Pa. EMS agency struggles as municipalities make few advancements in funding
“We’re going to do everything we can to keep the doors open,” said Jack Bonsell, president of Port Matilda EMS
By Halie Kines
Centre Daily Times
PORT MATILDA, Pa. — In late January, with the future of EMS service of thousands of Centre County residents at stake, five municipalities agreed to work together toward a solution on how to ensure the Port Matilda EMS survives.
Nearly four months later, there’s little clarity on what the future of Port Matilda EMS looks like beyond 2023 as the elected officials of the Upper Bald Eagle/Halfmoon COG haven’t found a concrete solution. Some officials in the COG have differing viewpoints than the EMS on what help is needed and when.
Each of the five COG municipalities — Port Matilda borough and Halfmoon, Huston, Taylor and Worth townships — have given extra money to the EMS this year. The amount varies across the municipalities (part of Ferguson Township is also in the EMS’ service area but not part of the COG). Some gave their entire budgeted amount at the beginning of the year or provided their quarterly payments early. Some, if not all, gave an extra amount to help increase hourly wages or to cover the cost of one person to attend an EMT training class.
But what the support will look like beyond this year has yet to be determined, with Port Matilda EMS joining a growing number of EMS companies around the country with unclear futures.
During a March 7 COG meeting, chair Keith Reese said the EMS is “financially solvent.”
“EMS right now is very financially solvent with this crew and staff they have. They have money right now that they cannot spend because they don’t have the staff. That’s a good place to be in and they are working on that to get the staffing and we’re standing by to help,” Reese said. “Anybody that has any inferences or beliefs that we’re not here for them — that’s false. It’s erroneous, it’s malicious. Whatever you want to call it, it’s just not true.”
Jack Bonsell, president of the Port Matilda EMS, who was not at the COG meeting, told the Centre Daily Times that the claim the EMS is “financially solvent” is incorrect. According to Bonsell, an infusion of cash between contributions from the municipalities and memberships, along with a state grant, does not tell the full story. While the EMS has added to its staff and has several people in an EMT training class, clarity on future funding is still needed.
Historically, the EMS can not survive on just memberships. Out of the 4,845 memberships the EMS sent out this year, 807 have been completed, as of March 7. The total income from these memberships is $84,051, which includes donations on top of the memberships. The public support and awareness has been greater recently, Bonsell said, and the COG also said it was appreciative of those who completed memberships.
The EMS also recently received a $150,000 grant from the state and was offered a loan from the county.
The grant can’t be used for payroll, Bonsell said. They could contract employees, he said, but there are some issues with that as well, because it’s not dollar for dollar. The cost could be inflated because they have to pay the employees as well as the staffing company.
Beyond that, there are other limitations.
“Just as an example, I can put propane in our tank to heat the building, but I can’t use that money to buy fuel for my trucks. I can put a roof on the building but it does me no good if I have no staff in here to keep dry. ... That $150,000 is very difficult to spend.”
Although there may be various stipulations on the grant, Bonsell said it will allow them to recruit and retain employees. It will give them the opportunity to use some of the money to go to a job fair and potentially hire people.
John Franek, Centre County’s administrator, attended the COG meeting after Halfmoon Supervisor Ron Servello inquired about grant opportunities from the county. Franek said there weren’t any grants available, but the commissioners offered a $50,000 “bridge loan” that could be repaid in about a year at 0% interest.
The COG discussed the option and what type of oversight would be needed in the event the EMS wanted the loan. Servello said they’re still trying to “figure out what the structure should be” between the COG and the EMS. Reese suggested the municipalities discuss the loan at their next board meeting to decide if they want to have oversight and an agreement with the EMS like they have with the Port Matilda Fire Company.
Port Matilda borough council member Mark Lively wondered if money is the solution right now, and questioned whether the EMS could be shut down because of how understaffed it is and how many calls it can’t respond to.
After a complaint was filed against the Port Matilda EMS for not covering all their calls, the EMS was put on a provisional status by the state, which Bonsell said is not uncommon for rural EMS services. That required a four-point action plan outlining how the company would work its way out of the situation. While provisional, their ambulances are getting inspected every year rather than every three years.
Every three months, Bonsell gives the state a report on where the EMS is on the plan, which includes advertising for new employees, meeting with the municipalities, providing a log of all of the missed calls and explaining why the calls were missed.
“So could Seven Mountains ( Emergency Medical Services Council) come in and shut me down? Absolutely not,” Bonsell said. “If I’m not following (the action plan), the state most likely ... will fine (us) up to $10,000 until this is fixed. ... At that point, when you become a liability to the state, then the state could shut you down.”
What can municipalities do?
The current EMS budget is $315,000, which includes payroll, workers comp, payroll taxes and utilities. The EMS does not currently get full funding from the municipalities it serves. Collectively, the COG municipalities gave the EMS $44,000 this year, Bonsell said during a previous COG meeting. Some of the municipal budgets are smaller than the entire EMS’ budget.
Servello said the 2023 budget shouldn’t be in the $300,000 range, as they’re not employing that many people to warrant that amount. Based on a projection done by the Halfmoon Township treasurer, Servello said it could be around $200,000.
The EMS is facing two problems, Lively said during the COG meeting. The issues, money and staffing, have different time frames.
The COG doesn’t have the ability to fix the staffing issue, he said. The municipalities are limited in where they can spend money, as their budgets are set for 2023 and won’t be opened up until the fall.
Many residents have asked the municipalities to implement a tax to help fund the EMS, Lively said. The municipalities wouldn’t be able to do that until after it is written, advertised and discussed at two meetings. The tax wouldn’t take effect until January 2024, he said, so that is “at best, a medium-term solution, maybe a long-term solution.”
The COG has started to discuss an EMS funding formula for 2024, but the first meeting was held behind closed doors, a potential violation of the Pennsylvania Sunshine Act.
Between the municipal contributions, memberships and donations, the grant and bridge loan, the potential tax increase and the financial committee’s work, the EMS is “set financially for the short-term, medium-term and long-term,” Lively said. The EMS — and many residents who have been vocal in their support of the EMS — do not hold the same view.
During the March 7 meeting, David Crow, a Halfmoon resident, said the EMS has been looking for municipal support from the beginning. He commented on the time and number of meetings it has taken to get here, and the lack of solution.
“The problem isn’t being solved. What we’re doing is kicking it down the road. ... People like these volunteers ... that are trying to help, they’re looking for that municipal commitment. And they’re not looking for this to take three or four months. They expect action soon. So at the town hall, you directed all of us be patient. But here we are,” Crow said.
Reese said that wasn’t representative of what is happening. They organized as quickly as they could, given the scheduling logistics of five municipalities, they’ve increased their contribution and are working on a viable funding solution, he said.
Other residents inquired about the townships using their American Rescue Act Plan funds to fund the EMS, which turned into a heated exchange with Supervisor Timothy Reese.
“Just because we have a little extra money, we can’t give it away all the time. We have to sparingly use our money. Liquid fuels every year is going down. We’re not getting near enough money from the state. Anything we can get, we’ll help them a little bit. We already did. We gave over $7,000 to EMS out of the ARPA funds,” Timothy Reese said.
‘We’re going to do everything we can’
Through this time, the public awareness has been much greater than it has ever been before, Bonsell said during an interview in February.
“Before, there was always that understanding that, you call 911 and somebody is going to be there. Now, there’s the awareness that they’re not potentially going to be there or they’ll be there but you’re going to have to wait,” he said.
He declined to comment on the timeline the municipalities are working on. But he did say he was surprised and disappointed that they haven’t gotten to some kind of resolution yet.
“I am a little disappointed that we have not got some kind of resolution prior to today. But again, I’m not here to blame COG, any municipalities. That’s not what I’m here for,” he said.
So, how will the Port Matilda EMS make it through 2023? Bonsell said the answer is a combination of things: financial and vocal support from the public, and state and local funding.
In general, improved insurance reimbursements — a statewide issue — is also a dire need.
“One of the things that really is hurting EMS as a whole is insurance reimbursements. They’re horrendous and there’s no outlook on the horizon to have that fixed,” Bonsell said. He estimated they get about a 50% return on any bill they send out through insurance.
Although there’s been no set resolution from the municipalities, they’ve all agreed to work with the EMS in some form, Bonsell said. So, the administrative board made the decision to go ahead with business as usual, to send out the memberships, and continue to try to hire employees. They’ve been advertising for employees with a starting rate of $14/hour, up from $11/hour.
That has garnered some interest, he said. As of March 10, the EMS has 5 paid employees, three volunteers and one paid employee on sick leave.
Near the end of February, Bonsell said he had just a small portion of the staff he would need in order to operate 24 hours a day, year-round. That’s not sustainable, he said. At the time, the EMS had been dispatched to roughly 47 calls but had to turn over 38 of them due to staffing.
“If I all of a sudden become fully staffed tomorrow and we hit every call from here to the rest of the year, there are 38 calls that even at 50% of our billing rate — which is $750 out the door — even at 50% we’re going to lose that income because we weren’t staffed for the early part of the year,” Bonsell said. That money may not make a huge difference in the grand scheme of things if they are fully staffed, have high membership rates, are awarded grants and the municipalities fund it in some form. But if the EMS is running “right on that edge,” there’s already roughly $12,300 missed out on.
Bonsell said there are seven people taking an EMT class, the majority of which were funded by the COG municipalities or private citizens, and they’ve all committed to working with the Port Matilda EMS after their graduation.
Additionally, the EMS is putting together a board of directors. They have a president, treasurer, someone to provide medical direction and a transportation director. They’re looking for someone who is interested in working and providing information to and from the state and the county, and a COG representative, among other positions. More information is available on the Port Matilda EMS Facebook page.
The Port Matilda EMS has a non-emergency wheelchair van that can be profitable when it’s running. They’re seeking more volunteers as drivers for the van and will be another way to generate income.
The EMS will continue to run and do what they can do to hire more staff until they can’t anymore.
“We’re going to do everything we can to keep the doors open because we have a commitment to the community,” Bonsell said.
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