OBSERVER file photo Pictured is the sport utility vehicle used by Chautauqua County for its fly car program to provide emergency medical services. Paramedics who use the vehicles responded to 5,576 EMS calls in 2021, and the system has run a deficit of $2,773,993 since its inception.

What is the cost of human life for taxpayers? That’s a question that the government asks on a regular basis and it’s something that Chautauqua County officials are wrestling with as well.

In the summer of 2017, Chautauqua County started its first fly car system, nontransporting emergency medical service vehicles that respond to and provide emergency medical services without the ability to transport patients.

Noel Guttman is the county’s fire coordinator and director of the Emergency Services Department. He was not the director when the program first began nearly five years ago, but he said the goal of the fly car system has never changed. “The overall mission is to save lives. It’s to help and treat people. That is the number one mission. It always has been and it always will be,” he said.

He noted that the fly car program is not meant to replace volunteer fire departments but rather work alongside them. “We are a blended service in Chautauqua County. We are working with volunteers, we are working with other ambulance services, and we’re working with the paid fire departments, because the overall goal always has been and always will be to give the best patient care we can to anybody we’re called to,” he said.

When a call is made for service, it is generally a Basic Life Support (BLS) call or an Advance Life Support (ALS) call. In recent years, having an emergency medical technician in a volunteer department who can provide ALS care has become more difficult, which is where the fly car can help assist.

When the program first began, there were three fly cars, each manned with one registered paramedic, from 6 a.m. to 6 p.m., six days a week. One fly car was in Mayville, one was in Gerry and one was in Arkwright.

There were three full-time and four part-time staff.

As time went on, changes were made. The fly car system expanded from 12 hours a day, six days a week, to 24 hours a day, seven days a week.

That allowed the paramedics to respond to more calls. In 2018, the fly car program responded to 1,851 calls. That number jumped in 2019 to 4,861. In 2020, when the pandemic kept many people at home, the calls dropped slightly to 4,680. But the numbers jumped again in 2021 to 5,576 calls.

Also, the locations of the fly cars changed. While the sport utility vehicle that was stationed in Mayville remains there, the Arkwright fly car was moved to the Sheridan Fire Department and the Gerry location was moved to the Falconer Fire Department.

The fly car program also added two ambulances — one in Celoron and one in Sheridan. The Celoron ambulance is staffed with an emergency medical technician 10 hours a day, six days a week, while the Sheridan ambulance is used by volunteers from the East Town of Dunkirk, West Town of Dunkirk, Hanover and Sheridan fire departments.

In January 2021, the fly car program added a fourth site, stationing a fly car in Lakewood.

According to Guttman, the fly car program now has 18 full-time paramedics, two which are senior supervisors, seven part-time paramedics and 13 causal paramedics. A “casual paramedic” is an individual who fills in when asked but is not regularly scheduled. Many of the casual paramedics are professional firefighters or work for an ambulance service, and help the county out when they can.

Guttman praises all the staff, including the casual staff. “We couldn’t do this without them,” he said.

COST OF THE PROGRAM

As staffing levels and locations have increased, so has the financial commitment to having a fly car system.

In 2019, the fly car program expense was $1,055,543. That increased in 2020 to $1,380,480 and increased again to $1,826,363 in 2021. For this current year, the program has been budgeted $1,924,097.

But when the fly car program was first adopted, the thought was it would pay for itself through medical billing. The county put out a Request For Proposals and hired Professional Ambulance Billing in Erie County to take care of the billing.

But Daniel Imfield, deputy fire coordinator, admits the billing for services rendered is quite complicated. “Billing EMS is not straightforward. The transporting agency, if they’re a billing agency, has to bill,” he said.

For example, in Dunkirk, their fire department sends a bill to the insurance company. Dunkirk keeps 60% of the revenue once it’s received and gives the county the remaining 40%.

Also BLS calls aren’t billable, but ALS calls are. But if a fire department requests BLS assistance at a scene, the county will still provide services, regardless if it will get paid or not.

But the revenue the county received has never come close to covering the costs.

In 2019, the fly car program’s revenue from billing was $588,304. That increased in 2020, but only to $631,327 and then to $654,973 in 2021.

That means the fly car program’s deficit was $467,239 in 2019, $749,153 in 2020, and $1,171,390 in 2021.

In fact, excluding the first five months of the program, the fly car system has run a deficit of $2,773,993 since its inception. That’s a far cry from breaking even.

Those numbers were provided to The Post-Journal and OBSERVER by county Legislature Chairman Pierre Chagnon. The Republican lawmaker from Bemus Point was a member of the county Legislature back when the program first began.

He noted how the county knew volunteerism among fire departments was dropping and they wanted to see what they could do to help. At the same time, there was a consultant firm that said a fly car system, which was being operated in Livingston County, could work here as well.

“They came to us with a detailed study — inches thick which they usually do — which said essentially it would be a break even proposition. Those of us on the legislature were like, ‘This is a no-brainer,'” Chagnon said in an interview. “Our communities are struggling to get paramedics and EMTs to respond to calls, especially the rural communities and the volunteer fire departments so we jumped on it.”

But less than two years into the program the county realized the consultant firm got it wrong.

The firm’s biggest error was in estimating who could be billed. “It became apparent to us that the consultant had assumed that we would be able to bill for Medicaid reimbursement and in New York state you cannot bill for Medicaid reimbursement. That was a substantial part of the problem,” Chagnon said.

There were other problems as well. In 2021, the county and the Jamestown Fire Department finalized an agreement for the county to be paid after years of negotiations. Yet even though a contract was signed, Chagnon said they never sent a single check that year.

In February, Chagnon said Jamestown finally sent its first payment but that was only for calls in 2022. “They delayed on the billing because they didn’t have computers in the fire station, they didn’t have the right software, they didn’t have people trained, and they needed to get approval from the state. It just went on and on,” he said.

Even though Jamestown has finally started to pay, Chagnon believes the city still owes the county revenue for all of 2021.

But even if the county gets Jamestown to pay for the calls in 2021, he admits that won’t come close to erasing the $1.17 million deficit from last year.

The county has made other strides to help with payments. The Falconer Fire Department is partnering with the county’s EMS Department, since it has a countywide Certificate Of Need authority to operate. By operating under the Certificate Of Need, Falconer can now bill for its EMS calls, a portion of which will be returned to the county. Other volunteer fire departments are looking into having the county partner as well.

WEIGHING THE COSTS

Once legislators realized the fly car program couldn’t pay for itself, the question was raised how much is the county willing to pay for. Every other week, Chagnon, County Executive PJ Wendel and others meet to discuss county budget and expenses. The fly car program is regularly discussed.

Chagnon said some legislators have suggested scaling the fly car program back. “Whenever we get into a discussion of shutting down, scaling back, cutting back, part of the discussion is always, ‘What is the impact if we do this?'” he said.

There’s also the recognition that many of the services provided by the county may never be covered financially. “We don’t charge for maintaining the roads. We don’t charge for maintaining the bridges. We don’t charge for the planning services that the county has. We don’t charge for a lot of the services the county provides and some people look at the fly car program in the same light,” he said.

Now that the fly car program is here, Wendel believes the county must do what it can to maintain it. “If you reduce something that’s there, then what time of day do you tell them we’re not going to have ALS. At what point does someone’s life become in danger because we don’t have it,” he said.

Wendel sees a lot of value in the fly car program, especially with fewer and fewer people volunteering. “What is the value you put on a human life? There’s myriads of people that have been saved by the program,” he said.

A volunteer firefighter and EMT in Lakewood himself, Wendel noted that when he first joined they averaged 400 calls annually. Now they’re more than double that. “One year we were over a thousand,” he said.

And Lakewood is not alone with increased need. “I hear it every day — the number of overdoses and ALS calls, the number of times the fly car is in the city of Jamestown,” he said.

So for now, Wendel said the county is going to do what it can to generate revenue for the fly car, even if it doesn’t cover the entire program. “We’re going to continue to find ways to recoup revenue and make sure we’re getting as much as we can, but at the end of the day what’s the price do you put on the lives that are saved?” he asked.