FULTON COUNTY — The Ambulance Service of Fulton County was forced to shut down at 7 p.m. Friday when the nonprofit determined it could not make payroll or afford to pay for its insurance.
ASFC CEO Roy Sweet said he determined the previous evening that the organization did not have enough money to pay all of its approximately $70,000 bi-weekly payroll. He said there were two other bills also due: a $33,000 workers compensation insurance bill and a $4,500 ambulance insurance bill. He said the combination of expenses combined with revenues coming in less than anticipated have forced the shut down.
Alan Mendelsohn, vice president of the ASFC board of directors, said ASFC had to lay off 55 of its 60 employees Friday.
Sweet, who took over ASFC in 2015 with a mandate to clean-up its management practices after several scandals, including the walk-out of 20 employees, said many factors during the past three years have pushed the organization to the edge of insolvency:
- Too many low paying Medicaid ambulance calls, which make up about half ASFC's responses, many of which fail to cover the full cost of service.
- An approximately 20 percent decline in overall calls from 8,450 in 2017, which Sweet attributed partially to the new dialysis center at Nathan Littauer Hospital, which reduced the number of service calls for dialysis patients.
- Too many zero payment calls, from individuals who either won't or can't pay for the service, naloxone treatment calls for opiod overdoses, which pay nothing and mandatory responses for fires or police actions, which sometimes don't require any ambulance transportation.
Sweet said the business model for the small rural ambulance service is broken.
"We've been circling the drain the whole time, it's just now our fingernails have let loose," Sweet said.
Mendelsohn said the office staff of five, including Sweet, will remain on duty for another 10 days approximately, to process incoming revenues from past service calls. He said the organization hopes to make good on its entire payroll by the end of next week, but the organization won't be able to reopen without a cash infusion of about $200,000.
"We didn't realize we were in extremis until [Thursday] night. We expected a larger check, a larger payment made to us [Friday] than we ended up getting," Mendelsohn said. "We also had workers comp and auto insurance, all due [Friday]."
"We had employees who would have been willing to stay and work with us in anticipation of being paid," Mendelsohn said. "But we couldn't send them out on the street without workers comp or auto-insurance."
Steven Santa Maria, the Fulton County Emergency Management Services Coordinator, said he received a call from the New York State Department of Health at 11 a.m. Friday informing him that ASFC might shut down, prompting him to scramble together a meeting of officials from the Fulton County Sheriff's Department and the Fulton County Emergency Medical Services Council to secure ambulance coverage for ASFC's territory, which includes Gloversville, and portions of the western part of Fulton County including the towns of Caroga and Bleecker.
"We were caught completely off guard by this, no previous warning," Santa Maria said.
Santa Maria said the New York State DOH has agreed to "relax" the territory rules for Certificates of Need, under which the ambulance services operate in order to cover for the hole in coverage created by ASFC's shut down. He said ASFC has about seven to eight ambulances, but only four of them are typically in operation.
The plan for coverage as described by Santa Maria includes: The Greater Amsterdam Volunteer Ambulance Corps. putting five ambulance rigs into operation for Fulton County, including two that will be stationed for the next 72 hours in Gloversville, where GAVAC will now have first priority in responding to calls. GAVAC will operate an additional five ambulances in Montgomery County, giving it 10 in service simultaneously.
Santa Maria said the Johnstown Area Volunteer Ambulance Corps has doubled its number of ambulances on call to two, to help pick up calls from the western part of Fulton County. He said the Johnstown City Fire Department Ambulance Service came back online at 6 p.m. Friday. The Johnstown firefighter-operated city ambulance service was started in January but had to shut down due to lack of proper insurance.
The western part of Fulton County will be covered by the Mohawk Valley Ambulance Corps and the St. Johnsville Volunteer Ambulance Corps, Santa Maria said. In addition, the Northampton Volunteer Ambulance Corps and seven other area firefighting-based agencies can provide assistance where needed, Santa Maria said.
"This is a pretty heavy lift for us. All I can tell you is we are moving forward with plans to make sure there is some stability over the next few days and then a plan for long-term stability going forward," Santa Maria said. "I really want to assure all of the residents and the visitors of Fulton County that we have a solid plan that all EMS calls will continue to be answered in Fulton County and answered in a timely and professional manner by qualified people."
Financial headwinds and devastating layoffs
Mendelsohn said he isn't legally allowed to "lobby" the government for funding. But he would like to "educate" local and state officials to the potential consequences of his ambulance service closing.
"Unfortunately, they're going to figure it out starting this weekend when there are 60 calls between now and Monday morning, which are going to have to be answered by the totally stretched GAVAC and JAVAC," Mendelsohn said. "The dispatch service is going to be in the unfortunate position where they will have to triage calls."
Mendelsohn said if ASFC doesn't get a significant cash infusion within the next six weeks the organization will likely dissolve.
Mendelsohn said the nonprofit service has approximately $10,000 in cash, but it has about $150,000 in debt, with $15,000 monthly debt payments, as well as a $2,000 monthly payment on a legal settlement with the service's former billing agency and a $5,000 quarterly payment due to the federal government for a Medicaid fraud case the service "self reported" and then settled several years ago.
Mendelsohn said he's talked to the mayors of Johnstown and Gloversville, Fulton County Board of Supervisors Chairman Jack Wilson, State Sen. Jim Tedisco's office and the state Department of Health.
"Nobody has any money for us," Mendelsohn said.
Mendelsohn said ASFC needs a permanent source of funding, which could be created with a taxing district, if the Fulton County Board of Supervisors were to vote to create one.
"If they charged every household in Fulton County $4 a year, we'd be solvent," Mendelsohn said.
Even a short shutdown will make it hard for ASFC to reopen however, because some of its employees may not return.
Adam Desrochers, a Hamilton County resident, was one of the 55 employees laid off Friday.
He said he used to be a shop stewart for the paramedics union that represents the employees of the service. He said the union made concessions to allow paychecks to be paid on Fridays instead of Thursdays to accommodate ASFC's financial troubles. He said some of the employees became concerned about the organization when there were several delayed paychecks over the past few months, but he said Friday was still a surprise.
"It was a shock," Desrochers said. "I have three little kids at home. So, I can't handle this uncertainty.
He said he's already decided not to return to ASFC, and will continue working for other ambulance services.
Another ASFC employee Kirkland Mihalek said he had no idea Friday would be his last day at work.
"I'm a little shocked by the whole situation. We all knew funds weren't great but I mean when I left this morning I still had a job, I found out halfway through my day the doors were closed," Mihalek said.
Mendelsohn said the ASFC board of directors will meet on Monday to discuss fundraising options. He said one idea might be creating a gofundme.com page, or other methods of soliciting charitable donations from the public.
He said he also wishes New York state would require a municipal stipend for mandatory service calls, which are a requirement of an ambulance service's Certificate of Need, but he isn't legally allowed to lobby for that.
"Last year we had to go to an eight-hour hostage situation in Gloversville, and then there was no ambulance transportation after that. We get paid nothing for that," Mendelsohn said.