County Notes: Shortchanging Local Ambulances

Last Wednesday at the Anderson Valley Community Services District budget committee, AV Fire Chief Andres Avila told the committee that the Valley’s volunteer ambulance service is operating on a very tight margin which barely covers its operational costs with no funds available to be set aside for capital equipment (i.e., a new ambulance at some point) or reserves, and thin staffing that is having to cover more shifts without the ability to be supplemented by paid responders. Avila added that Fifth District Supervisor Ted Williams continues to insist that the County has no money to help, turning down AV’s recent request for a $60k ambulance stipend to help close the staffing gap. Williams told Avila that if the Ambulance service needs more funding they should pursue a sales tax ballot measure. Avila said that he would not consider a ballot measure unless and until all other funding options had been pursued and unsuccessful. And those options are being actively explored. The primary funding for local ambulances comes from Medi-Cal (5 cents on the dollar) and Medicare (10 cents on the dollar) and private insurance which typically pays the full dollar of actual cost but only represents a small percentage of ambulance calls. In Anderson Valley the insurance revenues are supplemented by a membership program that locals can join which means members don’t have to pay for their family’s ambulance responses. Because of the tight ambulance budget (and lately high inflation rates), for example, the District/Ambulance service is already considering an increase in ambulance service membership fees. But Avila thinks that an increase membership fees might be undercut by fewer memberships resulting in no net new revenues for the ambulance. 

THE NEXT DAY, we read a Ukiah Daily Journal article about Visit Mendocino County’s latest press release describing how thrilled they are that their promotional budget is up to about $1.9 million, about $600k of which comes directly from that same County General Fund that Williams says can’t afford a $60k ambulance allocation — even when everyone involved knows that “visitors” to Mendocino County are the prime recipients of ambulance services due to their vehicle accidents and other health emergencies. 

THERE IS NO INDEPENDENT INDICATION that Visit Mendocino County’s $1.9 million budget benefits the local tourism industry other than their own self-serving claims that it does. In fact, historically, the local tourist economy is basically nothing more than a reflection of overall economic activity in the County and its ups and downs track closely with sales tax patterns. If Visit Mendocino County and their overlarge staff of wine and cheese and restaurant promoters had any real return on what they get, we would at least see some evidence that their activity is helping the tourist industry during their downturns such as during the covid and drought related dips in the last two years. But we don’t. 

THE COUNTY’S “BED TAX,” aka Transient Occupancy Tax, which imposes 10% on visitor lodging costs, is supposed to be in recognition that the “visitors” are creating a demand for local services (especially ambulance responses) that those visitors require. But the County continues to provide the historic $600k to the people whose primary objective is to increase the need for those services. (Never mind that there’s no evidence that they are successful.)

IN EFFECT, the Williams position is that the County prefers to waste money on ineffectual tourism promotion and expects the locals to pick up the tab for the increased services that come with tourism. 

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MENDOCINO NEWS PLUS reposted our item about Supervisor Williams refusal to provide a $60k supplement to the AV Ambulance with the Title: “SUPERVISOR WILLIAMS TO The Anderson Valley Ambulance Service: ‘There Is No Money’”

Supervisor Williams responded in MNP: 

“That's a misstatement of my position. It takes 3 votes to allocate county funds. A funding allocation to one (of 21) fire districts likely won’t succeed in light of the problem being widespread. The solution needs to be county wide or at least balanced.”

ms: We are all quite aware of how many votes Board decisions take. Apparently Supervisor Williams agrees that there’s a problem with Mendo’s ambulance services (especially inland) but he’s unwilling to address it unless he’s presented with a “county wide” solution or one which is “at least balanced” — whatever that may mean. Williams also presumes in advance that his colleagues would agree with whatever reluctance he seems to have, not even allowing the question to be considered by the Board to see if any of his colleagues that he unnecessarily reminds us about would agree. Of course, the problems of the county’s fractured ambulance services should be addressed “county-wide,” but as former Sheriff Allman and others reminded the Board the last time the subject arose, we need some short-term stop-gap measures like the one proposed by Chief Avila in the meantime. Especially considering that this Board of Supervisors has shown no interest in addressing the “county-wide” ambulance problem yet they rubber-stamp the $600k to the the tourism promoters no questions asked.

Williams replied: “We’ve created a JPA to begin addressing county wide ambulance service. “Board of Supervisors has shown no interest” conflicts with the largest fire and EMS allocations ever. The EMCC did not approve (and couldn't even find a second) for the AV proposal. The other half of my ad-hoc committee, Supervisor Mulheren, has not signaled support for a one district allocation. Ambulance/fire services elsewhere in the county have complained about a single district allocation. A winning solution will be one that addresses the problem beyond the boundaries of D5.”

ms: “… a JPA to begin addressing county wide ambulance service”? Where have we heard versions of this before? Like the EOA flop? The Triton study? The earlier consultant studies going all the way back to the 1990s? All of which acknowledged that the precarious inland ambulance arrangement needs more funding and attention than it’s getting. But very little was done and is being done. And when a sitting Supervisor says the Board will “begin addressing” something, we know what history tells us. Also, the subject here is ambulance services and their paltry funding streams. Let’s not pretend that whatever is meant by the bigger and off-topic subject of “largest fire and EMS allocations ever” are benefitting the ambulance services. By the way, what is wrong with short-term “one-district allocations”? Covelo and Anderson Valley are tied to the overall inland ambulance system and involve much longer travel times and don’t even get any revenue if they hand off the patient to an ALS ambulance. Any assistance they get would certainly benefit the overall service level. Nevertheless, please provide more info on this JPA and what they intend to do and when.

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Increased Medi-Cal Benefits For Mendo

Medi-Cal Older Adult Expansion - AB 133 

On May 1, 2022 Medi-Cal will expand eligibility for full scope Medi-Cal to all individuals aged 50 and over who meet eligibility regardless of citizenship or immigration status. This change will increase access to healthcare for older and disabled people. We anticipate this change will positively affect 402 local individuals currently enrolled in Medi-Cal by increasing benefits. 

The US Census Bureau American Community Survey (2020) reports 36,997 people aged 50 + reside in Mendocino County. EFAS data shows the total number of Mendocino County Medi- Cal recipients age 45+ at 12,096 (full and limited scope combined). While we do not have an accurate estimate on new applicants, we are pleased with this change and look forward to positive effects this will have on our community. 

(CEO report excerpt)

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MEASURE B NEWS: “We now have three full-time crisis workers inland. We continue to recruit for coastal response. Additional funding resources we have received will allow additional teams, which we are also recruiting for.” (April 15 CEO Report)

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SOCIAL SERVICES remains woefully understaffed and the statistics in the CEO report seem to be saying it’s getting worse. 

According to the CEO report’s Social Services report the Social Services vacancy rate is 27% overall. Family and Children’s Services (formerly CPS) has a 32% vacancy rate; Adults and Aging 29% vacancy; Administration 23% vacancy and Employment and Family Services (aka welfare eligibility, including food stamps and Medi-Cal) is at 22% vacancy. They also report 5 new hires (but don’t say since when).

But the vacancy report farther down in the CEO report says that Social Services is running at a 26% vacancy rate with 109 funded positions vacant out of 420. 

We won’t quibble about the minor discrepancy in the rates but the vacancy chart also says that Social Services is losing staff since last July. According to the CEO report chart there were 20 new hires since last July but 46 departures. While much attention is paid to the short staffing at the Sheriff’s Department (as it should be) there ought to be a similar level of attention to staffing and workloads in Social Services. And there should be an examination of why so ,many people are leaving Social Services jobs.

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IN A RECENT PRESS RELEASE about the Russian River and possible “emergency regulation to curtail water rights,” the State Water Board said they “support a voluntary conservation program that would work in parallel with curtailments.” 

“On June 15, 2021, the State Water Board adopted the emergency regulation, allowing the Board to determine when water is unavailable for diversion at water users’ priority of right and authorizing the Deputy Director to issue curtailment orders requiring recipients to cease diversions. California’s Office of Administrative Law approved the emergency regulation, putting it into effect on July 12, 2021. Curtailment orders were issued to water users in early August as the watershed’s drought conditions worsened and storage levels in Lake Mendocino continued to decline.”

“The Division plans to revise and readopt the emergency regulation in early May to guarantee that it is in place before the 2022 dry season begins.”

These meaningless press releases are meant to pretend that the water board is on top of water conservation and drought mitigation by confusing and obscuring the real issue: grapes. 

First we know that the reason that “storage levels in Lake Mendocino continued to decline” was that outflows during the winter were well above the minimum flows for the fish yet that outflow didn’t make it to the Pacific. Where did it go? Vineyard ponds. 

We also know that grapes are by far the biggest water consumers of Russian River water, yet we never hear the words “grapes” or “vineyards” in the Water Board’s press releases. Instead we hear about water rights, both “junior” and “senior,” and “water right priorities,” and the “rights” of those with more senior rights. Etc. But nothing about actual flow restrictions.

Then to make it worse, the Water Board says they “support a voluntary conservation program.” So the people whose vineyard revenue depends on Russian River water (and who are already quite aware of the drought and are probably already doing what they can to “conserve” without jeopardizing their revenue) are now going to be appealed to to not use any more water out of the goodness of their alcohol-fueled hearts.