TRURO — The symbiotic relationship between Provincetown, Truro, and the Lower Cape Ambulance Association (LCAA) will come to an end on July 1. Though the demise of the 86-year-old nonprofit had been planned for 2024, it will now happen a year earlier, following a Jan. 4 vote of the LCAA board, said Steven Roderick, its treasurer and operating officer.
The earlier closure is due to a breakdown in communication between LCAA, the Provincetown town manager, and Sylvester Consultants, Roderick said. Provincetown is paying $48,000 for the consultant to come up with a transition plan to safely merge the ambulance service with the town’s fire dept. Roderick said he intended to keep the nonprofit open through fiscal year 2024 to help Truro and Provincetown transition to their own professional departments. But Roderick said Provincetown’s administration stopped communicating in October.
“This lack of communication made it unworkable for LCAA to go forward with its good faith,” Roderick said.
Provincetown Town Manager Alex Morse disputed Roderick’s version of events. Morse said he had asked LCAA to reduce its cost for partial use of the service in 2024, that Roderick asked his board, and the response was to end the service early.
“For me, this is sad,” Roderick said. “Our service is great. We are able to provide a high level of care. The select boards talk the talk, but they have not done the work. When was the last time they created a regional plan?”
Since 1947, LCAA has functioned primarily as a transport service to Cape Cod Hospital for both Truro’s and Provincetown’s fire depts. The arrangement allowed “call” or volunteer firefighter-EMTs with other full-time jobs to leave their usual work and respond to medical emergencies in their towns. Afterward they could return to work rather than make the more-than-two-hour round trip to Cape Cod Hospital, because LCAA would make those rides for them. LCAA keeps the ambulance payments from insurance companies and private payers and receives annual payments from each town.
This system functioned well for years, and Roderick said it still offers the best bang for the buck. But the fire chiefs in Truro and Provincetown have wanted to sever ties with LCAA for the last few years.
The chiefs have been complaining that LCAA has not had the staff to meet its contractual obligation to the towns, according to a 2022 report by Tom Impey of Capital Strategic Solutions that Truro commissioned.
The towns pay LCAA to have three ambulances and crews available to both towns, but LCAA has not had the resources for a third ambulance for a few years, Impey wrote in his report. The LCAA has had trouble keeping its staff at full capacity: four medics in Provincetown and two in Truro.
Provincetown Fire Chief Mike Trovato said there is a Cape-wide paramedic shortage and that getting rid of LCAA won’t solve it. But at least with all the scheduling under his control, he said, he will know ahead of time and be able to call on his own staff.
“The way it is working now, no fault to anyone, but when LCAA was short-staffed I would not know about it until there was a call,” Trovato said.
Provincetown pays LCAA $1.02 million a year, and LCAA earned $620,000 in ambulance receipts from Provincetown runs. Yet when LCAA is short-staffed, Provincetown’s crew or “mutual aid” from other departments have to take up the slack.
The towns’ fire depts. have been slowly staffing up. Provincetown now hires a full-time rescue squad of eight people for nine months of the year and relies solely on LCAA only in the deep winter. Truro’s staff is now up to eight full-time paramedics and EMTs year-round. And both towns have on-call personnel and their own ambulances. With LCAA down one ambulance, LCAA personnel end up using the town ambulances but keeping the revenue, according to Impey’s report.
Morse said the news that LCAA is closing a year early is not unexpected, and the town is not completely unprepared.
“I want to make clear we are confident in our ability to make this transition and the expectation is our public safety will only improve with the proposal we will bring to town meeting,” Morse told the Independent.
Staffing Up
Of the two towns, Truro is in a slightly better position to make the transition in a few months. After rejecting the expenditure at the 2020 town election, voters in Truro last year approved $355,763 per year to hire four full-time firefighter-paramedics.
Those positions have been advertised, but they still have not been able find anyone, said Town Manager Darrin Tangeman.
Without LCAA, Truro will need to hire four more rescue workers. Salaries for these next four will be funded by the $430,000 the town previously paid to LCAA. Ambulance receipts brought in another $230,000 from Truro runs, Impey’s report stated. When those receipts begin going to town-staffed ambulance runs, that money can be diverted to the new fire dept.
Truro Fire Chief Tim Collins will still be asking town meeting for another $150,000 for “increased capital costs as well as additional salaries for increased staffing,” he wrote in the January edition of Truro Talks, the town manager’s newsletter. (Collins did not return a call seeking comment.)
Provincetown’s situation is more dire. The town must hire eight firefighter-EMTs by July 1. Those will be on top of the eight medics that usually begin work in Provincetown in April as the regular seasonal rescue squad.
This will be tricky, because Provincetown generally hires LCAA staff as seasonal rescue squad members, Roderick said. Trovato said he plans to hire as many LCAA paramedics to be full-time Provincetown employees as he can.
LCAA has 16 full-time employees and five part-time, Roderick said. But not all want to be firefighters along with their medical duties. There is a good chance that overtime costs will be an issue, at least for a while, Trovato said.
At the same time, Trovato wants to cultivate a new stable of firefighters who are available on call, since Provincetown’s densely packed downtown and isolated location at the tip of the Cape make a fast response by lots of firefighters essential.
“Yes, there will be bumps in the road, but there will always be an ambulance to go out the door; I know from the last 40 years, there is mutual aid,” Trovato said.
Morse said Truro and Provincetown are talking about a regional EMS service without LCAA.
As for the costs to Provincetown, Morse said he is now working with the consultant and Trovato to come up with an amount he will request at town meeting in April to hire eight new people. Morse estimated that with overtime, a billing service, a deputy chief at the fire department, and full benefits, the eight new people will cost $1.3 million. Provincetown would then hire another eight full-time people next year. All 16 together will cost $2 million, Morse said.
LCAA’s ambulance receipts from Provincetown runs and the fees the town pays to LCAA total about $1.5 million per year, though, so actually the new cost to taxpayers is just $500,000, said Morse.
Of course, LCAA is hardly alone when it comes to staffing problems, Roderick said. Truro has been unable to hire the four new paramedics that were approved last year — so finding 24 new medics in two years on the Outer Cape will be daunting.
Trovato, however, said paramedics prefer town jobs to private ambulance companies because the county retirement benefits are attractive. Trovato said he will definitely hire any LCAA employee as either a year-round staffer, an on-call per diem staffer, or a summer rescue squad staffer.
“I don’t want to see anyone lose their job,” Trovato said.
