After surviving for 25 years as a nonprofit public service corporation, the Trinity County Life Support ambulance service has initiated the formal process seeking to form a community service district to help stabilize revenues through a proposed $68 per parcel tax on properties within the service area.
The TCLS Board of Directors in February approved a resolution requesting that the county’s Local Agency Formation Commission undertake the proceedings required under the Cortese/Knox/Hertzberg Local Government Reorganization Act of 2000 to change the organization’s structure from a nonprofit to a community service district.
The Trinity County Board of Supervisors followed suit last week, adopting its own resolution requesting the LAFCo to initiate the process of forming a special district. The process would culminate next March with an up or down vote on a ballot measure for Trinity County voters within the service area to decide. Forming the district would require majority support, but the tax measure would require two-thirds, and the district would not be formed without approval of the tax to fund it.
TCLS was formed in 1993 after the previous ambulance service provider left the county without notice, taking the ambulance with him and leaving the area uncovered. The service area of TCLS includes 85 percent of the county, excepting Southern Trinity that is served by another provider and the Downriver area west of Cedar Flat that is served by the Hoopa ambulance.
TCLS provides advanced life support for pre-hospital transport, staffing an ambulance out of both Hayfork and Weaverville 24/7 with two other vehicles available as backup. It also provides annual low or no-cost public safety training and certifications for some 300 volunteer responders in the county.
In a presentation to the Board of Supervisors last week, TCLS Administrator/paramedic Kathy Ratliff said the service is struggling to retain staffing and is facing several funding challenges including a rising minimum wage and unreimbursed transport costs that would be reimbursed by Medicare and Medi-Cal to a government agency, but not a nonprofit.
“Without a change in structure and some form of support, we’re looking at rising deficits of $200,000 in 2019/20 and that puts our reserves at gone in 20/21,” she said.
To reduce costs, she and General Manager Shawn Poore’ are both working only part-time hours and ambulance staff members work 24-hour shifts with only 16 hours of pay. The additional eight hours are paid only if the sleep period is interrupted. That, combined with non-competitive wages, makes it difficult to recruit and retain adequate staffing.
“We knew this was coming and we’ve been studying it a few years. We brought in experts and talked about options such as partnering with Trinity Hospital or the Trinity Public Utilities District, but doing so would expose our partners to our own significant financial risk. County representatives said ‘no’ too, and our consultants recommended forming our own district, approaching the community for a tax measure to provide stable funding and to access Medi-Cal reimbursements,” Ratliff said.
Medicare and Medi-Cal patients account for nearly 70 percent of the annual ambulance call volume, and are reimbursed significantly less than the cost of providing the service, she said, adding the future of those reimbursements is hard to predict under fire from the Trump administration.
TCLS currently generates approximately $662,000 in patient transport revenue annually and requires approximately $1,100,000 to cover operations. A $68 parcel tax, assessed to roughly the same 9,555 properties within the Mountain Communities Healthcare District, would generate $649,740 annually.
With stable funding provided through formation of a CSD, Ratliff said additional medical staff could be hired at more competitive wages to reduce fatigue and stress; management could be restored to full-time hours and low-cost safety training could be maintained. Without it, services will continue to decline.
“We’ve been holding it together a long time without adequate staffing. Our service levels will decline. Recruitment will decline and advanced life support capacity will decline. It has been over the last three years due to lack of paramedic staffing,” Ratliff said.
General Manager Shawn Poore’ has also worked full-time as a flight paramedic for REACH serving all of Northern California and said “I was always amazed at the level of care provided here by TCLS. I was just five minutes on the ground and that is unheard of. The attitude of all the employees is not just to get from point A to point B, but to fix you on the way. I can’t tell you enough how the service you are provided here goes above and beyond. It is critical care by an amazing crew.”
He added, “There’s a lot of pride. It’s quite difficult to ask the community for money.”
From the audience, Kay Graves of Lewiston voiced concern about forming a special district for what is really a business “as much as we need ambulances. There are a lot of volunteer ambulance services. Is any of this money going to them? And there are costs to be a special district. People may be willing to pay to make sure we have ambulance service, but you’re loading a lot of things onto people’s property taxes.”
She added her family has used the ambulance “and I am grateful, but we paid. We paid our co-pay. We paid our bill, and now our parcel too? It’s a burden. This county’s been depressed for a long time. Our economy’s getting worse. It’s not a good idea to stack more burden on property owners.”
John Hamilton of Weaverville argued that only property owners should be allowed to vote on a parcel tax.
Board Chairman Judy Morris said the board’s action is only to submit the request to LAFCo, “and if LAFCo deems it can move forward, then it can go to the ballot next year.”
Every California county has a LAFCo to oversee the creation of new districts, cities, or annexations of service areas. It is a seven-member commission including three county supervisors, two public members and two existing CSD representatives. The proposed property tax would be submitted to all registered voters in the service area, not just property owners.
The board’s vote was unanimous to submit the proposal to LAFCo, with a recommended name change removing ‘county’ from the title. The proposed district would be called the Trinity Life Support Community Service District.