A Times Editorial

End justifies cost of public ambulance service

© St. Petersburg Times, published April 20, 2000

Emergency medical service is one of the most important public safety protections that local governments provide. The availability of trained lifesaving professionals in ambulances is every bit as important as police and fire protection.

Yet, in 1995 the Citrus County Commission abdicated its direct involvement by dismantling the county-run EMS and hiring a private company, Florida Regional Emergency Medical Services, to supply that vital service.

There were no complaints about the quality of service provided by the county-run EMS, and the only reason the commission cited for the changeover then was its desire to save taxpayers money. Speculation abounded, however, that it was retaliation for the EMS workers' earlier decision to form a union.

The county did save money, and some estimates put that savings at about $200,000 per year. However, even though the cost to county government went down, the fees Florida Regional charged residents went up, as did the number of medical calls responded to by volunteer firefighters.

Now, because Medicare reimbursement laws have changed, Florida Regional has decided that the amount of profit it makes in Citrus County is not enough and has announced plans to pull out Oct. 1. The commission sought proposals from other private companies to take over the service, but received no responses.

That should have opened the door for the commission to return to a county-run ambulance service. But the commissioners never seriously considered that option. Instead, they are poised to copy a system being used in Volusia County that establishes a local board of directors to oversee a private, not-for-profit corporation.

That system would require the commission to initially provide an undetermined amount of seed money to the private group, but with the anticipation the service eventually would pay for itself.

Volusia County has had great success with the system. It probably could work here, too, and it certainly is preferable to paying a for-profit company like Florida Regional to do the job. But no system is as directly accountable to the people it serves as one that is staffed by county-paid employees over whom the County Commission and administration have absolute oversight.

Whenever a private contractor is hired to perform a government service, taxpayers are removed one more step from the process they should be able to control with their money and their votes. As long as county workers do the job, the people they serve are ultimately in charge. If residents don't like the service they receive, or don't like the price, they can hold the commission directly responsible for improving it. That is simply not possible if a private company, regardless of profit motive, runs the service.

In addition, a county-run ambulance service grants residents greater access to information about the people they depend on to provide emergency medical services.

For instance, Florida Regional denied access to personnel records of paramedics and EMTs so that residents could be assured of their professional competency, or to identify those whose performance had been questioned. It is not clear if the not-for-profit system under consideration now would allow such sensible disclosure.

The commission should pause long enough to at least fairly weigh the costs of a county-run system to the public-private method. If the expenses are comparable, then the commission should opt for bringing back the county-run service. Even if it costs a bit more, the added accountability justifies it.

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