By Annysa Johnson
Milwaukee Journal Sentinel (Wisconsin)
Copyright 2006 Journal Sentinel Inc.
When 61-year-old Dale Guehlstorf and son-in-law William Gilman both collapsed from heart attacks at Gilman’s South Milwaukee home last year, paramedics from South Milwaukee and Oak Creek responded quickly to the scene.
Guehlstorf, who was twice revived before arriving at the hospital, insists he and his son-in-law are alive today because of the paramedics’ prompt response and expertise.
It wouldn’t happen again, says South Milwaukee Fire Chief Jay Behling, if Milwaukee County Executive Scott Walker eliminates, as feared, a $3 million contribution now paid into the system in an effort to close what could be a $90 million budget deficit next year.
“We would probably have to eliminate the program,” said Behling, whose paramedics also serve Cudahy.
Walker angered local officials in recent weeks when he first postponed a paramedic training class scheduled for September, then suggested he might cut the $3 million payment in 2007. He set off a firestorm of protest this month when he called the payment a “subsidy of local fire departments” and said the county had been “snookered” into paying for more than it should have in the past.
Now, local mayors and fire chiefs are accusing Walker of trying to dismantle a 33-year-old program considered a national model of regional cooperation. And one fire department, Greenfield’s, responded by refusing, for now, to collect data for the countywide emergency medical studies that have contributed to its status.
Walker said last week that he has no intention of dismantling the program, and that the county would continue to fund training, communication, record-keeping and medical oversight, now at about $2.8 million a year. What might cease, he said, is a $3 million annual payment split among municipalities to offset costs historically covered by the county, such as medical supplies and rig maintenance.
“We’ve not made any decisions, and we won’t until September,” Walker said.
“But I’ve got a $90 million hole . . . and now a $59 million pension contribution. Even if I wanted to raise taxes, the most I can do is $7 million,” he said. “Short of having Harry Potter for a budget director, I’ve got to balance the budget somehow. Anything that’s not mandated has to be considered.”
Modeled after Seattle plan
The Milwaukee County paramedic program, modeled after Seattle’s in the early 1970s, was designed to provide advanced life support services to all residents regardless of their income level or the municipality in which they lived. Unlike emergency medical technicians, who offer basic life support, paramedics can intubate patients, administer certain drugs and provide other treatment under medical direction on the scene or en route to a hospital.
Today, about 20 paramedic units cover the 242-square-mile county, broken down into zones. In all, 15 of the county’s 19 municipalities staff paramedic units. Those that don’t — Hales Corners, Greendale, St. Francis and Cudahy — are served by their neighbors under the county contract, but they’re not required to compensate those communities.
It’s been a partnership, however uneasy, from the beginning, with the municipalities supplying the ambulances and fringe benefits for the paramedics who staff them. The county kept the billing revenue and covered the rest of the costs, including base pay for each paramedic, plus an incentive equal to 5% of his or her salary; medical supplies; and rig maintenance.
That changed in 2004 when the county altered the system’s financial arrangement — the municipalities claim “unilaterally.” Beginning with the current contract, which ends this year, the county continued to pay for the infrastructure — training, medical direction and so on — but it shifted all other costs to the municipalities.
In return, the communities received the billing revenue according to a formula they devised, and, because that fell short of the amount projected, the county kicked in an additional $3 million for them to split among themselves.
County, municipalities differ
The county insists it never promised the payment in perpetuity and that these and any future changes are negotiated with the communities.
Local officials differ — vehemently.
“These aren’t negotiations,” said South Milwaukee’s Behling. “They put a gun to your head and say sign it, or there’s no deal.”
The latest round of recriminations raises the question: Whose program is it anyway?
Walker insists it’s the individual communities’. Their names are on the rigs, and paramedics answer to their local fire chiefs.
That galls West Allis Mayor Jeannette Bell, whose community was the first to staff a paramedic unit.
“It’s a county program; it’s always been a county program,” said Bell, who was outraged by Walker’s “snookered” reference. “If communities are providing service outside their boundaries, why shouldn’t that be paid for by a broad-based property tax through the county?”
Tax shift possible
Bell said Walker’s cut would only shift his budget problems onto others, forcing local municipalities to raise taxes or abandon their paramedic programs altogether. Departments estimate it would cost on average an additional $176,000 for the provider communities, though Behling projected South Milwaukee’s cost at $250,000 because it would generate less billing revenue than others.
“West Allis could raise the revenue from the fees because of our size and demographics,” Bell said. “But that’s not true of every community.”
Walker said local governments will find a way to fund a critical service or contract with others that do.
“The bottom line is people have an expectation,” he said.
Meanwhile, Dale Guehlstorf and his wife, Darlene, say they’re frustrated by the debate over what they see as an essential, lifesaving program.
“This is why we live here,” said Darlene Guehlstorf, who with her husband contemplated moving to Door County when he retired six years ago.
“Everyone’s complaining about people moving out of Milwaukee County,” she said. “Duh. If you keep cutting back programs, how long do you think people are going to stay?”