ROCKPORT — Just six Rockport residents without direct ties to Camden First Aid Association, its board of directors or North East Mobile Health attended Monday night's Rockport Select Board Workshop to discuss the future of emergency medical services in town.

The June 3 workshop was a follow-up to the May 29 presentation at the Camden Opera House, at which a panel of 13 members of an ad hoc review team discussed their recommendation that the towns of Camden, Hope, Lincolnville and Rockport sever ties with Camden First Aid and instead contract with North East for EMS and ambulance services.

One resident who spoke Monday night said that while there is an emotional attachment to Camden First Aid, she didn't think it was the town's business to subsidize their business. Another said it's a concern for them when emergency medical services becomes a corporate function as opposed to a community function. And a third said that at $35-pertaxpaying household, the amount Camden First Aid was seeking from Rockport to stay in business, seemed a reasonable amount of money to allow them time to work out their administrative issues in the short term.

Rockport residents at the workshop included Rusty Brace, Allen Mitchell, Adam Miceli, John Dietter, Judy Lindahl and Tom Murphy. Camden resident Parker Laite was there, as was Hope resident Joe Ryan. Ryan's wife, Ginny, is a Hope firefighter and member of CFAA's Access Team. CFAA Board members Neil Courtney and Kim Graffam attended, as did Justin Hills, a paramedic and CFAA employee. Graffam's husband, Leni Gronros, was also in attendance.

Rockport Select Board members Ken McKinley, Geoff Parker and Tracy Lee Murphy attended, along with Interim Town Manager Roger Moody. Rick Petrie, a paramedic and consultant to the review team, started off the discussion with an overview of the rationalization behind the team's recommendation to go with North East.

Also at the workshop were two representatives from North East Mobile Health, including Butch Russell, the clinical compliance officer, and Dennis Simmons, the division commander for the service's Rockport division.

Petrie led the discussion, going through the criteria the review team used to come to its recommendation. He said that cost and revenue are the major issues in rural EMS coverage, and that call volume is a major factor affecting EMS today.

"It's becoming harder and harder to be a volunteer in our community, there are too many things you need to know to do the job," said Petrie. "And a service needs to have at least 2,000 paying calls a year to pay for one qualifying paramedic's salary. Camden First Aid currently responds to 2,000 calls annually, 1,600 of which are billable."

Petrie said that with CFAA's current staffing levels and that call volume, "you can't make the numbers work."

"There is a disconnect there, and we need to look for other ways to make it work," said Petrie. "EMS needs to grow. But how do you serve the community while reducing the cost to bridge the gap of what it costs and what they get paid."

Responding to a question from Parker Laite about whether there were consultants available to assist entities such as Camden First Aid in managing the administration, and/or guiding them to a break-even point, Petrie said yes.

The cost for such consulting would be in the $30,000 to $50,000 range, and the service would dissect every piece of the operation to determine if it's viable or not.

"They recommend solutions that increase operational efficiency, as well as look at what revenue is being left on the table," said Petrie.

During a review of the Powerpoint presentation given last week in Camden, those at the Rockport workshop were told that in fiscal year 2013, Rockport allocated $24,000 to Camden First Aid. For fiscal year 2014, CFAA asked the town to allocate $129,000, but the 2013 Town Meeting Warrant only includes $48,000 for EMS, the amount unanimously recommended by both the Select Board and Budget Committee.

In FY2013, the total cost to the four towns for Camden First Aid's services was $57,000. In February the towns learned that the amount being requested for FY2014 had jumped to $407,000.

In FY2013, Camden paid $20,000, Hope paid $2,000 and Lincolnville paid $10,000. The FY2014 requested amounts were $74,000 from Camden, $27,000 from Hope and $77,000 from Lincolnville. Adding in Rockport's FY2013 and FY2014 figures and one gets to the totals of $57,000 and $407,000 respectively.

Since Camden First Aid first began talking publically about its financial hemorrhaging a year ago, the towns have been told that prior poor business decisions had created today's pain. But a legal agreement with the former manager, Christopher Knight, has prevented anyone from talking publically about the details of CFAA's past operation.

One thing the public now knows is that over the past four years the service has been unable or unsuccessful in collecting $1,153,000 in receivables for services it has provided. But the reasons behind those uncollected billings have not been articulated to date by CFAA Service Chief Julia Libby or her board.

Assuming the past uncollected billing had been written off, fiscal year 2012 budget figures provided at a Feb. 27 meeting with the four town select boards, managers/administrators and CFAA's board showed the organization in the red by $212,000, as far as a comparison of what had been billed versus what had been collected last year.

The FY2014 budget for expenses of $1,093,200 includes $477,500 for payroll, $43,000 for payroll taxes, $340,900 for operations, $43,000 for benefits, $100,000 for capital equipment, $60,000 for loan principal payments, $18,300 for administration, $2,500 for Access Team and $8,000 for the billing department. Built into this year's budget, according to Libby's budget presentation in Hope March 12, is a four percent salary increase for staff.

Camden First Aid has said during this time it would be willing to take on more community representation on its board of directors, and that it would be willing to discuss changes to its business model and mode of operation to help it become viable to continue serving the community. But for now, the organization needs an infusion of funding from the towns just to keep the doors open and the ambulances running.

In other media, Libby was quoted as saying she stood ready to close the doors of Camden First Aid July 1 if the towns failed to pass the funding requests this month at their town meetings. She also was quoted as saying all the equipment and the building would be given to the bank to liquidate.

McKinley said that there is a legal requirement that EMS groups give 30 days notice that they plan to close, but Moody said the law does not indicate punitive action if they fail to comply.

"There is no punishment if they don't do the notice, and close without filing one," said Moody.

Monday night, Camden First Aid Paramedic Justin Hills said he wasn't aware of any notice of closure being officially filed with the state, and Graffam said the board was not aware of a July 1 closure notice being filed yet either. In a phone call Wednesday, CFAA Deputy EMS Chief Julie Allen said the organization had not filed a pending closure notice with Maine EMS.

About 40 minutes into Monday night's workshop, the floor was opened to questions and comments from the audience. Rusty Brace said he was "surprised" and "shocked" at the difference between what Camden First Aid was seeking versus what North East proposed in RFP response, and asked if the review committee explored the reasons why.

Moody and Parker said yes, it was looked into, and there were numerous factors at play. They included the fact that North East is an existing service in town, so it gave them an ability to build onto and up, rather than needing to create capacity to serve, like Delta Ambulance would have to do. Delta, also a nonprofit service, was one of the four organizations that responded to the towns' RFP.

It was also learned that North East was not considering its offer to provide services to the four towns as a loss leader.

"It also comes down to critical mass. North East is aggressive with their accounts receivable collections, they make their size work for them, they are doing their homework to do what they need to do to be profitable," said Parker. "Delta said they were hedging their bets they could do the job, and that they would need to take on some debt with equipment purchases and relocation to the area. That too was considered."

Adam Miceli lives in Rockport, but he works for the city of Rockland as an assistant chief in the fire department that also provides EMS for the city. Miceli said that how an ambulance service makes money is not in emergency transports to the local hospital.

Miceli said that transfers are where the money is made. And he said that North East already dominates the market on transfers, and with Camden First Aid out of the picture, they will corner 98 percent of the local transfer work.

"They can offer their services [for a low fee to the towns] because of their size and their cornering the market on emergency and everyday transfers," said Miceli. "Medicare and Medicaid rules are such that runs to the local hospital make no money and Camden First Aid is currently North East's major competitor for transfers."

Miceli said that fears that North East will increase its prices down the road are unfounded.

"Some of the fears down the road that this will cost more down the road won't pan out because North East already has the market," said Miceli. "Transfer EMS is a taxi service from home to facility and facility to facility. I do believe a town should provide rapid EMS, but the transfers, no, those should not be taxpayer funded."

Leni Gronros said for him, the loss in the community if the towns don't vote to maintain EMS through Camden First Aid will be a personal loss for everyone.

"I have always considered Camden First Aid as a community service like fire, police, etc. There is personal comfort in knowing they are there, they are our neighbors. It's a concernto think of [the service] as a corporation function as opposed to a community function," said Gronros.

Parker responded, saying that it stands to reason that the current staff at Camden First Aid would apply to work at North East, if they were the prevailing EMS, and that North East would want to hire them because they are highly qualified.

"Do you supposed that half the people at CFAA would go there, and over time, you'll get to know the other half at North East you don't know today?" said Parker.

Gronros said he couldn't answer that question, and added that he only knew that Camden First Aid was highly involved in the community today, and that North East was not.

Butch Russell spoke up and said that North East strives to become committed to the communities they serve, and to that end have been part of local fundraising events, as well as offered EMS training to fire departments and hosted blood pressure clinics.

Joe Ryan asked the select board members if there was any doubt in their minds that Camden First Aid can fulfill their two-year contract, if funded. Parker said he believed it was "their intent to do that."

"At $35 per person, it would seem we could allow them time to work out their administrative issues during that two-year contract," said Ryan.

Resident Judy Lindahl disagreed and asked the select board to go with the review team's recommendation.

"As much as we have a huge emotional attachment to Camden First Aid, I don't think it's the town's business to subsidize them. I am not willing to pay more and I urge you to stick with the panel's decision," said Lindahl.

With Libby being quoted as saying Camden First Aid would cease operations July 1, Moody told the group Monday night the select board would have between June 13 and June 30 to meet and decide which EMS RFP to accept.

Lindahl asked if voters would know that before town meeting, and Moody said no, because town meeting is June 12. It was also noted that the warrant had already been published, and it included just $48,000 for EMS.

And while the amount allocated for EMS could not be increased at town meeting, (it could only be decreased) a motion from the floor could be made to allocate additional funding from somewhere else should the will of the voters be to support Camden First Aid.

Either way, the process is problematic, because not only has Rockport put less than Camden First Aid said it needs into the budget, Camden First Aid has said it needs all four town to be in sync and support them as a group. And the same holds true for North East, its quote and ability to make the numbers work relies on the call volume from all four towns, meaning that all four towns need to contract as a unit.

That led Moody to say that given the complication of the current decision-making process, going forward the towns might consider forming an EMS district. Such a district would give them strength in numbers, when it comes to going out to bid, but also make the final decision a smoother and less cumbersome process.

Miceli urged the town to streamline the decision-making process, as well as create an oversight or audit committee to review EMS service in the coming years, no matter which company is the ultimate provider.

Miceli also urged the select board to vote devoid of emotion.

"$35 per taxpayer seems like a relatively low cost. The downside is we are seeing budget cuts everywhere now. We look to our elected officials to use their brain, not their heart. As heartbreaking as it could be, we are at a position where things cost a lot of money and if you always make your decisions based on faces and friends, we will be spending a lot of money," said Miceli.

But, Ryan said, the emotional aspect "can't be denied."

"How does the select board hear that people find value in that $35 and then act on that?' he said.

For McKinley, the answer was clear.

"At town meeting, where people will vote on the money. Then there will be a publicized meeting, where we will decide on who to contract with and we want to hear from people then and there," said McKinley.

Related stories:

• Camden First Aid seeking $407,000 in funding from four-town taxpayers (posted Feb. 28)

• Camden, Lincolnville, Rockport to circulate requests for emergency services proposals (posted March 12)

• Hope gives preliminary nod to Camden First Aid; talks continue with four towns (posted March 15)

• Camden, Hope, Lincolnville, Rockport 'plowing new turf' with ambulance decisions (posted May 2)

• Time for Camden, Hope, Lincolnville, Rockport voters to decide their emergency care (posted May 30)

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Editorial Director Holly S. Edwards can be reached by email at hollyedwards@penbaypilot.com or by calling 207-706-6655.