Report on emergency services sparks passioned debate
The Jamestown Town Council’s April 14 review of a report advising major changes in the town’s emergency medical services sparked public opposition reminiscent of the animal control officer controversy of 2010.
The report from Municipal Resources Inc., a consulting company, was authored by Sue Prentiss and Don Bliss, who were on hand for the two-hour work session, which, like last year’s debates on the animal control officer, included strong public comments directed at the councilors and town administrator.
However, the animal control offi cer dispute was more straightforward than the JEMS debate for two reasons. The first one is that the debate over an animal control officer didn’t involve a significant change in the original recommendation for the future of animal control services.
Secondly, the issues underlying the animal control officer were clearly delineated in an analysis performed by Town Administrator Bruce Keiser. By contrast, nearly all the details about the JEMS problems, which led Keiser to commission a study by a consulting company, are under wraps.
Nevertheless, the problems were serious enough for the state Department of Health to “put us on notice that we had to address the way emergency services are delivered in Jamestown,” Keiser said. He added that the problems had been flagged during executive sessions of the Council.
During those sessions, “We became concerned about intra-agency cooperation,” Keiser said. “That was as disconcerting to me as it was to the health department. I respect the work of the JEMS volunteers, but I felt we had to make a midcourse correction.”
Keiser later put his position more bluntly. “If we can’t get the JEMS volunteers to work together harmoniously, we may have to consider a paid emergency medical service. If accommodations can be made to address the concerns on both sides, then all of Jamestown will benefit.”
JEMS member Judy Bell, who said she was speaking only for herself, said, “I cannot agree with [Municipal Resources’ assertion that] JEMS is perceived by the public in a negative light. Our public has confi dence in us and they should.
“Nor do I agree,” Bell continued, “that we have significant problems in senior management and the quality of patient care.”
“We are at times painfully aware,” Bell added, “that the basiclevel service we provide is not state of the art but we operate within the guidelines of our licenses and you cannot criticize a muskrat for not being a mink.”
Besides referencing internal problems at JEMS, Keiser said that there are significant problems in the relationship between JEMS and the Jamestown Fire Department, which is one of the causes of “unacceptable” responses, according to Keiser.
During the work session, the only example of inadequate performance referenced by Keiser involved a situation in which “the Fire Department had to assume full responsibility for response to an auto accident.”
The Municipal Resources’ report noted and underscored the friction between the two departments. It also noted that JEMS “has a perception that it is not an equal partner in the Jamestown public safety system.” However, despite this situation, Municipal Resources did not initially conclude that the town should give up on JEMS.
In the original January draft — which differs from the revised January draft posted on the town Web site — Municipal Resources stated, “The Jamestown Fire Department and Jamestown EMS should remain as two separate organizations.” There was also an alternative recommendation that said, “While we strongly believe that Jamestown EMS can remain a vibrant, effective agency in partnership with the Jamestown Fire Department and Police Department, we also acknowledge that the town may prefer to vest all EMS responsibilities in one agency.”
However, in the final report dated March 2011, Municipal Resources warned that the conflicts between JEMS and the Fire Department justify a much tougher response: “We recommend that the contract between the town and JEMS be dissolved and that the Fire Department establish an EMS division under the supervision of a qualified deputy fire chief.”
Currently, the memorandum of understanding between JEMS and the town has been extended to June 30 and could be extended again.
Resident Jane Bentley said that the reversal of the January recommendation suggested that “JEMS is being thrown under the bus.” In a subsequent response to resident Edwina Cloherty, who had expressed a litany of concerns about Keiser as well as the report, Councilor Mike White said he was “irritated” that whenever “we see management diffi culties with an organization and we look at that management and come to some sort of change in that bad management, why is that [it is interpreted as] ‘throwing them under the bus?’”
Nevertheless, several residents expressed suspicions about the change in Municipal Resources’ original recommendation, which prompted a bristling response from Town Council President Mike Schnack. “I didn’t go to Don and Sue and tell them what the recommendations should be,” he said. “We asked them for objective and quantitative measures.”
Questions about the actual number of report drafts persisted throughout the meeting. There are two documents posted on the town Web site: the final report and a draft that has a strikethrough over its January date with an insertion saying, “March 2011.” That draft does not include the more hopeful verbiage that appears in the unrevised January draft.
In its final report, Municipal Resources acknowledged the more sanguine recommendation in the unrevised January draft: “Based on our initial observations, the MRI team initially believed that the confl icts between [JEMS and the Fire Department] could be resolved amicably and to the benefit of the community. We had hoped that both organizations would make a sincere effort to resolve their differences by accepting, understanding and appreciating their respective cultures and perspectives.”
Since submitting the first draft, Bliss said, “There has been a drop in the number of JEMS members and other serious issues have emerged.” Consequently, he explained, Municipal Resources decided to issue its merger recommendation to accelerate a resolution of the problems before they reached “a crisis stage” or resulted in “an unpardonable incident.”
Bliss also said that “the bottom line is this: Take the best of what you have with JEMS and the best of the Fire Department and you’ll have a system that’s the envy of the state.”
Prentiss praised JEMS recordkeeping and ambulance maintenance as “impeccable” and “state of the art.”
She added that JEMS has “weekly and monthly training, and that’s impressive. But overall membership has declined by 40 percent over the last four years and a high turnover rate leaves JEMS open to holes in the consistency of their operations. And while everyone wants to do the right thing, there is an overall morale issue.” The morale issue was in reference to the friction between JEMS and the Fire Department.
Prentiss also noted, “There’s a looming question about going to [advanced-level service].”
The Council has held one discussion on the merits of elevating basic level service to advanced-level service, and the proposed town budget includes a $50,000 set-aside for JEMS to re-organize and transition towards the advanced service.
Prentiss echoed a caveat delivered by Keiser during the earlier discussion of advanced-level service. Namely, that there isn’t enough published data to prove that enhanced pre-hospital care leads to demonstrably superior outcomes in hospital treatment.
“It’s our recommendation,” said Prentiss, “that you implement ALS at a later stage.”
Referring to what he described as a lack of accountability on the part of JEMS, Keiser said that he has significant concerns about their proposed adoption of advanced-level service because “it’s very difficult to maintain [advanced-level service] when you have one ALS-type call once every three weeks or once a month.
“I communicated this to JEMS leadership, that we shouldn’t proceed towards ALS until we appreciate what the proper path should be,” Keiser continued. “But JEMS went ahead and applied to the Department of Health for advanced-level service licensure anyway.”
Pointing out that JEMS receives $185,000 in town support, Keiser said, “JEMS is a young, non-profit organization performing an essentially municipal-type function, but we do not have a mutual understanding that JEMS should be directly accountable to the town.”