CAMDEN — Julia Libby, Camden First Aid Association's service chief, said June 10, that she would renegotiate the cost of doing business with Camden, Hope, Lincolnville and Rockport, should floor votes at upcoming town meetings support the beleagured emergency medical service nonprofit. She declined to say how much money she would need to stay in business, but said she would cut items from her proposed budget, such as a new ambulance. She also said, contrary to rumors, that CFAA has not yet submitted a letter of intent to Maine's EMS oversight agency announcing that the organization is closing its doors.

"I would be willing to negotiate the price with the individual towns, or collectively," she said Monday.

Further dispelling local rumors, Libby also said the majority of her crew — nine fulltime and seven parttime — have indicated they will stick with CFAA, should the four-town citizens at town meeting vote to support keeping their current EMS service. She has, however, also encouraged them to apply for jobs with competitor North East Mobile Health Services.

"I am trying to keep the environment positive here," she said. "I have no hard feelings against North East. I said to staff, 'go ahead and apply at North East.' Don't worry. We all have to take care of ourselves."

How did we get here?

The reason towns are considering competing proposals for the future of their EMS service in the four towns for the first time in 77 years stems from Camden First Aid's dire fiscal situation that was made apparent last year, first to town managers and administrators, and then to selectmen.

CFAA's growing debt — which resulted from building and equipment loans, an expanded payroll, and uncollected receivables — is attributed to poor business and managerial practices during the late 1990s and first decade of this century, a situation that culminated three years ago in a tumultuous leadership overhaul.

Add to it the demographics of this area, with its high number of elderly care facilities and low call volume, along with decreased reimbursements from Medicare and Medicaid, and uncollected debt from patients who could not pay, and CFAA's revenue streams could not support its staff and need for capital improvements.

Even new leadership could not stem the fiscal bleeding, and in February, the nonprofit that barely ever raised its annual modest requests for contributions from the four towns suddenly was requesting $407,000 from the towns. That request came just as towns were beginning their own budget processes, injecting a layer of urgency to municipal budget meetings.

To provide due diligence to taxpayers, the towns responded by first circulating requests for proposals to area EMS services (see below for the proposals) to get an idea of what emergency medicine might cost, and then by assembling a 13-member review team to analyze the bids.

No one anticipated what the bids would look like, and the divergence in costs was striking. On May 29, the review team delivered its recommendation to contract with the Scarborough-based Northeast Mobile Health Services. The team cited the efficient business model of the for-profit Northeast, its high-quality service, and far reduced cost to taxpayers compared to Camden First Aid.

But the recommendation was just that, and the decision lies in the hands of citizens. And it is highly emotional decision, given the history of CFAA's 77 years in the communities, in one form or another.

Camden First Aid's ambulance service operated for decades out of the Camden Fire Department until it became its own entity in the 1990s, and got benevolent donations to grow, and construct its new facility on John Street.

For years, it functioned largely on the graces of volunteers, but that changed EMS services changed, becoming more regulated and professional. Now, it employs 10 fulltime and seven parttime personnel.

Northeast, a 13 year-old Scarborough-based for-profit, operates as a provider of out-of-hospital medical and medical transportation services. It has bases in Biddeford, Scarborough, Rockport, Richmond, Bowdoinham, and Dresden.

And, Libby said the nonprofit CFAA and the for-profit North East Mobile Health Services did have a conversation last fall about the potential acquisition of CFAA by North East, but at that point in time, CFAA wanted to see what town leaders had to say about the financial straits the nonprofit faced.

Libby said North East offered to buy CFAA, but she responded to that company's inquiry, "I'm not ready to give up the ship and want to see what the towns say."

North East's corporate executive officer, Kevin McGinnis, confirmed that discussion June 11, characterizing it as a "high altitude" conversation with a number of proposals put on the table.

Forward seven months, and the dynamics have changed. The four towns, acting through their town managers and administrators, have asked North East to prepare a two-year business contract in the event voters do not approve warrant articles that support renewing a contract with CFAA. A draft of the North East contract has been submitted to the town attorney of Hope and Lincolnville for initial review before being handed to Camden and Rockport town officials.

The towns, according to Lincolnville Town Administrator David Kinney, wanted "to prepare for a seamless transition as of July 1."

The intention is to be prepared for either eventuality, he said, June 10.

"I think it's safe to say that no one wants to be without an EMS provider, ever," Kinney said. "If it doesn't occur [a collective vote to go with North East], we don't use it [the contract]."

The saga of deciding the future of emergency medicine and ambulance transport in the four towns is coming to an end with annual town meeting votes — June 12 in Camden and Rockport, June 15 in Lincolnville and June 17 in Hope.

But the end may not be swift and decisive, especially if the townspeople in their respective communities take different tacks.

At a June 3 informational meeting in Camden about why a four-town review team is recommending North East Mobile Health Services over Camden First Aid, a citizen asked what happens if towns do not concur.

"Suppose one says yes and two say no," asked Robert Davies.

"That's the unknown we are dealing with," responded Select Board member John French. "It's up to the citizens in each community how they want to go."

"There is no answer?" said Davies.

"At this point, no," said French.

What will likely happen, said Kinney, is that after all four towns hold their annual town meetings, "there's going to be some reconciliation, a quick meeting of the minds."

At town meetings, it varies town to town

Citizens will be making their preferences known at annual town meeting on the floor, meaning they will be raising their hands yay or nay on what may on the surface seem a simple expenditure.

Depending on how the article is written, and where it is on the warrant, will drive the individual discussions. Those discussions will be vital to everyone understanding the complications of the vote(s). In two of the towns, Camden and Lincolnville, voters have the ability to increase spending on certain line items. Because the way the warrants are worded, Rockport voters do not have that say. Although Rockport voters can decrease spending, they cannot increase. However, it gets even more complicated in that town. [See below.]

The warrant articles, as relating to emergency medical services spending, Camden First Aid and Northeast:

CAMDEN — Wednesday, June 12

The EMS expenditure is embedded in Article 10, under "B. Public Safety."

It reads: Article 10: To see what sums of money the Town will vote to appropriate and raise, net of nonproperty tax revenues, for the 2013-2014 fiscal year budget for the following purposes, or act thereon:

B. Public Safety, total $1.9 million, Budget Committee recommends $174,000 be raised for Camden First Aid; Select Board recommends $100,000.

The Camden Town Meeting newsletter further explains that the EMS Review Team has recommended that the four towns contract with North East at a total cost of $28,000 for the four towns. Camden's share would be $10,000.

"If a voter wants the Select Board to continue to fund CFAA, the voter may speak in favor of full funding. If the amount approved contains full funding for CFAA, people might assume that voters want the Select Board to continue to fund CFAA. But as the administrative body, the Select Board has the responsibility to spend the funds in the manner they think appropriate for the community. This is especially true of EMS, since all four towns need to agree on the EMS provider in order to have an area with sufficient call volume and thus be financially sustainable."

HOPE — Monday June 17

The warrant reads: Article 11, To see what sums the Town will vote to raise and appropriate for Fiscal Year 2013-2014 for the following purposes:

e) Ambulance Services, $9,908 (of that, $5,000 is the requested amount from CFAA submitted last winter).

LINCOLNVILLE — Saturday, June 15

The warrant reads: Article 9, To see what sum the Town will vote to raise and appropriate for Ambulance Service. Board of Selectmen and Budget Committee recommend $77,000.

ROCKPORT — June 12

Rockport has the most complicated warrant article, and the proposed expenditure that supports Camden First Aid is embedded in the fire department line of the public safety budget.

It reads: Article 13, B, Fire Department, $384,564. In that, but not written on the warrant, is $48,000 for ambulance services. That $48,000 is half of the funding CFAA asked Rockport for last March.

If townspeople want to drop the number to accomodate the $12,000 request from North East, they could. But if they want to increase the number to fully fund CFAA's request, they cannot, according to how the Rockport warrant article is constructed.

However, there is another scenario that could be put into play. Voters could move the matter to Article 19, where, if the select board understands that is the will of the people to go with the higher number and contraact with CFAA, the select board could then use Article 19 to increase CFAA funding.

Article 19 asks voters to authorize the transfer of unexpended balances to fund balance and authorize overdrafts that may occur in town operations.

Will of the people

Although some selectmen have vowed to adhere to the will of the people articulated at town meeting, it is not known how well the will of the people will translate, given that a small number of citizens ever attend town meeting. Selectmen in each of the towns will have the final say with which company they choose to enter a contract. How much it comes down to following the will of the people, or exactly how clearly the will of the people is articulated, remains to be seen.

At last week's three informational meetings held in Camden, Lincolnville and Rockport, loyalties to Camden First Aid were balanced with calls for fiscal restraint. Nowhere was this more apparent than in Camden, where sentiments ran strongly in favor of CFAA's legacy and community contributions.

"If the town votes to support CFAA, I would not go against the will of the people on that," said Camden Select Board member French June 5. He said later that the select boards needed to conduct their due diligence to taxpayers and circulate a request for proposals.

"We have the numbers when asked," he said.

When a resident admonished the board for not helping out CFAA more, French responded: "I think Camden has always been a strong supporter of Camden First Aid. If the people of Camden, Rockport and Lincolnville want to work with CFAA, we'll work with them. We had to go get options. Now it is up to the communities."

His comment was reinforced by Select Board Chairman Martin Cates, who said, "To not give options breeds irresponsibility on our part."

French further urged citizens to attend town meeting, saying: "Your vote will count for something, for a lot of something. But you have to come to town meeting. I have to add, it's not the only budget item, so join in."

EMS proposals
(Read their complete proposals through the linked PDFs above)

Delta Ambulance Service proposes covering the four towns with a $44 per capita fee that totals $552,640. Breaking down town by town: Camden, $231,396; Hope, $62,832; Lincolnville, $103,400; and Rockport, $155,012.

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Camden First Aid Association is asking the towns to contribute 37 percent of its total $407,000 budget: $174,000 from Camden, $129,000 from Rockport, $77,000 from Lincolnville and $27,000 from Hope.

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North East Mobile Health Services proposes, for the first two years of a contract, charging Camden $10,000; Hope, $1,000; Lincolnville, $5,000; and Rockport, $12,000.

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Sterling Ambulance proposes charging Hope $6,500 annually for two years.

Annual town meetings are notoriously under-represented by citizens, a trend that has been under way for decades. In some years, it has been hard to pull in more than 50 interested citizens, a far cry from a century ago, or even 30 years, when annual town meeting drew hundreds to debate how to spend tax dollars. Voting at the polls the day prior to annual town meeting has further diverted interest from the annual collective gathering, and removed much of the more sensitive questions behind the polling curtain.

So if trends hold true this year, it will be 100-plus or -minus citizens in each town deciding the fate of local emergency medical services. Voters have intense discussions to look forward to, and there is little doubt that text messages will be flying back and forth between Camden and Rockport opera houses Wednesday night, as the voters tackle their warrants. Both meetings begin at 7 p.m. Wednesday.

As it has been stated over and over, the three towns of Camden, Lincolnville and Rockport will need to vote the same in order for the contracts with North East or CFAA to be viable.

The bottom line, however, is that no matter how constituents vote, they will not be voting for or against competing proposals from individual EMS companies. Citizens will be voting whether to spend proposed amounts for the purpose of emergency medical services. And, depending on which town they reside in, voters might choose to increase or decrease their amounts for emergency care.

"Citizens are the legislative body," said Camden Select Board member Don White. "This [the board] is the administrative body to vote on how the money is to be spent."

In Lincolnville, Kinney likens the process to that of townspeople determining how much to spend on plowing snow. Which snowplow company is awarded a contract is up the selectmen.

"To the greatest extent, every board I have ever worked with tries to implement the will of the voters as expressed at town meeting," he said.

That being said, he continued, the selectmen have the responsibility to be rational in their decisionmaking, especially if Camden First Aid ceases to exist.

Lincolnville has the fortunate position of being third in the schedule line-up of town meetings, with that town holding its annual gathering of citizens Saturday, June 15, at 10 a.m. at Lincolnville Central School. By then, Camden and Rockport will have made their crucial decisions. And given the varying emotional value residents place on CFAA, every municipality's vote this week and next is a wild card.

While a handful of residents (five) turned out for Lincolnville's session June 3, the seats in the Washington Street meeting room were almost all filled in Camden June 5. There, the discussion was passionate and pointed, and the select board, as well as the review team, were admonished several times for not doing enough initially to help save CFAA. They also raised questions, which follow:

What happens to the volunteer Technical Rescue Team and its equipment?

According to Libby, the team, which conducts high angle and mountain rescues, and responds to other outdoor emergencies, will create its own entity if CFAA dissolves. They will maintain their own equipment and charge for emergency responses. If CFAA stays, the team and its equipment will remain with CFAA.

McGinnis said North East, if awarded the local EMS contract, would approach leadership of the team about incorporating it to North East, or working out some other arrangement.

"It's a valuable service," he said.

What happens to the CFAA Access Team?

The team that responds with Jaws of Life hydraulic extrication equipment to car crashes and other, unique accidents will remain with CFAA if it survives. If not, the equipment will go to Lincolnville Fire Department. Although Camden Fire Department has ordered is own extrication equipment, if CFAA remains the local EMS provider, its access team will continue to respond to emergencies in Lincolnville, Rockport and Hope, said Libby.

Did Northeast offer to buy out Camden First Aid last fall?

According to Libby, North East's Kevin McGinnis talked with Libby and CFAA Board Chairman Steve Corson. At that meeting, Libby told McGinnis that CFAA wanted to hold off and see what town leaders had to say about the dire financial straits that the nonprofit was facing. She said North East did not offer to keep the name Camden First Aid intact, and did not offer to hire the CFAA staff.

North East's McGinnis said he and Dennis Simmons did sit with Libby and Corson after it had been announced that CFAA had financial problems.

"We came to them and did not offer any specific resource," he said. "We did talk at high altitude about other models to combine our services. And in that model there is the possbility of buying the base and equipment. We never got into the detail of any of that that might work. We made no specific offers and they made no specific requests."

Where would ambulances be housed if North East was awarded the contract?

CFAA owns its property on John Street. Libby said if CFAA dissolves, the nonprofit or the bank, Camden National, would mostly likely sell the land and building.

North East is currently renting space behind State of Maine Cheese on Route 1 in Rockport. McGinnis said North East has approached the CFAA board of directors about buying the property and equipment. CFAA's board is meeting June 13, and is holding off discussions until after that meeting, McGinnis said.

Will North East be able to continue to offer its low prices to the towns?

"We talked about that a lot," said French June 5. "North East is a big company, and can do a lot of transfers. And, they are building on community paramedicine. All three [CFAA, Delta and North East] are very good at service, but it all came down to business model and sustainability."

McGinnis said June 11 that North East is able to continue a sustainable service at a low subsidy rate.

"Again, our track record shows that we have decreased our subsidies over the years, not increased," he said. "Our business model does not rely on increasing subsidies or reimbursements. That's how we are able to be in Camden at the subsidy we quoted, successful and sustainable."

He added that one of the misconceptions is that North East is more a transfer service and that its 911 experience is limited.

"The reality is that we do more than 5,000 lights and siren responses a year, so we have quite a bit of experience," he said. "A good track record in our 911 communities."

He said the company also performs much community service and participates locally.

"We sponsor baseball teams, and provide first aid kits to ball teams," he said. "We bought defibrillators for police and senior citizens, ran Halloween haunted houses and we do standbys at community events at no charge. I think we have demonstrated that we are able to provide a good 911 service and be part of the communities we are involved in."

At the June 5 Camden meeting, residents discussed the financial unknowns.

"How does one address or handle the possibility they might come back around and ask for $50,000 the next time around," asked Camden resident John Scholz.

"It's a possibility," said French. "There's no crystal ball."

"In a two-year period, the community will save $300,000," said Select Board member Leonard Lookner. "It could go a long way to establishing a community ambulance service under the jurisdiction of the fire department."

McGinnis produced the following numbers for other towns North East currently services:

Richmond: 2009 to 2010 — $9,894; 2010 to 2011 — $9,069.50; 2011 to 2012 — $8,245; 2012 to 2015 — $0 per year.

Woolwich: Three-year contract ending 2013 — $2,500 per year. New contract approved ending 2016 — $0 per year. They had previously contracted with the city of Bath at $79,000 per year.

Bowdoinham: 2008 to 2011 — $2,500 per year. Second contract from 2011 to 2014 — $2,500 per year.

Dresden: In one contract from 2009 to 2014 — annual subsidy goes from $4,875 per year to $4,309.91.

What is the cost to taxpayers if CFAA remains?

The number that is being tossed around is $35 per home valued at $300,000 (also quoted as $11 per hundred thousand of property value). However, that is not a scientific number, and only arose in Rockport, when the question was asked June 3 by a resident.

It was a number that has since been transported to Camden, and erroneously used June 5 at that town's informational meeting. There have been no other numbers produced by anyone to break down how much property owners in each town would see their taxes rise if CFAA were fully-funded as the nonprofit requested.

That $35 number used in Rockport, and the formula used to reach it, is complicated and is not based on the average Rockport house. Rockport Select Board member Geoffrey Parker explained in an email:

"The one thing that complicates that particular question is that the funding for each town's share does not come from a per capita assessment (although it is originally apportioned that way, from CFAA's perspective) but rather is a function of property taxes.... Taking Rockport as an example, our taxable valuation is $994,699,920 and our taxes need to raise $12,889,166 for the county, schools and municipal budgets,  yielding  a mil rate of 12.95.

"Budget/total valuation = 0.01295784 or 12.95 one-thousandths, or 12.95 mils.

"So a house worth $100,000 will pay $1,295.78 in taxes.  Let’s take that to a $300,000 house (median in Rockport (?) and they would pay $3887.35 in taxes.

"If the amount to be raised was lowered by $117,000 (CFAA request of $129,000 versus Northeast request of $12,000) would mean we would need to raise $12,772,166 and the mil rate would be 12.84022, which would translate into $3,852.06 in taxes for the $300k home and would be a savings of $35.29.

"As a check we can simply (and more quickly) apply $117,000 as a function of the total taxes to be raised by this formula: cost savings/taxes to be raised = and we’d come up with .009077 or .9 percent savings; so the savings on the taxes of the $300k house would be 3887.35 X .009007739= $35.28 savings."

Camden Town Manager Patricia Finnigan offered the following:

"The simple answer is that $174,000 would be about 17 cents on the current tax rate of $13.68 per $1,000 of assessed value," she wrote, June 11.
 
"17 cents on a $200,000 home would equal $34   (.17 x 200 = $34)
17 cents on a $250,000 home would equal $42   (.17 x 250 = $42.50)
17 cents on a $300,000 home would equal $51   (.17 x 300 = $51)

Would CFAA's costs go down?

At the June 5 Camden meeting, resident T.C. Bland said that the budget committee met twice to discuss the EMS service proposal, before the RFP was initiated by the selectmen.

"Would it be appropriate for the committee to make a recommendation before town meeting, given the lay of the land," he asked.

"It doesn't accomplish anything," said Cates "Town meeting is the forum now for the discussion."

Bland then said, "Not knowing future costs of what might happen two years from now, do we also not know what is happening to CFAA two years from now?"

Is this a bridge or a $400,000 in perpetuity, asked another resident.

Bland said later in the meeting, "We've learned our lesson that we need to be more involved. If there is a contract, that will be determined. With contract negotitions, what do we need to do? I'm hearing there is going to be oversight and more pieces in the contract. We are not part of those contract negotiations. How do you contract for services CFAA provided? There are too many variables. If we tried to put all in a contract, it is going to be a very difficult process."

"It's why we have a very good town attorney," said Cates.

Is the equipment of Camden First Aid and North East on par?

Camden resident Richard Householder asked June 5 if a comparison had been done of bidders' equipment. "Did one company have more up-to-date equipment than others," he asked. Was there a look at number of ambulances available in event of disaster.

According to Rick Petrie, advisor to the review team, "With minor variations, they were all fairly comparable."

He added that there will be the same number of ambulances in the area as what currently exists. And, he said, the state inspects services annually.

"If something is lacking, the service is expected to fix it," he said.

What is the oversight?

"Oversight?" said Bland. "We have had a long, good run with CFAA with minimal subsidy. We may have been complacent and not watching the hen house. You are curent oversight. What do we need to do to make sure this doesn't happen again.?"

Cates responded that should North East be awarded the contract a community relations team would be established, with routine check points.

"So we don't let things get out of control in the hen house," he said.

McGinnis said June 11 that an emergency services review committee comprising representatives from each town would be established to continuously monitor and assess the service. Conclusions and reports would be made most likely on a quarterly basis, and the select boards informed once or twice a year, or as requested.

Was there any business help available for Camden First Aid?

At Camden's meeting, resident Lisa Ettinger asked if any thought had been given to helping develop a sustainable business model for CFAA.

Cates reiterated what had been said at previous meetings, that the current business model for sustaining a regional EMS service depends on a call volume of approximately 2,000 per year, which, in turn, supports the employment of a paramedic. CFAA's call volume is now approximately 1,600. Northeast currently has approximately 500 transfer calls a year at its Rockport station. Its ability to absord the four towns of Camden, Hope, Lincolnville and Rockport without asking for more money from each is due to the company's broad business base throughout the state. 

"They are now into a different money territory," said Cates. "In terms of management, how can our area support a municipally-run EMS service, both administratively, business plan-wise and monetarily?"

"It is sounding an awful lot like losing CFAA is a fait accompli in just numbers," said resident Bridget Qualey. "It is a tragic loss. Has that loss been factored in?"

It certainly is a valid point," said Cates. "The review team did not come to a conclusion ready to slew our neighbor. However, all this is is a recommendation. Yeah, this is tough. Absolutely."

He also said that North East is in the business of community paramedicine, working with doctors at hospitals creating a paramedicine program.

Community paramedicine is the expansion of an ambulance service into health care services other than just emergency response, resulting in a broader revenue base and decreased hospital costs.

Community paramedics work with home health care providers, keeping patients at home for basic, followup and routine care, and out of the expensive hospital environment. They also work with nursing homes, monitoring blood pressure for example, and conducting other simple functions.

Two successful models have been cited in past discussions: Emergency Health Services, a division of the Nova Scotia Department of Health and Wellness  and, Minnesota's Community Paramedic Program initiative.

Camden First Aid is also in the process of applying for community paramedicine status.

Read more

• Rockport EMS workshop sparsely attended, but dividing line clear

• Camden, Hope, Lincolnville, Rockport 'plowing new turf' with ambulance decisions

• Camden First Aid seeking $407,000 in funding from four-town taxpayers

• Hope gives preliminary nod to Camden First Aid; talks continue with four towns

• Camden, Lincolnville, Rockport to circulate requests for emergency services

The community factor

"There's a hidden element here," said Camden resident Meg Sideris, on June 5. "Not only are they [CFAA] friends and neighbors, they are us. They are doing business here, as opposed to a company that is not here.... Our neighbors are in a tough spot."

Camden Town Manager Patricia Finnigan returned to the topic of the viability of CFAA's business model.

"I think that is what is so heartbreaking," she said. "They could work 72 hours a day and it could not save the situation. It is the call volume. If we thought giving CFAA a bridge, and they were going to be right-sized, we wouldn't be sitting here. But that is an uphill battle that we will never overcome."

"We are a small region, with a low call volume and demographic challenges," she said, drawing analogies to community hospitals that are also going under. 

"For 60-70 years, CFAA was a volunteer organization," said Camden resident Mary Sweeney. "People are now all working, so now they have to pay people."

She asked if the towns asked CFAA, "What can we do to help you through this crunch."

"We did not," said Cates. "We went through the typical municipal process."

Sweeney responded: "If we had all worked together, we could have made the numbers smaller."

Again, the conversation returned to the viability of CFAA, and Finnigan questioned whether the nonprofit would be able to survive without an ongoing ever-increasing amount of money, a sizeable subsidy.

Cates said the review team did not "feel we wanted this to become a municipal service."

"We did talk about quasi-municipal, but to put that together takes time," said French. "We didn't have the time."

The same discussion occured in Lincolnville, and selectman Jason Trundy explained there on June 3 why the review team rejected the idea of municipalities taking over CFAA.

"It was brought up at two or three meetings," he said. "My personal opinion was, if all four towns want to go with CFAA it will only be prudent for towns to work with CFAA. The idea of quasi-municipal was talked about numerous times. Personally, after we reviewed RFPs and learned about the structure of EMS in Maine, and did interviews, and understood the magnitiude of what is going with EMS, it became evident that that is a very large undertaking by people who really know the business. North East has incredible experience and training second to none. Exepctations of staff was all top-knotch. Why establish four towns in trying to recreate what we can get for almost nothing from North East? The reality is, it doesn't make financial sense."

"To be successful, CFAA needs to grow their revenue and expand their customer base," said Finnigan.

"Whatever ambulance service is chosen, the patient will get to the hospital," said Libby, addressing the Camden citizens, June 5.

What will probably be lost, she said, is a "touch of care," illustrating that with an incident that she said occured the previous night when CFAA responded to a woman who fell down and struck her head. Her daughter wanted to ride in the ambulance with her, so CFAA personnel worked it to help take a car to the hospital for the daughter.

"There are no hard feelings," she said. "I inherited a huge deficit. Yes, I was associated with it when it was going through that [its leadership upheaval in 2010]. I fought hard to have an outside board. I am happy I tried for two years to save it. A lot of money was owed and mishandled, and there's nothing I can do about it."

After Libby spoke, Dennis Simmons, the North East division manager based in Rockport, went to the podium and said he wanted to allay a few of the fears..

"Yes, CFAA does wonderful care with wonderful compassion," he said. "That is EMS care. You will get that. They [North East personnel] are all local people. There are no people from away. Because we value local people and service. We have already extended the option to CFAA to come to work for us. Take $100,000 and spend it on parks and recreation. They [CFAA] set a standard and it is going to be tough to meet it but we will try, especially if they come to work with us."

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Editorial Director Lynda Clancy can be reached at lyndaclancy@penbaypilot.com; 706-6657.