PROVINCETOWN — Fire Chief Michael Trovato says this town needs its own emergency medical service to replace the Lower Cape Ambulance (LCA) Association, the nonprofit that has provided backup service to Provincetown and Truro since 1937.
When the chief argued that the VFW land should be reserved for a new police and fire station at the recent special town meeting, the need for its own larger rescue squad was one reason.
Trovato, who did not return calls from the Independent, has offered no explanation to the public, the select board, or LCA staff for his call for a town-run emergency service. The chief has requested $50,000 for a building needs analysis for a new annex for the fire station to provide room for an expanded rescue squad.
On Dec. 17, when Trovato asked the select board for a fourth town ambulance, board members were concerned that he was prematurely taking steps to grow his fleet.
“I just want to know for transparency purposes what is going on,” said the select board’s Robert Anthony.
The select board faces a complex equation of possibly changing a long-established arrangement between two towns and Lower Cape Ambulance.
The regional ambulance association was founded before World War II to assist Provincetown, Truro, and Wellfleet with the long drive to Cape Cod Hospital. Wellfleet got its own EMS department years ago. LCA has 20 staff members, with one ambulance and crew stationed at both Truro and Provincetown 24 hours a day year-round, and more in summer.
Provincetown has three of its own ambulances and Truro has two. Provincetown pays about $1 million a year for LCA’s services; Truro pays $430,000. For years, the arrangement has been seen as a less expensive alternative to the towns hiring more full-time EMTs.
In his budget message to the select board last year, Trovato wrote, “This department and Lower Cape Ambulance provide excellent basic and advanced life support care to the town for a fraction of the cost of any other option available.”
One year later Trovato’s opinion has changed.
Alarm in Truro
Provincetown funds the bulk of LCA’s budget, so both the town of Truro and the LCA need to know if the partnership will continue beyond the current contract, expiring in June 2020, said Steven Roderick, LCA’s chief operating officer and long-time treasurer.
Trovato’s recent statements have alarmed Truro officials and put the ambulance association “in limbo,” said Roderick. LCA has delayed buying a long-planned replacement ambulance.
Could Truro create its own full-time rescue service with the $430,000 it now pays LCA?
“That’s a big question,” said Truro Fire Chief Timothy Collins. “We’d have to do a cost benefit analysis.”
Trovato has criticized the arrangement with LCA, pointing out that in April the state Dept. of Public Health gave his department a “notice of serious deficiencies” for violating rules in responding to an emergency medical call.
The notice cited the department’s practice of responding to such calls in a town ambulance and then having the patient transported to Cape Cod Hospital by an LCA ambulance, potentially causing a dangerous delay.
Roderick said that, because of the state’s complaint, town ambulances and LCA now respond simultaneously when possible. He does not see it as a major problem.
Roderick said Thursday he doesn’t understand why Trovato has turned on the two-town ambulance service.
“I’m not 100-percent clear on what the issues are,” Roderick said. “Are they issues that cannot be solved? It has worked really well. If the model is truly broken, then OK, but I don’t believe it is.”
In the last year, Roderick said, there have been changes at LCA. In June John Thomas, Truro’s retired police chief, resigned as the chief executive officer of the ambulance association.
Thomas, who did not respond to a request for comment, took over the service in 2012 following the death of Jimmy Meads, the CEO of the ambulance service for 41 years, Roderick said. The reason for his resignation was a “personnel matter” about which Roderick would not comment.
Tracey Rose, a member of the ambulance service’s board of directors, said she too is perplexed by Trovato’s sudden change of heart.
“We had a wonderful relationship for years and years and something has rubbed him the wrong way,” Rose said. “John Thomas resigned and I don’t know if it’s coincidence or not.”
Whatever the reasons, ending the contract with LCA will have deep repercussions in both Provincetown and Truro.
Two Small, Remote Towns
At issue is how to provide high-quality care in two extremely small towns that get much bigger during the summer. Provincetown is farther from a hospital than any other town in Massachusetts.
For years, using a supplemental ambulance service made financial sense, Rose said. It meant towns need not hire full-time staff at union wages with health and retirement benefits. Trained paramedics and EMTs could pick up shifts at LCA to supplement their full-time salaries at other town fire departments.
But Lower Cape Ambulance must also keep its wages competitive, which is now at issue during contract negotiations, Roderick said.
LCA provides health insurance but no matching retirement plan, Roderick said.
“So we had some staff meetings for the first time in several years,” he said. “People came with some real issues and real concerns. It was about salary and benefits.”
LCA wages are a little lower than at other departments, Roderick said, but the quality of service is high.
“We have some of the most qualified EMTs and paramedics on Cape Cod,” he said.
Even if higher wages happen, Roderick said, it would still be more costly for the towns to create full-time ambulance crews.
He gave the example of overtime costs: if an EMT works 48 hours for LCA and 24 hours for Provincetown in that same week, only eight of those hours count as overtime. If all 72 hours were logged for Provincetown, “That’s a ton of overtime,” Roderick said.
“I’ve always believed a regional approach is less costly,” Roderick said. “I don’t see how Provincetown and Truro can afford two heavy-duty fire departments. And for me the money is second after quality of care.”