DARLINGTON — Even though there is still much to be established moving forward, the Lafayette County Board of Supervisors approved Nov. 17 the creation of a new County EMS Department that would help acquire services for the townships in the Rural Medical Service District.

“I am very pleased that the county wants to move forward with this,” Rural Medical Ambulance Service Board member Tim McComish said. “I know it will all work out.”

The County EMS Department will be a newly created department of the county and overseen by Memorial Hospital of Lafayette County. This solution was created to combat the ongoing issues between EMS volunteers and the Rural Medical Ambulance Service Board (RMASB). The department created would only involve Rural Medical and the townships and villages that they serve. It would not include any other EMS program in the county.

Two and a half years ago, RMASB met with Green County EMS (GCEMS) of Monroe in July 2018 and their service director Dan Nufer to see if they would be interested in coverage agreement with RMASB to cover the Rural Medical district, containing the townships of Darlington, Fayette, Seymour, Willow Springs and Lamont. The city of Darlington and the villages of Wiota and Gratiot were previously part of the district but left. 

GCEMS agreed to lease the ambulances, building and equipment from RMASB for one year for $1 and bring on the volunteers that were willing to stay as their own members. The volunteers had previously stated they would not work under the rule of Rural Medical. The agreement was for GCEMS to run everything. 

Nufer stated that for the last two years that agreement has worked out well. It was extended until July 2020. Again, the RMASB went to GCEMS for additional time. The GCEMS board agreed to extend the contract until Dec. 31, 2020 but will not go beyond that date. Nufer said that his board’s concern was when or if Nufer were to retire, they were going to have a difficult time to find a replacement to be able to manage both Green County EMS and Rural Medical.

During the meeting, president of RMASB Dave Ohnstad thanked Nufer and the GCEMS for being the helpful solution during their time of need and for “doing an excellent job in bringing his expertise here and working with our crew here.” 

“We are now very confident in choosing Lafayette County and MHLC,” Ohnstad said. “This option will have good access to more staffing, increase training and have a close working relationship with the crew, hospital and medical personal.”

The meeting began with Economic Development Director Abby Haas welcoming the packed room of county board supervisors, concerned citizens and EMS volunteers. Haas welcomed virtual panelists Gary Wingrove and Paul Anderson, president and system advisor at The Paramedic Foundation respectively. They spoke about the components of an ambulance operation and the need to have strong leadership, diligent training and education, the ability to engage the community, a safe functioning service and a financially stable program.

Wingrove mentioned the model that the county was looking at, creating a county EMS department is very much like three other programs in other states in the Midwest. 

Kathy Kuepers, CEO of MHLC, stated that the role of the MHLC in the County EMS Department would be to provide administrative support.

“We are here for Lafayette County if they chose to move forward,” Kuepers said. “If the department is developed, we are looking forward to working with all the EMTs who are the heart and soul of our EMS services.”

Supervisor Scott Pedley asked the panelists who would be funding the department and paying for the service.

COO of MHLC Molly Wiegel explained that whichever municipality wanted to join or have that EMS service in their area, they would be paying per capita for the services. If municipalities were not interested in signing up, they would not be paying per capita. 

Kuepers stated they would first be tasked to hire an experienced service director. The service director’s salary would come out of the County EMS Department’s budget, once one was created. MHLC would provide the medical director, which would be one of the ER physicians that works at the hospital and is board certified. That would be a cost to MHLC and not to the department. MHLC provides medical directors to other EMS services in the county and would be doing the same for this EMS service. The cost of the medical director would come out of MHLC’s budget due to it being an employee of MHLC.

They are looking at a six-month timeline in order to get the department running.

“When Lafayette County was approached with this, they had said we would be the long-term solution, not the short-term solution. To get this off the ground successfully, we need time to do our due diligence and do it correctly. We want it to thrive and be successful,” Kuepers said.

The State of Wisconsin requires any ambulance service to have an operational plan submitted and approved by the state. Rural Medical currently has an operational plan but it will need to be updated. The County EMS Department would need to have an operation plan in place by Dec. 31 and submit it to the state.

The creation of the department would be a long-term solution but it would take a couple months to get things established. Supervisors questioned with GCEMS not going past the end of the year, what would be the short-term solution if it wouldn’t work out.

RMASB would be in charge of coming up with a short-term solution for after the New Year for at least a couple of months. McComish stated that was a big concern when they started with the process.

“With the January deadline until about March, it could be touchy,” McComish said, “but we have ideas. We do have a backup plan. We do hope that the volunteers are willing to work with us during that time.”

The RMASB does have a medical director on board in Dr. Matt Solverson, who was the previous medical director that had left a few years ago but has stepped in to help during this time. The operational plan and roster would need to be updated but Nufer stated that even though the State isn’t always quick on getting things established, they may need to do “a few phone calls to make sure everything is nice and legal” in the eyes of the state.

Nufer added that he would be happy to help in any way that he could but his board will not go beyond the Dec. 31 deadline.

“The sooner you get a service director hired, the easier it will be,” Nufer said.

Kuepers wants to sit down with the current volunteers and hear what they want to say on the matters of a service director and find someone that all parties agree on.

When it came to costs of running the operation, Nufer said that two of the stipulations from the GCEMS board was they would only approve it if they could operate without a loss and they wouldn’t charge a per capita. GCEMS is able to not charge a per capita amount due to their call volume and have operated like that since 1974 when they began. GCEMS essentially broke even when they began managing Rural Medical. 

“The potential is Rural Medical has never been able to get into the interfacility patient transfer business. There are about 125-150 interfacility patient transfers per year. That is a very lucrative part of an ambulance company. With the personnel and the staff that the hospital has. It will enable the hospital to get into that business,” Ohnstad said.

Wiegel reiterated to the group that they expect revenue from the ambulance calls to pay for the service. While the fee from the transfers or calls will help, it will not make up all the cost. The per capita dollar amount will also be utilized.

“We will need both. The expectation is that there will be a per capita expense to this. We will honor that for a year and then once we understand what our future looks like, then we will adjust the rate for that future,” Wiegel said.

The current per capita cost is $15.

Supervisor Bob Boyle commented on hoping the volunteers stay on with them.

“You do a good job. It may be somewhat unfortunate that we got to this point but it is what it is. We need to move on. The EMTs here in Darlington have a good reputation and do a good job. I would urge you to stay on because we do need you and you do a great job,” Boyle said.

Nufer added again that the membership was great to work with and never dropped call. 

The motion was made by John Reichling, and seconded by Andy Schilling, to create a new County EMS department and passed 11-5 with Marion, Nancy Fisker, Donna Flannery, Rita Buchholz and Mike Klein against.

Scott Pedley then made the motion to create a department head for the EMS Department with Reichling seconding and that motion passed 13-3 with Marion, Fisker and Buchholz against.

“It is sad that Rural Medical will no longer exist but it is going to be in great hands,” McComish told the Republican Journal after the meeting.

The RMASB had pursued Lafayette County for a couple of years to see if they would take it over but it was never the right time.

“They started talking to us in the eleventh hour of this mess, knowing they [GCEMS] were ending it at the end of the year. (The) county thought that it was the time to step in,” McComish said.

He said that the service could continue to grow and if those who left the service — Wiota, Gratiot and the city of Darlington — want to get back in, they can do so.

“It is going in the right direction. I see nothing but success from it. I’m happy to see it working out. They will make it work right,” McComish said.

When asked if McComish had heard anything from the current volunteers for the Green County EMS-Darlington or Darlington Area EMS, he said he wanted to keep his distance to make sure they understood everything that was going on.