Fulton County

Ambulance alliance splinters over hospital transfer calls

Vital supply of cash is on the line
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FULTON COUNTY — Local ambulance services GAVAC and JAVAC are in dispute over territory formerly controlled by the now shutdown Ambulance Service of Fulton County, and GAVAC has ordered its employees to choose between working for it or their new competitor. 

A week after the Fulton County Emergency Medical Services Council put together a plan for providing coverage for territory formerly covered by the Ambulance Service of Fulton County – Gloversville and parts of western Fulton County – the cooperation that had briefly existed between the Greater Amsterdam Volunteer Ambulance Corps. and the Johnstown Area Volunteer Ambulance Corps. has turned into a dispute over which agency has the right of “first refusal” for the interfacility transfers at Nathan Littauer Hospital. Interfacility transfers involve moving patients between Nathan Littauer buildings, such as their nursing home.

On Thursday GAVAC was granted a 60-day emergency “certificate of need” to operate in Fulton County. During that same time period, JAVAC entered into an agreement with Nathan Littauer Hospital to pick up the lucrative interfacility transfers formerly handled by Ambulance Service of Fulton County (ASFC). 

An email written Thursday by Steven Santa Maria, Fulton County emergency management services coordinator, addressed to the state Department of Health and obtained by The Daily Gazette, explains the disputed territory. In his email Santa Maria said he has confirmed with Nathan Littauer officials that they have a “non-binding” agreement with JAVAC, but the hospital believes it can choose between whatever ambulance service it wants to make those transfers.

Santa Maria said he isn’t certain JAVAC has the legal authority to make the transfers, and wants the Adirondack-Appalachian Regional Medical Services Council to make the determination at its meeting Feb. 21. 

Santa Maria wrote: “It was suggested that the County Emergency Management Director make the determination of whether or not JAVAC would be allowed to provide interfacility transfer service to Nathan Littauer. It is the county’s position that this is not a county decision. The decision should be made based on applicable laws and policies. Fulton County believes that this is a decision that needs to be made by the NYSDOH and/or the Regional Council.”

Santa Maria’s email explained that the stakes are potentially high as to which agency is able to fulfill the hospital transfers.

“Both JAVAC and GAVAC have expressed a concern that without the ability to have primary authority to conduct the inter-facility transfers they may not financially be able to continue operations in Fulton County,” Santa Maria wrote. “This is of major concern to Fulton County Emergency Management. I am requesting that every effort be made to expeditiously find the answers to these questions. It is imperative for Fulton County to know what resources will remain available now and in the immediate future. I will remind you that both agencies have expressed concern of their viability to continue to conduct business in Fulton County without the revenue from the interfacility transfers.” 

GAVAC Executive Director Thomas Pasquarelli said he believes JAVAC has been acting illegally in taking some of the NathanLittauer calls. 

“Whether or not JAVAC entered into an agreement or not, I don’t know that answer, but I can tell you if JAVAC did enter into an agreement with Nathan Littauer, they are in violation of their certificate to operate. The only time they can do it is when they are transporting a patient that is going back to the area which they are licensed for,” he said. 

JAVAC officials did not return phone calls seeking comment Friday.

On Thursday Pasquarelli also issued an order, a copy of which has been obtained by The Daily Gazette, to his employees that they they could no longer work for JAVAC and GAVAC simultaneously, as some of his staff had been doing, a common practice among paramedics working for neighboring ambulance services. 

“Recently we have been notified that JAVAC has entered into an agreement with Nathan Littauer Hospital to handle all of the discharges from their facility,” Pasquarelli wrote. “This information has been confirmed by GAVAC management staff. With that said, it has always been GAVAC policy that our employees do no work for agencies in direct competition with GAVAC. As you are aware, GAVAC received the emergency CON [certificate of need] this week. This CON allows GAVAC to operate in the same area’s that ASFC served, inclusive of Nathan Littauer Hospital.” 

Pasquarelli told GAVAC staff the revenue from the Nathan Littauer transfers is vitally important for GAVAC to provide ambulance service for Fulton County. “Therefore, those of you that are employed in any capacity at JAVAC can choose to remain employed at JAVAC or maintain employment at GAVAC,” Pasquarelli wrote.  

Pasquarelli told The Gazette on Friday that GAVAC has spent $22,000 in payroll covering calls in Fulton County since the ASFC shutdown, and his agency needs to know it can get the revenue it needs to pay that expense. He said it’s dangerous for his full-time paramedics to do 24-hour shifts for JAVAC or other services, but then admitted that it has gone on for years. He said the leaking of his message to GAVAC staff to the media is good example of why GAVAC’s policy of prohibiting staff from working with direct competitors makes sense. 

“Us getting the CON makes JAVAC a competitor for us. We are now licensed to operate throughout all of Fulton and Hamilton counties,” he said.  

The state Department of Health issues certificates of need covering which services an ambulance service can perform. Only one agency can have the coveted “first call” responsibility for that territory, giving them the opportunity to take the call whenever they have the personnel available. 

For revenue-strapped ambulance services, territory is a high priority, as is maintaining qualified staff. Last week ASFC laid off 55 of its employees because it couldn’t make its bi-weekly $70,000 payroll or make necessary insurance payments.

The ambulance service has been scrambling to find a partner to provide a $200,000 cash infusion to help it resume operations, but will likely face dissolution if it can not do so within the next five weeks. 

GAVAC has deployed five ambulances into Fulton County to cover ASFC’s territory, and hired at least six of the former ASFC employees to help staff the ambulance shifts. 

The initial plan put in place to cover ASFC’s territory included five ambulances from GAVAC, two stationed 24/7 in Gloversville, two stationed at night in Broadalbin and one in Mayfield to cover “the North Country” into Hamilton County.

JAVAC also doubled its ambulances in operation from one to two, and the Johnstown Fire Department Ambulance Service came back online to provide coverage in the city. 

Santa Maria said JAVAC has shut down one of the two ambulances, so it has returned to the status quo it had before ASFC shut down. 

Pasquarelli blasted JAVAC’s pursuit of Nathan Littauer transfer calls. 

“They only have two ambulances, and they are only currently staffing one of them, so if they are doing transfers out of Nathan Littauer Hospital, who’s protecting the city and the town of Johnstown in their absence?” he said. “It’s a matter of dollars and cents. We just watched Fulton County’s largest ambulance service go out of business, literally, and they couldn’t do it [getting revenue from] all of the calls.”

Santa Maria said Fulton County would prefer that all of the existing ambulance services in Fulton County remain in operation and has no preference as to which is granted what territory.

“We really don’t have a dog in this fight. If it goes to GAVAC that’s fine, if it goes to JAVAC that’s fine. GAVAC has raised the question if whether it should be them. It’s important to Fulton County that both agencies remain viable,” he said.

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