operations.

That number has already reached $3.2 million with more likely to come. A bitter pill to swallow, but the tradeoff touted by proponents is ultimately having a much more efficient and financially sustainable system.

Shortly after those dollars are bottom lined, a vote is anticipated by the legislature’s 14 members, needing 8 votes for ratification on 2 levels.

First is the straight-up question of whether to shift to the county system or not, requiring a simple majority for passage.

Second is the okay to exceed the State-limited 2 percent tax cap as part of what would be a fatter county budget, requiring a super-majority.

Meanwhile, there have been at least three major studies done, two that have been released, one that has inexplicably not been made public.

One is the aforementioned consultant’s study conducted for the county by Fitch & Associates, released in the summer of 2024.

They offered four “Pathway Forward” options, stating, “a single-provider, [county system] offers the most affordable and efficient option to maintain acceptable system performance with the least tax burden.”

In their conclusion they state, “without active intervention, the cost of the EMS system in Greene County will continue to rise to unsustainable rates.”

A second report is titled, “New York State 2023 Evidence Based EMS Agenda for Future,” written by a State EMS Sustainability Technical Advisory Group (TAG).

TAG included experts from across the EMS field and, explaining the reason for their existence, cites a presentation made to the NY State Emergency Medical Services Council called, “EMS in Crisis, A New York State Perspective.”

That presentation was given on October 20, 2021, leading to the formation of TAG, whose members were then charged with writing a White Paper.

The White Paper summarized “the crux of the problem” as “every day we see new headlines across this State and the nation on EMS Coverage.”

Those problems were, “staffing shortages, the decline of volunteerism, stagnant reimbursement, hospital over-crowding, inadequate coverage, use of mutual aid, pay disparities, absence of consistency in the EMS model and the lack of EMS educational opportunities.

“Yet we have not developed a comprehensive approach to addressing our crumbling EMS system,” the White Paper states, sounding unsettlingly similar to, if not precisely the same as, what the Fitch study found.

A third report is the handiwork of a special Task Force established by Governor Kathy Hochul to give an overview of rural EMS services.

Their report was finalized in May, 2024, offering 35-plus recommendations for pulling EMS services back from the brink.

But the report has remained inexplicably hidden, apparently tied to the politics surrounding the State budget which is well past deadline and contains multiple EMS matters that would deeply impact the issue.

And now the New York State Association of Counties, in its opposition to portions of that State budget, is recommending that, “the State should be required to do a statewide EMS Plan through the SEMSCO (State Emergency Medical Services Council).”

“Our position is the State should take a comprehensive look and figure out what is going on,” a NYSAC spokesperson said. “It is very different in every community. It makes more sense for the State to do this.”

That is four separate reports about the same thing, unless you count a fifth, which is the study done by a special Greene County Task Force, a decade or so ago, on the troubles within local ambulance service.

Similar again to the Fitch study, they concluded the way to go was a county system. Back then, the towns voted it down, sticking with a network that many of those same towns now say is doomed.

Does that mean there should be a county ambulance system? This column has neither a dog in that fight nor the brilliance to know what’s right.

The lingering issue, however, does bring to mind the Mother Goose nursery rhyme that asks, “how much wood could a woodchuck chuck If a woodchuck could chuck wood?”

Which begs the further question, “how many consultations could consultants consult on if consultants could consult?”