BETTER THAN HEARSAY - The Gorilla and Elephant in the Room

CAIRO - It wasn’t easy to tell whether the gorilla or the elephant in the room should be what matters most in the ongoing discussions about struggling ambulance service in Greene County.

Both un-ignorable animals were used as metaphors when the Greene County Legislature hosted a meeting on the critical issue, last week.

It was the third such sitdown since an independent consultant’s report on emergency rescue within the county was unveiled, in September.

County lawmakers, town government leaders and area emergency services experts attend the gatherings, freely sharing their thoughts and ideas on the subject.

The consultant’s report has revealed what everyone already knew, that ambulance workers are in high demand and short supply.

They are underpaid and stretched thin on the job, typically on duty 80 hours in a week, spread between multiple agencies, forced to make ends meet.

And the consultant verified what municipalities throughout the county were well aware of, that they are increasingly hard-pressed to afford everything associated with running an ambulance squad.

Further, the study showed that the handful of units still able to maintain operations are “organized disparately,” adding to the difficulties.

The consultant, Fitch & Associates, was hired after town supervisors from the mountaintop visited the legislature, en masse, in the winter of 2023.

Three municipalities, Ashland, Hunter and Windham, provide primary ambulance response and transport for six hilltop towns, including Lexington, Prattsville and Jewett.

Those six towns are also covered by Greene County Emergency Medical Systems (GCEMS) and their flycars, a roving team of rigs literally on the road 24/7/365, manned and womaned by paramedics.

The flycars are strategically stationed and rotated throughout the county as calls for service and mutual aid demand, bringing highly-trained medics to the scene in remarkably fast time, servicing all towns.

They are respectfully referred to as “hospitals on wheels,” equipped with the latest in mobile life-saving equipment and expertise to administer it.

The flycars do not provide patient transport, a responsibility left to municipal  squads including the three hillt owns and valley towns such as Catskill, Coxsackie, Durham and Greenville.

Speaking collectively, mountaintop leaders warned lawmakers that they were economically surviving on borrowed time, sending cold shivers through the entire ambulance network.

“These towns have said that they are on the way out,” legislature chairman Patrick Linger said. “They mean it when they say it, and this can’t be ignored. Even one system failure is a problem for everyone.”

Taxpayers ultimately foot the whole bill for municipal service, whether through their own town or contracting with another town.

The flycars are administered by a non-profit agreement with the county which pays upfront, then taxes the various municipalities.

Given the dire forecast, lawmakers retained Fitch & Associates who, based upon their findings, made four recommendations for improvement.

The fourth recommendation was the formation of a unified county system, ending separate municipal units and either adding transport capability to the flycars or eliminating them, establishing a completely new system.

A general consensus has emerged that the fourth recommendation is the right path, immediately accompanied by the gorilla and elephant in the room, depending upon which possible snag to success is identified.

While there is wide agreement that something must change, not everyone is convinced a countywide system would achieve the goal of stabilizing ambulance service and response times over the long term.

And there are a plethora of perspectives on what matters most in terms of getting the ball permanently rolling in the right direction.

County administrator Shaun Groden said the overall cost of transitioning from municipally-owned units to a county-run system is the gargantuan gorilla in the room, the ultimate determining factor.

Early estimates put the price tag somewhere between $10 to $12 million as worker wages and health benefits significantly rise, existing municipal units and their equipment are bought out by the county, and other variables.

GCEMS chief of operations Steve Near acknowledged that expense is an abundantly-sized ape, but said the more ponderous problem is the elephant in the room.

The pachyderm, Near said, is having no guarantee a single county system will result in plentiful workers magically appearing, no matter how many dollars are pumped into it.

And while leaving critters out of it, longtime GCEMS president Mark Evans said the “overarching thing is response time,” calling for certainty that the current excellent times do not go backward.

No one referred to a giraffe in the garage, but another unavoidable beast might be the very real possibility that some municipalities won’t embrace the countywide system, for any number of reasons.

Two towns, Greenville and Durham, operating as non-profits, refused to cooperate with the consultant, not providing requested information. 

There is fear they will, as the poet Dylan Thomas wrote, “rage rage against the dying of the [municipal ambulance] light,” turning the entire unification effort into a complicated mess.

On the other hand, it is also possible none of the identified obstacles would prevent the county from creating the system, whether the towns sign on or not, including Greenville and Durham.

That is a contentious scenario no one wants although county leaders privately say it is not off the table, given what previously happened.

A decade or so ago, a special Task Force was established to study the same ambulance service which was then similarly suffering.

After nearly a year of compiling all the facts and figures and coming to the precipice of moving ahead on a countywide system, Catsklll and Ashland, two key towns, backed off, dooming the project.

Learning their lesson, lawmakers are putting the onus on towns to commit to the plan, not wanting to again come away with nothing.

Towns, in turn, are saying they can’t commit until they know precisely what they are committing to, and nobody argued the point, leaving the conversation in limbo.

Talks were ended after nearly two hours. The next sitdown is slated for mid-January. Between then and now, a small group of ambulance administrators will huddle.

They will be focused on advising the county on exactly what will be needed, in terms of equipment, personnel, overall costs, etc, to operate one countywide system.

When the county has that data, a conceivable budget will be assembled, putting in black-and-white the bottom line tax burden.

It could then be as simple as pie, deciding whether or not to spend that kind of money, although gorillas and elephants tend to be disruptive little rascals, especially when squeezed into a fiscal nook and cranny.