By Thomas Caywood
Sunday Telegram
GARDNER, Mass. — Blaming everything from the Post Office to confusion over whose responsibility it is, dozens of Central Massachusetts cities and towns have yet to produce state-approved plans for providing emergency medical services, a requirement that has been on the books for nearly two years.
A 2000 state law that was intended to improve the quality of emergency medical care in Massachusetts directed municipalities to draft ambulance “service zone plans” and have them approved by the state no later than Dec. 31, 2006.
Less than 40 percent of the cities and towns in the region had done so as of last month, according to a Telegram & Gazette analysis of a state report.
Meanwhile, the state agency charged with approving and overseeing the service zone plans says it’s powerless to do anything about the continued widespread failure to comply with the law here and throughout Massachusetts.
“That law doesn’t contain any carrots or sticks for cities and towns,” said Paul Dreyer, director of the state Department of Public Health’s Bureau of Healthcare Safety and Quality.
“So, what we have been trying to do,” Mr. Dreyer said, “is rely on their good will and make the case that the submission of service zone plans will result in better EMS coordination.”
That strategy hasn’t produced much in the way of results.
Nearly two years after the deadline passed, 44 cities and towns in the region still did not have service zone plans approved by the public health department as of last month.
The law, dubbed “EMS 2000,” which requires service zone planning, makes municipal executives such as town managers and mayors ultimately responsible for compliance.
Clinton Town Administrator Michael J. Ward referred questions about why the town didn’t have a state-approved plan to Fire Chief Richard J. Hart, who in turn referred them to his coordinator of emergency medical services, a firefighter.
Chief Hart said it was his understanding that Clinton’s service zone plan had been completed earlier in the year. However, Clinton was not listed among the municipalities with an approved plan as of last month.
Gardner Mayor Mark P. Hawke said he wasn’t sure exactly how the requirement has been allowed to go unfulfilled for nearly two years in his city. But, Mr. Hawke said, a draft plan had recently crossed his desk for his signature.
“Honestly, looking at this, I cannot see how it would improve anything,” Mr. Hawke said. “From what I can find out all it does is record response times, staffing levels, backups and so on. It’s kind of who does what. It’s just another form we have to fill out.”
Shrewsbury Town Manager Daniel J. Morgado said he doesn’t intend to file a service zone plan.
“I think the whole process needs to be looked at again in light of current fiscal reality,” said Mr. Morgado, noting that law was drafted in the late 1990s.
“We need to look at what we’re doing, why we’re doing it, to what end we’re doing it, what it’s going to cost, and who’s going to pay,” Mr. Morgado said. “Until those questions get answered, we will continue to provide outstanding EMS service, but we’re going to do it without this whole elaborate planning system.”
The DPH’s Mr. Dreyer acknowledged that, while the list of towns in compliance has grown slowly over the years, he can’t force recalcitrant towns such as Shrewsbury to go along.
“We have engaged in numerous communications with municipalities, but the fundamental problem is that if the municipalities don’t choose to cooperate, we have little recourse,” he said.
But Mr. Dreyer and other advocates of service zone planning said the process is more than just useless bureaucratic paper shuffling, as some critics charge.
Perhaps most importantly, they say, service zone plans allow cities and towns to set response time standards that private ambulance services must meet to qualify to respond to 911 calls - an important source of business for the 52 private ambulance companies in Central Massachusetts.
The plans, which average around 20 pages, cover details from the number of ambulances to the type of ambulances to the training level of the emergency medical technicians staffing them, said Edward C. McNamara, executive director of Central Massachusetts EMS, an agency charged with helping to coordinate ambulance service in the region.
Mr. McNamara said the purpose of the EMS 2000 law is to “improve and enhance the quality of our emergency medical services.”
“It brings out a lot of stuff that a lot of towns really haven’t thought about. If we’re running a major event like a town fair, do we have a good plan for emergency medical care? It gives them an opportunity to look at all that,” Mr. McNamara said.
State Rep. Jennifer M. Callahan, D-Sutton, a former nurse who serves on the Legislature’s Public Health Committee, said that while the law was passed before she was elected, she supports its aims.
“Everybody’s got to stop pointing fingers. This is a good thing. I haven’t heard anybody say it’s not a good thing to set standards,” she said.
Ms. Callahan said that, after being contacted by the T&G in connection with this story, she looked into three communities in her district that, according to the state, did not have approved plans as of last month: Millville, Sutton and Uxbridge.
“I found some varying degrees of answers,” Ms. Callahan said.
Millville officials told her they submitted a plan and were asked to revise some aspects of it, which they did, she said.
“They sent it out in April, and now nobody can find it,” she said. “It wasn’t like they didn’t do it. They did it, but somehow it was lost in transit.”
In Sutton, town officials had expected a private ambulance service to draft and submit the plan, she said.
“In that case, there was a breakdown in who was really responsible for filing the plan,” Ms. Callahan said.
Meanwhile, Uxbridge chalked up the overdue plan to an impending change in ambulance coverage in the town and a major mill fire last spring, she said.
“Three different communities, three different reasons for why it had not risen to the point where they had been added to the list” of cities and towns complying with the EMS 2000 planning requirements, Ms. Callahan said.
Mr. McNamara said that while there is still a long way to go before Central Massachusetts is fully covered by service zone plans, the region is ahead of other parts of the state.
“There are some regions of the state that have no service zone plan approvals,” Mr. McNamara said.
In addition to the 27 local cities and towns covered by plans as of last month, Mr. McNamara estimated about 15 or 20 others are preparing them or getting them approved.
And the dozens of others?
“We do talk to them. The (public health) department has sent out some letters recommending communities start the process because they’re already a few years late,” Mr. McNamara said.
The only enticement in the law, he said, is that municipalities that comply are eligible for state emergency medical services grants. Alas, there are no state emergency medical services grants, he said.
Ms. Callahan, the state lawmaker, said it’s time for all sides to come together, led by the Department of Public Health, and fully implement the law.
“Is it a lack of clarity on who’s responsible? It sounds like, for some communities, it might be that,” Ms. Callahan said. “Is it a lack of coordination and following up on who’s responsible? Sounds like there’s a little bit of that here, too.
“This is the one call you never want to hear, that the emergency response time was delayed for some reason,” she said. “I don’t think we can ever take our eye off the mark of how important this is.”