It’s hard to imagine a more insulting and hypocritical but little noticed project initiated by the CEO and the Supervisors last May and described by CEO Darcy Antle in her July CEO Report:
“EMS Fiscal Assessment — At the May 6th Board of Supervisors meeting, LEMSA [Sonoma County’s Local Emergency Medical Services Agency] and OES [Mendocino County’s Office of Emergency Services] staff were directed to conduct a fiscal assessment of our rural EMS providers receiving County EMS enhancement funding. Laytonville, Anderson Valley, and Covelo Fire Departments all committed to completing a three-year fiscal assessment to include fiscal years 22/23, 23/24, 24/25. Reports are due on Friday, August 15, 2025, and will include:
Current billing rates
Current reimbursement rates
Number of EMS transports
Annual agency EMS budget
Identified gaps in budget
Agency efforts to improve identified funding gaps
Review of how County funding has been used since 2014
Intent of ongoing funding support into the future
Intergovernmental Transfer/ Ground Emergency Medical Transport (IGT/GEMT) funding enrollment and participation
Confirmation of 100 percent Patient Care Reporting (PCR) completed and submitted for billing of all patient contacts.”
A little history.
More than ten years ago after several consultant studies documented the fragile, fragmented and underfunded state of ambulance services in Mendocino County, the Supervisors grudgingly allocated around $66k per year to supplement the strained budgets of each of the three ambulance operations in the unincorporated area of the County: Covelo, Laytonville and Anderson Valley. Over the ensuing years the purchasing power of that $200k allocation has dropped dramatically while the cost of operations for ambulance services has risen.
All three of these ambulance operations are staff by VOLUNTEERS who at most get a small “shift stipend” to standby for 911 calls, stipends that are mostly covered by that County allocation. All of these small volunteer operations average one or two calls per day, frequently at night, often to stressful and grisly accident scenes. The VOLUNTEERS are required to undergo rigorous training and certifications, as are their vehicles and equipment which must meet standards imposed on professional, paid ambulance outfits.
On top of these challenges, billing for these operations is a complex, frustrating and hit-and-miss affair. Most of their calls require complex paperwork followed by structured bills to Medicare, Medi-Cal, private insurance and, occasionally, private individuals. Private insurers and Medicare/Medi-Cal have strict billing and review requirements. Because Medicare and Medi-Cal pay less than ten cents on the dollars (when they finally get around to paying) and private uninsured patients often can’t afford the cost, if an ambulance operation gets more than 20% of their bills paid in a given year they consider that a good year.
Plus, a significan percentage of emergency responses end up not needing a transport or are otherwise not billable.
Fortunately, in Anderson Valley, many local families are members of the ambulance service and pay $95 a year (for basic family membership) and $160 a year (to include air ambulance membership) as a form of insurance against the high sticker price of individual ambulance responses.
By law the ambulance operations cannot charge more than the cost of the service, even though they are not reimbursed at anywhere near the actual cost of the service, except for the minority of calls which are covered by patients with private health insurance.
Yet here’s Mendocino County conducting a formal review — a “fiscal assessment” — of how that grudging $200k per year (one third to each of the three ambulance operations) is being used. They even go so far as to question whether “100 percent Patient Care Reporting (PCR) is completed and submitted for billing of all patient contacts.”
This is the same county that hands out millions of dollars without question every year to well-paid professional, non-volunteer, sole-source Mental Health service providers with no comparable studies, analyses or budget reviews or reporting and certainly no “fiscal assessment.”
As you might imagine, most of the people targeted by these insulting studies, the people who provide bargain basement volunteer emergency responses in very difficult circumstances around the clock, are not exactly thrilled to have the grossly overpaid and underforming County bureaucrats pay top dollar to Sonoma County’s overpaid and underperforming LEMSA to “assess” their already underfunded operations as if they have to prove that they provide a worthwihle service deserving of a small supplementary budget band-aid.
ON LINE COMMENTER John Kriege asks:
“I looked at the May 6 Minutes and Agenda and can’t find anything close to the directions from the July CEO report. Is she just making stuff up?
Mark Scaramella replies:
According to their meeting agenda/minutes list for 2025, there are no minutes posted for the May 6 board meeting. However, during the “preliminary budget review” portion of the video for that May 6 meeting, under item 4c, Jen Banks, long-time Mendo rep of the Sonoma County “LEMSA” (Local Emergency Services Management Agency), suggested the assessment of the three Mendo districts at just over two hours into the meeting. A few minutes later Haschak referred to “these audits to see what the real needs are.” Banks told the board that the review would determine “if dollars are still needed by the County.” Haschak said, “The problem for me is we are adding $66,000 more (for each of the three districts) to the General Fund cost. … I don’t want to add more to our general fund problem.” Supervisor Ted Williams called it a “performance audit or a needs assessment,” adding that “we know it will be what it is today or more. … maybe we should just include it as an ongoing expense and find some other way to balance the budget.” CEO Antle laughed her joyless cackle and said that if the Board wanted to fund the ambulance districts they’d have to tell her where else to cut to cover the $200k. … “Do you want to cut roads?,” asked Antle. “I’m not trying to be difficult here, I’m just out of money.” The entire discussion was a typical half-hour long rambling Board discussion with no clear conclusion other than that the Ambulances are “an ongoing need.” But Antle’s budget was allocating one-time funds to it and the Board did not think that was a long-term solution. Haschak said, “We can agree we need to fund this, but we need to do these audits to move it forward.” Auditor Chamise Cubbison asked the Board not to call it an “audit,” but instead “call it an ALS review.” (The original allocation was supposed to be a substitute for funding “Advanced Life Support, i.e., paramedics on ambulances which would cost a lot more for round the clock paramedics.) The Board members (Supervisor Norvell was not in attendance) seemed to support the ambulance funding, but in the end they agreed with Banks that “We can work with OES and conduct an assessment of EMS enhancement funding for Mendocino County.”
Nobody asked how much Banks’ “assessment” itself would cost. Historically, asking Banks/LEMSA has been expensive.
The point is that while they agreed that providing the $66k (an amount that has not changed for eleven years) to the three ambulance services should be “an ongoing expense,” with Williams saying that while they will discover that the need will be as much or more as the current allotment, they still called for an assessment which ended up being described by CEO Antle in her July report which we quoted yesterday.
They also noted that LAFCo is currently conducting “municipal service reviews” of the three districts which would address essentially the same kinds of things, yet they still ordered the “assessment.”
If you were an ambulance volunteer, knowing that you and your fellow volunteers are providing professional life-saving service around the clock for next to nothing, how would you interpret this assessment other than that the Board is looking to possibly cut costs for a service that is already mostly volunteer?
I would have covered this more at the time, but I thought it might just go away like most of the other Board directives, or at least be folded into the Municipal Service Reviews. Then it appeared in the CEO report.
An old quote comes to mind:
“No one’s life, liberty, or possessions are safe while the legislature is in session.”
I wish I could credit the genius who came up with this.