The Archuleta County Board of County Commissioners (BoCC) approved a resolution authorizing three local ground ambulance service providers to provide services in the county and giving the BoCC authority over authorizing further providers at its June 4 meeting.
The three ambulance providers authorized by the resolution are Pagosa Springs Medical Center (PSMC) Emergency Medical Services (EMS), Los Pinos Fire Protection District and Upper Pine Fire Protection District.
At a BoCC work session earlier in the day, the BoCC discussed the ordinance with PSMC EMS Deputy Chief Connie Cook, who stated that the resolution that would be before the BoCC had taken about a year and half to draft and that PSMC EMS was “really excited” to have it approved.
She added that, from what she had seen from similar agencies in other counties, “we have really done a good job of collaborating and cooperating to make this happen. A lot of my other chiefs and … leadership in other jurisdictions are struggling with their counties to come up with a resolution that everybody is happy with and even some of them opting out of … any kind of authorization to provide ground ambulance service in their counties, which I think we discussed, at length, over the last six months or so how important that is for the county to retain some control over who is practicing and providing ground ambulance service in the county.
“So, I love the resolution is short and sweet and simple, and I believe it leaves us a lot of room to grow in the future and evolve to see where our county goes, where our service goes.”
Commissioner Ronnie Maez asked why other counties had withdrawn from authorizing ground ambulance services.
Cook stated that she was unsure, adding that her peers “kind of felt like their counties weren’t supporting and/or giving them the opportunity to be the sole provider or to look at who’s already providing service and kind of just, ‘Oh, now the state’s taking care of licensing, so we don’t need to have anything to do with it.’”
She added that the Colorado Department of Public Health and Environment assuming control over ambulance licensing has decreased the administrative burden of licensing.
But, she said, “the one piece that was the most important was the counties being able to retain some say and control over who provides ground ambulance service and … I hate to say it because it’s my industry, but there are bad apples out there. So ABC ambulance company can come in and start farming out and cherry picking the transports that actually pay. EMS, it’s an in-the-red business, especially if you provide 911 service. There’s never enough money to cover what the actual costs are to do business and, so, if another company were to come in, a private company, and just start doing the interfacility transports with people who have good insurance coverage, that would take away any bit of revenue that we can capture from those transports. I think it’s been a great move on the county’s part and it’s been very supportive of us as the main providers in the county.”
She added that she was not only referring to PSMC EMS but also to Los Pinos and Upper Pine fire protection districts, which provide EMS services in portions of the county.
Cook indicated that the resolution also includes language authorizing operations by other providers that the authorized ambulance service providers specifically request, although she stated that there are currently no such providers that provide frequent-enough service to count as providing ground ambulance services according to state regulations.
She added that the county is “ahead of the curve” and that Hinsdale County copied much of the language included in the resolution for its own resolution on authorizing ground ambulance services, including authorizing PSMC EMS to provide services in the county.
Cook stated that she is still working with Mineral County to determine what its plans concerning licensing are.
“For the three counties that we provide service in, it’s now a piece of cake for us and that is a huge relief,” she said, adding that PSMC EMS will now be working on ensuring compliance with the state regulations.
Maez commented that he hopes complying with the state regulations will not cost PSMC “too much.”
Cook replied that the licensing changes would be “beneficial,” creating consistency and accountability for ground ambulance providers in the state, which she commented is “sorely needed.”
She explained that the new licensing process and requirements originated from the death of Elijah McClain, a Black man who was killed in Aurora, Colo., as a result of paramedics illegally injecting him with ketamine following his detention by police.
The two paramedics involved and one police officer involved were later convicted of negligent homicide related to the death.
Cook stated that the impact of this incident was felt across the industry and that, under the new regulations, providers would be “held to a much higher state of accountability than we have in the past.”
She stated that the local licensing process is “good” and that PSMC EMS has “done our best to provide the highest-quality care and services to our community that we can in a very honest way.”
“So, yeah, we’re going to continue to do that,” said an audibly emotional Cook.
Maez expressed his appreciation for the services that PSMC EMS provides and commented that it is important to “maintain a level of continuity and establish a good standing with the people we work with to provide good care to the people of Archuleta County.”
Commissioner Veronica Medina noted the importance of retaining local control over authorization.
Cook commented that larger ambulance companies lack the community grounding that PSMC EMS has and are more focused on business.
“It’s been a long 18 months and I’m super grateful for the support that we get from you guys because it is not that way in a lot of counties,” Cook said, again sounding emotional.
“We’re a community, you know,” Maez said.
“Even small communities that you would think that the support would be there, it’s not, and, so, I’m just super grateful,” Cook replied.
“We appreciate ya. I don’t ever want to use your services, but we appreciate ya,” Maez said.
“We’ve had some pretty significant things happen in this community and … to be able to consistently deliver is a huge point of pride for us,” Cook said with emotion.
Commissioner Warren Brown noted that Archuleta County is difficult to serve from a “geographical standpoint” and that he feels that opening the county to outside services who lack an interest in establishing a consistent service for the community would be “irresponsible and not protecting the business and the people here that need services every single day. Whether the money runs or not, they need it every time.”
Cook commented that this is why maintaining control over which providers are authorized is important.
“You can’t … just take the money-making calls and say you’re providing service to your community,” she said.
Brown commented that he would be open to another provider potentially providing service, but they would have to accept all calls in the community.
Cook added that the resolution would give the BoCC power to set conditions for services interested in entering the community and providing services.
She also expressed her appreciation for the county being willing to work with PSMC EMS in drafting the resolution and for the work county staff did in drafting the resolution, in particular highlighting the work of Executive Assistant Mary Helminski and County Attorney Todd Weaver.
Cook added that the process of drafting a resolution has been more difficult in La Plata County, which she described as an “ongoing battle.”
She stated that she is pleased that the Archuleta County process was smooth and that the county made implementing the resolution a priority.
Medina concluded the discussion by thanking Cook.
At the meeting, prior to the BoCC approving the resolution, Weaver explained that the county previously would provide licenses for ambulance service providers, but that the state has taken over such licensing.
However, he indicated that the county could retain control over which ambulance service providers would be authorized to operate in the county.
Weaver stated that the resolution lays out which services are authorized in the county and the process for gaining such authorization, which requires BoCC approval.
The BoCC then unanimously approved the resolution.
josh@pagosasun.com
